Acute renal failure in liver transplant patients: Indian study.

The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.

Genetic analysis of maydis leaf blight resistance in subtropical maize (Zea mays L.) germplasm.

Knowledge on the genetics of maydis leaf blight (MLB) is crucial to breed the resistant maize cultivars to combat disease epidemics as a sustainable and cost-effective approach. The present investigation was framed to understand the genetics of MLB resistance in subtropical maize. Two contrasting genotypes CM119 (susceptible) and SC-7-2-1-2-6-1 (resistant) were used to generate six genetic populations, namely P1, P2, F1, F2, BC1P1 and BC1P2, and evaluated in three target environments for MLB resistance under artificial epiphytotic condition. The CM119 and SC-7-2-1-2-6-1 showed susceptible and resistant reactions with mean disease reaction of 3.89-3.98 and 1.88-2.00, respectively. The derived generations, namely F1, F2, BC1P1 and BC1P2 showed mean disease reaction of 2.15-2.28, 2.44-2.51, 2.19-2.24 and 2.22-2.28, respectively in the test locations. The segregating generations (F2: 0.35-0.37; BC1P1: 0.24-0.29 and BC1P2: 0.17-0.20) showed variation for MLB disease resistance over the parental and first filial generations (P1: 0.11-0.17; P2: 0.08-0.13 and F1: 0.12-0.14). The genetic analysis of MLB resistance revealed the nonallelic interactions of duplicate epistasis type across the test locations. Among the gene interactions, dominance x dominance [l] effect was predominant over additive x additive [i] and additive x dominance [j] effects. The segregation analysis and the prediction of the number of major loci revealed at least two major genes associated with MLB tolerance in subtropical maize. Our investigation paved the foundation for the improvement of subtropical maize germplasm of MLB resistance.

Bacterial lipopolysaccharide-induced oxidative stress in the impairment of steroidogenesis and spermatogenesis in rats.

Microbial infections, localized as well as systemic, are known to cause transitive or permanent male infertility. However, the mechanisms of infection-induced infertility are largely unknown. Earlier reports showed that steroidogenesis and spermatogenesis are affected during bacterial lipopolysaccharide (LPS)-induced acute inflammation. The present study used an LPS rat model to investigate the role of oxidative stress in spermatogenesis. Intraperitoneal administration of bacterial LPS (5mg/kg body weight) to adult male albino rats elevated testicular malondialdehyde (MDA) and 4-hydroxy-2-nonenal (HNE), and decreased the activities of testicular antioxidant enzymes such as catalase, superoxide dismutase, glutathione peroxidase, and glutathione reductase. The GSH/GSSG ratio also decreased significantly. Time series analysis revealed transitory oxidative stress and expression of inflammatory mediators such as interleukin-1beta (IL-1beta), inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) from 3h to 12h after LPS. Testicular expression of steroidogenic acute regulatory (StAR) protein decreased to 24h, in correlation with damage to spermatogenesis. These data are consistent with oxidative stress as a major causal factor in altered steroidogenesis, spermatogenesis, and perhaps male infertility during endotoxin-induced acute inflammation.

Breast Tuberculosis.

Tuberculosis affects over a billion people worldwide. There is a raise in incidence of extrapulmonary tuberculosis in recent years. Mammary tuberculosis has been estimated to be 0.1 % of breast lesions examined histologically, and it constitutes about 3-4.5 % of surgically treated breast diseases in developing countries. Breast tuberculosis is paucibacillary and routine diagnostic tests such as microscopy, culture, and nucleic acid amplification tests such as polymerase chain reaction techniques do not have the same diagnostic utility as they do in pulmonary tuberculosis. Also, the histology resembles various other granulomatous mastitis. The coexistence of carcinoma and breast tuberculosis adds challenge to diagnosis. Correct diagnosis of tuberculous mastitis is important as the treatment of differential disease varies from steroid to surgery which can have devastating consequences in patients suffering from breast tuberculosis.

Early diagnosis of gallbladder carcinoma: an algorithm approach.

Gall bladder carcinoma is the most common biliary tract cancer. Delayed presentation and early spread of tumor make it one of the lethal tumors with poor prognosis. Considering that simple cholecystectomy for T1 disease could offer a potential cure, it is increasingly needed to identify it at early stages. Identification of high-risk cases and offering prophylactic cholecystectomy can decrease the incidence of gallbladder carcinoma. With advances in diagnostic tools like contrast-enhanced endoscopic ultrasound, elastography, multidetctor CT, MRI, and PET scan, we can potentially diagnose gallbladder carcinoma at early stages. This paper reviews the various diagnostic modalities available and an algorithmic approach to early diagnosis of gallbladder carcinoma.

Disseminated cutaneous cysticercosis and neurocysticercosis: A rare occurrence.

Disseminated cysticercosis is a parasitic infestation of pork tapeworm, Taenia solium. A 19-year-old female presented with multiple nodules all over her body since 12 months. Histopathology showed features suggestive of parasitic granuloma with multinucleated giant cells and plenty of eosinophils admixed with necrosis. Ultrasonography of these lesions showed multiple well-defined cystic lesions of varying size with a few specks of calcification. Cranial computed tomography scan showed bilateral, multiple, small hyperdense lesions in the supratentorial compartment. She was treated with oral albendazole and oral corticosteroids. This case is being reported because of its rare, disseminated nature with cutaneous, neural and ocular involvement.

Fournier's Gangrene: Current Practices.

Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20-30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes.

Second lumbrical and interossei latency difference in Carpal Tunnel Syndrome.

OBJECTIVE: To evaluate the diagnostic value of second lumbrical and interossei distal motor latency difference (2LIDMLD) in diagnosing CTS of different electro-physiological grades of CTS. METHODS: 2LIDMLD was standardized in 120 hands of healthy controls. Subjects with clinically diagnosed CTS and CTS with incidental polyneuropathy were prospectively evaluated with 2LIDMLD in addition to other standard diagnostic tests. Sensitivities of these tests were compared in patients with CTS of varying grades of severity and CTS associated with polyneuropathy. RESULTS: Two hundred and fifty hands of 130 patients met the clinical criteria for CTS. Sensitivity and specificity of 2LIDMLD, palm-wrist distal sensory latency difference (PWDSLD), and median distal motor latency (MDML) were 85.60% and 96.67%, 68.80% and 96.10%, 60.80% and 97%, respectively. Sensitivity of 2LIDMLD in mild CTS was similar to that of PWDSLD. In severe CTS, and CTS with polyneuropathy, 2LIDMLD was the most sensitive test. It was the only test of localizing value in 16% of hands with severe CTS, when all other methods failed due to absent median motor and sensory responses. CONCLUSIONS: 2LIDMLD is a sensitive, specific for diagnosis of all grades of CTS. It is an accurate and reliable method that helps especially in diagnosis of severe CTS and CTS associated with polyneuropathy, when other standard localized tests fail. SIGNIFICANCE: The second lumbrical is relatively less affected in severe carpal tunnel syndrome and median to ulnar comparison, using 2LIDMLD, appears to be a reliable and a valuable technique in the localization of severe CTS and CTS associated with polyneuropathy, especially when the median sensory or motor responses are absent on routine conduction studies.