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   2016| December  | Volume 144 | Issue 6  
    Online since April 28, 2017

 
 
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ORIGINAL ARTICLES
Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality
Anurag Bhargava, Reshma Kaushik, Rajeev Mohan Kaushik, Anita Sharma, Sohaib Ahmad, Minakshi Dhar, Garima Mittal, Sushant Khanduri, Priyannk Pant, Rajesh Kakkar
December 2016, 144(6):901-909
DOI:10.4103/ijmr.IJMR_1764_15  PMID:28474627
Background & objectives: Scrub typhus is a re-emerging mite-borne rickettsiosis, which continues to be underdiagnosed, with lethal consequences. The present study was conducted to determine the seasonality, clinical presentation and predictors of mortality in patients with scrub typhus at a tertiary care teaching hospital in northern India. Methods: Scrub typhus was suspected in patients attending the hospital as per the standard case definition and serological evidence was obtained by performing an IgM ELISA. Results: A total of 284 patients with scrub typhus from urban and rural areas were seen, predominantly from July to November. The most common clinical presentation was a bilateral community-acquired pneumonia (CAP), which resembled pneumonia due to atypical pathogens and often progressed to acute respiratory distress syndrome (ARDS). An acute undifferentiated febrile illness (AUFI) or a febrile illness associated with altered sensorium, aseptic meningitis, shock, abdominal pain, gastrointestinal bleeding or jaundice was also seen. Eschars were seen in 17 per cent of patients, and thrombocytopenia, transaminitis and azotaemia were frequent. There were 24 deaths (8.5%) caused predominantly by ARDS and multi-organ dysfunction. The mortality in patients with ARDS was high (37%). ARDS [odds ratio (OR)=38.29, 95% confidence interval (CI): 9.93, 147.71] and acute kidney injury (OR=8.30, 95% CI: 2.21, 31.21) were the major predictors of death. Interpretation & conclusions: The present findings indicate that scrub typhus may be considered a cause of CAP, ARDS, AUFI or a febrile illness with multisystem involvement, in Uttarakhand and Uttar Pradesh, especially from July to November. Empiric therapy of CAP may include doxycycline or azithromycin to ensure coverage of underlying unsuspected scrub typhus.
  11 2,005 404
REVIEW ARTICLES
Ketoprofen-induced photoallergic dermatitis
Tiffany Yvonne Loh, Philip R Cohen
December 2016, 144(6):803-806
DOI:10.4103/ijmr.IJMR_626_16  PMID:28474616
Drug-induced photosensitivity reactions are significant adverse effects. Ketoprofen is one of the most common drugs that can cause skin rash in sun-exposed areas. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketoprofen, are often used for a variety of symptoms, including pain and fever. An understanding of the presentation and clinical course of ketoprofen-induced photosensitivity is necessary to correctly diagnose and manage this condition. Ketoprofen-induced photosensitivity reactions usually present as photoallergic dermatitis, which is a cell-mediated immune process. The benzophenone moiety in ketoprofen plays a major role in ketoprofen's ability to act as a photosensitizer. Several agents, such as fenofibrate and octocrylene have been found to be associated with aggravation of ketoprofen-induced photoallergic dermatitis or cross-photosensitization, and these reactions result from structural similarities with ketoprofen. Treatment of ketoprofen-induced photoallergic dermatitis includes discontinuation of ketoprofen, topical or systemic corticosteroids and avoidance of sun exposure and agents known to exacerbate dermatitis. In conclusion, photoallergic dermatitis is a significant adverse effect of ketoprofen. Some agents known to worsen dermatitis may be found in sun protection products (notably, octocrylene in sunscreen). Educating the patient to avoid these products is critical to treatment. Since NSAIDs, such as ketoprofen, are used commonly for a variety of illnesses, drug-induced photoallergic dermatitis should be high on the differential in individuals using these medications who present with acute onset of a rash in sun-exposed areas.
  9 1,339 438
ORIGINAL ARTICLES
Abundance & distribution of trombiculid mites & Orientia tsutsugamushi, the vectors & pathogen of scrub typhus in rodents & shrews collected from Puducherry & Tamil Nadu, India
Sadanandane Candasamy, Elango Ayyanar, Kummankottil Paily, Patricia Anitha Karthikeyan, Agatheswaran Sundararajan, Jambulingam Purushothaman
December 2016, 144(6):893-900
DOI:10.4103/ijmr.IJMR_1390_15  PMID:28474626
Background & objectives: Human cases of scrub typhus are reported every year from Puducherry and adjoining areas in southern India. However, information on the presence of causative agent, Orientia tsutsugamushi, and its vectors is lacking. Hence, the objective of the study was to find out the vector as well as pathogen distribution in rodents and shrews present in the scrub typhus-reported areas in southern India. Methods: Trombiculid mites were collected by combing rats and shrews collected using Sherman traps and identified to species level following standard taxonomical keys. The serum samples of the animals were used for Weil-Felix test and the clots containing blood cells were used for DNA extraction and polymerase chain reaction (PCR). Results: A total of 181 animals comprising four rodent species and one shrew species were collected from 12 villages. High proportion of chiggers was collected from the shrew, Suncus murinus (79.1%) and Rattus rattus (47.6%). A total of 10,491 trombiculid mites belonging to nine species were collected. Leptotrombidium deliense, the known vector of scrub typhus pathogen, was the predominant species (71.0%) and the chigger (L. deliense) index was 41.1 per animal. Of the 50 animals screened for the pathogen, 28 showed agglutination against OX-K in Weil-Felix test indicating the presence of antibodies against O. tsutsugamushi, the causative agent of scrub typhus. PCR carried out with the DNA extracted from blood samples of two of the animals were positive for GroEl gene of O. tsutsugamushi. Interpretation & conclusions: L. deliense index was well above the critical limit of chigger load, indicating that all the villages were receptive for high risk of transmission of scrub typhus to human. Pathogen positivity was higher among animals collected from villages recorded for higher chigger indices due to active transmission between the chigger mites and reservoir host animals. The results are suggestive of routine vector/pathogen surveillance at hot spots to initiate timely preventive measures.
  8 1,110 277
Number of decidual natural killer cells & macrophages in pre-eclampsia
Jelena Milosevic-Stevanovic, Miljan Krstic, Dragana Radovic-Janosevic, Jasmina Popovic, Marija Tasic, Slavica Stojnev
December 2016, 144(6):823-830
DOI:10.4103/ijmr.IJMR_776_15  PMID:28474619
Background & objectives: The process of human placentation is complex and still not well understood. This study was aimed to examine the relationship between clinical features of pre-eclampsia and degree of trophoblastic invasion after its immunohistochemical visualization in the context of possible alterations in the number of natural killer (NK) cells and macrophages in the decidua. Methods: This prospective study included a study group comprising 30 pregnant women with pre-eclampsia delivered by caesarean section and a control group comprising 20 healthy pregnant women also delivered by caesarean section. Samples of placental bed obtained during caesarean section were analyzed after immunohistochemical labelling CD56 + NK cells, CD68 + macrophages and cytokeratin 7 trophoblastic cells. Results: In pre-eclampsia, there was a significantly lower number of CD56 + NK cells in the decidua (P<0.001) and a higher number of CD68 + macrophages (P<0.001) compared to control group. In the subgroup of pre-eclampsia with intrauterine growth retardation (IUGR), a significantly greater number of NK cells (P<0.05) was recorded, as well as an increased number of macrophages, but not significantly compared to pre-eclampsia without IUGR. There was no significant difference in the distribution of these cells in the decidua in relation to the severity of pre-eclampsia. CD56 + NK cells were significantly less (P<0.05) and macrophages were more (P<0.05) in the group with poor trophoblastic invasion. Interpretation & conclusions: Alterations in the number of immune cells in relation to the degree of trophoblastic invasion indicated their role in aetiopathogenesis of pre-eclampsia, while the direct association between their number and severity of pre-eclampsia was not confirmed.
  7 978 319
CORRESPONDENCES
Mapping dengue cases through a national network of laboratories, 2014-2015
Vasna Joshua, Manoj V Murhekar, M Ashok, K Kanagasabai, M Ravi, R Sabarinathan, BK Kirubakaran, V Ramachandran, Nivedita Gupta, Sanjay Mehendale
December 2016, 144(6):938-941
DOI:10.4103/ijmr.IJMR_673_16  PMID:28474634
  6 1,201 285
ORIGINAL ARTICLES
Correlation of cartilage metabolic markers & antioxidants with the severity of knee osteoarthritis
Sonam Choden Bhutia, Mingma Lhamu Sherpa, SK Dewan, TA Singh
December 2016, 144(6):932-934
DOI:10.4103/ijmr.IJMR_1235_14  PMID:28474632
Osteoarthritis is characterized by the degeneration of articular cartilage. Cartilage metabolic markers have been explored as possible markers for osteoarthritis, and osteogenic protein -1 (OP-1) has emerged out to play a major role in cartilage repair. Oxidative stress has been implicated as a mediator of cartilage damage in patients with osteoarthritis. The aim of this study was to correlate the cartilage metabolic markers and antioxidants with the severity of knee osteoarthritis.
  5 851 237
Preclinical safety & toxicity evaluation of pooled, allogeneic human bone marrow-derived mesenchymal stromal cells
Mathiyazhagan Rengasamy, Pawan Kumar Gupta, Udaykumar Kolkundkar, Gurbind Singh, Sudha Balasubramanian, Swathi SundarRaj, Anoop Chullikana, Anish Sen Majumdar
December 2016, 144(6):852-864
DOI:10.4103/ijmr.IJMR_1842_15  PMID:28474622
Background & objectives: Administration of ex vivo-expanded human bone marrow-derived mesenchymal stromal cells (hBMMSC) obtained from single donors has shown therapeutic benefits in both preclinical and clinical studies. In this study, the safety, toxicity and biodistribution profiles of a pooled hBMMSC population, produced from three healthy donors were assessed in rodent and non-rodents. Methods: The pooled hBMMSC population was characterized by their expression of various cell surface markers, differentiation potential and immunomodulatory activity. To establish in vivo safety of the pooled cells, these were administered by various injection routes into rodents and non-rodents to determine overall toxicity, biodistribution and tumorigenic potential in a series of preclinical studies. Results: Single injections of hBMMSC at various doses through intravenous or intramuscular routes did not cause toxicity in rats and rabbits. In addition, repeat administration of hBMMSC was also well tolerated by rats, and no prenatal toxicity was observed by multiple administration in the same animal species. Ex vivo-expanded and cryopreserved hBMMSCs did not induce tumour formation in severe combined immunodeficient (SCID) mice. Interpretation & conclusions: Our results showed that the pooled hBMMSC population was non-toxic, non-teratogenic and non-tumorigenic in animals. Further studies need to be done to find out if it can be safely administered in human patients.
  5 1,219 403
IREB2, CHRNA5, CHRNA3, FAM13A & hedgehog interacting protein genes polymorphisms & risk of chronic obstructive pulmonary disease in Tatar population from Russia
Gulnaz Faritovna Korytina, Leysan Zinurovna Akhmadishina, Elena Vitalievna Viktorova, Olga Vladimirovna Kochetova, Tatyana Victorovna Viktorova
December 2016, 144(6):865-876
DOI:10.4103/ijmr.IJMR_1233_14  PMID:28474623
Background & objectives: Chronic obstructive pulmonary disease (COPD) is a complex chronic inflammatory disease of the respiratory system affecting primarily distal respiratory pathways and lung parenchyma. This study was aimed at investigating the association of COPD with IREB2, CHRNA5, CHRNA3, FAM13A and hedgehog interacting protein (HHIP) genes in a Tatar population from Russia. Methods: Six single nucleotide polymorphisms (SNPs) (rs13180, rs16969968, rs1051730, rs6495309, rs7671167, rs13118928) were genotyped by the real-time polymerase chain reaction in this study (511 COPD patients and 508 controls). Logistic regression was used to detect the association of SNPs and haplotypes of linked loci in different models. Linear regression analyses were performed to estimate the relationship between SNPs and lung function parameters and pack-years. Results: The rs13180 (IREB2), rs16969968 (CHRNA5) and rs1051730 (CHRNA3) were significantly associated with COPD in additive model [Padj =0.00001, odds ratio (OR)=0.64; Padj =0.0001, OR=1.41 and Padj =0.0001, OR=1.47]. The C-G haplotype by rs13180 and rs1051730 was a protective factor for COPD in our population (Padj =0.0005, OR=0.61). These results were confirmed only in smokers. The rs16969968 and rs1051730 were associated with decrease of forced expiratory volume in 1 sec % predicted (Padj =0.005 and Padj =0.0019). Interpretation & conclusions: Our study showed the association of rs13180, rs16969968 and rs1051730 with COPD and lung function in Tatar population from Russia. Further studies need to be done in other ethnic populations.
  5 1,060 268
REVIEW ARTICLES
Respiratory sinus arrhythmia as a non-invasive index of 'brain-heart' interaction in stress
Ingrid Tonhajzerova, Michal Mestanik, Andrea Mestanikova, Alexander Jurko
December 2016, 144(6):815-822
DOI:10.4103/ijmr.IJMR_1447_14  PMID:28474618
Respiratory sinus arrhythmia (RSA) is accepted as a peripheral marker of cardiac-linked parasympathetic regulation. According to polyvagal theory, the RSA is also considered as the index of emotion regulation. The neurovisceral integration model posits that parasympathetic modulation of the heart marked by RSA is related to complex nervous regulation associated with emotional and cognitive processing. From this perspective, high resting RSA amplitude associated with a greater withdrawal during stressors and subsequent recovery could represent a flexible and adaptive physiological response system to a challenge. Conversely, low resting RSA accompanied by an inadequate reactivity to stress might reflect maladaptive regulatory mechanisms. The RSA reactivity is different with various types of stressors: while the RSA decreases to cognitive tasks indicating a vagal withdrawal, the RSA magnitude increases to emotional challenge indicating an effective cognitive processing of emotional stimuli. The RSA reactivity to stress could have important implications for several mental disorders, e.g. depressive or anxiety disorder. It seems that the study of the RSA, as a non-invasive index of 'brain-heart' communication, could provide important information on the pathway linked to mental and physical health.
  5 2,144 451
PERSPECTIVE
Is elimination of kala-azar feasible by 2017?
CP Thakur
December 2016, 144(6):799-802
DOI:10.4103/ijmr.IJMR_335_16  PMID:28474615
  4 1,760 443
ORIGINAL ARTICLES
Viruses causing severe acute respiratory infections (SARI) in children ≤5 years of age at a tertiary care hospital in Rajasthan, India
Bharti Malhotra, M Anjaneya Swamy, PV Janardhan Reddy, ML Gupta
December 2016, 144(6):877-885
DOI:10.4103/ijmr.IJMR_22_15  PMID:28474624
Background & objectives: Severe acute respiratory infection (SARI) is one of the leading causes of death among children worldwide. As different respiratory viruses exhibit similar symptoms, simultaneous detection of these viruses in a single reaction mixture can save time and cost. The present study was done in a tertiary care children's hospital for rapid identification of viruses causing SARI among children less than or equal to five years of age using multiplex real-time reverse transcription polymerase chain reaction (RT-PCR) kit. Methods: A total of 155 throat swabs were collected from equal number of children suspected to have SARI and processed for extraction of nucleic acids using automated extraction system. Multiplex real-time RT-PCR was done to identify the viruses in the samples. Results: The overall positivity for viruses in the study was found to be 72.9 per cent with a co-infection rate of 19.5 per cent. Human metapneumovirus (HMPV) was the predominant virus detected in 25.7 per cent children followed by influenza A (H1N1)pdm09, human rhinovirus (HRV) and human adenovirus (HAdV) in 19.9, 11.0 and 8.8 per cent children, respectively. The HMPV was at its peak in February 2013, HAdV showed two peaks in March-April, 2012 and November 2012-March 2013 while HRV was detected throughout the year. Interpretation & conclusions: Multiplex real-time PCR helped in rapid identification of viruses. Seventeen viruses were detected in SARI cases with overall positivity of 72.9 per cent. HMPV was the most predominant virus. However, for better clinico-virological correlation, studies are required with complete work up of all the aetiological agents, clinical profile of patients and treatment outcome.
  3 2,093 402
Immunogenicity & safety of a single dose of live-attenuated Japanese encephalitis vaccine SA 14-14-2 in adults
Siraj Ahmed Khan, Sanjeeb Kakati, Prafulla Dutta, Purvita Chowdhury, Jani Borah, Rashmee Topno, Santoshkumar M Jadhav, Pradyumna K Mohapatra, Jagadish Mahanta, Mohan D Gupte
December 2016, 144(6):886-892
DOI:10.4103/ijmr.IJMR_712_15  PMID:28474625
Background & objectives: Japanese encephalitis (JE) caused by mosquito-borne Flavivirus is one of the leading causes of viral encephalitis in Asia. Control strategies include vector control and human vaccination. Due to lack of immunization programmes in endemic regions, there are still high mortality and morbidity. A live-attenuated SA 14-14-2 JE vaccine (LAJEV) has been licensed and used in Asian countries, including India. We report the assessment of immunogenicity and safety of the vaccine in adults during the first mass adult vaccination campaign carried out in Assam, India. Methods: One thousand and seventy five adults (aged ≥15 yr) who received LAJEV were monitored for adverse events following immunization for one year. The safety assessment of vaccinated population was evaluated till 28 days and at 6 and 12 months. Blood samples collected from the enrolled participants were tested by plaque reduction neutralization test (PRNT 50 ) to assess the neutralizing antibody titres (NATs) before vaccination and 28 days, six and 12 months post-vaccination (PV). Results: Among the 1075 vaccinated individuals, four reported minor adverse effects from 30 min to 28 days PV. Based on the pre-vaccination NAT, the study participants were categorized as seronegative, moderately seropositive and strongly seropositive. Nearly 85.5 per cent of JE seronegative participants seroconverted by 28 days PV. The geometric mean titre (GMT) in all the three groups increased by 28 days and decreased by six and 12 months PV. Nearly 60 per cent of the moderately positive individuals exhibited four-fold rise in GMT, 28 days PV. Almost 95.5 per cent of the participants in the study population remained seroprotected at the end of 12 months PV. Interpretation & conclusions: This study on immunogenicity and safety of LAJEV in adults showed that a single dose of the live-attenuated vaccine was safe and induced protective immunity to both JE seronegative and naturally seropositive adults. Further study is required to find out long term protective efficacy of this vaccine.
  3 1,042 289
Protection against osteoarthritis in experimental animals by nanogold conjugated snake venom protein toxin gold nanoparticle-Naja kaouthia cytotoxin 1
Antony Gomes, Partha Pratim Saha, Tanmoy Bhowmik, Anjan Kumar Dasgupta, Subir Chandra Dasgupta
December 2016, 144(6):910-917
DOI:10.4103/ijmr.IJMR_1078_14  PMID:28474628
Background & objectives: Increased severity of osteoarthritis (OA) and adverse side effects of its treatment led to the search for alternative therapies. It was previously reported that snake venom protein toxin Naja kaouthia cytotoxin 1 (NKCT1) and gold nanoparticle (GNP) individually have potential against excremental arthritis. In this study, we analyzed the protective activity of GNP conjugated protein toxin NKCT1 (GNP-NKCT1) against experimental OA. Methods: Gold nanoparticle conjugation with NKCT1 (GNP-NKCT1) was done and its physiochemical properties were studied. OA was induced in male albino rats by intra-articular injection of bacterial collagenase and treatment was done with NKCT1/GNP-NKCT1/standard drug (indomethacin). Physical parameter (ankle diameter), urinary markers (hydroxyproline, glucosamine, pyridinoline, deoxypyridinoline), serum and synovial membrane pro-inflammatory markers [tumour necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), IL-17, vascular endothelial growth factor (VEGF)] and matrix metalloproteinase 1 (MMP1) were measured. Joint histopathology and scanning electron microscopy imaging of articular cartilage surface were also done. Results: Physical parameters, urinary markers, serum and synovial membrane pro-inflammatory makers and MMP1 were increased in arthritic rats and significantly restored after GNP-NKCT1/NKCT1 treatment. Joint histopathology and scanning electron microscopy imaging of articular cartilage surface also indicated the protective effect of GNP-NKCT1 against inflammatory response and cartilage degradation in osteoarthritic rats. Interpretation & conclusions: In this study restoration of the arthritic markers and bone degradation by GNP-NKCT1 treatment indicated the anti-osteoarthritic property of GNP-NKCT1. Further studies need to be done to confirm these findings.
  3 994 267
Epidemiological & clinical profile of influenza A (H1N1) 2009 virus infections during 2015 epidemic in Rajasthan
Bharti Malhotra, Ruchi Singh, Pratibha Sharma, Deepa Meena, Jyoti Gupta, Aditya Atreya, BR Meena
December 2016, 144(6):918-923
DOI:10.4103/ijmr.IJMR_1183_15  PMID:28474629
Background & objectives: Pandemic influenza A (H1N1) 2009 virus emerged in 2009 and caused pandemic with high morbidity and mortality in India and worldwide. The number of H1N1-positive cases varied in different years in Rajasthan. The objective of the study was to present the epidemiological profile of pandemic influenza A (H1N1) 2009 virus cases in Rajasthan from January to March 2015. Methods: A retrospective descriptive, record-based analysis of suspected and confirmed cases of pandemic influenza A (H1N1) 2009 virus infection in Rajasthan, India, from January to March 2015 was performed. Testing was done as per the Centers for Disease Control guidelines at nine laboratories approved by the Government of Rajasthan. Data were analyzed in terms of demographic characteristics, clinical presentation and outcome. Results: Among 18,187 tested cases, 6203 (34.10%) were positive. Death occurred in 378 cases, with six per cent case fatality rate. Maximum number of cases (n=2801) and deaths (n=101) were from Jaipur zone. The highest number of cases, 47.60 per cent (2953/6203) and deaths, 52.11 per cent (197/378) were in the age group of 26-50 yr; 52.64 per cent (199/378) of deaths occurred in females. The highest number (63.5%) of deaths was from urban areas. Associated risk factors were observed in 59.44 per cent of the death cases, pregnancy being the predominant predisposing factor. In 61.92 per cent of patients, death occurred within three days of hospitalization. Interpretation & conclusions: H1N1 epidemic caused high morbidity and mortality in early 2015, particularly in the younger and middle-aged population and pregnant women in Rajasthan State of India. The study highlights the regular surveillance of influenza like illness, early diagnosis and timely initiation of therapy in suspected cases.
  3 2,108 381
Feeder & basic fibroblast growth factor-free culture of human embryonic stem cells: Role of conditioned medium from immortalized human feeders
Pooja Teotia, Shilpa Sharma, Balram Airan, Sujata Mohanty
December 2016, 144(6):838-851
DOI:10.4103/ijmr.IJMR_424_15  PMID:28474621
Background & objectives: Human embryonic stem cell (hESC) lines are commonly maintained on inactivated feeder cells, in the medium supplemented with basic fibroblast growth factor (bFGF). However, limited availability of feeder cells in culture, and the high cost of growth factors limit their use in scalable expansion of hESC cultures for clinical application. Here, we describe an efficient and cost-effective feeder and bFGF-free culture of hESCs using conditioned medium (CM) from immortalized feeder cells. Methods: KIND-1 hESC cell line was cultured in CM, collected from primary mouse embryonic fibroblast, human foreskin fibroblast (HFF) and immortalized HFF (I-HFF). Pluripotency of KIND-1 hESC cell line was confirmed by expression of genes, proteins and cell surface markers. Results: In culture, these cells retained normal morphology, expressed all cell surface markers, could differentiate to embryoid bodies upon culture in vitro. Furthermore, I-HFF feeder cells without supplementation of bFGF released ample amount of endogenous bFGF to maintain stemness of hESC cells. Interpretation & conclusions: The study results described the use of CM from immortalized feeder cells as a consistent source and an efficient, inexpensive feeder-free culture system for the maintenance of hESCs. Moreover, it was possible to maintain hESCs without exogenous supplementation of bFGF. Thus, the study could be extended to scalable expansion of hESC cultures for therapeutic purposes.
  3 1,010 234
Genetic polymorphisms of N-acetyltransferase 2 & susceptibility to antituberculosis drug-induced hepatotoxicity
Surendra K Sharma, Brajesh Kumar Jha, Abhishek Sharma, V Sreenivas, Vishwanath Upadhyay, Chandrita Jaisinghani, Rohit Singla, Hemant Kumar Mishra, Manish Soneja
December 2016, 144(6):924-928
DOI:10.4103/ijmr.IJMR_684_14  PMID:28474630
Background & objectives: The N-acetyltransferase 2 (NAT2) gene encodes an enzyme which both activates and deactivates arylamine and other drugs and carcinogens. This study was aimed to investigate the role of NAT2 gene polymorphism in anti-tuberculosis drug-induced hepatotoxicity (DIH). Methods: In this prospective study, polymerase chain reaction-restriction fragment length polymorphism results for NAT2 gene were compared between 185 tuberculosis patients who did not develop DIH and 105 tuberculosis patients who developed DIH while on anti-tuberculosis drugs. Results: Frequency of slow-acetylator genotype was commonly encountered and was not significantly different between DIH (82.8%) and non-DIH (77.2%) patients. However, the genotypic distribution of variant NAT2*5/*7 amongst slow-acetylator genotypes was significantly higher in DIH (56%) group as compared to non-DIH (39%) group (odds ratio 2.02; P=0.006). Interpretation & conclusions: The present study demonstrated no association between NAT2 genotype and DIH in the north Indian patients with tuberculosis.
  1 942 313
Bone marrow extract as a growth supplement for human iliac apophyseal chondrocyte culture
Balasubramanian Balakumar, Karthikeyan Rajagopal, Vrisha Madhuri
December 2016, 144(6):831-837
DOI:10.4103/ijmr.IJMR_8_15  PMID:28474620
Background & objectives: Human bone marrow is rich in various growth factors which may support the chondrocyte growth. This study was conducted to compare the culture characteristics of human growth plate chondrocyte in foetal bovine serum (FBS) and human autologous bone marrow extract (BME) in monolayer culture. Methods: Iliac crest apophyseal cartilage was harvested from four donors, aged between two and nine years, undergoing hip surgery. Chondrocytes were propagated under two culture conditions, with 10 per cent FBS and 10 per cent autologous BME harvested from the same donors. Cells were harvested at 7, 14 and 21 days to assess viability, morphology, cell count and immunocytochemistry. Results: With an initial seeding density of 2500 cells/cm 2 , the average yield in monolayer cultured with FBS was 3.35 × 10 5 , 5.9 × 10 5 , 14.1 × 10 5 and BME was 0.66 × 10 5 , 1.57 × 10 5 and 3.48 × 10 5 at 7, 14 and 21 days, respectively. Viability was 98.21 per cent with FBS and 97.45 per cent with BME at 21 days. In BME supplemented cultures, hyaline phenotype was maintained up to 21 days. The yield was higher in the FBS supplemented group; however, the phenotype could not be maintained by the FBS group as long as BME group. Interpretation & conclusions: Autologous BME was found to be a safer alternative to FBS for human studies. BME could maintain the hyaline phenotype for a longer time. Ways to enhance the cell yield needs to be explored in future studies.
  1 710 197
REVIEW ARTICLES
Diagnostic & prognostic role of microRNAs in paediatric acute myeloid leukaemia
Sachin Kumar, Sameer Bakhshi
December 2016, 144(6):807-814
DOI:10.4103/ijmr.IJMR_220_15  PMID:28474617
Dysregulation in microRNAs (miRNAs) expression has been observed in distinct acute myeloid leukaemia (AML) subtypes, and their potential as an effective diagnostic and prognostic biomarker is slowly being realized. Certain miRNAs have been found to be associated with various cytogenetic and molecular abnormalities of prognostic significance in AML. Experimental evidences have indicated the potential of modulating miRNA expression as an effective antileukaemic strategy. This has opened a new window for miRNAs-based targeted therapies. In this review, we present results of some studies analyzing the dysregulation in miRNAs expression pattern in paediatric AML and also discuss their use as diagnostic and prognostic markers.
  1 839 262
BOOK REVIEWS
Autism spectrum disorders: Phenotypes, mechanisms and treatments
V Ashok Mysore
December 2016, 144(6):948-949
DOI:10.4103/0971-5916.205403  
  - 392 153
The importance of nutrition as an integral part of disease management
Namrata Singh, Anoop Saraya
December 2016, 144(6):949-950
DOI:10.4103/0971-5916.205404  
  - 452 172
CLINICAL IMAGES
Massive cerebral infarct due to Trousseau's syndrome in gastric cancer
CA Mansoor, A Jemshad
December 2016, 144(6):945-945
DOI:10.4103/ijmr.IJMR_377_15  PMID:28474636
  - 636 192
Granulomatous cheilitis with gingival enlargement
Pooja Arora, Arvind Ahuja
December 2016, 144(6):946-947
DOI:10.4103/ijmr.IJMR_1950_15  PMID:28474637
  - 766 213
COMMENTARIES
Role of decidual natural killer cells & macrophages in pre-eclampsia
Pranab Dey
December 2016, 144(6):793-795
DOI:10.4103/ijmr.IJMR_863_16  PMID:28474613
  - 1,006 1,311
Insights into in vitro environments for human cartilage tissue engineering
Samuel J. K. Abraham, Hiroshi Yoshioka
December 2016, 144(6):796-798
DOI:10.4103/ijmr.IJMR_1237_16  PMID:28474614
  - 1,097 275
CORRESPONDENCES
Avian influenza A H7N9 virus infections not evident among high-risk groups in India
Shailesh D Pawar, Babasaheb V Tandale, Rashmi S Mali, Varsha A Potdar, Sadhana S Kode, Dipankar Biswas, Mandeep S Chadha
December 2016, 144(6):942-944
DOI:10.4103/ijmr.IJMR_718_15  PMID:28474635
  - 675 159
EDITORIAL
Eliminating HIV & AIDS in India: A roadmap to zero new HIV infections, zero discrimination & zero AIDS-related deaths
Riya Palchaudhuri, Max Niggl, Clovis Steve Palmer
December 2016, 144(6):789-792
DOI:10.4103/ijmr.IJMR_1902_16  PMID:28474612
  - 1,323 1,444
ORIGINAL ARTICLES
Nasopharyngeal aspirate & blood cytokine profile in infants hospitalized for respiratory syncytial virus bronchiolitis: A pilot study from south India
Suresh Natarajan, Ganesh Ramasamy, N Pavan Kumar, S Subash Babu, Lalitha Janakiraman
December 2016, 144(6):929-931
DOI:10.4103/ijmr.IJMR_1120_14  PMID:28474631
Background & objectives: Following a respiratory syncytial virus (RSV) bronchiolitis, only some infants develop serious illness, and a proportion of them develop recurrent wheeze subsequently. Studies have revealed that cytokine expression following RSV infection may influence the severity and also the risk for subsequent reactive airway disease. This present study was conducted to determine the blood, and nasopharyngeal aspirate (NPA) cytokine profile among infants admitted for RSV bronchiolitis. Methods: In this prospective pilot study, a sample size of 15 cases and 15 controls was included. Detailed history, physical examination, blood sample and NPA collection were done. Cytokines (IFNγ and IL-4) estimation was done in the blood and NPA samples of cases and blood samples of controls. Results: The mean levels of interferon gamma in controls (blood) and cases (NPA and blood) were 5.95, 9.54 and 32.02 pg/ml, respectively. The mean levels of interleukin-4 in controls (blood), and cases (NPA and blood) were 1280.77, 956.08 and 692.37 pg/ml, respectively (P<0.05). Interpretation & conclusions: Our study showed that infants with RSV bronchiolitis evoked a Th1 response in both blood and NPA. Large multicentre studies are needed to validate our findings.
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PANEL OF REVIEWERS (2016)
Panel of Reviewers (2016)

December 2016, 144(6):951-968
Full text not available  [PDF]  [Mobile Full text]  [EPub]
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STUDENT IJMR
Echocardiographic abnormalities in cirrhosis & their correlation with severity of cirrhosis using Child-Pugh score among patients in a tertiary care hospital
Jagruti Balde, N Karthik Rao, Kirthinath Ballala, Jyothi Samanth, K Ranjan Shetty, Navin Patil, A Avinash, George Varghese
December 2016, 144(6):935-937
DOI:10.4103/ijmr.IJMR_1486_15  PMID:28474633
Background & objectives: Child-Pugh score (CPS) is a widely used prognostic marker in cases of cirrhosis and pulmonary arterial hypertension (PAH). However, the role of this score in the quantification of severity of PAH is not well studied. In mild cases, echocardiography is more sensitive. This study was done to assess the association between echocardiography and severity of cirrhosis using CPS. Methods: A cross-sectional study was done from April to June 2014 in 42 patients with cirrhosis using a pre-tested semi-structured interview schedule. Results: There was no significant association between echocardiographic changes and CPS in patients with liver cirrhosis. Interpretation & conclusions: Advising an echocardiographic evaluation may prove beneficial in patients of Child-Pugh Grades B and C. However, more extensive studies are required to confirm the same.
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