Role of 18Fluorocholine Positron Emission Tomography/Computed Tomography in the Localization of Culprit Lesions in Patients of Persistent/Recurrent Primary Hyperparathyroidism: A Prospective Study in COVID Times.

Introduction: Recurrent/persistent primary hyperparathyroidism in patients who have undergone previous parathyroidectomy is a challenging condition. Imaging is important for localizing the parathyroid adenoma for re-exploration and 18F-Fluorocholine (18F-FCH) positron emission tomography/computed tomography (PET/CT) seems ideal for this purpose. Aim: This prospective study attempted to ascertain the utility of 18F-FCH PET/CT as an investigation in preoperative localization of abnormal parathyroid tissue in recurrent/persistent primary hyperparathyroidism while comparing it with 99mTc-Sestamibi dual-phase scintigraphy with early single-photon emission CT (SPECT)/CT and neck ultrasonography (USG). Methods: Twenty patients with biochemical features of recurrent/persistent primary hyperparathyroidism were enrolled into this study. They underwent neck USG, 99mTc-Sestamibi dual-phase scintigraphy with early SPECT/CT and 18F-FCH PET/CT for localization of parathyroid lesions. Six patients underwent surgical resection of the detected lesions, 3 were awaiting surgery, and 11 were managed conservatively. One patient died due to COVID. Results: The calculated positive predictive values on a per-lesion basis of neck USG, 99mTc-sestamibi scintigraphy and early SPECT/CT and 18F-FCH PET/CT in the cohort of the 5 operated patients were 75% (3/4), 71.4% (5/7), and 71.4% (5/7), respectively. On a per-patient basis, the lesion detection rate was 100% for 99mTc-sestamibi scan and FCH PET (5/5) and 80% on neck USG (4/5). Conclusion: 18F-FCH PET/CT is a highly accurate imaging modality for the detection of parathyroid lesions in patients with recurrent/persistent primary hyperparathyroidism.

A nationwide assessment comparing nonelective open with minimally invasive complex colorectal procedures.

AIM: The use of minimally invasive colorectal surgery has increased greatly for both benign and malignant disease. Studies evaluating complex procedures have been largely limited to elective indications. We aimed to compare the outcome of a laparoscopic with an open transverse (TC) and total abdominal colectomy (TAC) in the nonelective setting. METHOD: Comparative analysis was made using the Nationwide Inpatient Sample (2008-11) of patients undergoing a nonelective TC or TAC identified by ICD-9-CM procedure codes. The risk-adjusted 30-day outcome was assessed using regression modelling accounting for patient characteristics, comorbidity and surgical procedure. RESULTS: We identified 7261 admissions including 818 laparoscopic and 6443 open procedures. The mean age of the population was 65 ± 17 years and patients in the laparoscopic group were younger (56 ± 20 vs. 66 ± 17 years; P < 0.05). The rate of a single complication was lower in the laparoscopic group (26% vs. 38%; P < 0.01), but this did not remain significant following a logistic regression analysis. Mortality was significantly lower in the laparoscopic group (3.1% vs. 17%; P < 0.01) and this remained true after adjusting for covariates (OR = 0.62; P < 0.05). Laparoscopic cases were associated with a shorter median length of stay (10 vs. 13 days; P < 0.01) and hospital charge ($75,758 vs. $98,833; P < 0.01). CONCLUSION: A nonelective laparoscopic TC or TAC is associated with an equivalent complication rate and lower mortality compared with an open operation. The results should encourage surgeons with the appropriate skills to consider a laparoscopic approach for nonelective pathology requiring a complex colectomy.

Functional Radionuclide Imaging, In-Vitro Radioiodine Uptake Estimation and RT-PCR in the Evaluation of Sodium Iodide Symporter (NIS) Expression and Functionality in Breast Cancer: A Pilot Study.

Breast cancer is a common malignancy in females, which is considered as a systemic disease, whose treatment involves combined modality including systemic as well as local treatment. Recent studies have shown that breast cancer also expresses Sodium Iodide Symporter (NIS) gene, like in the thyroid, which is the factor responsible for the uptake of iodide by the thyroid, enabling radioiodine therapy of thyroid disorders. This study aimed to evaluate various radionuclide imaging characteristics, in vitro radioiodine uptake (RAIU) and evaluation of NIS expression by using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) to explore sodium iodide symporter (NIS) expression and iodine uptake in breast cancer and to explor e whether radioiodine can be used for the diagnosis and treatment of breast cancer. Ways of differential regulation of NIS expression in breast cancer has also been explored. Female patients with palpable breast lump and histologically proven infiltrating duct carcinoma were taken up for the study, which included 50 females of mean age 49 years. (range: 23-73 years). The patients were categorized into different groups, depending on the type of the study performed. The uptake patterns in various imaging modalities were analyzed and compared with invitro and RT-PCR studies. 68 % of breast cancer cases showed (99m)Tc-pertechnetate uptake at the initial images. This finding could partly be due to tumor vascularity, which is usually higher compared to the normal tissues. The uptake in the delayed imaging could be related to that due to NIS in the breast. Use of perchlorate or stable iodine did not alter the pertechnetate uptake pattern in breast tumor. Good correlation between (99m)Tc-pertechnetate and (99m)Tc-tetrofosmin uptake in breast cancer was demonstrated. In vitro radioactive iodine uptake in the breast tumor was significantly higher than that in the normal breast tissue. Only 42 % of breast tumor samples studied using RT-PCR showed NIS expression. Correlation between (99m)Tc-pertechnetate uptake and NIS expression could not be well established. Further studies with higher dose of radioiodine and/or mechanisms of differentially blocking the thyroid are required to assess the feasibility of radioiodine therapy for breast cancer.

Fatal rabies despite post-exposure prophylaxis.

Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

Clinical profile of dengue haemorrhagic fever from Jan 2009 to Dec 2009 in and around Aurangabad.

In present study 890 serum samples suspected of dengue fever on clinical grounds were received in department of Microbiology. Out of these 249 cases showed thrombocytopenia (platelet count < 1 lakh/cumm) and were subjected to rapid dengue serological test as well as IgM capture ELISA. 11(4%) cases were diagnosed as primary dengue infection (only IgM positive) by rapid dengue IgG/IgM bispot immunocomb test. There were 123(49%) cases with only IgG positive suggesting secondary/past dengue infection. Both IgM and IgG were seen in 24(10%) cases. Number of cases negative for both IgM and IgG were 91(37%). IgM positive cases were confirmed by IgM capture ELISA. Classical dengue fever (DF) was noted in 168 (67%) patients and dengue hemorrhagic fever (DHF) in 81(33%) cases. Common clinical presentations of DHF were fever 78 (96%), body-ache 74 (91%), arthralgia 74 (91%), retro-orbital pain 65 (80%), abdominal pain 07 (09%). Bleeding manifestation were in the form of petechiae, melena, epistaxis, hematuria, hemoptysis, hematemesis, bleeding gums and conjunctival hemorrhages. Out of 81 DHS patients 13 (16%) patients had platelet count between 50,000 and 1 lakh. 68 (84%) patients had platelet count below 50,000. Majority of these patients 47 (58%) had platelet below 20000 and were IgG positive. Thrombocytopenia correlated well with bleeding manifestations in our patients. In an epidemic setting if the patients present with fever, vomiting, musculoskeletal pain and bleeding along with low platelet count a strong possibility of DHF/DSS should be kept.

Zoonotic infections of buffalopox in India.

Four outbreaks of buffalopox in domestic buffaloes, with considerable mortality with high case fatality rates in young buffalo calves and high morbidity with significant productivity loss in terms of reduction in milk yield in adult animals along with severe zoonotic infection in milk attendants were recorded at various places in India, during 2006-2008. In buffaloes, the pox lesions were confined to udder and teats of the majority of the affected animals, and in few animals the lesions were appeared on the hindquarters, indicating generalized infection. The overall disease morbidity, mortality and case fatality rate were 6.8%, 0.7% and 11.4% respectively. Milkers developed pox-like lesions on the hands, forearms and forehead accompanied by fever, axillary lymphadenopathy and general malaise. The causative agent of the outbreaks, buffalopox virus (BPXV), was confirmed upon virus isolation in cell culture, electron microscopy, A-type inclusion (ATI) and ankyrin repeat protein (C18L) gene-specific polymerase chain reactions (PCR). Further, sequence analysis of the BPXV isolates from human and buffalo showed more identity of ATI and C18L genes sequences with that of other orthopoxviruses at nucleotide and amino acid levels and confirmed a close relationship of BPXV with Vaccinia virus (VACV) or VACV-like viruses. Considering the zoonotic impact and productivity losses of buffalopox infection, the control measures are imperative in curtailing economic and public health impact of the disease.

Study of onychomycosis: prevailing fungi and pattern of infection.

A mycological study of onychomycosis was undertaken in 88 patients. The nails were judged to be infected by their clinical appearance. Direct microscopy of the nail clips in 20% KOH solution was positive in 72 (81.8%) and culture was positive in 43 (48.8%) cases. Out of the samples cultured, dermatophytes were grown in 26 cases (29.5%), non dermatophyte moulds in 12 (13.6%) and Candida spp. in 5 (5.6%) while 45 (51.1%) samples yielded no growth. Amongst dermatophytes, T. rubrum was found to be commonest etiological agent (57.6%) followed by T. mentagrophyte. Amongst the non-dermatophyte mould (NDM), Aspergillus spp. was the most prevalent species followed by Alternaria spp, Curvularia spp. and Fusarium spp. Commonest age group affected was above 31 years. Males were predominantly affected (65%), male to female ratio being 1.8:1. Fingernails were affected more frequently than toe nails with the ratio of 3:1. Distal and lateral subungual onychomycosis (DLSO) was more common (50%) than other clinical pattern followed by proximal subungual onychomycosis (PSO) (20.4%), white superficial onychomycosis (SWO) (2%), total dystrophic onychomysosis (TDO) (14%) and paronychia (10.2%).

Peripheral blood gene expression profiling in rheumatoid arthritis.

We carried out gene expression profiling of peripheral blood mononuclear cells (PBMCs) in 29 patients with active rheumatoid arthritis (RA) and 21 control subjects using Affymetrix U95Av2 arrays. Using cluster analysis, we observed a significant alteration in the expression pattern of 81 genes (P<0.001) in the PBMCs of RA patients compared with controls. Many of these genes correlated with differences in monocyte counts between the two study populations, and we show that a large fraction of these genes are specifically expressed at high levels in monocytes. In addition, a logistic regression analysis was performed to identify genes that performed best in the categorization of RA and control samples. Glutaminyl cyclase, IL1RA, S100A12 (also known as calgranulin or EN-RAGE) and Grb2-associated binding protein (GAB2) were among the top discriminators. Along with previous data, the overexpression of S100A12 in RA patients emphasizes the likely importance of RAGE pathways in disease pathogenesis. The altered expression of GAB2, an intracellular adaptor molecule involved in regulating phosphatase function, is of particular interest given the recent identification of the intracellular phosphatase PTPN22 as a risk gene for RA. These data suggest that a detailed study of gene expression patterns in peripheral blood can provide insight into disease pathogenesis. However, it is also clear that substantially larger sample sizes will be required in order to evaluate fully gene expression profiling as a means of identifying disease subsets, or defining biomarkers of outcome and response to therapy in RA.

Bacteriological and mycological study of corneal ulcers in and around Aurangabad.

In the present study an attempt was made to find out bacteria and fungi causing corneal ulcers. Sixty cases of corneal ulcer were studied. Corneal scrapings from patient of corneal ulcer were collected and processed for isolation of bacterial and fungal agents. The commonest age group affected was 21-30 yrs. Incidence of corneal ulcer was more in males 39 (65%) as compared to females 21 (35%). Trauma was the commonest predisposing factor. Out of sixty cases of corneal ulcer positive cultures were obtained in 23 (38.33%). Bacteria were isolated in 10 (16.66%) fungi in 12 (20%) and mixed culture in 1 (1.66%) of the patients. Among the bacterial isolates commonest was Staphylococcus aureus 6 (10%). Among fungal isolates Fusarium species was the commonest isolate 4 (6.66).

Mapping a gene for 46,XY gonadal dysgenesis by linkage analysis.

46,XY gonadal dysgenesis was transmitted as an autosomal-dominant trait in a large family with multiple affected members. Expressivity of the trait was highly variable, ranging from pure to partial gonadal dysgenesis associated with normal female genitalia or sexual ambiguity, to mild hypospadias in otherwise normal males. The phenotypic features of this trait appeared to be confined to the genitourinary system. Multipoint parametric analysis using markers D5S664, D5S633, and D5D2102 yielded an LOD score of 4.47, assuming sex-limited, autosomal-dominant inheritance with a penetrance of 0.6. Because mutation in testis-determining genes leads to gonadal dysgenesis in 46,XY individuals, we postulate that the gene mapped by this study normally plays a role in gonadal differentiation.

Epidemiology of cholera--a five year study.

A total of 286 strains of Vibro Cholerae were isolated and tested over a period of five years. The strains were identified by standard methods and confirmed by slide agglutination tests with polyvalent, Ogawa and Inaba antisera. The non-agglutinating strains were tested with O-139 antisera. The maximum number of cases were found in the age group of 0-10 years. The number of females affected was more than the males. V. cholerae O-139 was isolated in the year 1998 and then again in 2000. V. cholerae serotype Inaba was found only in the year 1999. All of the other isolates belonged to the serotype Ogawa. The periodic shift between O1 and O-139 serogoups is reminiscent of the shifts from the Ogawa to the Inaba serotypes periodically witnessed among V. cholerae, possibly mediated by the immune pressure in the population.

Nature of peritoneal macrophages from DCC immunized mice.

Peritoneal macrophages from mice immunized with the delipidified cell component (DCC) of Mycobacterium leprae showed changes in various parameters such as increased protein synthesis, levels of hydrolytic enzyme and augmented phagocytic ability indicating activation of the cells. Furthermore, the surface structure of the cells were quite different from that of the macrophages of normal mice. These observations indicate that the peritoneal macrophages have been activated to phagocytose and kill M. leprae better in the immunized mice. The ability to kill the pathogen by these cells was reported by us earlier.

In vivo effect of delipidified cell component of Mycobacterium leprae in relation to infection with leprosy bacteria in mice.

The delipidified cell component (DCC) of Mycobacterium leprae was used as an immunomodulatory agent in Swiss white mice. The peritoneal macrophages of these mice were activated to produce increased amount of reactive oxygen intermediates like hydrogen peroxide (H2O2) and superoxide. These macrophages also attained the ability to kill M. Leprae in vitro as shown by several assay systems including the conventional mouse foot-pad technique. The increased levels of superoxide seem to be responsible for the killing of M. leprae as addition of the enzyme superoxide dismutase, which breaks down O2, resulted in survival of these bacilli inside the macrophages. The increased production of H2O2 does not seem to be responsible for killing M. leprae. The results indicate that the DCC of M. leprae acts as an effective immunomodulator in mice leading to the activation of macrophages with increased production of H2O2 and superoxide as well as enabling them to kill M. leprae via the action of superoxide anions.

Diagnosis of poststernotomy infection: comparison of three means of assessment.

Of 737 adults undergoing cardiac operations through a median sternotomy over a 2-year period (January 1988 to January 1990), sternal-substernal space infection requiring mediastinal exploration developed in 8. Six of these patients as well as 18 additional patients were evaluated for possible poststernotomy wound infection by computed tomography (4 true positive, 4 false positive, 10 true negative, 2 false negative), indium-111 leukocyte scanning (5 true positive, 0 false positive, 18 true negative, 1 false negative), and epicardial pacer wire cultures (6 true positive, 1 false positive, 12 true negative, 0 false negative). On the basis of this experience it is suggested that in addition to computed tomography, indium-111 leukocyte scanning and epicardial pacer wire cultures may be useful in the diagnosis of poststernotomy deep wound infection.

Six years clinical experience with the Omniscience cardiac valve.

Clinical data on the Omniscience valve prosthesis were obtained from 194 patients (92 mitral valve replacements, 65 aortic valve replacements, 11 tricuspid valve replacements and 26 multiple valve replacements). Follow-up was 98% complete for a total of 443 patient-years with a mean of 2.6 years and maximum of six years. The mean age of patients was 50.3 +/- 14.5 years, with a range of two months to 75 years. Seventy-five percent of patients were in NYHA functional class III-IV preoperatively; postoperatively, over 93% of patients were in class I-II. Hospital mortality was 12.4% and late mortality was 3.2% per patient-year. The linearized rates for complications were as follows (per patient-year): thromboembolism 2.9%; valve thrombosis 0.7%; anticoagulant bleeding 2.7%; endocarditis 0.9%; pannus formation 0.2%; periprosthetic leak 0.5%. All significant valve related complications occurred at a rate of 5.9% per patient-year. The complications were fatal at a rate of 1.1% per patient-year and the risk of reoperation on the valve site was 1.1% per patient-year. Actuarial survival at six years was 84.8% +/- 5% for the whole group (88.6 +/- 5.7% for aortic, 84.3 +/- 9.4% for mitral valve replacement, 86.0 +/- 5.5% for single valve replacement and 77.1 +/- 10.2% for multiple valve replacements). Based on the duration of the study and absence of restrictive selection criteria, these clinical data demonstrated a reliable degree of safety and performance for this prosthesis.