Maternal fetal immunological relationship particularly mycobacterial immunity

Thirty-nine paired maternal and cord blood from normal full term deliveries were tested for lymphocyte function by proliferative response to mitogens – Phytohemagluttin-P (PHA) and Poke weed mitogens (PWM). Monocyte function was assessed by the ability of the monocytes to release hydrogen peroxide (H 2O2 ) in response to standard stimulus (PMA). Mycobacterial immunity was assessed by lymphocyte proliferative response to purified proteins derivative (PPD) and IgM and IgG antibody response to H37Rv and 5 atypical mycobacteria. Lymphocyte functions were significantly lower in cord blood (PHA 20.6, PWM 21.2) as compared with maternal blood (PHA 65.8, PWM 37.8). The capacity of fetal monocytes to release H2O2 was comparable to maternal monocytes. The mean proliferative response of fetal lymphocytes to tubercular protein (PPD) was 0.67 as compared (P< 0.01) tO maternal lymphocytes (3.79). Nearly 86% of the cord blood did not show any response to PPD. None of the cord blood showed IgM antibody response to H37RV nor to any of the range of 5 atypical mycobacteria though maternal IgM and IgG response was present. There was only passive transfer of IgG antibody from mother to fetus. Hence, though this is a highly endemic area for atypical mycobacteria and M. tuberculosis, there was apparently 170 transplacental transfer of antigen in normal sensitized mothers

Immune response to BCG vaccination in children

The world-wide programme of mass BCG vaccination started in 1921' and used extensively since the forties has provided evidence that BCG vaccine has a protective value. This was confirmed by studies done on experimental animals.2 Despite this, no vaccination has become more controversial than BCG vaccination in recent times. The protection conferred by BCG vaccination in children is important because of the serious consequences of tuberculosis in them. The aim of this study was to assess the immunological response of children to BCG vaccination

Surface markers of lymphoblasts in acute lymphoblastic leukaemia

58 children with acute lymphoblastic leukaemia (ALL) were studied for the effect of initial clinical and laboratory features and surface markers of lymphoblasts on the prognosis. 18.9% of them had T cell leukaemia while 3.4% had B-cell leukaemia. Six pre-treatment features were related to T-cell ALL, i.e. - age over 6 years, boys, presence of mediastinal enlargement, haemoglobin over 8g/dl, markedly elevated leucocyte count and CNS involvement. 90% of T-Cell ALL survived for less than 6 months. Both the cases of B-cell leukaemia died within 8 weeks. Identification of T and B cell leukaemia warrants more aggressive treatment for these patients to achieve remission and survive longer

Impact of real-time ultrasound guidance on complications of percutaneous dilatational tracheostomy: a propensity score analysis

Abstract Introduction Recent studies have demonstrated the feasibility of real-time ultrasound guidance during percutaneous dilatational tracheostomy, including in patients with risk factors such as coagulopathy, cervical spine immobilization and morbid obesity. Use of real-time ultrasound guidance has been shown to improve the technical accuracy of percutaneous dilatational tracheostomy; however, it is unclear if there is an associated reduction in complications. Our objective was to determine whether the peri-procedural use of real-time ultrasound guidance is associated with a reduction in complications of percutaneous dilatational tracheostomy using a propensity score analysis. Methods This study reviewed all percutaneous dilatational tracheostomies performed in an 8-year period in a neurocritical care unit. Percutaneous dilatational tracheostomies were typically performed by trainees under guidance of the attending intensivist. Bronchoscopic guidance was used for all procedures with addition of real-time ultrasound guidance at the discretion of the attending physician. Real-time ultrasound guidance was used to guide endotracheal tube withdrawal, guide tracheal puncture, identify guidewire entry level and confirm bilateral lung sliding. The primary outcome was a composite of previously defined complications including (among others) bleeding, infection, loss of airway, inability to complete procedure, need for revision, granuloma and early dislodgement. Propensity score analysis was used to ensure that the relationship of not using real-time ultrasound guidance with the probability of an adverse outcome was examined within groups of patients having similar covariate profiles. Covariates included were age, gender, body mass index, diagnosis, Acute Physiology and Chronic Health Evaluation II score, timing of tracheostomy, positive end-expiratory pressure and presence of risk factors including coagulopathy, cervical spine immobilization and prior tracheostomy. Results A total of 200 patients underwent percutaneous dilatational tracheostomy during the specified period, and 107 received real-time ultrasound guidance. Risk factors for percutaneous dilatational tracheostomy were present in 63 (32%). There were nine complications in the group without real-time ultrasound guidance: bleeding (n = 4), need for revision related to inability to ventilate or dislodgement (n = 3) and symptomatic granuloma (n = 2). There was one complication in the real-time ultrasound guidance group (early dislodgement). The odds of having an adverse outcome for patients receiving real-time ultrasound guidance were significantly lower (odds ratio = 0.08; 95% confidence interval, 0.009 to 0.811; P = 0.032) than for those receiving a standard technique while holding the propensity score quartile fixed. Conclusions The use of real-time ultrasound guidance during percutaneous dilatational tracheostomy was associated with a significant reduction in procedure-related complications.http://deepblue.lib.umich.edu/bitstream/2027.42/111730/1/13054_2015_Article_924.pd

Study of the Anatomical variations of the liver in Human

INTRODUCTION: The liver is the largest abdominal organ. Variations of the liver can occur in the form of external morphology and the internal branching pattern of the hepatic vasculature. Knowledge about the normal and variant anatomy is essential for the interventional radiologist and the hepatobiliary surgeons for a better postoperative results. AIM OF THE STUDY: To describe the anatomical variations of the hepatic artery and portal vein (PV) within the liver in terms of branching pattern and determine the frequency of each pattern. MATERIAL AND METHODS: The morphological features were studied using 70 formalin fixed livers. The branching pattern of the hepatic vasculature was studied using 100 contrast enhanced computed tomography and 15 formalin fixed livers each for hepatic artery and PV using modified luminal casting technique. RESULTS: The morphological variations include fissures in the right, left, caudate and quadrate lobes of the liver (81.4 %), elongated left lobe or Beaver's lobe or Netter's type 4 (12.86 %), Netter type 2 liver (1.43%), pons hepatis (22.9 %), conical shaped right lobe (18.57%), notched border (10%) and accessory lobe (12.86%). Variations in caudate lobe including underdeveloped and hypertrophied caudate and papillary process were noted. Variations in the extra-hepatic branching of the vasculature was found in 22%. The most common variation was the replaced right hepatic artery (RHA), seen in 13%. The normal intra-hepatic branching pattern was observed in 53.33%. The RHA gave rise to cystic artery and artery to caudate lobe. In 6.6%, the cystic artery arose from left hepatic artery and in 6.6%, the artery to caudate lobe arose from left hepatic artery. Caudate lobe also received dual supply from RHA. The right anterior division of RHA, in addition to its supply to segments V and VIII, it also supplied caudate lobe (20%), cystic artery (6.67%), segment IV (6.67%) and segment VI (6.67%). The right posterior division in addition to its supply to segments VI and VII, it also supplied gall bladder (6.67%), caudate lobe (6.67%), segment V (13.33%) and VIII (13.33%). Radiologically, the normal PV anatomy was seen in 89%. The most common variation was trifurcation of PV (5 %). In one case the left PV gave a branch to segment VII which has not been encountered earlier. Using the modified luminal casting technique all the 15 specimens displayed Type I PV anatomy. Variations were encountered in the intra-hepatic branching pattern and the most common variant pattern observed was the right posterior segmental division supplying segment VIII and only in one case a rare left PV variation, in which it gave branches to segments V and VIII was noted. CONCLUSION: In this study, various morphological variations of liver were observed. Variations in the segmental supply was observed which has not been studied in detail previously in the Indian population. In both hepatic arterial and PV branching patterns, the variations on the left side are infrequent. A prior knowledge of such variations will help the interventional radiologist to reduce misinterpretations and subsequent misdiagnosis and guide the hepatobiliary surgeon in minimizing iatrogenic complications

Cell mediated immunity in post-streptococcal glomerulonephritis

Cell mediated immunity was assessed in 30 children with acute post streptococcal glomerulonephritis (APSGN) in parallel with 20 normal children and 15 children without nephritis who showed evidence of skin-sore ß-Hemolytic streptococcal infection. Delayed cutaneous hypersensitivity to 2,4, dinitrochloro benzene (DNCB) was similar in the three groups. There were no significant differences in the proportion of early and total T-rosettes. Lymphocyte transformation response to phytohemagglutinin- P (PHA), purified protein derivative (PPD) and BCG was similar in them, indirect leucocyte migration inhibition response to PPD, streptokinase streptodornase (SK-SD), and group A ß-Hemolytic T12 streptococcal antigens were not significantly different in patients when compared to normal controls and streptococcal infection controls. Cell mediated immunity was normal in APSGN in children by all the parameters studied

Humoral immunity in acute post-streptococcal glomerulonephritis

children with acute post-streptococcal glomerulonephritis in parallel with IS children with only skin streptococcal infection and 20 normal children. B-lymphocytes as assessed by EAC rosettes estimation was significantly elevated in patients. Markedly high anti-DNase B antibody titres were demonstrated in patients and to a less extent in skin infection controls, as compared to normal controls. C3 levels were decreased in all the patients and C4 levels were decreased in 76%. The levels returned to normal 2 months later. C3 and C4 levels were normal in skin infection and normal controls. Serum IgG, IgM, IgA were normal in patients and Rheumatoid factor was positive in only 24% o f patients, all of whom had a low positive titre. These studies indicate marked humoral immune response to streptococcal infection in patients with APSGN. IgG anti-IgG immune complex did not play a sign&ant role in our patients

A Propensity Score Analysis of the Impact of Invasive Intracranial Pressure Monitoring on Outcomes after Severe Traumatic Brain Injury

Although a recent clinical trial (BEST TRIP) demonstrated no improvement in outcomes with invasive intracranial pressure (ICP) monitoring (ICPM) following severe traumatic brain injury (TBI), its generalizability has been called into question. In several global settings ICPM is not the standard of care and is used at the discretion of the attending neurosurgeon. Our objective was to determine the impact of ICPM on mortality and 6-month functional outcomes following severe TBI. The setting was a referral trauma center with 36 intensive care unit (ICU) beds and 300?600 TBI admissions per year. During a 2-year period data were prospectively entered into a severe TBI registry. Patients with severe TBI aged >12 years meeting Brain Trauma Foundation (BTF) criteria for ICPM were included in the study. Outcomes of interest were in-hospital mortality and poor 6-month functional outcome defined as Glasgow Outcome Scale (GOS) score of 3 or lower. A propensity score based analysis incorporating known predictors of outcome in TBI was utilized to examine the impact of ICPM on outcomes. Of 1345 patients meeting study criteria 497 (37%) underwent ICPM. In-hospital mortality was 35% (471/1345). Of 454 patients for whom 6-month outcome was available, 161 (35%) suffered a poor functional outcome. Following propensity score analysis ICPM use was associated with an 8% (p?=?0.002) decrease in mortality but no significant effect (p?=?0.2) on functional outcome. The use of ICPM following severe TBI was associated with decreased in-hospital mortality. Further clinical trials of ICPM in TBI may be warranted.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140170/1/neu.2015.4015.pd