Azithromycin resistance and its molecular characteristics in Neisseria gonorrhoeae isolates from a tertiary care centre in North India

Treatment guidelines for management of uncomplicated gonorrhoeae have been recently modified owing to alarming upsurge in azithromycin resistance. This study investigated the prevalence and genetic determinants of gonococcal azithromycin resistance in India. Four (5.7%) of 70 gonococcal isolates were resistant to azithromycin. Of 16 isolates investigated for molecular mechanisms of resistance, 13 (81.3%) and 6 (37.5%) isolates exhibited mutations in coding and promoter regions of mtrR gene, respectively. However, ermA, ermB and ermC genes or mutations in rrl gene were absent in all isolates. Azithromycin resistance is low in India posing no immediate threat to use of dual-therapy for syndromic management.     

1,450 nm Long-Pulsed Diode Laser for Nonablative Skin Rejuvenation

Background:. There has been growing patient demand for laser technology to treat rhytids and to refine skin texture without the associated lifestyle hindrance common to ablative cutaneous procedures. Nonablative laser systems have been developed to meet this need and, in many instances, have replaced ablative lasers as the preferred treatment modality.
Objective:. To review long-pulsed diode laser technology in the treatment of a variety of cutaneous disorders.
Materials and Methods. All publications involving 1,450 nm long-pulsed diode laser technology were reviewed and discussed.
Results. The latest generation of nonablative lasers, in the midinfrared electromagnetic spectrum, selectively targets and heats dermal tissue to stimulate collagen remodeling while sparing the epidermis.
Conclusions. Demonstrating efficacy in the treatment of a wide range of cutaneous disorders, including facial rhytids, acne vulgaris, and atrophic scars, the 1,450 nm diode laser is a useful addition to the nonablative laser armamentarium.     

Expression of pS2, c-erbB-2, and cathepsin D during the menstrual cycle in human breast cancers

Background: Many studies have addressed the effect of the timing of surgery for breast cancer relative to menstrual cycle phase, with conflicting results. Explanations for the possibility that survival could be altered by the appropriate timing of breast cancer surgery in humans remain speculative. Methods: We examined the expression of three estrogen related proteins (c-erbB-2, cathepsin D, pS2) in the breast tumors from 69 premenopausal women sampled in different phases of the menstrual cycle. Data on S-phase fraction and hormone receptor expression were also analyzed. Immunohistochemical assays were used to measure the proteins of interest. S-phase fraction was determined by flow cytometry. Analyses were performed based on fraction of cells staining positive for the protein, density of stain, and a histoscore that combined both fraction of positive cells and density. Results: We found no differences in c-erbB-2, cathepsin D, hormone receptor, or S-phase levels in tumors sampled in the follicular versus luteal phase, or perimenstrual versus periovulatory phase. The exception was pS2, which was expressed at greater levels during the luteal than during the follicular phase of the cycle (p<0.01); but there was no difference in pS2 expression when the patients were classified as periovulatory versus perimenstrual. Conclusions: Our findings do not support a variation in c-erbB-2, cathepsin D, S-phase fraction, or receptor expression as an explanation for the differences in breast cancer prognosis when surgery is timed by menstrual cycle phase. The finding that pS2 (an indicator of hormone sensitivity, and possibly better prognosis) is expressed at higher levels in tumor samples during the luteal phase suggests that the biologic profile of breast tumors may vary with the menstrual cycle and that these variations deserve further study.     

Bleeding complications associated with peritoneal dialysis catheter insertion.

OBJECTIVE: To identify the incidence of bleeding complications associated with peritoneal dialysis catheter insertion. DESIGN: Retrospective review at a tertiary-care center of all double-cuffed Tenckhoff catheters placed surgically from 1 January 1992 to 1 October 2003 to identify the incidence of major bleeding complications occurring with catheter insertion. Major bleeding episodes were defined as > or = 3% decline in hematocrit, or the need for surgical intervention or blood transfusion within 2 weeks of insertion. RESULTS: 292 catheters had been inserted in 263 patients. Six patients satisfied the criteria for a major bleeding event, for a major bleeding complication rate of 2%. Bleeding was associated with perioperative anticoagulation in 3 patients, uremia and thrombocytopenia in 1 patient, aspirin use and thrombocytopenia in 1 patient, and 1 patient experienced intraoperative bleeding. Coagulation parameters were not obtained prior to the procedure in 2 of the 6 patients. CONCLUSION: The rate of serious bleeding complications related to catheter insertion is low and usually associated with anticoagulation. Holding anticoagulation therapy for a minimum of 24 hours during the postoperative period should eliminate much of the risk. Coagulation parameters should also be obtained and corrected preoperatively.     

Antifungal potential of disulfiram.

Disulfiram, an alcohol antagonistic drug has been on the market since 1949 with 80% bioavailability and an established safety profile. Recently it has been reported as a P-glycoprotein efflux pump modulator. Herein we report its antifungal potential. The MIC50 and MIC90 of disulfiram for yeast isolates is 4 and 8 microg/ml, respectively, and the MIC range is 1-16 micro g/ml for both fluconazole sensitive and resistant strains. Interestingly, disulfiram also showed fungicidal activity on Aspergillus spp. with MIC50 and MIC90 of 2 and 8 microg/ml, respectively.     

Other genomic disorders and congenital heart disease

Congenital heart disease (CHD) is the common birth defect worldwide. Despite its recognized burden on public health, the etiology in the vast majority of individuals remains unknown. Chromosomal abnormality plays an important role, frequently observed as large cytogenetically visible rearrangement or small submicroscopic structural variation in the genome. Several genomic disorders are now recognized that are increasingly responsible for CHD with variable penetrance. Single gene disorders, epigenetic alterations, and environmental etiologies are also significant contributors. Our understanding of the genetic basis of CHD has increased exponentially with the escalating use of next generation sequencing to identify ever so small submicroscopic genomic imbalances at the level of coding exons in CHD. This review focuses on genomic disorders other than 22q11.2 deletion, that are major players in the etiology of human cardiac malformations.     

The dynamics of alpha-fetoprotein and albumin synthesis in human and rat liver during normal ontogeny.

The dynamics of synthesis of alpha-fetoprotein (AFP) and albumin have been studied in rat and man by immunocytochemical localization of each protein in the liver and its quantitation in serum at different periods of normal intrauterine and extrauterine life. The proteins are present only in the cytoplasm of hepatocytes. During physiologic development, an inverse relationship exists between the serum concentrations of the two proteins, the latter for each appearing to be directly related to the number of hepatocytes synthesizing it. AFP-containing cells are randomly distributed, while albumin-containing cells are more uniformly spread out. Both, however, are often preferentially located around venous channels. In the case of AFP-containing cells, the last to disappear with advancing postnatal age are seen around the hepatic veins. When both proteins are present in serum, several hepatocytes seem to syntehsize the two simultaneously, though others contain only one of them. It is unlikely that in the physiologic state different populations of hepatocytes are assigned to synthesize AFP and albumin separately.