Diagnostic Value of Serum Gamma Glutamyl Transpeptidase (GGT) for Early Diagnosis of Biliary Atresia.

Early differentiation of biliary atresia (BA) from idiopathic neonatal hepatitis (INH) is of important as outcome of Kasai portoenterostomy is directly related to the age of surgery. We need to have a simple and cheap biochemical test in resource poor countries like Bangladesh, to pick up BA early. Serum gamma glutamyl transpeptidase (GGT) has been shown to be a useful marker to differentiate BA from INH. Objective of the study was to find out the diagnostic value of gamma glutamyl transpeptidase (GGT) in differentiating Biliary atresia (BA) from idiopathic neonatal hepatitis (INH). This observational cross section study was carried out at the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Study period was from January 2014 to June 2015. Consecutive infants with neonatal cholestasis (defined as conjugated bilirubin >1.0mg/dL when total bilirubin was ≤5.0 or >20.0% to total bilirubin) were included in this study. Clinical details and the results of laboratory tests were recorded in a proforma. BA was diagnosed on the basis of liver biopsy. Different biochemical parameters especially the results of serum GGT level (normal up to 60U/L), were compared between two groups (BA and INH). Receiver Operator Characteristic (ROC) curve for GGT was constructed to find out the best cut off value to discriminate BA from INH by using SPSS (version 20.0). After confirming cholestasis, a total of 165 cases were enrolled for study. Among them 86 cases were diagnosed as INH or BA. Among these 86 cases, 38(44.2%) cases were BA and 48(55.8%) cases were INH. On comparing 38(44.2%) cases of BA with 48(55.8%) cases of INH it was found that low birth weight (13.0% vs. 31.0%, p<0.05), persistently acholic stools (76.0% vs. 44.0%, p=0.002) and mean GGT values (921 vs. 264, p<0.001) were significantly different between them. At a cut off value of 524U/L (8.7 times upper limit of normal) the area under curve (AUC) for GGT was 0.81 with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 81.7%, 72.9%, 70.5%, 83.3% and 76.1% respectively for the diagnosis of Biliary atresia. Serum GGT value of >524 U/L or 8.7 times upper limit of normal value was fairly good in differentiating BA from INH and can be used as a screening investigation in developing countries.

Regulated compensated donation in Pakistan and Iran.

PURPOSE OF REVIEW: Paid living unrelated kidney donor transplantation has flourished in Pakistan and Iran. This review discusses the dynamics and consequences of organ trade in Pakistan and of a regulated paid donor model in Iran on transplant activities in these countries. RECENT FINDINGS: In 2007, over 2500 renal transplants were performed in Pakistan, where more than 70% were from socioeconomic disadvantaged kidney vendors. More than half of recipients were foreigners who paid US$20,000-30,000. Recipients of vendor kidneys had poor outcome and high infectious complications. Regulated paid donor kidney transplant in Iran number around 1500 per year and constitute 70% of the total transplants. Graft survival rates are similar to those for living related donors. The donors are paid US$1200 and additional monies are negotiated between the recipient-donor pair. This model claims to have abolished waiting lists, although many poor patients wait for deceased donors. In both countries, recipients are relatively rich and vendors are the poor of the society who sell kidneys for quick money or to repay debts. SUMMARY: Paid donation, regulated or commercial, leads to coercion and exploitation of the poor and benefits the rich. This situation has forestalled deceased donor program and hence other solid-organ transplants. The way forward is to promote deceased donors by making transplant available to all who need it.

VX211, a vigorous new walnut hybrid clone with nematode tolerance and a useful resistance mechanism.

VX211 is a highly vigorous Paradox hybrid clone that outgrew other walnut seedlings in the presence of nematodes. A four-year macroplot trial involving Paradox VX211 and a standard Paradox selection, AX1, demonstrated that the damage threshold level of Pratylenchus vulnus on commercially available walnut rootstocks is < 1 nematode/250 cm³ of soil. Using 1 as the initial population level (Pi) within an inoculation zone of 80 L of soil, the P. vulnus population level increased 2,500-fold in the first year of growth. Three years after inoculation soil population levels of P. vulnus on VX211 were significantly reduced compared to that of the moderately vigorous AX1. Growth of VX211 was 35% greater than that of AX1 regardless of the Pi. Examination of stained roots revealed that feeding and reproduction by P. vulnus on VX211 was primarily ectoparasitic. This is the first report on a new walnut rootstock that can be readily cloned, has high vigor, exhibits tolerance to low population levels of P. vulnus, reduces nematode feeding and reproduction within the root terminus, and is currently available to California growers.

Splenic tuberculosis presenting as pyrexia of unknown origin.

We report a case of a previously healthy 38-year old lady who presented with prolonged fever and hepatosplenomegaly. Intensive investigations were performed for pyrexia of unknown origin which revealed negative. CT scan of the abdomen showed multiple hypodense lesions which did not respond to broad-spectrum antibiotics. Percutaneous biopsy of the splenic lesion revealed granuloma formation and Langhan's giant cells suggestive of TB. She responded well with anti- TB medication but required extended treatment duration of 24 months due to persistence of the splenic lesion on repeated CT scans. This case illustrates a very rare clinical entity of isolated splenic TB with a therapeutic dilemma following incomplete resolution, despite prolonged treatment.

Reproductive Variability of Field Populations of Meloidogyne spp. on Grape Rootstocks.

Variability in penetration, development, and reproduction of two resistance-breaking field pathotypes (pt.) of Meloidogyne arenaria, M. incognita, and a population of mixed Meloidogyne spp. virulent to grape hosts were compared on two resistant Vitis rootstocks 'Freedom' and 'Harmony' in separate tests. 'Cabernet Sauvignon' was included as a susceptible host to all four nematode populations. Secondstage juveniles (J2) of the mixed population failed to penetrate Freedom roots. By contrast, 6% of J2 in the M. incognita population penetrated Freedom roots but did not develop beyond the swollen J2 stage. The two resistance-breaking populations of M. arenaria differed in their virulence except on susceptible roots of Cabernet Sauvignon. More J2 of M. arenaria pt. Freedom penetrated Freedom roots and reached adult stage than did M. arenaria pt. Harmony. Later life stages of M. arenaria pt. Freedom occurred earlier and in greater numbers in Harmony roots than did M. arenaria pt. Harmony. Reproduction of M. arenaria pt. Freedom was greater in Freedom and Harmony roots than M. arenaria pt. Harmony. Thus, one population of M. arenaria is highly virulent and the other is moderately virulent.

Influence of four nematodes on root and shoot growth parameters in grape.

Two grape cultivars, susceptible French Colombard and tolerant Rubired, and four nematodes, Meloidogyne incognita, Pratylenchus vulnus, Tylenchulus semipenetrans, and Xiphinema index, were used to quantify the equilibrium between root (R) and shoot (S) growth. Root and shoot growth of French Colombard was retarded by M. incognita, P. vulnus, and X. index but not by T. semipenetrans. Although the root growth of Rubired was limited by all the nematodes, the shoot growth was limited only by X. index. The R:S ratios of Rubired were higher than those of French Colombard. The reduced R:S ratios of Rubired were primarily an expression of reduction in root systems without an equal reduction in shoot growth, whereas in French Colombard the reduced R:S ratios were due to a reduction in both shoot growth and root growth and to a greater reduction in root growth than shoot growth. All nematodes reproduced equally well on both cultivars. Both foliage and root growth of French Colombard were significantly reduced by M. incognita and P. vulnus. Nematodes reduced the shoot length by reducing the internode length. Accumulative R:S ratios in inoculated plants were significantly smaller than those in controls in all nematode treatments but not at individual harvest dates. Bud break was delayed by X. index and was initiated earlier by P. vulnus and M. incognita. All buds in nematode treatments were less vigorous than in controls.