Presentation and endoscopic management of biliary ascariasis

Ascaris lumbricoides is a common parasite and the most serious and dramatic presentation is hepatobiliary and pancreatic ascariasis (HPA). Therefore, this study was planned prospectively to elucidate the clinical presentation of HPA and evaluate the efficacy and safety of endoscopic intervention. In this study we documented 77 consecutive patients with HPA from January 2000 to November 2005. All the patients had endoscopically proven HPA. A total of 77 patients were included in the study. The age ranged from 6 to 80 years, with the third decade most commonly (28.6%) affected. Females were 6 times more likely to be affected than males. The commonest presentation was biliary colic (97.4%); other presentations were acute cholangitis (15.6%), obstructive jaundice (9.1%), acute pancreatitis (6.5%), choledocholithiasis (6.5%), acute cholecystitis (6.5%) and liver abscess (2.6%). In this report 51 (66.2%) had living, 10 (13%) had dead and 16 (20.8%) had both living and dead worms. Choledocholithiasis was associated only with dead worms. From one to 23 worms were found in the biliary tree. In 94.8% of cases we had to remove the worm by wide papillotomy followed by basket extraction. We did not experience any major complications during or following the procedures. Three patients had recurrent HPA during the course of follow-up (1 to 12 months). The majority of patients with HPA presented with biliary colic. This should be kept in mind in the management of an acute abdomen, especially in tropical countries. Endoscopic extraction is a safe and effective procedure for the treatment of HPA.     

Hydrogen peroxide inhibits IL-12 p40 induction in macrophages by inhibiting c-rel translocation to the nucleus through activation of calmodulin protein

Although the antimicrobial activity of reactive oxygen species (ROSs) is well defined, the role of ROSs in regulating the immune response of the body is not well understood. We now provide evidence that hydrogen peroxide (H2O2), a major component of ROSs, inhibits interleukin-12 (IL-12) p40 and IL-12 p70 induction in murine macrophages and catalase pretreatment prevents H2O2-mediated down-regulation of IL-12. Endogenous accumulation of H2O2/ROSs in macrophages treated with alloxan resulted in IL-12 p40 inhibition. Although nuclear expression of both p50 and p65 NF-kappaB increased on H2O2 exposure, nuclear c-rel level was inhibited. Overexpression of c-rel restored IL-12 p40 on stimulation with lipopolysaccharide plus IFN-gamma during H2O2 treatment. H2O2 did not inhibit c-rel induction in cytosol; however, it prevented the transport of c-rel from cytosol to the nucleus. H2O2 activated calmodulin (CaM) protein in the cytosol, which subsequently sequestered c-rel in the cytosol preventing its transport to the nucleus. The CaM inhibitor trifIuoperazine increased both nuclear c-rel and IL-12 p40 levels in H2O2-treated macrophages, emphasizing a role of CaM in these processes. H2O2/ROSs thus down-regulate IL-12 induction in macrophages by a novel pathway inhibiting c-rel translocation to the nucleus through activation of CaM protein.     

Association of strong immune responses to PPE protein Rv1168c with active tuberculosis

Accurate diagnosis of tuberculosis (TB) infection is critical for the treatment, prevention, and control of TB. Conventional diagnostic tests based on purified protein derivative (PPD) do not achieve the required diagnostic sensitivity. Therefore, in this study, we have evaluated the immunogenic properties of Rv1168c, a member of the PPE family, in comparison with PPD, which is routinely used in the tuberculin test, and Hsp60 and ESAT-6, well-known immunodominant antigens of Mycobacterium tuberculosis. In a conventional enzyme immunoassay, the recombinant Rv1168c protein displayed stronger immunoreactivity against the sera obtained from patients with clinically active TB than did PPD, Hsp60, or ESAT-6 and could distinguish TB patients from Mycobacterium bovis BCG-vaccinated controls. Interestingly, Rv1168c antigen permits diagnosis of smear-negative pulmonary TB as well as extrapulmonary TB cases, which are often difficult to diagnose by conventional tests. The immunodominant nature of Rv1168c makes it a promising candidate to use in serodiagnosis of TB. In addition, our studies also show that Rv1168c is a potent T-cell antigen which elicits a strong gamma interferon response in sensitized peripheral blood mononuclear cells obtained from TB patients.     

Removal of Pb (II) by Immobilized and Free Filaments of Marine <Emphasis Type="Italic">Oscillatoria</Emphasis> sp. NTMS01 and <Emphasis Type="Italic">Phormidium</Emphasis> sp. NTMS02

Pb²⁺ removal ability of the immobilized and free filaments of marine cyanobacteria Oscillatoria sp. NTMS01 and Phormidium sp. NTMS02 was studied using batch experiments. Biosorption of lead by immobilized filaments was studied as a function of pH (2, 4, 6, 8, 10), contact time (5–180 min) and initial lead concentration (1, 3, 5, 7 mg/L) and the removal efficiency of free filaments was studied by culturing in the marine medium with the initial concentration (1, 3, 5, 7 mg/L) at pH 7 and incubated for 10 days. The maximum percentage removal was observed at 25 min for immobilized Oscillatoria sp. NTMS01 and 30 min for immobilized Phormidium sp. NTMS02. At 4th and 6th day of incubation, 89% and 77% removal was observed at 1 mg/L of initial lead concentration by free filaments of Oscillatoria sp. NTMS01 and Phormidium sp. NTMS02 respectively and further the removal was decreased with increasing concentration. Chlorophyll-a content was decreased in a dose dependent manner. About 40 and 50% reduction of chlorophyll-a was observed at higher concentration in Oscillatoria sp. NTMS01 and Phormidium sp. NTMS02 respectively. The adsorption capacity of immobilized Oscillatoria sp. NTMS01 was found to be (Q_max) 217.39 which is comparatively higher than other sorbents. The Pb²⁺ removal efficiency was performed as described in terms of Langmuir and Freundlich isotherms. These organisms is found to fit better by the Langmuir isotherms.     

Evaluation of normal or minimally elevated alanine transaminase,age and DNA level in predicting liver histological changes in chronic hepatitis B

Background: Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level and age are used in the evaluation of chronic hepatitis B (CHB). Aim: We designed this study to evaluate liver histology with ALT and its relation with age and HBV DNA. Methods: During the period of October 2006 to July 2009, 499 CHB patients were included in this study with detectable HBV DNA at PCR. Of these, 181 had normal ALT, 200 had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were labelled as Group 1, 2 and 3 respectively. Results: A strong positive correlation was found between ALT and histological activity index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group 1 with positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among those with HBeAg‐negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had fibrosis ≥2. In Group 2, 14 (15.7%) had moderate‐to‐severe HAI and 19 (21.2%) had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34 (30.6%) had moderate‐to‐severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting significant histological changes. Further, HAI and fibrosis were significantly greater in the age of >30 years. Conclusions: We recommend liver biopsy in HBeAg‐negative CHB over 30 years of age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of 2 × ULN.     

Insulin resistance in development and progression of nonalcoholic fatty liver disease

Although insulin resistance(IR)is strongly associated with nonalcoholic fatty liver disease(NAFLD),the association of IR and NAFLD is not universal and correlation between IR and severity of NAFLD is still controversial.In this review,we summarize recent evidence that partially dissociates insulin resistance from NAFLD.It has also been reported that single-nucleotide polymorphisms in the diacylglycerol acyltransferase gene,rather than IR,account for the variability in liver fat content.Polymorphisms of the patatin-like phospholipase 3 gene have also been reported to be associated with NAFLD without metabolic syndrome,which suggests that genetic conditions that promote the development of fatty changes in the liver may occur independently of IR.Moreover,environmental factors such as nutrition and physical activity as well as small intestinal bacterial overgrowth have been linked to the pathogenesis of NAFLD,although some of the data are conflicting.Therefore,findings from both genetically engineered animal models and humans with genetic conditions,as well as recent studies that have explored the role of environmental factors,have confirmed the view that NAFLD is a polygenic disease process caused by both genetic and environmental factors.Therefore,IR is not the sole predictor of the pathogenesis of NAFLD.     

Biochemical Changes of Fresh Water Cyanobacteria Dolichospermum flos-aquae NTMS07 to Chromium-Induced Stress with Special Reference to Antioxidant Enzymes and Cellular Fatty Acids

This investigation examined the efficiency of Dolichospermum flos-aquae NTMS07 in the removal of Cr(VI) from exposure water at various concentrations (2.5, 5, 7.5, 10 mg/L) over different time intervals of contact (1–5 days). Chromium removal was maximum at 2.5 mg/L, and decreased with increased concentration. The responses of the antioxidative enzymes superoxide dismutase (SOD) and catalase (CAT) were measured, and the composition of fatty acids was evaluated at a concentration of 5 mg Cr/L. Significant increases in the activity levels of SOD and CAT were obtained. The level of total unsaturated fatty acids decreased with exposure to Cr. It is proposed that the observed decrease in total unsaturated fatty acid level is a defense mechanism against Cr-induced oxidative stress and cell membrane damage.