Typhoid Fever.

Typhoid fever is one of the most common febrile illnesses encountered by the physicians in Bangladesh. Diagnosis is not difficult but has lately become a challenge due to changed clinical pattern of the disease, lack of adequate facilities for blood, stool, urine culture, excessive reliance on nonspecific Widal test and non availability of any reliable rapid diagnostic tests. Further, the indiscriminate and injudicious use of antibiotics for treating fever in undiagnosed febrile illnesses early has created problems to the physicians to reach to a diagnosis later on. This has also led to the emergence of high level resistance to many of the commonly used antibiotics in our country. Ciprofloxacin is often used empirically for treating the disease though there is already a high level resistance. In case the organism is in-vitro sensitive to ciprofloxacin but resistant to nalidixic acid, a much higher dose of drug is required to maintain the MIC which is 10 times higher than usual. Third generation cephalosporins (ceftriaxone and cefixime) are still the effective drugs for treating typhoid fever. The drug needs to be used in proper dose and duration to prevent emergence of resistance. Azithromycin though advocated by many as an alternative to ciprofloxacin in resistant cases, has recently lost its credibility due to emergence of resistance. We should not rely on Widal test in diagnosing typhoid fever. In a suspected case, the patient should not be prescribed any antibiotic without sending blood sample for culture sensitivity.

Beneficial effect of modified egg on serum T3, T4 and dyslipidaemia following dietary Zn-supplementation in Wistar rat.

A fall in serum T3 and T4 along with increase in serum cholesterol, triglycerides, LDL-c and VLDL-c and decrease in HDL-c was observed in albino Wistar rats when fed on semi-synthetic diet containing either 40 or 80mg Zn/kg diet. Zn concentrations were observed to increase with decreased concentration of Cu and Mg in their tissues. On including modified egg (Indian Patent Application No. 2264\Del\2005) in the Zn supplement diet, the levels of T3 and T4, lipid profile in serum and mineral status approached closer to control group-I. The data suggest that hypothyroidism and dyslipidaemia caused by excessive Zn in diet can be ameliorated on consuming these modified eggs due to restoration of mineral status in the body.

Effect of modified egg* on developmental defects in neonates of NIDDM induced Wistar rats.

Maternal Zn deficiency has been suggested as the contributing factor for all congenital malformations during pregnancy particularly in diabetes. Maternal Zn-supplementation, therefore, was suggested as one possible nutrition intervention during pregnancy to improve its outcome. But a number of trials with Zn-supplementation are not consistent and discourage the use of excessive Zn-supplementation during pregnancy. Instead a multivitamin/ mineral supplement to them has been suggested to reduce its complication. Accordingly, the poultry egg was modified for trace elements, vitamin-E and omega-3 fatty acids so as to use it as a dietary supplement for diabetics to reduce their complications during the pregnancy. The results showed that NIDDM induced rats fed either on 40 or 80 mg Zn/kg diet delivered less number of pups/litter and their body weight was higher at birth as compared to control group fed 20 mg Zn/kg diet. During the weaning period, some abnormalities characterized by restricted movements of the hind legs, curl toes of limbs, eye opening problems, less hair on the body and more head to body ratio were observed. Whereas number of pups delivered per litter were more with higher body weights without abnormalities in the pups in NIDDM groups fed egg mixed diet. Further Zn, Cu and Mg concentrations were significantly less in the liver, hair and abdominal muscles in pups in NIDDM groups but their concentrations were restored approaching closer to control in pups in groups fed egg mixed diet estimated on 18th day of weaning period. The excretion of these trace elements increased in the urine of dams fed Zn supplemented diet but decreased in the dams fed egg mixed diet on 15th day of their suckling period. The data suggest that if these modified eggs are included in the regular diet during pregnancy, they may protect the neonates in womb against the damaging effect of imbalances of physiologically important nutrients due to diabetes or environmental contamination.

Long term excessive Zn-supplementation promotes metabolic syndrome-X in Wistar rats fed sucrose and fat rich semisynthetic diet.

During the last two decades Zinc (Zn) as a micronutrient is being used indiscriminately in agricultural and husbandry practices and also in baby foods and multivitamin supplements with a view that Zn is non-toxic and promotes linear growth and body weight in the consumers. The long-term effect of increasing Zn load in the body has not been worked out so far. In this study, three groups of rats were fed on a semi-synthetic diet containing 20 mg (control, group-I), 40 mg (group-II) and 80 mg Zn /kg (group-III) diet respectively for 6 months. The results revealed that the gain in body weight increased in rats in Zn-concentration dependent manner. The urine examined on weekly basis showed glucosuria in group-II on week 10 and in group-III on week 8 and thereafter. The arterial blood pressure was significantly higher in group-II and III than their control counter parts on monthly basis. Histochemical examination of skin revealed an increase in the number of adipocytes filled with triglycerides making a subcutaneous fatty tissue thicker in group-II and group-III than that of control group. The blood profile after 180 days of dietary treatment, displayed a significant rise in glucose, total lipids, cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol, insulin, cortisol and aldosterone whereas HDL-cholesterol, T3, T4 and TSH showed a reduction in their levels in the blood serum. The tissue metal status showed an increase of Zn, Cu and Mg in the serum, a rise in Zn in liver, hair and abdominal muscles and fall in Cu and Mg concentrations in liver, hair and abdominal muscles. This data suggest that Zn in excess in diet when fed for longer periods of time induces metabolic syndrome-X.

Risk factors in early neonatal sepsis.

OBJECTIVE: To study the maternal and neonatal risk factors for neonatal sepsis. MATERIALS AND METHODS: This is prospective case control study, conducted on the neonates up to 7 days of life with a diagnosis of neonatal sepsis. There were 100 cases of neonatal sepsis and 100 control cases. The neonates in the case and control groups were evaluated for various maternal and neonatal risk factors. RESULTS: The factors which carried a significant risk for development of neonatal sepsis were premature rupture of membrane (PROM), meconium stained amniotic fluid (MSAF), foul smelling liquor, low birth weight, prematurity and low Apgar score at birth. The blood culture was positive in 22% of cases. The commonest organisms isolated were S. aureus and Klebsiella. The overall mortality was 11%. The incidence of risk factors was almost equal in culture positive and culture negative cases. CONCLUSION: The study identifies PROM, MSAF, foul smelling amniotic fluid, prematurity, low birth weight and low Apgar score at birth as strong risk factors for development of neonatal sepsis. In the presence of above factors, the neonate should be screened and observed for sepsis and considered for early institution of antibiotics.

Is interferon-alpha and retinoic acid combination along with radiation superior to chemo-radiation in the treatment of advanced carcinoma of cervix?

Locally advanced cervical cancers comprise a large majority of the gynecologic cancers in India and other developing countries. Concurrent chemo-radiation has improved the survival of high risk stage I and stage II cervical cancers. There is no evidence that the same survival benefit has been achieved with chemo-radiation in stage III and stage IV disease. Interferon-alpha and Retinoic acid have synergistic anti-proliferative activity. In combination with radiation, they substantially enhance the sensitivity of the squamous carcinoma cells to radiation. Based on these observations from the in vitro studies, a few clinical trials have evaluated the combination of interferon-alpha and Retinoic acid, concomitant with radiation, to treat cervical cancers. The results from these early trials were encouraging and the combination had minimal toxicities. However, till date, no phase III randomized controlled trial has been done to evaluate this therapeutic modality.

Sirenomelia.

Sirenomelia is a rare congenital anomaly with incidence of 1.5-4.2 per 100,000 births. Vascular steal phenomenon, posterior axial mesodermal defect or teratogenic defects have been implied in its pathogenesis. The authors present two cases with associated upper limb involvement and vertebral defects and complete absence of one lower limb bones in one case. Autopsy revealed abnormalities in internal organs. Both cases were associated with single umbilical artery and severe oligohyramnios. Sirenomelia should be suspected in antenatal period in cases presenting with severe oligohydramnios and intrauterine growth retardation for a early diagnosis and appropriate management of pregnancy.

Cloning and sequencing of an apparently recombinant promoter for napin gene from Brassica campestris genomic library and its evolutionary significance.

From a genomic library of Brassica campestris (brown sarson cv. B54), we have cloned and sequenced about 2 kb of upstream regulatory region from one of the 2S albumin-coding gene family. The sequence has several seed-specific promoter motifs. A sequence alignment of the 5' flanking regions of the available Brassica 2S storage protein genes showed that our sequence is a double crossover recombinant product of the two members of the napin gene family. A possible explanation of this fact is that Brassica species evolved through gene duplication and recombination from a common ancestor with fewer number of chromosomes and genes.

Serum TNF-alpha and free radical scavengers in neonatal septicemia.

Tumor necrosis factor-alpha (TNF-alpha) and free radicals have been implicated in the pathogenesis of neonatal septicemia and its complications. This case control study was conducted between November 1996 to July 1997 to determine the levels of TNF-alpha and free radical scavengers viz. superoxide dismutase (SOD) and glutathione peroxidase (GPX) in the serum of 30 septic neonates and 20 healthy controls. Patients with neonatal sepsis registered significantly higher levels of TNF-alpha, SOD and GPX in comparison to controls (p < 0.05). The neonates with septic shock had five fold increase in TNF-alpha levels (2262 +/- 605.8 pg/ml) as compared to those without shock (738.8 +/- 728.8 pg/ml). There was no statistically significant difference in levels of antioxidant enzymes between neonates with shock and without shock. The levels of TNF-alpha and antioxidant enzymes were not affected by the type of organism isolated in blood culture.

Perception about AIDS among residents of a Calcutta slum.

A study was carried out in a slum area of South Calcutta to assess the impact of the current mass education programme against AIDS. Two hundred and six residents, mainly of lower middle class, aged 18-60 years of both sexes were selected at random. They were interviewed to know their perception and sources of information about AIDS. Two-third of them had their own TV and radio, which they watched/heard for about three and half hours each day. Another 28% watched TV outside for about one and half hours a day. About 46% were daily readers and 20% occasional readers of newspapers. Fifty nine percent knew about persons vulnerable to get AIDS, but most of them associated it to promiscuity only. Avoiding it was the main means known to them for preventing AIDS. The role of condom in it was known to only 2.5% residents. The source of their knowledge was mainly TV, either alone or with other mass media (67%). Such knowledge was related to higher education. To make perception about AIDS more effective, it is suggested that local health and voluntary agencies should involve the community in the AIDS education programme along with the back-up of mass media. An apex agency solely responsible for AIDS education should be set up for each big city to co-ordinate the activities of local agencies.

Deduced amino acid sequence of 2S storage protein from Brassica species and their conserved structural features.

2S seed storage albumin coding regions from five Brassica species, namely Brassica campestris, B. oleracea, B. nigra, B. juncea, and B. carinata have been cloned by PCR amplification of genomic DNA using oligonucleotide primers and their nucleotide sequences have been determined. These sequences showed more than 85% homology amongst themselves and considerable homology with some other crucifer 2S protein coding sequences. The deduced amino acid sequences showed more homology due to some inconsequential mutations in codons without changing the amino acids. Computer analysis of the protein sequences for possible secondary structure revealed a high degree of conservation of hydrophilic and hydrophobic domains and the invariant positions of cysteine residues. Unrooted phylogenic tree based on the coding region of 2S albumin from different Brassica species cloned by us and published sequences from other Cruciferae indicated that these genes originated before the evolutionary divergence of different Brassica species and were conserved due to some stringent structural and functional features required for seed metabolism.

Fatal pulmonary infection caused by Mycobacterium smegmetis in an infant.

Mycobacterium smegmetis is a rapidly growing mycobacteria which is usually regarded as an environmental saorophyte. Recently it has been isolated from human beings mainly from skin and soft tissue lesions. Pulmonary lesions are extremely rare. A case of pulmonary consolidation caused by M. smegmetis in an infant is reported. The outcome was fatal. The organism was resistant to various antitubercular drugs. A brief review is presented.

Bypassing successive cloning of two fragments by one step cloning using polymerase chain reaction.

The polymerase chain reaction (PCR) was used for bringing together two DNA fragments present in two different plasmids. This helped avoiding the difficulties of two successive subcloning in the same plasmid and uncertainities of obtaining rightly oriented constructs. Two different fragments of DNA present in different plasmid were digested with the same enzyme and then ligated. The ligation mixture was used for the PCR using two oligo primers; one was specific for the 5' end of the other fragment and the other one was for the 3' end of the other fragment. The desired amplified fragment was separated by gel electrophoresis, eluted and was cloned in plasmid pBluescript KS(+). The same procedure is also applicable for one step cloning of more than two fragments in desired orientation.

Organization and size class homogeneity of ribosomal RNA genes of catfish Heteropneustes fossilis.

The ribosomal RNA genes of catfish Heteropneustes fossilis Bloch were examined by Southern blot analysis of genomic DNA digested with restriction enzymes and probed with labelled catfish ribosomal RNA. The major repeat length is 12 kb and about 300 copies per haploid genome are tandemly arranged. The repeat lengths are homogeneous in size in different tissues and individuals. A restriction site polymorphism exists in some of the repeats.