Culture Positive Brucella Endocarditis in a Case of Baloon Mitral Valvotomy

Brucella endocarditis is a rare condition which occurs as a focal complication in chronic brucellosis cases. We report a rare brucella endocarditis case in a RVHD patient. A 26 years old male was admitted with fever on off for almost one year. The blood culture yielded growth of Brucella melitensis after ten days of incubation. Isolated colonies were reconfirmed as Brucella species by PCR study. Patient’s serum tested positive for brucella slide agglutination test and STAT titer was 640IU. Echocardiography showed vegetation on mitral valve. Patient was treated with both medical and surgical intervention. After chemotherapy, patient’s blood culture was sterile, slide agglutination & STAT (40IU) were negative. Repeat echocardiography showed no fresh vegetation. Considering high mortality rate (80%) in Brucella endocarditis, it is very important for clinicians to suspect it. Prompt antibiotic therapy and surgical intervention is life saving in fatal cases

Degradation of Internalized αvβ5 Integrin Is Controlled by uPAR Bound uPA: Effect on β1 Integrin Activity and α-SMA Stress Fiber Assembly

Myofibroblasts (Mfs) that persist in a healing wound promote extracellular matrix (ECM) accumulation and excessive tissue contraction. Increased levels of integrin αvβ5 promote the Mf phenotype and other fibrotic markers. Previously we reported that maintaining uPA (urokinase plasminogen activator) bound to its cell-surface receptor, uPAR prevented TGFβ-induced Mf differentiation. We now demonstrate that uPA/uPAR controls integrin β5 protein levels and in turn, the Mf phenotype. When cell-surface uPA was increased, integrin β5 levels were reduced (61%). In contrast, when uPA/uPAR was silenced, integrin β5 total and cell-surface levels were increased (2–4 fold). Integrin β5 accumulation resulted from a significant decrease in β5 ubiquitination leading to a decrease in the degradation rate of internalized β5. uPA-silencing also induced α-SMA stress fiber organization in cells that were seeded on collagen, increased cell area (1.7 fold), and increased integrin β1 binding to the collagen matrix, with reduced activation of β1. Elevated cell-surface integrin β5 was necessary for these changes after uPA-silencing since blocking αvβ5 function reversed these effects. Our data support a novel mechanism by which downregulation of uPA/uPAR results in increased integrin αvβ5 cell-surface protein levels that regulate the activity of β1 integrins, promoting characteristics of the persistent Mf

Genetic association study of selected candidate genes (ApoB, LPL, Leptin) and telomere length in obese and hypertensive individuals

<p>Abstract</p> <p>Background</p> <p>A genetic study was carried out among obese and hypertensive individuals from India to assess allelic association, if any, at three candidate loci: Apolipoprotein B (ApoB) minisatellite and two tetranucleotide repeat loci; LPL (Lipoprotein lipase) and Leptin. Attempt has also been made to find out whether telomere length attrition is associated with hypertension and obese individuals.</p> <p>Methods</p> <p>Venous blood samples were collected from 37 normal, 35 obese and 47 hypertensive individuals. Genomic DNA was extracted from peripheral blood mononuclear cells (PBMC) and PCR amplifications were achieved using locus specific primers. Genotyping of ApoB minisatellite was performed using 4% polyacrylamide gel electrophoresis (PAGE) followed by silver staining, whereas LPL and Leptin loci were genotyped using ALF Express™ DNA sequencer. Telomere length was determined using a recently developed real time based quantitative PCR, where the relative telomere length was determined by calculating the relative ratio of telomere (T) and single copy gene (S) PCR products which is expressed as T/S ratio.</p> <p>Results</p> <p>All the three loci are highly polymorphic, display high heterozygosity and conform to Hardy-Weinberg's equilibrium expectations. ApoB minisatellite displayed 14 alleles, whereas LPL and Leptin tetranucleotide loci were having 9 and 17 alleles, respectively. Interestingly two new alleles (9 and 11 repeats) were detected at ApoB locus for the first time. The alleles at Leptin locus were classified as Class I (lower alleles: 149-200 bp) and Class II alleles (higher alleles: >217 bp). Higher alleles at ApoB (>39 repeats), predominant allele 9 at LPL and alleles 164 bp and 224 bp at Leptin loci have shown allelic association with hypertensive individuals. After adjusting the influence of age and gender, the analysis of co-variance (ANCOVA) revealed the relative telomere length (T/S ratio) in hypertensive individuals to be (1.01 ± 0.021), which was significantly different (P < 0.001) from obese (1.20 ± 0.023) and normal (1.22 ± 0.014) individuals. However, no significant difference in the relative telomere length was observed among male and female individuals, although age related decrease in telomere length was observed in these limited sample size.</p> <p>Conclusion</p> <p>The present study revealed that allelic association at ApoB, LPL, Leptin loci and loss of telomere length may have strong genetic association with hypertensive individuals. However, further study on larger sample size is needed to draw firm conclusions.</p

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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ICAR: endoscopic skull‐base surgery

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Primary desmoplastic small round cell tumor of the testis: First case in India and review of the literature

The purpose of this study is to describe the aggressive clinical behavior of desmoplastic small round cell tumor (DSRCT) of the testis and review of the literature. A 17-year-old male having painless testicular mass and neck swelling diagnosed to have metastatic DSRCT of the testis. Patient received aggressive chemotherapy with P6 protocol. The patient progressed on treatment and died due to extensive metastasis. Primary DSRCT of the testis is extremely rare mesenchymal tumor occurring in adolescence, with a tendency for extensive metastases. Management should be multimodal approach with aggressive polychemotherapy, surgical tumor debulking and radiotherapy. However the overall prognosis is very poor with <20% survival rates at 2 years

Culture Positive Brucella Endocarditis in a Case of Baloon Mitral Valvotomy

Brucella endocarditis is a rare condition which occurs as a focal complication in chronic brucellosis cases. We report a rare brucella endocarditis case in a RVHD patient. A 26 years old male was admitted with fever on off for almost one year. The blood culture yielded growth of Brucella melitensis after ten days of incubation. Isolated colonies were reconfirmed as Brucella species by PCR study. Patient’s serum tested positive for brucella slide agglutination test and STAT titer was 640IU. Echocardiography showed vegetation on mitral valve. Patient was treated with both medical and surgical intervention. After chemotherapy, patient’s blood culture was sterile, slide agglutination & STAT (40IU) were negative. Repeat echocardiography showed no fresh vegetation. Considering high mortality rate (80%) in Brucella endocarditis, it is very important for clinicians to suspect it. Prompt antibiotic therapy and surgical intervention is life saving in fatal cases