Primary renal primitive neuroectodermal tumor.

Primitive Neuroectodermal Tumor of the kidney is a rare entity. Very few cases of primary renal PNET have been reported to date. Most literature about rPNET is isolated case reports. We report a case of rPNET in a 39-year-old male with a pre-operative diagnosis of renal cell carcinoma with renal vein thrombosis. The patient underwent radical nephrectomy with thrombolectomy, and histopathological examination revealed a highly aggressive tumor composed of monotonous sheets of round cells. Tumor cells were positive for CD 99 and FLI-1, hence confirming the diagnosis of Primitive Neuroectodermal Tumor. Post-surgery, patient was given VAC/IE-based adjuvant chemotherapy. In view of highly aggressive nature of this tumor, prompt diagnosis and imparting effective chemotherapy regimen to the patient is required, and it is important to differentiate PNET from other small round-cell tumors because of different therapeutic approach.

Do They Really Mean It? Children's Inference of Speaker Intentions and the Role of Age and Gender.

Interpreting other people's intentions during communication represents a remarkable challenge for children. Although many studies have examined children's understanding of, for example, sarcasm, less is known about their interpretation. Using realistic audiovisual scenes, we invited 124 children between 8 and 12 years old to watch video clips of young adults using different speaker intentions. After watching each video clip, children answered questions about the characters and their beliefs, and the perceived friendliness of the speaker. Children's responses reveal age and gender differences in the ability to interpret speaker belief and social intentions, especially for scenarios conveying teasing and prosocial lies. We found that the ability to infer speaker belief of prosocial lies and to interpret social intentions increases with age. Our results suggest that children at the age of 8 years already show adult-like abilities to understand literal statements, whereas the ability to infer specific social intentions, such as teasing and prosocial lies, is still developing between the age of 8 and 12 years. Moreover, girls performed better in classifying prosocial lies and sarcasm as insincere than boys. The outcomes expand our understanding of how children observe speaker intentions and suggest further research into the development of teasing and prosocial lie interpretation.

Isolated intraorbital metastasis in breast carcinoma.

We report a case of metastases to the eye, in a 30 year old lady with carcinoma breast leading to isolated metastatic involvement of the lateral rectus muscle with no evidence of metastases at any other site in the body after a follow up of one year after completion of chemotherapy.

Study of efficacy and safety of modified adjuvant intraperitoneal chemotherapy regimen in carcinoma ovary.

OBJECTIVE: It has been demonstrated in few trials that intraperitoneal and intravenous (IP/IV) chemotherapy improves survival in advanced stage ovarian cancer (OC). However, in view of high treatment-related toxicities, various modifications in treatment schedules have been tried. In this study, response and tolerability of IP paclitaxel on day 8 with IV paclitaxel on day 1 and IV cisplatin day 2 in carcinoma ovary were evaluated. PATIENTS AND METHODS: In this prospective observational study, from March 2013 to December 2015, the efficacy and tolerability of adjuvant IP/IV chemotherapy in optimally cytoreduced Stage III epithelial OC (EOC) patients were assessed. RESULTS: Totally, sixty patients were enrolled. The median age of patients was 53 years (32-67 years). Out of a total of 360 IP cycles, 316 cycles (88%) were completed. Forty-five patients (76%) received all the 6 cycles by IP route. Eight out of those 45 patients had one or more adjustment including delay or dose reduction. After median follow-up of 22 months, eight patients (14%) had local or systemic recurrence. Median progression-free survival not reached yet. Catheter block was seen in five cases. Two cases had needle displacement and extravasations of drug around the port chamber. Six patients had Grade 3 abdominal pain and cramp. Grade 3/4 leukopenia was experienced by thirty patients (50%), but febrile neutropenia occurred in only 6 (10%) patients. Renal complication present in 4 (7%) patients. CONCLUSIONS: In Indian patients, adjuvant chemotherapy with day 8 I/P paclitaxel in optimally cytoreduced EOC is associated with comparable survival outcomes, less side effects and high treatment completion rate relative to literature published from Western countries.

Epidemiology and resistance pattern of bacterial isolates among cancer patients in a Tertiary Care Oncology Centre in North India.

OBJECTIVES: To examine the epidemiology of microbiologically documented bacterial infection and the resistance pattern, among cancer patients undergoing treatment at RGCIRC, Delhi. DESIGN AND SETTING: Retrospective observational study in which culture reports obtained over 1 year in 2013, were analyzed. RESULTS: 13329 cultures were obtained over 1 year in 2013 and were analyzed. 23.6 % samples showed positive culture with majority being gram negative isolates (67.9 %). E. coli was the commonest gram negative isolate (49.4%) followed by klebsella (29.7%) and Staph. aureus was the commonest gram positive isolate. There was high incidence of ESBL in blood and urine (87.2% & 88.5%) and BLBLI were also high (78% & 83.9%). Carbapenem resistance was comparatively low (10%) and colistin sensitivity was quiet high (> 95%). CONCLUSIONS: Prevalence of MRSA and VRE in our institute is very less, whereas prevalence of ESBLs and BLBLI isolates amongst gram negative infections is around 80%. Gram negative isolates had poor sensitivity to cephalosporins and fluoroquinolones.

IgA myeloma presenting as Henoch-Schönlein purpura with nephritis.

IgA nephropathy (IgAN) and Henoch-Schönlein purpura (HSP) are both characterized by IgA-mediated tissue injury, including mesangial proliferative glomerulonephritis. Abnormalities of IgA1 glycosylation are described in IgA nephropathy and HSP nephritis. IgA-antineutrophil cytoplasmic antibodies (ANCA) have been inconsistently described in the serum of patients with HSP. In IgA myeloma, the paraprotein-mediated renal lesion is typically cast nephropathy; IgAN or HSP have only rarely been reported in myeloma even when an IgA paraprotein is circulating in large concentrations. We report the case of a 50-year-old man with IgA myeloma who presented with HSP including nephritis and rapidly progressive renal failure. His IgA1 had altered O-glycosylation in the pattern seen in IgAN and also contained an IgA-ANCA. This case adds further weight to the evidence that IgA1 O-glycosylation abnormalities predispose to mesangial IgA deposition and also that IgA-ANCA may have a pathogenic role in the development of HSP.

Assessing the hypothalamo-pituitary-adrenocortical axis using physiological doses of adrenocorticotropic hormone.

We compared cortisol responses to 1 microgram adrenocorticotropic hormone (ACTH), 250 micrograms ACTH and insulin-induced hypoglycaemia (IIH), in patients suspected to have secondary hypocortisolism. Twenty-four patients (16 with hypothalamopituitary disorders and 8 on long-term glucocorticoid therapy) and eight healthy controls, underwent all three test protocols, with intervals of one day between each test. Mean cortisol responses to all three tests were comparable in both groups, but were more closely correlated for IIH vs. the 1 microgram ACTH test (r = 0.96) than for IIH vs. the 250 micrograms ACTH test (r = 0.88). Seven patients had discrepant results; all had a normal peak cortisol response to 250 micrograms ACTH (> 550 nmol/l), but a subnormal response to 1 microgram ACTH. Six of these also had a subnormal response to IIH. Cortisol responses to IIH match more closely those for 1 microgram ACTH in individual instances than those for 250 micrograms ACTH. The standard 250 micrograms ACTH stimulation, being supraphysiological, leads to underdiagnosis of the hypocortisolaemic state. The 1 microgram ACTH stimulation test should replace the standard 250 micrograms ACTH stimulation test in assessing the hypothalamo-pituitary-adrenocortical axis in secondary hypocortisolism.

Effect of trifluoperazine, a potential drug for tuberculosis with psychotic disorders, on the growth of clinical isolates of drug resistant Mycobacterium tuberculosis.

The effect of the antipsychotic drug trifluoperazine (TFP) on the in-vitro growth of 50 clinical isolates of Mycobacterium tuberculosis was tested. Of these isolates, 29 were susceptible to all five of the antitubercular drugs isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide, and 21 were resistant to one or more of the five drugs. The minimum inhibitory concentration (MIC) of TFP was 4 microg/ml for 40% of both the susceptible (12/29) and resistant (8/21) isolates and 8 microg/ml for 55% (16/29) and 48% (10/21) of the susceptible and resistant isolates respectively. Further analysis of the data for resistant isolates indicated that the MIC of TFP was 4 microg/ml and 16 microg/ml respectively for 50% (4/8) and 75% (6/8) of the isolates resistant to one drug only from isoniazid, streptomycin or pyrazinamide. Of the nine isolates resistant to two drugs, isoniazid and streptomycin, the MIC was 4 microg/ml for 33% (3/9) and 16 microg/ml for 80% (7/9). The MIC of TFP for two isolates resistant to the three drugs isoniazid, rifampicin and streptomycin was 8 microg/ml for one and 32 microg/ml for the other. Of two isolates resistant to all five drugs, it is of interest to note that the MIC of TFP was only 4 microg/ml for one but 32 microg/ml for the other. Because the above MICs are for TFP as a single drug, it would be desirable to study the antitubercular activity of the serum of tuberculosis patients with psychotic problems receiving regular antitubercular therapy supplemented with TFP at its recommended and tolerated dose.

Anaerobic flora in endodontic infections.

Microbiological and clinical data from 56 patients with endodontic infections were evaluated. Samples were collected using autoclaved paper points. Specimens were processed for isolation of aerobic and anaerobic bacteria. Antimicrobial sensitivity and resistance profiles of the recovered isolates was also performed. Forty nine positive cultures (87.5%) were obtained from the 56 consecutive necrotic root canal systems which were sampled. A total of 69 aerobic bacteria and 21 anaerobic bacteria were recovered. Aerobic bacteria were isolated from 35 patients (72%), anaerobic bacteria from 3 (6%) and mixed aerobic and anaerobic bacteria from 11 patients (22%). The most common aerobic isolate was Klebsiella pneumoniae. The predominant anaerobic isolate was Bacteroides species. One isolate was recovered from 25 patients (51%) whereas in the remaining 24 patients (49%) more than 1 isolate were recovered. These data illustrate the polymicrobial nature of endodontic infections in half the patients studied and the role of anaerobic bacteria in a quarter of them.

Incidence of R-plasmids in toxigenic & non-toxigenic strains of Escherichia coli from children with diarrhoea.

Toxigenic (30) and non-toxigenic (30) multiresistant strains of Esch. coli were studied for the incidence of R-plasmids. ST+, LT+ and ST+ LT+ plasmids were produced by 66.7, 30 and 3.3 per cent of toxigenic strains, respectively. ACST was the predominant resistance pattern in both the types. Incidence of R-plasmid in the toxigenic strains was 73.3 per cent as compared to 60 per cent in the non-toxigenic strains. Non-conjugative R-plasmid was present in 10 per cent of the non-toxigenic strain. In 13.3 per cent of toxigenic Esch. coli strains along with the transfer of antibiotic resistance, the ability to produce enterotoxin was also conferred on the recipient. This suggests that the genes coding for antibiotic resistance and enterotoxin are frequently associated and can be transferred together in vitro.

Bacteriology of ophthalmic infections with special reference to anaerobes.

A total of 138 eye specimens were processed for aerobic and anaerobic cultures. Clinical data were obtained from 50 patients with unilateral ophthalmic infection. Cultures from the uninfected eye of 38 of these 50 patients were also processed for comparison. In addition, 50 cultures were obtained from one or both eyes of 30 healthy controls who had no eye infection. Anaerobes and aerobes were isolated from infected eyes of 6 (12%) and 37 (74%) patients respectively. No growth was observed in infected eye of 8 (16%) patients. A mixture of aerobes and anaerobes were recovered only in 2 cases. Of the total 47 aerobic isolates from infected eye specimens, Staphylococcus aureus (11), coagulase negative staphylococci (12) and Streptococcus pneumoniae (9) were predominant isolates. Six anaerobes isolates included Gram positive nonsporing anaerobic bacilli (4 including Propionibacterium acne) as predominant isolates. Clostridium perfringens was isolated from a case of post operative endoophthalmitis. From the uninfected eye of same patients though the number and types of aerobic bacteria were similar, none grew any anaerobes. Aerobic and anaerobic bacteria were isolated in 70 and 6 per cent of eye swabs respectively from the healthy controls.

Cluster of cases of clinical cholera due to Vibrio cholerae 010 in east Delhi.

A total of 514 samples of acute diarrhoeal stools received over a period of four months yielded 315 isolates morphologically and biochemically resembling V. cholerae. Out of 315 isolates, 223 (70.8%) were identified as V. cholerae 01, 20 (6.4%) as 0139 and 42 (13.3%) as 010. Thirty (9.5%) isolates did not agglutinate with any of the available antisera. All V. cholerae 010 isolates showed complete homogeneity in their biochemical and physiological properties. This strain appears to be closely related to El Tor biotype of V. cholerae 01, since it was positive for some of the tests used for identification of El Tor. The ability of strain 010 to grow in the presence of 6 per cent salt provides it the status of an important environmental pathogen. Acquisition of some virulence genes from El Tor vibrios by this strain 010 appears to be one of the mechanisms involved in the emergence of this serogroup.

Plasma cortisol response to 1 microgram adrenocorticotropin at 0800 h & 1600 h in healthy subjects.

BACKGROUND & OBJECTIVES: Cortisol response to 250 micrograms adrenocorticotropin (ACTH) exhibits no circadian variation. Information on the circadian variation, if any, in cortisol response to 1 microgram ACTH, which is considered as a physiological dose is not available. As the 1 microgram ACTH stimulation test is projected as an outpatients procedure with no time constraint, this information is very important. Hence, this study was designed to assess whether any circadian variability exists in cortisol response to 1 microgram ACTH in healthy subjects. METHODS: Thirty six healthy volunteers (23 male and 13 female) with mean age of 32.2 +/- 9.0 yr were consecutively studied after obtaining informed consent. On day 1, prestimulated and stimulated plasma cortisol samples were collected at 0800 h and, at 30 and 60 min following an intravenous bolus of 1 microgram ACTH, and on day 3, plasma cortisol samples were similarly collected at 1600 h. Cortisol estimation was done by a sensitive and specific radioimmunoassay. Stimulated plasma cortisol of 500 nmol/1 or more was defined as a normal response. RESULTS: The prestimulated and peak cortisol levels at 0800 h (377.5 +/- 93.3 and 729.1 +/- 183.2 nmol/l) were higher (P < 0.001 and P < 0.01) than those at 1600 h (230.1 +/- 75.7 and 665.8 +/- 138.6 nmol/l). However, a stimulated cortisol response of 500 nmol/l or more was observed at both 0800 h and 1600 h in all subjects at 30 min but not at 60 min. The [symbol: see text] (peak-basal) response was higher at 1600 h than that at 0800 h (432.8 +/- 136.8 vs 351.5 +/- 177.3, P < 0.01). INTERPRETATION & CONCLUSION: The demonstration of normal cortisol response to 1 microgram ACTH both at 0800 h and 1600 h suggests that the test can be performed at any time of the day.

In vitro susceptibility testing of Mycobacterium tuberculosis strains to trifluoperazine.

The presence of calmodulin-like protein (CAMLP) has been demonstrated in mycobacteria and it has been observed that there is a positive correlation between levels of CAMLP, phospholipids as well as lipids and growth. Thus the use of trifluoperazine, which is a calmodulin antagonist, would inhibit the growth of mycobacterial cells. The authors carried out in vitro susceptibility testing of Mycobacterium tuberculosis strains to trifluoperazine with their minimum inhibitory concentrations (MIC) determination. 70 strains of M. tuberculosis isolated from cases of pulmonary as well as extrapulmonary tuberculosis were included. The following antimycobacterial drugs: streptomycin, isonized, rifampicin, ethambutol were tested on Lowerstein and Jenson (LJ) slopes using the resistance ratio method and the proportion method for pyrazinamide testing. All strains and the control H37RV were cultured into Youmans and Karlson's liquid medium and MICS were determined for trifluoperazine. Trifluoperazine MICs ranged between 8-32 microg/ml for strains susceptible to routine antimycobacterial drugs while strains resistant to streptomycin and isoniazid had lower MIC values, between 8-16 microg/ml. As trifluoperazine is already in human use for psychotic disorders, its antitubercular activity could pave the way for human trials as an antitubercular drug.

Changing trends in bacteriology of burns in the burns unit, Delhi, India.

A retrospective study of bacterial isolates from the wounds of patients admitted to burns unit, was undertaken at Guru Tegh Bahadur Hospital, University College of Medical Sciences, Delhi, India, over a period of 5 years between July 1997 and April 2002. The study compared the results obtained with the previous 5 years data (June 1993-June 1997) from the same unit to determine the changing patterns and emerging trends of bacterial isolates and their antimicrobial susceptibilities. Pseudomonas species (31%) and Staphylococcus aureus (22%) were the most common pathogens followed by Klebsiella species (19%). Multi-drug resistant (MDR) Acinetobacter species (9%) have emerged as an important nosocomial pathogen in our burn unit. Most of the gram-negative isolates obtained were found to be multi-drug resistant and 61% of the tested isolates were extended spectrum beta-lactamase (ESBL) producers. Concomitant resistance to penicillin and aminoglycosides was observed in 61% of Enterococcus fecalis isolates. When compared with the results of previous 5 years (June 1993-June 1997) Pseudomonas spp. was still the commonest pathogen in the burns unit. However, isolation of this organism and other gram-negative organisms has decreased in comparison to previous years. The incidence of antimicrobial resistance has markedly increased over the past years resulting in limitation of therapeutic options.

Web mining in soft computing framework: relevance, state of the art and future directions.

The paper summarizes the different characteristics of Web data, the basic components of Web mining and its different types, and the current state of the art. The reason for considering Web mining, a separate field from data mining, is explained. The limitations of some of the existing Web mining methods and tools are enunciated, and the significance of soft computing (comprising fuzzy logic (FL), artificial neural networks (ANNs), genetic algorithms (GAs), and rough sets (RSs) are highlighted. A survey of the existing literature on "soft Web mining" is provided along with the commercially available systems. The prospective areas of Web mining where the application of soft computing needs immediate attention are outlined with justification. Scope for future research in developing "soft Web mining" systems is explained. An extensive bibliography is also provided.

Clinical and bacteriological profile of hospitalized community acquired pneumonias--a preliminary study.

The spectrum of clinical and bacteriological features of 46 cases of pneumonias presenting to U.C.M.S. and Guru Tegh Bahadur Hospital complex in East Delhi over a period of three months are presented and their etiopathogenesis discussed. The high incidence of pneumonias in admitted patients belonging to the population adjacent to the hospital is highlighted. Etiological diagnosis based on sputum culture and sensitivity tests was possible only in 37% cases, and there is need for the use of newer even though invasive methods for arriving at the bacteriological diagnosis.

Clinicohaematological profile in chronic renal failure.

OBJECTIVE: Aim of the study was to observe the clinicohaematological profile, bone marrow and serum iron indices of patients with chronic renal failure. METHOD: A total of 27 patients of chronic renal failure were selected, irrespective of their age, sex, clinical profile and etiology. These patients were not on dialysis, haematinics or erythropoietin therapy. They underwent series of biochemical and haematological investigation including bone marrow aspiration and also estimation of serum iron indices. RESULTS: The commonest cause of chronic renal failure in study group was diabetes mellitus (20%), glomerulonephritis (8%). Fifty percent of the patients on first presentation were in end-stage renal disease. Most patients presented with features of anaemia (94%), uraemia (63%) and fluid overload (96%). Severity of anaemia was correlating with degree of azotemia. Sixty percent of the patients had microcytic hypochromic anaemia, five percent had macrocytic anaemia while 30% had normocytic normochromic anaemia. The reticulocyte count was high in 46% of the patients. RDW-CV of greater than 14 was observed in 67%. Thrombocytopaenia was found in 52% of the patients. Leucocyte count was within normal range in 75%. In differential leucocyte count and absolute eosinophil count was high in 32% of the subject. In bone marrow examination 61% of the patients had normal bone marrow cellularity, 75% were having erythroid hyperplasia. Fifty seven percent of the cases had bone marrow iron store of zero, 37.8% had normal bone marrow iron store, 6.5% had increased bone marrow iron store. Serum ferritin was low in 62% and serum iron was below normal in 74% of the patients. CONCLUSION: Majority (65%) of patient had microcytic hypochronic anaemia because of iron deficiency and 33% of patient had parasitic infestation.

Growth hormone therapy.

Growth hormone therapy with rhGH (recombinant human growth hormone) has been recommended for treatment of GH deficient short stature in children, repeated hypoglycemias in infancy and early childhood due to GH deficiency, short stature accompanying chronic renal failure prior to renal transplantation and Turner's syndrome. It is now increasingly recommended to adults with GH deficiency following pituitary tumour surgery or irradiation or idiopathic hypopituitarism. There are other indications for its use where evidence for protein catabolism is very strong such as burns injury. The end points of GH therapy in children include achievement of desirable adult height or a growth rate velocity of < 2.5 cm/year. In adults GH deficiency, GH therapy is intended for improvement of general well being, body composition and metabolic markers of GH function.

Preliminary survey of leptospirosis amongst febrile patients from urban slums of East Delhi.

AIM: To determine the possibility of leptospirosis among patients from urban slums presenting with febrile illness during monsoon and post-monsoon season. METHODS: Evidence of leptospirosis in 180 patients with febrile illness was determined by looking for presence of immunoglobulin M (IgM) antibodies by leptospiral IgM enzyme linked immunosorbent assay (ELISA). The test was carried out on 160 Widal test negative and 20 Widal test positive sera received from febrile patients during June to September 2001. RESULTS: Twenty-seven out of 180 (15%) sera were positive for leptospiral IgM antibodies. CONCLUSIONS: This preliminary survey indicates that leptospirosis could be an important cause of febrile illness in patients from urban slums during monsoon and post-monsoon season.