There were 21 patients with rapidly progressive multiple sclerosis (MS) treated on a phase 1/2 study of intense immune suppressive therapy and autologous hematopoietic stem cell (HSC) support with no 1-year mortality. Following transplantation, one patient had a confirmed acute attack of MS. Neurologic progression defined by the expanded disability status scale (EDSS) did not increase in disability by 1.0 or more steps in any of 9 patients with a pretransplantation EDSS of 6.0 or less. In 8 of 12 patients with high pretransplantation disability scores (EDSS > 6.0), progressive neurologic disability as defined by at least a 1-point increase in the EDSS has occurred and was manifested as gradual neurologic deterioration. There were 2 patients with a pretransplantation EDSS of 7.0 and 8.0 who died from complications of progressive disease at 13 and 18 months following treatment. Our experience suggests that intense immune suppression using a total body irradiation (TBI)-based regimen and hematopoietic stem cell transplantation (HSCT) are not effective for patients with progressive disease and high pretransplantation disability scores. Further studies are necessary to determine the role of intense immune suppressive therapy and HSC support in ambulatory patients with less accumulated disability and more inflammatory disease activity. Specifically, more patients and longer follow-up would be required in patients with an EDSS of 6.0 or less before drawing conclusions on this subgroup.
Partial anomalous pulmonary venous return (PAPVR) is a spectrum of congenital cardiovascular abnormalities. It is most commonly found as an incidental finding. However, it can lead to severe pulmonary hypertension depending on the magnitude of the shunt involved. We report a case of a 60-year-old female patient with PAPVR detected incidentally on imaging. We aim to highlight the incidence of PAPVR in adults and to elaborate on its unique association with a duplicated superior vena cava.
Strain variation in the spirochaete B. anserina has been reported MULEY, 1968, 1972;PARATKAR and MEHTA, 1973). This information on strain variation is of paramount significance from the prophylaxis point of view. In spirochaetosis, strain specific immunity is produced and in some cases partial protection is afforded where two strains share common antigens. In this communication, studies with a strain isolated from the Akola region of Maharastra (India) as compared to the local Jabalpur (India) strain are presented.Akola strains of B. anserina were procured from a private poultry farm cmd were passaged in chickens 6 weeks of age. After infection, birds were treated by penicillin injection (20,000 IU, intramuscular per bird). A new batch of chickens were infected with Jabalpur strain of B. anserina and were similarly treated. Ten days after recovery, recovered plasma was obtained. The recovered chickens were saved for challenge test. Similarity or otherwise of the strains under study was detected by the cross immobilization test.For challenge test, the recovered chickens with Akola strain infection, were challenged with 0.2 ml. B. anserina Jabalpur strain infected blood by intra-muscular mute. Jabalpur strain recovered chickens were likewise challenged with Akola strain. The challenged chickens were observed daily for the presence or absence of infection for a total period of ten days. Presence or absence of spirochaetes was observed under dark ground illumination.It was observed that Akola strain was equally potent in infecting the susceptible chickens and followed practically the same course as observed in chickens infected with Jabalpur strain of B. anserina. * Associate Prof. Very. Medicine (Officer In charge Ambulatory Clinic).
Primary hepatic angiosarcoma (PHA), a rare and aggressive malignancy, has rarely been reported to present with disseminated intravascular coagulation with liver hemorrhage. Incidence is estimated at 0.5–2.5 cases per 10,000,000. To our knowledge, it has not been reported to mimic liver abscess with a septic presentation. Advanced imaging techniques may aid in the diagnosis, though biopsy with microscopy and immunohistochemistry is the mainstay. Prognosis is very poor, with a 5-year survival rate estimated at 6.4%. We present the case of a 70-year-old man who presented with sepsis thought to be due to a multifocal liver abscess, who did not respond to drainage and antibiotics. This atypical course led to further workup which subsequently revealed a diagnosis of PHA.
Abstract. Atmospheric concentrations of South Asian anthropogenic aerosols and their
transport play a key role in the regional hydrological cycle. Here, we use
the ECHAM6-HAMMOZ chemistry–climate model to show the structure and
implications of the transport pathways of these aerosols during spring
(March–May). Our simulations indicate that large amounts of anthropogenic
aerosols are transported from South Asia to the northern Indian Ocean and western Pacific. These aerosols are then lifted into the upper troposphere
and lower stratosphere (UTLS) by the ascending branch of the Hadley
circulation, where they enter the westerly jet. They are further transported
to the Southern Hemisphere (∼15–30∘ S)
and downward (320–340 K) via westerly ducts over the tropical Atlantic
(5∘ S–5∘ N, 10–40∘ W) and Pacific
(5∘ S–5∘ N, 95–140∘ E). The
carbonaceous aerosols are also transported to the Arctic, leading to local
heating (0.08–0.3 K per month, an increase by 10 %–60 %). The presence of anthropogenic aerosols causes a negative radiative forcing
(RF) at the top of the atmosphere (TOA) (−0.90 ± 0.089 W m−2) and surface (−5.87 ± 0.31 W m−2) and atmospheric warming (+4.96 ± 0.24 W m−2)
over South Asia (60–90∘ E, 8–23∘ N), except over the Indo-Gangetic Plain (75–83∘ E, 23–30∘ N), where RF at the TOA is
positive (+1.27 ± 0.16 W m−2) due to large concentrations of
absorbing aerosols. The carbonaceous aerosols lead to in-atmospheric heating
along the aerosol column extending from the boundary layer to the upper
troposphere (0.1 to 0.4 K per month, increase by 4 %–60 %) and in the
lower stratosphere at 40–90∘ N (0.02 to 0.3 K per month, increase by 10 %–60 %). The increase in tropospheric
heating due to aerosols results in an increase in water vapor
concentrations, which are then transported from the northern Indian
Ocean–western Pacific to the UTLS over 45–45∘ N (increasing water vapor by 1 %–10 %).
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