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S Jain

Publications and source records attributed to S Jain.

At least 325 records · Page 18Linked to original sources

Expression of ARNT, ARNT2, HIF1 alpha, HIF2 alpha and Ah receptor mRNAs in the developing mouse.

The basic helix-loop-helix-PAS (bHLH-PAS) protein ARNT is a dimeric partner of the Ah receptor (AHR) and hypoxia inducible factor 1 alpha(HIF1 alpha). These dimers mediate biological responses to xenobiotic exposure and low oxygen tension. The recent cloning of ARNT and HIF1(homologues (ARNT2 and HIF2 alpha) indicates that at least six distinct bHLH-PAS heterodimeric combinations can occur in response to a number of environmental stimuli. In an effort to understand the biological relevance of this combinatorial complexity, we characterized their relative expression at a number of developmental time points by parallel in situ hybridization of adjacent tissue sections. Our results reveal that in general there is limited redundancy in the expression of these six transcription factors and that each of these bHLH-PAS members displays a unique pattern of developmental expression emerging as early as embryonic day 9.5.

Animals↗

Epilepsies among twins born in families of Indian probands with epilepsy.

Twins have a high frequency of adverse perinatal events and have been reported to have an increased risk of seizures. Contrary to popular belief, a recent study reported that twins do not have an increased risk of seizures. We studied the relationship of twinning and epilepsy in India. The frequency of twinning in families of probands with epilepsy was compared with the frequency of twinning among hospital births in the same region of India. We also compared consecutively ascertained probands with epilepsy for their twin status and the occurrence of epilepsies in their twin and non-twin relatives. The frequency of twin births in families of 524 probands with epilepsy was comparable to the twin births among consecutive deliveries over a 3-year period in another government hospital in the same catchment area (1:99 vs. 1:75). Every 1 in 58 of probands with epilepsy was a twin while a twin was born in these families every 1 in 71 live births. The frequency of epilepsy in non-proband twin relatives was 1.5% compared with 2% among non-proband, non-twin relatives. This data suggests that twin birth is not a major risk factor for seizures even in families of Indian probands with epilepsy. Family data such as ours can be used to study the contribution by genetic factors in the pathogenesis of complex genetic diseases such as human epilepsies.

Adult↗

Prognostic evaluation of early indicators in fulminant hepatic failure by multivariate analysis.

Viral hepatitis is the commonest cause of fulminant hepatic failure (FHF) in developing countries. We evaluated the early indicators of prognosis in these patients by multivariate analysis. The records of 204 consecutive patients with acute liver failure admitted with hepatic encephalopathy over five years were studied. The etiology of these patients included virus related in 186 (91.1%), drug induced in 15 (7.4%), Wilson's disease in one (0.5%), acute Budd-Chiari syndrome in one (0.5%), and malignant infiltration in one (0.5%). Patients with FHF complicating viral hepatitis were analyzed by univariate and multivariate analysis. These patients were further subclassified depending upon the interval between the onset of jaundice and the onset of encephalopathy into hyperacute (HALF; interval 0-7 days), acute (ALF; interval 8-28 days) and subacute liver failure (SALF; interval 4-12 weeks). Sixty (32.3%) patients with viral hepatitis survived. Univariate analysis showed that the interval between onset of encephalopathy and onset of jaundice, grade of encephalopathy, raised intracranial pressure, prothrombin time, and serum bilirubin levels on admission were related to outcome in these patients. Multivariate logistic regression analysis showed that the presence of raised intracranial pressure at the time of admission, prothrombin time >100 sec on admission, age (>50 yr), and onset of encephalopathy seven days after onset of jaundice were associated with poor prognosis. Forty seven (37.0%) of 129 patients with HALF survived compared with 9 (22.5%) of 40 with ALF and 4 (21.1%) of 19 with SALF (P = NS). Raised intracranial pressure was more frequent in patients with HALF (48.8%) than in patients with ALF (32.5%) and SALF (15.8%; P = 0.01), while clinically detectable ascites was more frequent in patients with SALF (78.9%) compared with HALF (19.7%) and ALF (37.5%; P < 0.0001). The factors adversely affecting the outcome in our patients with FHF complicating viral hepatitis include presence of overt clinical features of raised ICP at the time of hospitalization, prothrombin time (>100 sec) on admission, age (>50 yr), and onset of encephalopathy seven days after onset of jaundice.

Adolescent↗

The role of peer review in internal quality assurance in cytopathology.

In 1992 we set up a peer review system to address all the steps involved in the production of a cytopathology report. The aim of the study was to generate accurate, timely and clinically relevant cytopathology reports. During a four year period we monitored and recorded activities such as turnaround time and adequacy of sampling as well as errors including typographical, SNOMED, coding, technical, labelling of slides, clerical, macroscopic and microscopic errors. The findings were discussed at weekly laboratory meetings attended by technical, scientific, clerical and medical staff. Minor errors not needing immediate action were discussed and incorporated as future improvements into the workings of the laboratory. For major discrepancies with potential implications for patient management, supplementary reports were issued and the relevant clinician was informed of the outcome. Detailed peer review of 1.3% of the total workload, during the period of the study, led to comments on some aspects of the original report in 24.9% of the reviewed cases. The majority of comments (57%) were minor, concerning issues related to the pre-analytical (clinical history, demographics, clerical and technical) aspects of the cases. The post analytical (microscopic description, diagnosis, recommendation and coding) phase of cases attracted 43% of the comments. In 1.1% of cases, the reviewer made suggestions regarding the diagnosis, and in 0.4% of cases a different recommendation was made. Cost-benefit analysis revealed that our internal quality assurance (IQA) activities added $1.20 to the total cost of each cytopathology case received and processed in the laboratory. On the benefit side, analysis of the data showed a continuous fall in the number of errors in both the pre-analytical and post-analytical phases of report generation. Furthermore, the turnaround time fell from 3.0 days at the beginning of the study to 1.7 days at present. These IQA activities have highlighted the importance of such a review system in detecting errors in cytopathology reporting. Recognition of the fact that cytopathology suffers from observer variability has led to the adoption of a uniform approach to cytological reporting among cytotechnologists and pathologists.

Costs and Cost Analysis↗

Histologic-radiologic correlation of mammographically detected microcalcification in stereotactic core biopsies.

Core biopsy is an alternative technique to surgical excision for assessment of nonpalpable mammographically detected suspicious lesions. The pattern of radiologic calcification is often considered to have diagnostic importance. The aim of this study was to correlate radiologic and histologic features of calcification, with respect to appearance, distribution, and size, to determine the significance, if any, of different radiologic patterns of calcification. Core biopsy samples from 124 women who had 129 mammographically suspicious areas of calcification were examined. Core biopsy samples (five cores per procedure) were obtained stereotactically using a 14-gauge needle in an automated Biopty (Bard Australia, Chatswood, NSW, Australia) gun. In 30 lesions no histologic calcification was found. In the others, there was a poor correlation between radiology and histology with respect to the appearance and distribution of calcification. In a subgroup of 53 women, radiographs of biopsy cores were available to allow correlation with the size of histologic calcification. Calcification of <100 microm assessed histologically was not visible on core biopsy specimen radiographs and may not represent the calcification seen mammographically. Thus, radiography of core biopsy samples and histologic measurement of the size of calcification in core biopsy specimens is useful to reduce false-negative diagnoses in which a biopsy has been performed to evaluate mammographically suspicious calcifications.

Biopsy↗

Inoculation cutaneous tuberculosis.

Two cases of inoculation cutaneous tuberculosis are presented. As commonly occurs, the diagnosis could not be confirmed bacteriologically due to the small numbers of organisms present. However, both patients responded to antituberculosis chemotherapy.

Adolescent↗

Free versus pedicled omental grafts for limb salvage in Buerger's disease.

BACKGROUND: Buerger's disease is a disabling and progressive disease that affects young smokers with a variable and unpredictable course. Free or pedicled omental transfer are the possible modes of management for these patients, and these modes are compared in the present study. METHODS: Of the 43 patients who had Buerger's disease who were treated at the Department of Surgery, Jawahar Lal Nehru (JLN) Hospital, Ajmer, between January 1990 and December 1995, 15 patients underwent application of free omental grafts (group A); 28 patients underwent pedicled omental transplantation (group B). The clinical results obtained with the use of either technique were compared. RESULTS: There were no statistically significant differences in the relief of intermittent claudication (80% vs 82%), rest pain (82% vs 91%), coldness (83% vs 87%), discolouration (80% vs 82%), ulceration (75% vs 78%) and post-amputation ulcer healing (75% vs 86%) in the two groups (P > 0.05); but the time taken for the relief of intermittent claudication, rest pain and coldness was significantly less in group B. Major amputations were not required in both the groups. CONCLUSIONS: These findings suggest that the ultimate clinical benefits obtained with the use of either free or pedicled omental grafts in patients with Buerger's disease are similar, supporting a possible local action of the omentum.

Adult↗

Juvenile myoclonic epilepsy: disease expression among Indian families.

OBJECTIVES: Juvenile myoclonic epilepsy (JME) is a common, age related, idiopathic generalized epileptic syndrome. We aimed to define the expression of JME in Indian probands and study the occurrence of seizures/epileptic syndromes in their family members. METHODS: We studied 225 JME probands with a uniform protocol. recording the type and frequency of seizures, precipitating factors, EEG data, and family history. Detailed family pedigrees were drawn to include all the 1st- and 2nd-degree relatives of probands. The seizures/epileptic syndromes in relatives examined were classified in a uniform way. RESULTS: The clinical and EEG characteristics of 225 JME probands from India were similar to those reported in probands from different ethnic backgrounds. The incidence of febrile convulsions in probands with JME was similar to that of the general population but was much lower (0.2%) among their relatives. A positive family history of seizures among 1st- or 2nd-degree relatives was noted in 79 of 225 (35%) probands. The risk of relatives being affected as well as their risk of expressing a type of idiopathic generalized epilepsy (IGE) varied as a function of the degree of relation with the probands. CONCLUSIONS: The clinical expression of JME among probands from India is fairly similar to that reported in probands of different ethnic backgrounds. The risk of relatives being affected as well as their risk of expressing a type of IGE (including JME) varies as a function of the degree of relation with the probands. The reduced occurrence of febrile convulsions among the relatives of JME probands probably represents an ascertainment bias. A much larger database of this type should be helpful in understanding the interactions of different genes that are believed to be responsible for some of the inherited human epileptic syndromes like JME and other IGEs.

Adolescent↗

Deletion of algK in mucoid Pseudomonas aeruginosa blocks alginate polymer formation and results in uronic acid secretion.

Chronic pulmonary infection with Pseudomonas aeruginosa is a common and serious problem in patients with cystic fibrosis (CF). The P. aeruginosa isolates from these patients typically have a mucoid colony morphology due to overproduction of the exopolysaccharide alginate, which contributes to the persistence of the organisms in the CF lung. Most of the alginate biosynthetic genes are clustered in the algD operon, located at 34 min on the chromosome. Alginate biosynthesis begins with the formation of an activated monomer, GDP-mannuronate, which is known to occur via the products of the algA, algC, and algD genes. Polymannuronate forms in the periplasm, but the gene products involved in mannuronate translocation across the inner membrane and its polymerization are not known. One locus of the operon which remained uncharacterized was a new gene called algK between alg44 and algE. We sequenced algK from the mucoid CF isolate FRD1 and expressed it in Escherichia coli, which revealed a polypeptide of the predicted size (52 kDa). The sequence of AlgK showed an apparent signal peptide characteristic of a lipoprotein. AlgK-PhoA fusion proteins were constructed and shown to be active, indicating that AlgK has a periplasmic subcellular localization. To test the phenotype of an AlgK-mutant, the algK coding sequence was replaced with a nonpolar gentamicin resistance cassette to avoid polar effects on genes downstream of algK that are essential for polymer formation. The algKdelta mutant was nonmucoid, demonstrating that AlgK was required for alginate production. Also, AlgK- mutants demonstrated a small-colony phenotype on L agar, suggesting that the loss of AlgK also caused a growth defect. The mutant phenotypes were complemented by a plasmid expressing algK in trans. When the algKdelta mutation was placed in an algJ::Tn501 background, where algA was not expressed due to polar transposon effects, the growth defect was not observed. AlgK- mutants appeared to accumulate a toxic extracellular product, and we hypothesized that this could be an unpolymerized alginate precursor. High levels of low-molecular-weight uronic acid were produced by the AlgK- mutant. When AlgK- culture supernatants were subjected to dialysis, high levels of uronic acids diffused out of the dialysis sac, and no uronic acids were detectable after extensive dialysis. In contrast, the mucoid wild-type strain produced only polymerized uronic acids (i.e., alginate), whereas the algKdelta algJ::Tn501 mutant produced no uronic acids. Thus, the alginate pathway in an AlgK- mutant was blocked after transport but at a step before polymerization, suggesting that AlgK plays an important role in the polymerization of mannuronate to alginate.

Alginates↗

Internal quality assurance activities of a surgical pathology department in an Australian teaching hospital.

AIM: To assess the role of a quality assurance programme in improving the service provided by a surgical pathology department. METHODS: A continuous internal quality assurance study of the activities of an anatomical pathology department in an Australian teaching hospital was undertaken over a five year period. This addressed all steps involved in the production of a surgical pathology report. These were addressed in an open forum which included technical, scientific, clerical, and medical staff. Minor errors not needing immediate action were discussed and incorporated into laboratory practice. For major discrepancies with potential implications for patient management supplementary reports were issued and the relevant clinician informed of the outcome. RESULTS: Comprehensive peer review of 8.9% of the total workload of the department (3530 cases) and all the frozen sections (916 cases) over a period of five years, beginning in 1991, led to comments on some aspects of the original report by the reviewer in 19.6% of the cases. The great majority of the comments were minor, concerning issues related to the microscopic findings (4%), macroscopic description (3.1%), clerical aspects (3%), typographical errors (3%), coding errors (2.7%), technical errors including poor sections and incorrect labelling (1.7%), inadequate clinical history (1.2%), and incomplete or incomprehensible diagrams (0.9%). In two cases (0.05%) the original report did not state proximity of the tumour to surgical margins and in three of the frozen sections (0.3%) the original diagnosis was incorrect. However, in these cases the frozen section assessment did not alter the overall management of the cases. CONCLUSIONS: This study highlights the importance of a review system in detecting errors in surgical pathology reporting. Recognition of the fact that surgical pathology is not infallible has improved the end product. It has also minimised interobserver variability in the department, resulting in a uniform approach among the pathologists to macroscopic description, specimen sampling, special stains, and histological reporting.

Cryopreservation↗

Fatal non-bacterial thrombotic endocarditis following viperine bite.

Non-bacterial thrombotic endocarditis (NBTE) commonly occurs in patients with wasting disease (e.g. malignancy) or with valves damaged following trauma due to intra-cardiac foreign body, scarring or marked turbulence. Although disseminated intravascular coagulation (DIC) is well documented following viperine bite and the underlying mechanism of NBTE is thought to be DIC, there is no report of NBTE in humans following snake bite. We report a young male who following viperine bite developed local swelling, superficial gangrene of tissues at the site of bite, and oliguria and died following multiple cerebral infarcts and acute renal failure. The post-mortem examination showed NBTE of the aortic valve, multiple embolic infarcts of brain, spleen and kidneys, acute tubular necrosis and features of DIC in the brain in the form of fibrin thrombi in the capillaries, perivascular hemorrhages and necrosis.

Adult↗

Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage.

OBJECTIVE: This study was designed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses. SUBJECTS AND METHODS: In a randomized study, 50 patients (38 males and 12 females; age range, 2-72 years; average age, 35 years) with liver abscesses (amebic, 20; pyogenic, 11; indeterminate, 19) underwent either percutaneous needle aspiration (n = 25) or catheter drainage (n = 25) along with appropriate antimicrobial therapy. In patients assigned to the needle aspiration group, an 18-gauge needle was used to aspirate the abscess cavity. Repeated aspiration was attempted only once in each patient not responding to the first aspiration; nonresponse to the second aspiration was considered failure of treatment, and these patients were given catheter drainage (however, these patients were not included in the catheter drainage group). For catheter drainage, 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique. In patients with multiple abscesses (seven in aspiration group and five in catheter group), all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment. Patients were followed up to assess the outcome of the percutaneous treatment, length of hospital stay, and development of any complications. Sonography was performed every third day during hospitalization. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved. RESULTS: Although percutaneous needle aspiration was successful in only 15 (60%) of the 25 patients after one (n = 11) or two (n = 4) aspirations, catheter drainage was curative in all 25 patients (100%) (p < .05). Among the successfully treated patients, the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups. Although the average time needed for a 50% reduction in the size of the abscess cavity was significantly (p < .05) greater in the aspiration group than in the catheter group (11 days versus 5 days), the average time taken for total resolution of abscess was the same (15 weeks) in both groups. No major complications were encountered. No relapse was documented on clinical and sonographic examination during follow-up, which ranged from 8 to 37 weeks. CONCLUSION: Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses. Needle aspiration, if limited to two attempts, has a high failure rate.

Adolescent↗