Thyroiditis as a presenting feature of mumps.

Thyroiditis complicating mumps is rare and occurs 1 week after the parotitis. A 9-year-old boy with a history of contact with a case of mumps presented with thyroid swelling. Thyroid scan showed a diffusely reduced uptake. The aspiration cytology showed lymphocytic thyroiditis. Thyroid function tests were normal and antithyroid antibodies were absent. Parotitis occurred 12 days after the onset of thyroiditis.     

Breeding habitats of malaria vectors: A. fluviatilis, A. annularis and A. culicifacies, in Koraput district, Orissa

Anopheline breeding habitats were studied in two different geoclimatic zones. The vectors A. fluviatilis, A annularis and A. culicifacies breed in all types of habitats. Streams were most productive for the main vector, A. fluviatilis and breeding was intense during winter and early summer. In the rainy season, breeding occurred in terraced paddy fields. A. culicifacies were produced in large numbers in rivers in summer and in paddy fields in rainy and cold seasons. Considering the vastness of these breeding habitats, vector control measures by larviciding or any other bioenvironmental means will not be a feasible alternative even though house spraying poses serious problems in this area due to several reasons. The use of personal protection methods is suggested.     

Evidence in support of nitric oxide (NO) involvement in the cyclic release of prolactin and LH surges

Studies were undertaken to determine whether nitric oxide (NO) is involved in induction of the prolactin surge on proestrus and in that induced by ovarian steroids in ovariectomized (ovx) rats, by using inhibitors of NO synthase, the enzyme that generates NO. Two week-ovariectomized rats were treated either with estradiol benzoate (EB, 30 μg/rat, s.c.) alone, or with EB and 2 days later with progesterone (P, 2 mg/rat, s.c.) to evoke a prolactin surge in the afternoon. Injections of the NO synthase inhibitor methyl ester (40 mg/kg, s.c.) at 10.00, 12.00, and 14.00 h completely suppressed the steroid-induced prolactin surge in the afternoon. Similarly, another NO synthase inhibitor, (100 mg/kg, s.c.), injected at 1000, 1200, and 1400 h on proestures suppressed prolactin and luteinizing hormone (LH) surges, but failed to alter the daily increase of corticosterone. These studies confirm our earlier report and show that NO is involved in the complex processes that initiate the afternoon prolactin and LH surges of proestrus.     

Wolbachia in the Asian rice gall midge, Orseolia oryzae (Wood-Mason): correlation between host mitotypes and infection status

Using a PCR‐based method, we detected Wolbachia in the Asian rice gall midge. Furthermore, results showed that all females across all biotypes are infected with Wolbachia. However, all male flies are not infected and show different infection frequency in different biotypes. We have also identified three mitotypes, in the rice gall midge, based on DraI restriction pattern of a portion of the 12S rRNA gene that was PCR amplified using primers specific to this gene. All the females and infected male flies had type 1 mtDNA while uninfected males showed only type 2 or 3 mtDNA. Inheritance patterns of mtDNA revealed the existence of a correlation between mtDNA type and Wolbachia infection in the Asian rice gall midge. Evidence for paternal inheritance of mtDNA in Wolbachia‐free gall midge is also presented.     

Prediabetes and hypertension

Prediabetes occurs due to two basic defects--insulin resistance and/or beta-cell failure. An observation suggested that insulin resistance may be associated with essential hypertension. There are some thoughts to favour the argument that insulin resistant Individuals are at a higher risk to develop hypertension as compared to insulin sensitive individuals. Some pathophysiological causes which have been commonly observed and hypothesised are narrated in this article. Management of hypertension in prediabetes should include antihypertensives and therapeutic lifestyle modification. To manage hypertension in prediabetes one should think for dietary modification, reduced salt intake, physical activity, smoking cessation, use of statins and antihypertensives.     

Letter to the editor regarding: ‘Impalpable breast lesion localisation,a logistical challenge: results of the UK iBRA-NET national practice questionnaire’

Breast Cancer Research and Treatment -     

Hypereosinophilia in Acute Lymphoblastic Leukemia: Two Cases with Review of Literature

Eosinophilia is rare in acute leukemia at presentation. Discrete reports and case studies in recent years have created significant interest in the field of “Acute leukemia with eosinophilia”. We herein present two cases of eosinophilia in association with acute lymphoblastic leukemia with brief review of literature in this field. First case is about 21-year-old female who presented with mediastinal mass along with leukocytosis and hypereosinophilia. On evaluation, she was found to have T cell acute lymphoblastic leukemia. After ruling out benign causes of eosinophilia, she was treated with modified BFM-90 protocol. Her eosinophilia resolved after 4 weeks of induction therapy. Second case is about 32-year-old male who was diagnosed as a case of mixed phenotype leukemia (B cell/myeloid type) along with severe eosinophilia. His hypereosinophilia finally resolved by week 16 of modified BFM-90 protocol. Diagnosing ALL is challenging when eosinophilia is the initial presentation. These two cases emphasize on the importance of considering ALL amongst one of the etiological causes of eosinophilia as delay in diagnosis endangers patient’s life at risk. Also eosinophilia per se is an independent poor risk factor, hence prompt diagnosis and early treatment is the key in all such cases.     

CD47 regulates the phagocytic clearance and replication of the Plasmodium yoelii malaria parasite

Several Plasmodium species exhibit a strong age-based preference for the red blood cells (RBC) they infect, which in turn is a major determinant of disease severity and pathogenesis. The molecular basis underlying this age constraint on the use of RBC and its influence on parasite burden is poorly understood. CD47 is a marker of self on most cells, including RBC, which, in conjunction with signal regulatory protein alpha (expressed on macrophages), prevents the clearance of cells by the immune system. In this report, we have investigated the role of CD47 on the growth and survival of nonlethal Plasmodium yoelii 17XNL (PyNL) malaria in C57BL/6 mice. By using a quantitative biotin-labeling procedure and a GFP-expressing parasite, we demonstrate that PyNL parasites preferentially infect high levels of CD47 (CD47^hi)-expressing young RBC. Importantly, C57BL/6 CD47^−/− mice were highly resistant to PyNL infection and developed a 9.3-fold lower peak parasitemia than their wild-type (WT) counterparts. The enhanced resistance to malaria observed in CD47^−/− mice was associated with a higher percentage of splenic F4/80⁺ cells, and these cells had a higher percentage of phagocytized parasitized RBC than infected WT mice during the acute phase of infection, when parasitemia was rapidly rising. Furthermore, injection of CD47-neutralizing antibody caused a significant reduction in parasite burden in WT C57BL/6 mice. Together, these results strongly suggest that CD47^hi young RBC may provide a shield to the malaria parasite from clearance by the phagocytic cells, which may be an immune escape mechanism used by Plasmodium parasites that preferentially infect young RBC.Malaria, caused by Plasmodium parasites, remains a major cause of mortality and morbidity in the developing world. Among the four principal human Plasmodium species, Plasmodium falciparum is the most virulent, being responsible for more than 90% of malaria-associated deaths. Likewise, Plasmodium species that infect rodents and nonhuman primates also differ widely in their fulminant nature and in the mortality they cause (1–3). How different Plasmodium species have evolved to exhibit this wide array of virulence and disease severity remains one of the major unsolved questions in malaria biology and pathogenesis.One important factor that is associated with Plasmodium parasite burden and disease severity is the age constraint of the host red blood cells (RBC) they infect. The age-based preference for restricted invasion of RBC by the Plasmodium parasite is characterized as young RBC (reticulocyte), aged RBC (mature), or both young and aged RBC. Plasmodium species that preferentially infect and grow inside young RBC generally cause a low-grade, self-resolving infection that is rarely fatal (e.g., Plasmodium vivax and Plasmodium ovale), whereas those that infect both young and aged RBC cause more fulminant infection that can be fatal in the absence of immunity (e.g., P. falciparum) (1, 4–6). Thus, along with host genetic background and immune response, restriction for age-specific RBC invasion is a major determinant of the severity and outcome of malaria infection.Malaria parasites have evolved to use redundant receptors and pathways to invade the RBC. For example, sialic acid (7) and Duffy antigen (8) are the major RBC receptors for invasion of P. falciparum and P. vivax, respectively, although other receptors and invasion pathways are known to exist (9, 10). Although a redundancy in RBC receptor use would ensure successful invasion by mitigating the effects of polymorphism and immune targeting, the reasons behind the RBC age-based preference for invasion are not fully clear and remain a subject of debate.Survival of normal cells through the course of their life cycle is essential to maintain homeostasis, and aberrant cells (e.g., senescent or foreign antigen-expressing cells) are eliminated through a sophisticated programmed cell removal system that relies on the recognition of self and nonself determinants (11). CD47, a cell surface molecule in the Ig superfamily, is ubiquitously expressed on many cell types, including RBC, and is a marker of self to avoid early clearance by phagocytic cells through ligation of signal regulatory protein alpha (12). In contrast, altered expression or conformational changes in CD47 may lead to a molecular switch that triggers a phagocytic signal to remove aged or damaged cells (11). Recent studies have shown that the level of CD47 expression is higher in progenitor cells and declines as they undergo maturation and are subsequently aged (13). This age-dependent difference in CD47 expression shields young cells but allows clearance of aging and damaged cells from the system.CD47 is overexpressed in cancer cells (11, 14, 15), and the CD47–signal regulatory protein alpha interaction is considered a major pathway of immune evasion by tumor cells (15). Administration of anti-CD47 antibodies enabled the phagocytosis of tumor cells in vitro, reduced their growth, and prevented the metastasis of human patient tumor cells (14). In this article, using the murine Plasmodium yoelii nonlethal model, we provide quantitative evidence for age of RBC as the basis for the survival and growth of malaria parasites and provide supporting data that suggest that P. yoelii nonlethal parasites prefer to grow inside younger RBC, which allows them to evade immune clearance by phagocytic cells through a CD47-mediated process, and that CD47 modulates the clearance of malaria infection. To our knowledge, this is the first report that provides a molecular basis for the age-dependent preference for infection of RBC by a Plasmodium parasite and sheds light on its implications for the severity of malaria infection in a host.     

Surgical Management of Resistant Priapism

We report a 31 year old patient, presented with painful erection since 48 hours. There was no known predisposing factor on history and examination. Surgery for priapism is rarely indicated nowadays but conservative management failed to achieve detumescence in our case. So Winter’s shunt surgery was done which failed then a formal shunt was created between corpora cavernosa and spongiosum which also failed to achieve detumescence. After 4 days - a formal left side cavernosa saphenous shunt procedure was done and detumescence achieved within 24 hrs .Follow up showed good results.