Epidemiology, Clinico-Haematological Profile and Management of Aplastic Anaemia: AIIMS Experience.

BACKGROUND: The incidence of aplastic anaemia (AA) is higher in Asia than in the West. The precise incidence of AA in India is not known due to lack of epidemiological study. 20-40% of pancytopenic patients in referral centres are of aplastic anaemia. PATIENTS AND METHODS: This was an analysis of 1501 patients diagnosed with aplastic anaemia over a period of seven and half years (January 2007- June 2014) attending the Aplastic clinic of department of haematology of All India Institute of Medical Sciences, New Delhi. The details regarding medical history, physical examination, complete blood count, bone marrow aspirate and biopsy, treatment received, were retrieved. Inherited bone marrow failure was screened in patients below 35 years. Treatment response was analysed for various treatment modalities. RESULTS: 1501 patients of AA from 20 different states of India were analysed. The bulk of patients were from Uttar Pradesh (28.7%), Bihar (23.6%), Delhi/NCR (20%) and Haryana (7%).The average number of new aplastic anaemia patients enrolled per year 214 (range: 101 -263). The median age at presentation was 25 years (range 2-83),with M;F - 2.3:1. Severity of AA revealed: severe (SAA): 75%, very severe (VSAA): 15%, non-severe (NSAA): 10%. Inherited bone marrow failure syndromes constituted 5% (75 patients) of all aplastic anaemia patients. The most common clinical presentations were pallor (97%), bleeding manifestations (69.6%) and fever (54%). The haematological parameters showed: median level of haemoglobin level: 5.9 gm/dL, WBC: 2700/mm3, ANC: 380/mm3, platelet: 1 0000/mm3. PNH clone was present in 13.5% of patients. 107 patients (7%) were lost to follow up or expired before any treatment was initiated. Only 69 patients (4.5%) received treatment with HLA-matched sibling stem cell transplantation and another 232 (15.5%) patients received ATG plus cyclosporine as immunosuppressive therapy. Seven hundred thirteenpatients (47.5%) received cyclosporine. The overall response to various treatment modalities was: HLA matched sibling haematopoietic stem cell transplant: 75.3%, Anti-thymocyte globulin plus cyclosporine: 58.7%, cyclosporine plus androgen: 45.6%, cyclosporine alone: 32.2%. CONCLUSION: Management of AA is a real challenge in developing countries.This is one of the largest case series from a single centre from India. It is our endeavour to reduce the detrimental outcome by increasing awareness among patients and referring physicians to reduce the delay between diagnosis and treatment.

Amphotericin B--fat emulsion in treatment of visceral leishmaniasis--a cost effective substitute for liposomal amphotericin B.

In spite of high dosage and prolonged treatment schedule of sodium antimony gluconate, unresponsiveness and relapse ranging from 25 to 40% has been reported. The cure rate of 90 to 92.9% with amphotericin B-fat emulsion is comparable to that with liposomal amphotericin B (80 to 100%). Due to high cost liposomal amphotericin B is beyond the reach of most of the Indian patients, whereas the cost of treatment with amphotericin B-fat emulsion is quite affordable. Further large scale studies with amphotericin B-fat emulsion are required to evaluate its effectiveness in Indian kala-azar patients and to establish its optimal dose.

Strong association of socioeconomic status with genetic ancestry in Latinos: implications for admixture studies of type 2 diabetes.

AIMS/HYPOTHESIS: Type 2 diabetes is more prevalent in US American minority populations of African or Native American descent than it is in European Americans. However, the proportion of this epidemiological difference that can be ascribed to genetic or environmental factors is unknown. To determine whether genetic ancestry is correlated with diabetes risk in Latinos, we estimated the proportion of European ancestry in case-control samples from Mexico and Colombia in whom socioeconomic status had been carefully ascertained. METHODS: We genotyped 67 ancestry-informative markers in 499 participants with type 2 diabetes and 197 controls from Medellín (Colombia), as well as in 163 participants with type 2 diabetes and 72 controls from central Mexico. Each participant was assigned a socioeconomic status scale via various measures. RESULTS: Although European ancestry was associated with lower diabetes risk in Mexicans (OR [95% CI] 0.06 [0.02-0.21], p = 2.0 x 10(-5)) and Colombians (OR 0.26 [0.08-0.78], p = 0.02), adjustment for socioeconomic status eliminated the association in the Colombian sample (OR 0.64 [0.19-2.12], p = 0.46) and significantly attenuated it in the Mexican sample (OR 0.17 [0.04-0.71], p = 0.02). Adjustment for BMI did not change the results. CONCLUSIONS/INTERPRETATION: The proportion of non-European ancestry is associated with both type 2 diabetes and lower socioeconomic status in admixed Latino populations from North and South America. We conclude that ancestry-directed search for genetic markers associated with type 2 diabetes in Latinos may benefit from information involving social factors, as these factors have a quantitatively important effect on type 2 diabetes risk relative to ancestry effects.

A cost effective fermentative production of succinic acid from cane molasses and corn steep liquor by Escherichia coli.

AIM: Development and optimization of an efficient and inexpensive medium for succinic acid production by Escherichia coli under anaerobic conditions. METHODS AND RESULTS: Initially, 0.8 gl(-1) of succinic acid was produced in 60 h in 300-ml medium. On optimization, glucose and peptone were replaced by cane molasses and corn steep liquor. Three hundred ml of this medium was inoculated with 4% (v/v) of seed inoculum, incubated at 39 degrees C for 72 h, resulted in 7.1 gl(-1) of succinic acid in 36 h. Scale up in a 10-l fermentor under conditions of controlled pH and continuous CO2 supply in this medium resulted in 17 gl(-1) of succinic acid in 30 h. CONCLUSIONS: A ninefold increase in succinic acid production was obtained in 500-ml anaerobic bottles with optimized medium having cane molasses and corn steep liquor as against initial medium containing glucose and peptone. However, a subsequent scale up in a 10-l fermentor resulted in a 2.5-fold increase in succinic acid production as against optimized medium used in 500-ml anaerobic bottles. SIGNIFICANCE AND IMPACT OF THE STUDY: Succinic acid production was enhanced in medium consisting of inexpensive carbon and nitrogen sources in a shorter span of time.

HPLC--how necessary is it for haemoglobinopathy diagnosis in India?

Cation exchange high performance liquid chromatography (HPLC) is emerging as the method of choice for the initial screening of thalassemias and haemoglobinopathies and quantification of Haemoglobins (Hbs) like HbA, HbA2 and HbF. Since it is expensive, the present study was conducted to evaluate the need for HPLC in Indian laboratories and identify situations where it would be imperative. Eighty three patients suspected to have thalassemia and haemoglobinopathies were analysed. Both HPLC and alkaline gel electrophoresis detected 14 cases of HbE syndrome and 14 cases of HbS syndrome. However of the 14 cases diagnosed as HbD syndrome by alkaline electrophoresis, eight cases were diagnosed as Hb Q India, 1 case as HbD Iran and 5 cases of HbD Punjab on HPLC. Thirty-one cases were detected to have beta heterozygous thalassemia based on the high HbA2 levels (>3.9%) and eight cases were diagnosed as beta homozygous thalassemia by both HPLC and gel electrophoresis. One of them had an unknown Hb migrating in F-A region. Her mother also had same unknown Hb variant. In view of electrophoretic migration and retention time (RT) on HPLC, possibility of HbG-San Jose was considered. HPLC being an automated instrument is highly sensitive and specific, has high resolution and helps in quantification of various haemoglobins. However in a developing country like India where economical factors play a major role in planning for management of patients, the role of HPLC is limited.

Effect of serum dilution in diagnosis of malaria in community.

Recently, it has been shown that immunological methods can be used for the diagnosis of malaria other than sero-epidemiology. A study has been done to investigate optimum binding capacity of antigen-antibody (Ag-Ab) at different serum dilutions. For validating antigen-antibody (Ag-Ab) reaction at 1:100, 1:1000 and 1:1000 serum dilutions, have been tested in two different laboratories to establish validation of the ELISA method. Inter laboratory test on synthetic peptide (RI) ELISA was found comparable and meaningful for assessing malaria transmission in defined locality at 1:100 dilution. Results also showed that 1:1000 serum dilution can be useful for diagnostic purpose.

Microorganisms as an alternative source of protein.

Demand for human food and animal feed proteins from nonconventional sources has increased, particularly in developing countries. Microbial protein is one such source. It is desirable because it is amenable to controlled intensive cultivation and is less dependent on variations in climate, weather, and soil. Microbial proteins must be evaluated for nutritive value, safety, and economic considerations before mass production is undertaken.

Laboratory assessment of indigenous plant extracts for anti-juvenile hormone activity in Culex quinquefasciatus.

Of 15 plants tested, five plant extracts showed anti-juvenile hormone-like activity against laboratory colonised late fourth instar larvae and adult female mosquitoes. Petroleum ether extract of Eichhornia crassipes and acetone extracts of Ageratum conyzoides, Cleome icosandra, Tagetes erectes and Tridax procumbens showed growth inhibitory (P less than 0.001) and juvenile hormone mimicing activity to the treated larvae of C. quinquefasciatus.. Larval pupal intermediates, demalanised pupae, defective egg rafts and adult with deformed flight muscles were few noticeable changes. Biting behaviour was observed to be affected only in Ageratum, Cleome and Tridax extracts (P less than 0.001). Loss of fecundity was observed in the treated mosquitoes but no sterilant effects could be seen. Adults, obtained from larvae exposed to the plant extracts produced significantly shorter egg-rafts (P less than 0.005) than in control.