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2017| February | Volume 145 | Issue 2
Online since
June 19, 2017
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REVIEW ARTICLES
Current status of lupus nephritis
Ajay Jaryal, Sanjay Vikrant
February 2017, 145(2):167-178
DOI
:10.4103/ijmr.IJMR_163_16
PMID
:28639592
Systemic lupus erythematosus (SLE) is a systemic disease of unknown aetiology with variable course and prognosis. Lupus nephritis (LN) is one of the important disease manifestations of SLE with considerable influence on patient outcomes. Immunosuppression therapy has made it possible to control the disease with improved life expectancy and quality of life. In the last few decades, various studies across the globe have clarified the role, dose and duration of immunosuppression currently in use and also provided evidence for new agents such as mycophenolate mofetil, calcineurin inhibitors and rituximab. However, there is still a need to develop new and specific therapy with less adverse effects. In this review, the current evidence of the treatment of LN and its evolution, and new classification criteria for SLE have been discussed. Also, rationale for low-dose intravenous cyclophosphamide as induction agent followed by azathioprine as maintenance agent has been provided with emphasis on individualized and holistic approach.
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EDITORIALS
Potential danger of isolated platelet transfusion in patients with dengue infection
CE Eapen, SC Nair
February 2017, 145(2):158-160
DOI
:10.4103/ijmr.IJMR_937_16
PMID
:28639589
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ORIGINAL ARTICLES
Guillain–Barre syndrome: Demographics, clinical profile & seasonal variation in a tertiary care centre of central India
Manisha Shrivastava, Shah Nehal, Navaid Seema
February 2017, 145(2):203-208
DOI
:10.4103/ijmr.IJMR_995_14
PMID
:28639596
Background & objectives:
Guillain–Barre syndrome (GBS) is an autoimmune disease and a recognized cause of generalized progressive paralysis worldwide. The present study was aimed to document the clinical findings, demographics and seasonal variations amongst the patients with GBS during the hospital stay.
Methods:
A retrospective analysis of 66 referred cases diagnosed as GBS was conducted. Medical records and the data related to age, sex, antecedent illness, duration of symptoms before admission, muscle power graded by the Medical Research Council scale, functional scores, details of Intensive Care Unit complications and need for ventilation were obtained. The patients were divided into four seasonal groups: S1 (spring, February to April), S2 (summer, May to July), S3 (rainy, August to October) and S4 (winter, November to January) and parameters were studied.
Results:
The mean age of the patients was 40.69 yr. Forty one (62.1%) patients had a history of preceding illness. Forty nine (74.2%) patients showed quadriparesis as most common complaint. Thirty three (50%) patients were of acute inflammatory demyelinating polyneuropathy (AIDP) variant. The highest number of GBS cases (60%) was found in S1 and S2. The maximum duration of hospital stay was observed in S3 group (mean 23 days).
Interpretation & conclusions:
GBS seems to affect all age groups with male preponderance. Most common antecedent event and presenting feature were flu-like illness and quadriparesis, respectively. AIDP was the most common variant. Most cases occurred from February to July (S1 and S2 group) (maximum in July) with preceding influenza and diarrhoea and maximum duration of hospital stay was observed in S3 group. Prospective studies with follow up of GBS patients need to be done to confirm findings.
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EDITORIALS
Reconsidering axillary surgery for early breast cancer
Ismail Jatoi
February 2017, 145(2):155-157
DOI
:10.4103/ijmr.IJMR_1837_16
PMID
:28639588
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ORIGINAL ARTICLES
Viral aetiology of wheezing in children under five
Prithi Sureka Mummidi, Radha Tripathy, Bhagirathi Dwibedi, Amarendra Mahapatra, Suryakanta Baraha
February 2017, 145(2):189-193
DOI
:10.4103/ijmr.IJMR_840_15
PMID
:28639594
Background & objectives:
Wheezing is a common problem in children under five with acute respiratory infections (ARIs). Viruses are known to be responsible for a considerable proportion of ARIs in children. This study was undertaken to know the viral aetiology of wheezing among the children less than five years of age, admitted to a tertiary care hospital in eastern India.
Methods:
Seventy five children, under the age of five years admitted with wheezing, were included in the study. Throat and nasal swabs were collected, and real-time multiplex polymerase chain reaction (PCR) assay was used to screen for influenza 1 and 2, respiratory syncytial virus (RSV), parainfluenza virus (PIV) 1, 2, 3 and 4, rhinovirus, human meta-pneumovirus, bocavirus (HBoV),
Coronavirus
, adenovirus,
Enterovirus
and
Parechovirus
.
Results:
The total viral detection rate was 28.57 per cent. Viral RNA markers were detected from children diagnosed to be having pneumonia (3 cases), bronchiolitis (9 cases), episodic wheeze (2 cases) and multitrigger wheeze (6 cases). RSV was the most common virus (35%) followed by PIV1, 2 and 3 (20%), HBoV (10%) and rhinovirus (5%). However, mixed infection was observed in 30 per cent of cases.
Interpretation & conclusions:
The study reported the presence of respiratory viral agents in 28.57 per cent of children with wheezing; RSV and PIV were most common, accounting to 55 per cent of the total cases. Mixed infection was reported in 30 per cent of cases. Seasonal variation in the occurrence of these viruses was also noted. Further studies need to be done with a large sample and longer follow up period to verify these findings.
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Study of adverse drug reactions in patients with diabetes attending a tertiary care hospital in New Delhi, India
Abhishank Singh, Shridhar Dwivedi
February 2017, 145(2):247-249
DOI
:10.4103/ijmr.IJMR_109_16
PMID
:28639602
The present prospective observational study was carried out in a tertiary care hospital in New Delhi, India from May 2014 to June 2015 to report adverse drug reactions (ADRs) in patients with type 2 diabetes mellitus (T2DM) using antidiabetic drugs. A total of 220 patients (121 males, 99 females) were enrolled. ADRs were recorded on the prescribed form. Causality and severity assessment was done using Naranjo's probability scale and modified Hartwig and Siegel's severity scale, respectively. Commonly prescribed drugs were biguanides, peptide hormone and sulphonylurea. A total of 26 ADRs were recorded (16 in males and 10 in females). Most commonly observed ADRs were related to endocrine and gastrointestinal system. Severity assessment of ADRs showed seven (26.9%) ADRs as moderate, and 19 (73.1%) as mild. No severe reactions were observed. ADRs were mostly related to endocrine and gastrointestinal system. More information on prescribed drugs and their side effects is required for ensuring patient safety.
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Comparative analysis of Luminex-based donor-specific antibody mean fluorescence intensity values with complement-dependent cytotoxicity & flow crossmatch results in live donor renal transplantation
Ajay Kumar Baranwal, Deepali Krishan Bhat, Sanjeev Goswami, Sanjay Kumar Agarwal, Gurvinder Kaur, Jasmeet Kaur, Narinder Mehra
February 2017, 145(2):222-228
DOI
:10.4103/ijmr.IJMR_222_16
PMID
:28639599
Background & objectives:
Antibodies specific to donor human leucocyte antigen (HLA) play a critical role in graft rejection and graft loss. In recent years, techniques for their detection have evolved significantly providing an ever-increasing degree of sensitivity and specificity, from the conventional cell-based assays to the advanced solid-phase system based on the Luminex platform. Consensus is still evolving on the routine employment of all these methods, either stand alone or in combination. The objective of this study was to explore the near-accurate mean fluorescence intensity (MFI) cut-off values detected on Luminex platform predicting the strength of cell-based crossmatch results.
Methods:
Serum samples from 116 primary renal transplant recipients awaiting transplantation were tested for the presence of antidonor antibodies by the complement-dependent cytotoxicity (CDC) and flow crossmatch (FCXM) methods with their corresponding donors as well as for HLA-donor-specific antibodies (DSA) detection using a sensitive single antigen bead (SAB) assay.
Results:
None of the patients having HLA Class I DSA with MFI values <1000 showed positivity for T-cell FCXM or CDC crossmatch, while in the group having MFI values between 1000 and 3000, 54 per cent showed positivity for the FCXM but none by the CDC method. However, in the group having MFI values >3000, 95 per cent of cases were positive for FCXM. Further, those groups with MFI values between 3000 and 5000, only 36 per cent were positive for CDC crossmatch, while 90 per cent showed positivity in the group with MFI >7000.
Interpretation & conclusions:
A cut-off MFI value of 3000 for Luminex SAB-based assay was found to significantly correlate with the FCXM positivity while a MFI value of 7000 and above predicted a positive CDC crossmatch. MFI cut-off value obtained as a surrogate marker for CDC and FCXM tests will help in resolving the limitations of different cell-based techniques.
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COMMENTARY
Wheezing in children with viral infection & its long-term effects
Kana Ram Jat, Sushil Kumar Kabra
February 2017, 145(2):161-162
DOI
:10.4103/ijmr.IJMR_1459_16
PMID
:28639590
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ORIGINAL ARTICLES
Prenatal diagnosis of steroid 21-hydroxylase-deficient congenital adrenal hyperplasia: Experience from a tertiary care centre in India
Sudhisha Dubey, Veronique Tardy, Madhumita Roy Chowdhury, Neerja Gupta, Vandana Jain, Deepika Deka, Pankaj Sharma, Yves Morel, Madhulika Kabra
February 2017, 145(2):194-202
DOI
:10.4103/ijmr.IJMR_329_16
PMID
:28639595
Background & objectives:
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder with a wide range of clinical manifestations. The disease is attributed to mutations in
CYP21A2
gene encoding 21-hydroxylase enzyme. In view of severe phenotype in salt-losing cases, issues related to genital ambiguity in girls and precocity in boys, most families opt for prenatal testing and termination of affected foetus. CAH can be diagnosed
in utero
through direct molecular analysis of
CYP21A2
gene, using DNA extracted from foetal tissues or cells obtained from chorionic villus sampling or amniocentesis. The objective of this study was to evaluate the feasibility and accuracy of prenatal diagnosis (PND) using sequencing and multiplex ligation probe amplification (MLPA) methods in families at risk for CAH.
Methods:
Fifteen pregnant women at risk of having an affected offspring with CAH were included in this study. Ten families had previous affected children with salt-wasting/simple virilising form of CAH and five families did not have live children but had a high index of suspicion for CAH in previous children based on history or records. Mutation analysis was carried out by Sanger sequencing and MLPA method.
Results:
Seven different mutations were identified in 15 families. Deletions and I2g mutation were the most common. Of the 15 foetuses analyzed, nine were unaffected while six were affected. Unaffected foetuses were delivered, they were clinically normal and their genotype was found to be concordant to the prenatal report. All except two families reported in the second trimester. None of the couples opted for prenatal treatment.
Interpretation & conclusions:
Our preliminary findings show that PND by direct mutation analysis along with MLPA is a feasible strategy that can be offered to families at risk.
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VIEW POINT
Manochaitanya
programme for better utilization of primary health centres
Narayana Manjunatha, Gaurav Singh, Santosh Kumar Chaturvedi
February 2017, 145(2):163-165
DOI
:10.4103/ijmr.IJMR_11_16
PMID
:28639591
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REVIEW ARTICLES
Synaptic roles of cyclin-dependent kinase 5 & its implications in epilepsy
Aparna Banerjee Dixit, Jyotirmoy Banerjee, Manjari Tripathi, Chitra Sarkar, P Sarat Chandra
February 2017, 145(2):179-188
DOI
:10.4103/ijmr.IJMR_1249_14
PMID
:28639593
There is an urgent need to understand the molecular mechanisms underlying epilepsy to find novel prognostic/diagnostic biomarkers to prevent epilepsy patients at risk. Cyclin-dependent kinase 5 (CDK5) is involved in multiple neuronal functions and plays a crucial role in maintaining homeostatic synaptic plasticity by regulating intracellular signalling cascades at synapses. CDK5 deregulation is shown to be associated with various neurodegenerative diseases such as Alzheimer's disease. The association between chronic loss of CDK5 and seizures has been reported in animal models of epilepsy. Genetic expression of CDK5 at transcriptome level has been shown to be abnormal in intractable epilepsy. In this review various possible mechanisms by which deregulated CDK5 may alter synaptic transmission and possibly lead to epileptogenesis have been discussed. Further, CDK5 has been proposed as a potential biomarker as well as a pharmacological target for developing treatments for epilepsy.
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ORIGINAL ARTICLES
Evaluation of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study group of India (DIPSI) criteria] as a diagnostic test for gestational diabetes mellitus
Reva Tripathi, Divya Verma, Vinod Kumar Gupta, Shakun Tyagi, M Kalaivani, Siddarth Ramji, YM Mala
February 2017, 145(2):209-214
DOI
:10.4103/ijmr.IJMR_1716_15
PMID
:28639597
Background & objectives:
There is no consensus regarding optimal standard for diagnosis of gestational diabetes mellitus (GDM). In this study, use of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study Group of India (DIPSI) criteria] as a diagnostic test for GDM in pregnant women was compared with different oral glucose tolerance tests (OGTTs).
Methods:
This prospective study included 936 pregnant women, who underwent plasma glucose evaluation two hours after the challenge of 75 g glucose load irrespective of the timing of last meal (DIPSI criteria for GDM). After three days, standard 75 g OGTT was done in all women irrespective of previous plasma glucose value. Accuracy of the first result was compared to OGTT using cut-offs as per the World Health Organization (WHO) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of GDM.
Results:
Of the total 936 pregnant women, 73 (7.8%) patients had plasma glucose value ≥140 mg/dl when measured two hours after glucose load. When comparing with the WHO and IADPSG criteria, the sensitivity values were 65.1 and 74.1 per cent, respectively, and the corresponding specificity values were 96.3 and 96.9 per cent, respectively. On comparing with the WHO OGTT, only 41 of the 73 (56.2%) were true positives, whereas when IADPSG criteria were used, true positives were 46 (63%). False negative cases were also present when classified by the WHO and IADPSG criteria though in lesser numbers than false positives. The positive predictive values (PPVs) for the WHO and IADPSG criteria were 56.1 and 63 per cent, respectively, and their corresponding negative predictive values were 97.7 and 97.9 per cent, respectively.
Interpretation & conclusions:
Our findings showed that when 75 g glucose load in non-fasting state was used as a diagnostic test for GDM, almost one quarter of patients with GDM escaped diagnosis as sensitivity values were low. On the other hand, some GDM cases were falsely labelled as normal as this test did not account for cases of fasting hyperglycaemia. In addition, comparison with other OGTTs showed low PPVs. Hence, use of DIPSI criteria for diagnosing GDM must be reconsidered till further validation.
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Faecal microbiota of healthy adults in south India: Comparison of a tribal & a rural population
Balamurugan Ramadass, B Sandya Rani, Srinivasan Pugazhendhi, KR John, Balakrishnan S Ramakrishna
February 2017, 145(2):237-246
DOI
:10.4103/ijmr.IJMR_639_14
PMID
:28639601
Background & objectives:
The relevance of the gut microbiota to human health is increasingly appreciated. The objective of this study was to compare the gut microbiota of a group of adult tribals with that of healthy adult villagers in Tamil Nadu, India.
Methods:
Faeces were collected from 10 healthy tribal adults (TAs) in the Jawadhi hills and from 10 healthy villagers [rural adults (RAs)] in Vellore district, Tamil Nadu. DNA was extracted, and 456 bp segments comprising hypervariable regions 3 and 4 of the 16S rRNA gene were amplified, barcoded and 454 sequenced.
Results:
Totally 227,710 good-quality reads were analyzed. TAs consumed a millets-based diet, ate pork every day, and did not consume milk or milk products. RAs consumed a rice-based diet with meat intake once a week. In both groups,
Firmicutes
was the most abundant phylum, followed by
Proteobacteria
,
Bacteroidetes
and
Actinobacteria
. The median
Firmicutes
-to-
Bacteroidetes
ratio was 34.0 in TA and 92.9 in RA groups.
Actinobacteria
were significantly low in TA, possibly due to non-consumption of milk.
Clostridium
constituted the most abundant genus in both groups, but was significantly more abundant in TAs than RAs, while
Streptococcus
was significantly more abundant in RA (
P
<0.05). Analyses of genetic distance revealed that the microbiota were distinctly different between TA and RA, and principal component analysis using 550 distinct taxonomically identifiable sequences revealed a clear separation of microbiota composition in the two groups. Phylogenetic analysis of major microbiota indicated clustering of microbial groups at different major branch points for TAs and RAs.
Interpretation & conclusions:
Phylum
Firmicutes
and genus
Clostridium
constituted the bulk of the faecal microbiota, while significant differences in composition between the groups were probably due to differences in diet and lifestyle.
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Haematological profile of patients with mixed-phenotype acute leukaemia from a tertiary care centre of north India
Manupriya Sharma, Man Updesh Singh Sachdeva, Parveen Bose, Neelam Varma, Subhash Varma, RK Marwaha, Pankaj Malhotra
February 2017, 145(2):215-221
DOI
:10.4103/ijmr.IJMR_324_14
PMID
:28639598
Background & objectives:
Mixed-phenotype acute leukaemia (MPAL) is a rare neoplasm with no definite treatment protocols and a distinctly poor outcome. Advancement in polychromatic flow cytometry has made its identification easier. This prospective study was designed to identify cases of MPAL and study their clinical presentation and haematological profile in a tertiary care hospital in north India.
Methods:
Ethylenediaminetetraacetic acid (EDTA)-anticoagulated bone marrow aspirate samples of patients diagnosed as acute leukaemia (AL) on the basis of morphology were utilized for immunophenotyping. A comprehensive panel of fluorochrome-labelled monoclonal antibodies targeting myeloid, B-cell, T-cell and immaturity markers was utilized. The patients diagnosed to have MPAL, on the basis of the World Health Organization 2008 classification, were selected for further analyses.
Results:
There were 15 (2.99%) patients with MPAL of the total 501 cases of AL. Seven were children, all males and mean age of 5.08±3.88 yr. Eight were adults, male:female=6:2 and mean age of 21.43±5.74 yr. Eight were diagnosed as B/myeloid and seven were T/myeloid. No association was observed between age and immunophenotype of MPAL. On morphology, 11 were diagnosed as AML and four as ALL, and no specific morphology of blasts was predictive of a MPAL.
Interpretation & conclusions:
MPAL appeared to be a rare neoplasm (2.99% of AL cases). A comprehensive primary panel of monoclonal antibodies should be used to identify this neoplasm known to have a poor outcome.
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CORRESPONDENCE
Serum prolactin levels in patients with psoriasis: Results of a pilot study
Gaytri Khatri, Vikram K Mahajan, Karaninder S Mehta, Krishan Kumar Sharma, Satya Bhushan, Pushpinder S Chauhan
February 2017, 145(2):250-252
DOI
:10.4103/ijmr.IJMR_814_15
PMID
:28639603
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ORIGINAL ARTICLES
Effects of polysaccharide fractions isolated from
Caltha palustris
L. on the activity of phagocytic cells & humoral immune response in mice with collagen-induced arthritis: A comparison with methotrexate
Agnieszka Suszko, Bożena Obmińska-Mrukowicz
February 2017, 145(2):229-236
DOI
:10.4103/ijmr.IJMR_704_14
PMID
:28639600
Background & objectives:
The extracts from
Caltha palustris
L. have been shown to be beneficial for treating arthritis and
rheumatism
. In this study, the immunomodulatory effects of polysaccharide fractions B and C of
C. palustris
extracts were studied, using the collagen-induced arthritis (CIA) mouse arthritis experimental model. The aim was to determine the activity of blood phagocytic cells and humoral immune response in CIA mice treated with polysaccharide fractions from
C. palustris.
Methods:
The effects of fractions B and C of
C. palustris
were explored by evaluating phagocytic activity of peripheral blood granulocytes and monocytes and humoral immune response in sheep red blood cell (SRBC)-immunized mice. The results were compared with methotrexate (MTX) treatment. Following the onset of CIA, DBA/1J mice were treated for 21 days with B or C fractions (10 mg/kg; i.p.) or MTX (every 48 h, 6.6 mg/kg; i.p.).
Results:
The results showed that fraction B reduced the level of interleukin (IL)-1β, boosted nitric oxide synthesis in murine peritoneal macrophages stimulated
in vitro
with lipopolysaccharide and enhanced the monocyte phagocytic activity. Exposure of SRBC-immunized mice to fraction B and MTX during the course of CIA resulted in decreased total anti-SRBC haemagglutinin titres.
Interpretation & conclusions:
Fraction B of
C. palustris
polysaccharides modulated macrophage function and exerted beneficial effects on the clinical course of CIA in mice. The results also suggested efficacy of fraction B was comparable to that of MTX treatment for certain parameters.
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CLINICAL IMAGES
Intraoral malignant melanoma
Neelam Mittal, Vijay Parashar
February 2017, 145(2):253-253
DOI
:10.4103/ijmr.IJMR_1515_15
PMID
:28639604
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BOOK REVIEWS
Health and nutrition in adolescents and young women: Preparing for the next generation
Prema Ramachandran
February 2017, 145(2):256-257
DOI
:10.4103/0971-5916.208373
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Adult stem cells in aging, diseases and cancer
Ramesh Bhonde
February 2017, 145(2):254-255
DOI
:10.4103/0971-5916.208372
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Nutrition for the primary care provider
Uma Iyer
February 2017, 145(2):254-254
DOI
:10.4103/0971-5916.208443
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94
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