Factors influencing local and distant recurrence following resection of periampullary cancer.

BACKGROUND: Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences. METHODS: This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed. RESULTS: Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM (P < 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM. CONCLUSION: Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery.

Reducing health disparities: key factors for successful implementation of social network testing with HIV self-tests among men who have sex with men with a non-western migration background in the Netherlands.

Improving testing uptake among men who have sex with men with a non-western migration background (MSM-NW) is a public health priority, as people who are unaware of their HIV infection are at higher risk of transmitting HIV and are unable to benefit from HIV treatment. Formative semi-structured interviews with 13 MSM-NW assessed key factors for the successful implementation of social network testing with HIV self-tests (SNT-HIVST). Interviews were thematically analysed. Participants mentioned that SNT-HIVST might overcome barriers to regular HIV testing including; being seen while testing, disclosure of sexual identity, and stigma related to HIV and sexual practices. Trust between the HIVST distributer and receiver was important. Finally, SNT-HIVST requires tailored peer support to address practical, informational, and emotional needs. MSM-NW distributing HIVST can have an important role in reducing health disparities in testing uptake among MSM-NW. Provided sufficient trust among MSM-NW; key factors found for successful implementation were education through an e-tool, and establishing quality support by a peer-coordinator for unanticipated questions. In conclusion, HIVST distribution has the potential to reduce health disparities in testing uptake, in particular, if adjusted to MSM-NWs individual preferences and the needs and preferences of the person they are inviting to test.

Mature outcomes and prognostic indices in diffuse large B-cell lymphoma in Malawi: a prospective cohort.

Outcomes for diffuse large B-cell lymphoma (DLBCL) in sub-Saharan Africa (SSA) are poorly described. We report mature data from one of the first prospective SSA cohorts. Patients aged ≥18 years with DLBCL were enrolled in Malawi 2013-2017. Participants were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy and concurrent antiretroviral therapy (ART) if positive for human immunodeficiency virus (HIV+). Eighty-six participants (mean age 47 years, standard deviation 13) were enrolled: 54 (63%) were male and 51 (59%) were HIV+, of whom 34 (67%) were on ART at DLBCL diagnosis. Median CD4 count was 0·113 cells × 109 /l (interquartile range [IQR] 0·062-0·227) and 25 (49%) had HIV viral load <400 copies/µl. Participants received median six cycles CHOP (IQR 4-6). No patients were lost to follow-up and the 2-year overall survival was 38% (95% confidence interval 28-49). In multivariable analyses, Eastern Cooperative Oncology Group performance status (PS) ≥2 and lactate dehydrogenase (LDH) >2× upper limit of normal (ULN) were associated with mortality. HIV status was not associated with mortality. A simplified prognostic model of LDH >2× ULN and PS ≥2 performed at least as well as the age-adjusted International Prognostic Index. DLBCL can be successfully treated in SSA and outcomes did not differ by HIV status. A simplified prognostic model prognosticates well and may be easier to use in resource-limited settings but requires validation.

Plasma Epstein-Barr virus DNA for pediatric Burkitt lymphoma diagnosis, prognosis and response assessment in Malawi.

Point-of-care tools are needed in sub-Saharan Africa (SSA) to improve pediatric Burkitt lymphoma (BL) diagnosis and treatment. We evaluated plasma Epstein-Barr virus (pEBV) DNA as a pediatric BL biomarker in Malawi. Prospectively enrolled children with BL were compared to classical Hodgkin lymphoma (cHL) and nonlymphoma diagnoses. Pediatric BL patients received standardized chemotherapy and supportive care. pEBV DNA was measured at baseline, mid-treatment, and treatment completion. Of 121 assessed children, pEBV DNA was detected in 76/88 (86%) with BL, 16/17 (94%) with cHL, and 2/16 (12%) with nonlymphoma, with proportions higher in BL versus nonlymphoma (p < 0.001) and similar in BL versus cHL (p = 0.69). If detected, median pEBV DNA was 6.1 log10 copies/mL for BL, 4.8 log10 copies/mL for cHL, and 3.4 log10 copies/mL for nonlymphoma, with higher levels in BL versus cHL (p = 0.029), and a trend toward higher levels in BL versus nonlymphoma (p = 0.062). pEBV DNA declined during treatment in the cohort overall and increased in several children before clinical relapse. Twelve-month overall survival was 40% in the cohort overall, and for children with baseline pEBV detected, survival was worse if baseline pEBV DNA was ≥6 log10 copies/mL versus <6 log10 copies/mL (p = 0.0002), and also if pEBV DNA was persistently detectable at mid-treatment versus undetectable (p = 0.041). Among children with baseline pEBV DNA detected, viremia was the only significant risk factor for death by 12 months in multivariate analyses (adjusted hazard ratio 1.35 per log10 copies/mL, 95% CI 1.04-1.75, p = 0.023). Quantitative pEBV DNA has potential utility for diagnosis, prognosis, and response assessment for pediatric BL in SSA.

Renormalization Group Flows of Hamiltonians Using Tensor Networks.

A renormalization group flow of Hamiltonians for two-dimensional classical partition functions is constructed using tensor networks. Similar to tensor network renormalization [G. Evenbly and G. Vidal, Phys. Rev. Lett. 115, 180405 (2015)PRLTAO0031-900710.1103/PhysRevLett.115.180405; S. Yang, Z.-C. Gu, and X.-G. Wen, Phys. Rev. Lett. 118, 110504 (2017)PRLTAO0031-900710.1103/PhysRevLett.118.110504], we obtain approximate fixed point tensor networks at criticality. Our formalism, however, preserves positivity of the tensors at every step and hence yields an interpretation in terms of Hamiltonian flows. We emphasize that the key difference between tensor network approaches and Kadanoff's spin blocking method can be understood in terms of a change of the local basis at every decimation step, a property which is crucial to overcome the area law of mutual information. We derive algebraic relations for fixed point tensors, calculate critical exponents, and benchmark our method on the Ising model and the six-vertex model.

Increased Fas ligand expression of peripheral B-1 cells correlated with CD4+ T-cell apoptosis in filarial-infected patients.

Cellular hyporesponsiveness observed during helminth infections is attributed to factors such as antigen-presenting cells (APC) dysfunction, increased interleukin-10(IL-10), regulatory T cells and induction of CD4+ T (Th)-cell apoptosis. Increased Fas ligand (FasL) expression on the surface of B-1 cells and induction of apoptosis of Th cells by FasL-expressing B-1 cells due to helminth infection were demonstrated in murine model of helminth infection where as profile of FasL expression, Th-cell apoptosis and correlation between these two populations of cells in clinical filariasis remain unknown. In this study, we have scored the profile of apoptotic Th-cell population and FasL-expressing B-1 cells in different clinical categories of filariasis. The peripheral apoptotic T-helper cells were significantly increased in filarial patients compared to endemic controls. Expression of FasL on the surface of peripheral B-1 cells increased in filarial patients and positively correlated with peripheral apoptotic T-helper cells indicating FasL-expressing B-1 cells may be one of the important mediators of Th-cell apoptosis and immune anergy during filarial pathology.

Hodgkin lymphoma, HIV, and Epstein-Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study.

BACKGROUND: Contemporary descriptions of classical Hodgkin lymphoma (cHL) are lacking from sub-Saharan Africa where human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) are prevalent. METHODS: We describe a prospective cHL cohort in Malawi enrolled from 2013 to 2015. Patients received standardized treatment and evaluation, including HIV status and EBV testing of tumors and plasma. RESULTS: Among 31 patients with confirmed cHL, the median age was 19 years (range, 2-51 years) and 22 (71%) were male. Sixteen patients (52%) had stage III/IV, 25 (81%) B symptoms, and 16 (52%) performance status impairment. Twenty-three patients (74%) had symptoms >6 months, and 11 of 29 (38%) had received empiric antituberculosis treatment. Anemia was common with median hemoglobin 8.2 g/dL (range, 3.1-17.1 g/dL), which improved during treatment. No children and 5 of 15 adults (33%) were HIV+. All HIV+ patients were on antiretroviral therapy for a median 15 months (range, 2-137 months), with median CD4 count 138 cells/µL (range, 23-329 cells/µL) and four (80%) having undetectable HIV. EBV was present in 18 of 24 (75%) tumor specimens, including 14 of 20 (70%) HIV- and 4 of 4 (100%) HIV+. Baseline plasma EBV DNA was detected in 25 of 28 (89%) patients, with median viral load 4.7 (range, 2.0-6.7) log10 copies/mL, and subsequently declined in most patients. At 12 months, overall survival was 75% (95% confidence interval [CI], 55%-88%) and progression-free survival 65% (95% CI, 42%-81%). Baseline plasma EBV DNA and persistent viremia during treatment were associated with poorer outcomes. CONCLUSION: cHL in Malawi is characterized by delayed diagnosis and advanced disease. Most cases were EBV associated and one-third of adults were HIV+. Despite resource limitations, 12-month outcomes were good.

Comparative seroprevalence and risk factor analysis of Trypanosoma evansi infection in equines from different agro-climatic zones of Punjab (India).

As parasitaemia is low and fluctuating during the chronic stage of infection, accurate detection of Trypanosoma evansi in blood is difficult. The primary aims of this investigation were to assess for the first time the seroprevalence of T. evansi in all agro-climatic zones of Punjab, by indirect enzyme-linked immunosorbent assay (iELISA) and card agglutination test (CATT/T. evansi), and to evaluate the risk factors associated with latent trypanosomosis. A total of 319 equine serum samples collected from 12 districts of Punjab (India) belonging to different agro-climatic zones revealed 39 (12.23%) and 9 (2.82%) samples to be positive by CATT/T. evansi and iELISA, respectively. The highest prevalence was recorded from the Ludhiana district (42.86% and 7.14% by CATT/T. evansi and iELISA, respectively) in the central plain zone (for which the overall prevalence was 15% and 4.17%, respectively). There was fair agreement between the tests for the detection of T. evansi (kappa = 0.345). Species was the most influential risk factor for infection, with odds ratios (ORs) of 2.81 and 5.63 for donkeys/ mules, in comparison with horses, by CATT/T. evansi and iELISA, respectively. The female equine population (OR = 3.13, 95% confidence interval [CI] = 1.32-7.67 [CATT]) was found to be at a higher risk of seropositivity for T. evansi, particularly on 'unorganised' (inappropriately managed) farms (OR = 3.18, 95% CI = 1.53- 6.65 [CATT]) and among animals used for commercial purposes (OR = 2.51, 95% CI = 1.20-5.21 [CATT]). In conclusion, to declare disease-free status, use of the iELISA followed by retesting of suspect samples by CATT/T. evansi is suggested.

La détection minutieuse de Trypanosoma evansi dans le sang est difficile en raison du nombre faible et fluctuant de parasites pendant la phase chronique de l'infection. L'étude présentée par les auteurs vise, d'une part, à réaliser une première évaluation de la prévalence sérologique de T. evansi dans chacune des zones agro-climatiques du Pendjab en utilisant une épreuve immuno-enzymatique (ELISA) indirecte et le test d'agglutination sur carte pour la trypanosomose (CATT/T. evansi) et, d'autre part, à évaluer les facteurs de risque associés à une présence inapparente de la trypanosomose. Au total, sur les 319 sérums d'équidés prélevés dans 12 districts du Pendjab (Inde) appartenant à des zones agro-climatiques différentes, 39 échantillons (12,23 %) ont donné des résultats positifs avec le CATT/T. evansi et 9 échantillons (2,82 %) ont donné des résultats positifs à l'ELISA indirecte. La prévalence la plus élevée a été enregistrée dans le district de Ludhiana (42,86 % de résultats positifs avec le CATT/T. evansi et 7,14 % de résultats positifs avec l'ELISA indirecte) dans la zone des plaines centrales (où la prévalence globale s'élevait, suivant les méthodes de test, à 15 % et 4,17 %, respectivement). La détection de T. evansi par les deux tests a été concordante (kappa = 0,345). Le facteur de risque ayant le plus d'influence sur la probabilité d'infection était l'espèce, ce risque étant plus élevé chez les ânes et les mulets que chez les chevaux (rapport de cotes [odds ratio, OR] de 2,81 [CATT/T. evansi] et de 5,63 [ELISA indirecte]). Les femelles présentaient également un risque plus élevé de posséder des anticorps anti-T. evansi que les mâles (OR = 3,13 ; intervalle de confiance [IC] à 95 % : 1,32­7,67 [CATT]), en particulier dans les élevages « informels ¼ (sans gestion sanitaire) (OR = 3,18 ; IC à 95 % : 1,53­6,65 [CATT]) ainsi que parmi les animaux utilisés à des fins commerciales (OR = 2,51 ; IC à 95 % : 1,20­5,21 [CATT]). En conclusion, pour la démonstration de l'absence d'anticorps, les auteurs recommandent d'utiliser l'ELISA indirecte puis de soumettre les échantillons douteux à un test de confirmation au moyen du CATT/T. evansi.

La detección precisa de Trypanosoma evansi en la sangre resulta difícil porque en la fase crónica de la infección la parasitemia es baja y fluctuante. Los autores describen una investigación encaminada principalmente a determinar por primera vez la seroprevalencia de T. evansi en todas las zonas agroclimáticas del Punjab por ensayo inmunoenzimático indirecto (ELISAi) y por aglutinación en placa, así como los factores de riesgo asociados a la tripanosomosis latente. De un total de 319 muestras de suero equino procedentes de 12 distritos del Punjab (India) situados en diferentes zonas agroclimáticas, la aglutinación en placa deparó resultado positivo en 39 de ellas (un 12,23%) y el ELISAi en 9 (2,82%). El máximo nivel de prevalencia se registró en el distrito de Ludhiana (42,86% y 7,14% por aglutinación en placa y ELISAi, respectivamente), sito en la zona de la planicie central (que en conjunto deparó una prevalencia del 15% y el 4,17%, respectivamente). Ambas pruebas resultaron bastante coincidentes por lo que respecta a la detección de T. evansi (coeficiente kappa = 0,345). El factor de riesgo más influyente resultó ser la especie: en comparación con los caballos, los asnos o mulas presentaban una razón de probabilidad (RP) de 2,81 y 5,63 para la aglutinación en placa y el ELISAi respectivamente. Se observó que la población de yeguas (RP = 3,13; intervalo de confianza [IC] al 95% = 1,32­7,67 [aglutinación en placa]) presentaba un riesgo más elevado de seropositividad para T. evansi, especialmente en explotaciones «desorganizadas¼ (mal gestionadas) (RP = 3,18; IC 95% = 1,53­6,65 [aglutinación en placa]) y entre los animales utilizados con fines comerciales (RP = 2,51; IC 95% = 1,20­5,21 [aglutinación en placa]). Los autores concluyen proponiendo que, a los efectos de declarar la ausencia de enfermedad, se utilice en primer lugar el ELISAi, seguido de la prueba de aglutinación en placa para las muestras sospechosas.

A vocational rehabilitation intervention for young adults with physical disabilities: participants' perception of beneficial attributes.

BACKGROUND: Finding and maintaining employment is a major challenge for young adults with physical disabilities and their work participation rate is lower than that of healthy peers. This paper is about a program that supports work participation amongst young adults with chronic physical disabilities. The study aims to explore their experienced barriers and facilitators for finding and maintaining employment after starting this program, the participant-perceived beneficial attributes of the program and participants' recommendations for additional intervention components. METHODS: Semi-structured interviews (n = 19) were held with former intervention participations. Interviews were recorded and transcribed ad verbatim. Themes were derived using the phenomenological approach. RESULTS: Physical functions and capacities, supervisor's attitude, self-esteem and self-efficacy and openness and assertiveness were experienced barriers and facilitators for finding and maintaining employment. Improvement of self-promoting skills and disclosure skills through job interview-training, increased self-esteem or self-efficacy through peer-support, a suitable job through job placement, improvement of work ability through arrangement of adjusted work conditions and change of supervisor's attitude through education provided to the supervisor were perceived as beneficial attributes of the intervention. Respondents recommended to incorporate assertiveness and openness skills training into future intervention programs. CONCLUSIONS: The findings suggest that programs supporting work participation should be designed to provide challenging, real-world experiential opportunities that provide young adults with physical disabilities with new insights, self-efficacy and life skills. Also, such programs should facilitate context centered learning. Former intervention participants, therefore, evaluated job-interview training, sharing learning and social experiences with peers, job placement, arrangement of adjusted work conditions and education as beneficial attributes of the 'At Work' program. In addition, they recommended, to incorporate more training on assertiveness and disclosure. We advise professionals to include these beneficial attributes in similar interventions in other contexts.

Increased IgG antibody responses to excretory/secretory antigens in neonates born from mothers infected with filarial nematodes.

The present investigation aimed to evaluate the extent to which maternal filarial infection influences IgG subclass immune responses in the cord blood of neonates. Prevalence of antigenaemia was detected using an Og4C3 assay. Filaria-specific IgG subclasses against excretory/secretory antigens were measured by ELISA. Transplacental transfer of circulating filarial antigen (CFA) was observed from 34.8% of CFA-positive mothers to their respective cord bloods. Filaria-specific IgG1, IgG2 and IgG4 responses were significantly higher among cord bloods of infected mothers compared to cord bloods of uninfected mothers. In contrast, the IgG3 response was significantly higher among cord bloods of uninfected mothers. The study shows that transplacental transfer of filarial antigens and filaria-specific IgG4 occurs more in mothers having high worm burdens, and transfer of filaria-specific IgG3 occurs more in the cord blood of uninfected mothers. The findings of the study provide evidence for the development of prenatal sensitization to filarial antigens in utero, and high filaria-specific IgG4 in cord blood may serve as a marker for in-utero sensitization.

Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi.

Burkitt lymphoma (BL) is the most common paediatric cancer in sub-Saharan Africa (SSA). Anthracyline-based treatment is standard in resource-rich settings, but has not been described in SSA. Children ≤18 years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL, median age was 9·2 years (interquartile range 7·7-11·8), 48 (66%) were male and two were positive for human immunodeficiency virus. Twelve (16%) had stage I/II disease, 36 (49%) stage III and 25 (34%) stage IV. Grade 3/4 neutropenia occurred in 17 (25%), and grade 3/4 anaemia in 29 (42%) of 69 evaluable children. Eighteen-month overall survival was 29% (95% confidence interval [CI] 18-41%) overall. Mortality was associated with age >9 years [hazard ratio [HR] 2·13, 95% CI 1·15-3·94], female gender (HR 2·12, 95% CI 1·12-4·03), stage (HR 1·52 per unit, 95% CI 1·07-2·17), lactate dehydrogenase (HR 1·03 per 100 iu/l, 95% CI 1·01-1·05), albumin (HR 0·96 per g/l, 95% CI 0·93-0·99) and performance status (HR 0·78 per 10-point increase, 95% CI 0·69-0·89). CHOP did not improve outcomes in paediatric BL compared to less intensive regimens in Malawi.

PCR and ELISA vis-à-vis microscopy for detection of bovine anaplasmosis: a study on associated risk of an upcoming problem in North India.

This investigation demonstrates the status of bovine anaplasmosis caused by A. marginale in bovines from Submountain and Undulating Zone of Punjab. Out of 184 suspected animals, 25 (19.51%), 47 (31.71%), and 78 (68.75%) were positive by microscopy, indirect ELISA, and PCR assay, respectively. The microscopy showed 29% sensitivity and 99% specificity, while ELISA showed 32% sensitivity and 79% specificity in concordance with PCR assay. Five false negative samples by msp1ß PCR were reconfirmed for Anaplasma spp. targeting 16S rRNA gene. The sequence analysis showed the presence for A. marginale specific restriction site, indicating variation in the local strains of the organism resulting in no amplification with msp1ß gene primers. Of 82 samples positive by PCR, 57 were negative by ELISA indicating lower efficacy of ELISA to detect early anaplasmosis. The assessment of risk factor with results of PCR technique indicated that cattle (Odds ratio = 2.884), particularly those of age > 1 years (Odds ratio = 2.204) of district Pathankot (Odds ratio = 3.182) of Submountain Zone (Odds ratio = 2.086), were at high risk of anaplasmosis. All three districts of Submountain Zone are at higher risk indicating the impact of biotic and abiotic factors on the incidence of disease.

Next-generation sequencing-based multi-gene mutation profiling of solid tumors using fine needle aspiration samples: promises and challenges for routine clinical diagnostics.

Increasing use of fine needle aspiration for oncological diagnosis, while minimally invasive, poses a challenge for molecular testing by traditional sequencing platforms due to high sample requirements. The advent of affordable benchtop next-generation sequencing platforms such as the semiconductor-based Ion Personal Genome Machine (PGM) Sequencer has facilitated multi-gene mutational profiling using only nanograms of DNA. We describe successful next-generation sequencing-based testing of fine needle aspiration cytological specimens in a clinical laboratory setting. We selected 61 tumor specimens, obtained by fine needle aspiration, with known mutational status for clinically relevant genes; of these, 31 specimens yielded sufficient DNA for next-generation sequencing testing. Ten nanograms of DNA from each sample was tested for mutations in the hotspot regions of 46 cancer-related genes using a 318-chip on Ion PGM Sequencer. All tested samples underwent successful targeted sequencing of 46 genes. We showed 100% concordance of results between next-generation sequencing and conventional test platforms for all previously known point mutations that included BRAF, EGFR, KRAS, MET, NRAS, PIK3CA, RET and TP53, deletions of EGFR and wild-type calls. Furthermore, next-generation sequencing detected variants in 19 of the 31 (61%) patient samples that were not detected by traditional platforms, thus increasing the utility of mutation analysis; these variants involved the APC, ATM, CDKN2A, CTNNB1, FGFR2, FLT3, KDR, KIT, KRAS, MLH1, NRAS, PIK3CA, SMAD4, STK11 and TP53 genes. The results of this study show that next-generation sequencing-based mutational profiling can be performed on fine needle aspiration cytological smears and cell blocks. Next-generation sequencing can be performed with only nanograms of DNA and has better sensitivity than traditional sequencing platforms. Use of next-generation sequencing also enhances the power of fine needle aspiration by providing gene mutation results that can direct personalized cancer therapy.

In utero sensitization modulates IgG isotype, IFN-γ and IL-10 responses of neonates in bancroftian filariasis.

In utero exposure has been considered as a risk factor for filarial infection. To evaluate the influence of maternal infection on filarial-specific IgG subclass response in neonates and their correlation with plasma levels IL-10 and interferon-γ, 145 pairs of mothers and their respective cord bloods were examined. Transplacental transfer of circulating filarial antigen (CFA) was observed in 34·8% cord bloods from CFA positive mothers. Filarial-specific IgG1, IgG2 and IgG4 responses of cord bloods were found to be positively correlated with CFA of mothers. In contrast, IgG3 responses negatively correlated with CFA of mothers. The % of similarity of recognition pattern in the cord blood with maternal blood was high for IgG3 response than IgG4 in all three groups. An increased levels of IL-10 and decreased levels of interferon gamma (IFN-γ) were observed in cord blood of infected mothers. Interferon gamma was positively correlated with IgG3 and negatively correlated with IgG4 level. On the other hand, IL-10 was positively correlated with IgG4 and CFA, indicating that cytokines may play a role in modulating the immune responses in cord bloods of sensitized foetus. The findings of the study reveal that in utero tolerance or sensitization may influence the filarial-specific immunity to infection in neonates.

Hydrocele fluid: can it be used for immunodiagnosis of lymphatic filariasis?

BACKGROUND & OBJECTIVES: Diagnosis of lymphatic filariasis using serum has been established but the utility of hydrocele fluid for the purpose is not exactly known. Since, hydrocele is a chronic form of the disease manifestation in a variety of situations and often poses difficulty in diagnosing its origin, we have evaluated the usefulness usage of hydrocele fluid for diagnosis of filarial origin of hydrocele in this study. METHODS: Paired samples of serum and hydrocele fluid from 51 individuals with hydrocele, living in an endemic area of Wuchereria bancrofti were assessed. Circulating filarial antigen, filarial specific antibody and cytokine assay were performed in both serum and hydrocele fluid of patients. RESULTS: Og4C3 assay detected circulating filarial antigen (CFA) in serum and corresponding hydrocele fluids. The level of IgG, IFN-γ and IL-10 were found to be high in CFA-negative, while IgM and IgE were high in CFApositive hydrocele fluid and serum samples associated with hydrocele. On the other hand neither CFA-positive nor CFA-negative hydrocele fluid and serum samples associated with hydrocele showed any difference in IgG4 level. INTERPRETATION & CONCLUSION: This study showed that the filaria related antigens and antibodies found in serum can be detected with equal sensitivity in hydrocele fluid. Therefore, it can be used as an alternative to serum for immunodiagnosis of filariasis, and help monitoring the filarisis elimination programme.

Immuno-epidemiology of bancroftian filariasis: a 14-year follow-up study in Odisha, India.

Forty asymptomatic, circulating filarial antigen negative (CFA(-ve)) and ten asymptomatic, circulating filarial antigen positive (CFA(+ve)) individuals were followed up longitudinally over a period of 14 years at intervals of 7 years in order to investigate the immunological, parasitological and clinical changes that took place in an endemic area due to natural process. The clinical status, microfilaremia, circulating filarial antigenemia and immunological responses to filarial antigens (DSSd1 and Sd30) prepared from cattle filarial parasite Setaria digitata, were examined. The observations showed that 19 individuals had developed either antigenemia or filarial symptoms (acute filarial lymphangitis/hydrocele) from CFA(-ve) group. Three individuals had cleared antigenemia and one had developed microfilaremia from CFA(+ve) group after 7 years. Increased IgG and IgM and low IgG2 and IgG4 level responses along with high lymphocyte production were observed in CFA-negative individuals. This was in contrast to observations made in CFA(+ve) subjects. The results of the present study indicated that the changes taking place in the immunological, clinical and CFA status of individuals residing in filaria endemic regions developed different clinical manifestation with course of time.

Maternal filarial infection: association of anti-sheath antibody responses with plasma levels of IFN-γ and IL-10.

Maternal filarial infection influences the risk of acquiring infection and development of immunity in children. Here we have analysed the blood samples of 60 mothers (24 infected and 36 uninfected) and their corresponding cord bloods to assess the impact of maternal infection on the anti-sheath antibodies and cytokine production in neonates born from them. About 69·4% of non-infected mothers and their cord bloods showed the presence of anti-sheath antibodies, while only 16·6% of the cord bloods from infected mothers were positive for it. The IL-10 level was significantly high in cord bloods of infected mothers compared with non-infected mothers. At the same time the IL-10 level was also observed to be remarkably high in cord bloods of both infected and non-infected mothers negative for anti-sheath antibody. In contrast, IFN-γ levels were significantly high in cord bloods of non-infected mothers compared with infected mothers and the increment was prominent in cord bloods of both infected and non-infected mothers positive for anti-sheath antibody. The study reveals that the presence or absence of anti-sheath antibodies in association with cytokines skews the filarial specific immunity to either Th1 or Th2 responses in neonates. This may affect the natural history of filarial infection in early childhood.

Retromolar trigone squamous cell cancers: a reappraisal of 16 section MDCT for assessing mandibular invasion.

AIM: To reinvestigate the accuracy of 16 section multidetector computed tomography (MDCT) in assessing mandibular invasion in retromolar trigone (RMT) squamous cell cancers (SCC). MATERIALS AND METHODS: A search for diagnosed cases of early RMT SCC that were both imaged and treated at Tata Memorial Centre, Mumbai, India, between 2007 and 2010, was undertaken and yielded 37 patients. The average tumour size was 2.6 cm. All patients had undergone segmental, marginal, or hemimandibulectomy within 2 weeks of imaging. Imaging records archived on the picture archiving and communication system (PACS) were analysed. Contrast-enhanced CT had been performed using a 16 section MDCT system using the puffed-cheek technique. Image acquisition was at 2.5 mm section thickness, but axial images and isotropic coronal and sagittal multiplanar reformations were generated ad hoc from 0.625 mm retro-reconstructed images. Optimal oblique reformations were generated at will by the radiologist to depict the RMT in its entirety. The soft-tissue algorithm and bone window or bone algorithm reformations and axial images were analysed on a volume viewer integrated within the PACS using triangulation. Two investigators independently studied the images and these were compared with the findings at histopathology. RESULTS: The sensitivity, specificity, and accuracy of 16 section MDCT for mandibular cortical and marrow invasion was 94, 90, and 91.8% and 83, 92, and 89%, respectively. Use of ad hoc generated oblique reformation contributed to the enhanced sensitivity and specificity. The accuracy for inferior alveolar canal invasion was 100%. There was excellent agreement between the two observers. CONCLUSION: Sixteen-section MDCT used to its full potential has high accuracy for the detection of mandibular invasion in RMT SCC.

Horizontal glottectomy: oncological results.

OBJECTIVE: The aim of this study was to assess the oncological results of patients after horizontal glottectomy. METHODS: A cohort of 35 patients (34 males and 1 female, mean age 59.2 years) who underwent a horizontal glottectomy between June 2001 and June 2010 was analysed retrospectively. The mean follow-up period was 77.9 +/- 28.1 months. The Kaplan-Meier method was used to analyse overall survival and disease-specific survival. RESULTS: All of the patients were decannulated and put on a normal diet following nasogastric feeding tube removal. The overall survival rates at 3 and 5 years were 97 and 93% respectively. The 3- and 5-year disease-specific survival rates were 100 and 97% respectively. There were 2 local recurrences (5.7%), 1 distant metastasis (2.8%), and 2 second primary tumours (5.7%). CONCLUSION: Horizontal glottectomy is an oncologically safe technique in properly selected patients with glottic tumours.

A rare case report on neonatal complications from Nepal: solitary neonatal hepatic abscess.

Neonatal liver abscess is a rare condition with a high mortality rate. However, in a low-resource setting, high clinical vigilance and the use of readily accessible diagnostic modalities can help in early diagnosis and, along with appropriate medical management, prevent lethal complication. Case presentation: We present the case of a patient who presented with one day of sudden abdominal distension and two episodes of projectile nonbilious vomiting. A solitary liver abscess was diagnosed using ultrasonography and contrast-enhanced computed tomography findings, and the patient was treated conservatively with parenteral broad-spectrum antibiotics. Following the completion of the antibiotic dose, an ultrasound of the abdomen reveals that the size of the liver abscess has decreased. Clinical discussion: Neonatal liver abscess is a rare clinical condition that causes significant morbidity and mortality in premature and term babies. In a neonate with potential risk factors, a high index of suspicion is required to make the diagnosis. Baseline tests, as well as computed tomography with or without contrast, aid in the definitive diagnosis of a hepatic abscess. For management, a multidisciplinary approach should be considered, including correction of the predisposing factor as well as appropriate medical and/or surgical intervention. Conclusion: Neonatal liver abscess is frequently overlooked due to its rarity. Thus, whenever a neonate exhibits the aforementioned clinical spectrum, it should be considered in the differential diagnosis, and a diagnostic workup and treatment should be initiated as soon as possible to avoid debilitating complications.