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Background: Opportunistic intestinal infections cause a significant morbidity and mortality among the HIV infected people. The present study was undertaken to find the prevalence of intestinal opportunistic parasitic infections among the HIV infected populace in eastern Nepal and to correlate the occurrence with the CD4 T cell counts. Materials and Methods: Stool from 122 HIV infected people were examined microscopically for the presence of parasitic ova/cyst. CD4 T cell enumeration was done using FACS Count (Becton Dickinson). Stool from 100 age matched HIV negative controls were also examined. Results: A male preponderance in the parasite positivity was seen. Twenty five of symptomatic and 2.8% of asymptomatic harboured one or more intestinal parasites.12.3% of the study population had intestinal parasitoses with 7.3% being infected with opportunistic parasites. The mean CD4 count of the subjects was 307 while those with parasitoses were 204. A statistically significant difference was seen between the CD4 counts of symptomatic and asymptomatic patients. Conclusion: Coccidian parasites are frequent opportunistic intestinal parasites infecting HIV infected patients. A lowered CD4 count predisposes to acquisition of these agents. Regular monitoring of CD4 counts and screening for these opportunistic agents in the HIV infected will help reduce the mortality and morbidity associated with infections by these agents. Keywords: HIV; Opportunistic infection; CD4 count; AIDS DOI: http://dx.doi.org/10.3126/jpn.v1i2.5405 JPN 2011; 1(2): 118-121

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Background:The understanding and management of neurological disorders is undergoing revolutionary changes over the last three decades in the background of ever increasing advances in medical technologies, diagnostic techniques, therapeutic processes and, molecular and genetic medicine. The fruits of these advances can reach patients only if the psychosocial hurdles in their delivery are identified, acknowledged and addressed.Aim:To explore the beliefs and practices of patients with neurological disorders in a tertiary care center in the eastern Nepal.Materials and Methods:One hundred patients attending neurology/medicine outpatient for neurological disorders were interviewed about their beliefs regarding the triggering factors, causation and treatment-seeking behavior particularly from traditional healers.Result:Of the 100 patients (49 males, 51 females) recruited in the study, 51% expressed having ‘no idea’ about their illness. Only 20% patients gave medically congruent explanation for their illness. Psychological factors were attributed as triggering factors by 16% of patients, of which two-thirds were females. Chance, destiny and ‘jadu tona’ topped the list of triggering factors. Forty-four percent patients had sought help of traditional faith healers (‘Dhami Jhakri’) before seeking medical help. Traditional faith healers were approached by patients irrespective of their educational background. Fifty-nine percent of patients who first sought traditional faith healers, believed in ‘jadu-tona’. Of those interviewed, 16% were planning to go to a faith healer in near future.Conclusion:The beliefs of patients with neurological disorders frequently do not conform to current medical opinion. There is need for greater communication and education of patients by their treating physicians.

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of 4-year FFS was 0.40 (95% CI, 0.24-0.57) for iPET(−)&TF and 0.52 (95%CI, 0.33-0.70) for iPET(+)&TE group (P** = 0.1). Conclusion:The long-tem outcome of patients who progress despite negative iPET is poor and might be worse than iPET(+) patients and treatment escalation. NMRF-2 is present in ≈30% of ABVD not responding patients. Background: Hodgkin lymphoma (HL) most commonly develops in young adults and is successfully treated in the overwhelming majority of patients with current treatment programs. This has driven efforts to maintain high cure rates while minimizing long-term toxicity of therapy. The optimal strategy to accomplish these 2, potentially conflicting, objectives is controversial. We reviewed our institutional experience with chemotherapy alone (ChT) or combined modality therapy (CMT), with a special focus on long-term risks of treatment. Results: One hundred thirty six patients with a CR to ChT (gallium, n = 48; PET-CT, n = 88) were identified. ChT consisted of ABVD or ABVD hybrids in~90% of patients. Consolidation radiation therapy (RT) was administered to 117 while 19 were observed. There were no differences in baseline prognostic factors between cohorts. In the CMT group, the median RT dose was 24 Gy (range, 18-36 Gy). For CMT and ChT alone patients, 5-year progression-free survival was 97% (95% CI, 91%-99%) and 84% (95% CI, 57%-94%). Corresponding 10-year values were 93% (95% CI, 82%-97%) and 84% (57%-94%). On multivariate analysis, use of CMT was the only predictor of improved progression-free survival (HR, 0.21; 95% CI, 0.05-0.91).OS at 10 years for CMT was 96% (95% CI, 90%-99%) and for ChT alone was 94% (95% CI, 65%-99%). The only statistically significant factor associated with improved OS on multivariate analysis was younger age (HR, 0.05; P = .04). Secondary malignancy risk was nearly equivalent at 10 years, with 3% (95% CI, 1%-8%) and 6% (95% CI, 1%-35%) in the CMT and chemotherapy alone groups, respectively.Only one secondary malignancy, a papillary thyroid cancer, developed in the ChT alone group. There were 7 secondary neoplasms in the CMT group. These included acute myelogenous leukemia, follicular lymphoma, diffuse large B-cell lymphoma, small cell lung cancer, colon cancer, and 2 basal cell carcinomas. The small cell lung cancer was the only malignancy clearly arising within the RT field, occurring in an active smoker 13 years after treatment. There were no cardiac events in the follow-up period.Conclusions: Following a complete metabolic response to ChT, the addition of consolidative RT results in superior progression-free survival in early-stage Hodgkin lymphoma. The risk of secondary malignancies and cardiac disease was quite low after conformal RT using modest doses. CMT remains the most effective approach to cure Hodgkin lymphoma. However, methods to identify patients with residual disease after ChT, beyond PET-CT, are needed to improve the therapeutic ratio.

Introduction We conducted a study to see the activity of hypomethylating agent (HMA) in relapsed refractory lymphoma. In parallel, we studied KIR expression and promoter methylation before and after treatment with HMA. Allele-specific stochastic KIR expression is maintained in mature natural killer (NK) cells by a combination of DNA methylation and histone modification, with DNA methylation being dominant. The aim of this part of the study is to understand how KIR gene expression changes in response to epigenetic therapy, so that we then can manipulate NK cells to optimize the effect of chemo-immunotherapy of neoplastic diseases. Methods Blood samples were collected from patients enrolled in an open-labeled phase I trial of the combination of azacitidine with cyclophosphamide, vincristine and rituximab in relapsed/refractory lymphoma. Regimen: Azacitidine on days one through five (starting at 25mg/m2), followed by oral cyclophosphamide at 300 mg/m2 on days six through nine, vincristine 1.4 mg/m2 day eight, and rituximab 375 mg/m2 day eight. Each cycle was to be repeated every 21 days, up to eight cycles if participants continued to benefit from therapy. Sampling: Between 10-20uL whole blood was collected from eligible patients before commencement of therapy and on Cycle 1 Day 5, Cycle 2 Day 1 and Cycle 3 Day 1. Peripheral blood mononuclear cells (PBMC) were isolated immediately ex vivo using Lymphocyte Separation Media (Lonza), and were divided into two aliquots: one for flowcytometry and the other for pyrosequencing (Epigendx, Hopkinton, MA). Samples from each time point were stained with fluorescently-labelled antibodies to CD3, CD16, CD56, CD14, CD20 and four different KIRs. For calculating the number of KIRs per NK cell, we used a gating strategy in which CD56dim NK cells are identified, and then the number of KIR expression is counted on those by sequential gating. The percentages of monocytes and lymphocytes among the PBMC population were also determined using CD14 and CD20 antibodies. Monocytes were further characterized according to their CD16 expression into Classical (CD14highCD16negative), Intermediate (CD14highCD16low), and Non-classical (CD14lowCD16high). Results PBMC from 10 patients were available for flow cytometric analysis and pyrosequencing. There were statistically significant differences (p=0.0089) in percent of DNA methylation determined by PBMC pyrosequencing, with significant decrease from Cycle 1 Day 1 to Cycle 1 Day 5 and then an increase from Cycle 1 day 5 to Cycle 2 Day 1. The decline in the percent of DNA methylation in PBMC at day 5 of cycle 1 of the chemotherapy was also found to be statistically significant (Figure 1; p=0.0202). There was a large variation in the types and numbers of KIR molecules expressed at baseline (Table 1) on CD56dim NK cells among the patients in the cohort studied, with no significant differences between the various time points and response to treatment. Despite an apparent trend of increasing percentages of non-classical and intermediate monocytes (at the expense of classical monocytes), the data was not statistically significant (Figure 2; p=0.06). We also noticed a trend of decreasing percentage of monocytes and increasing percentage of lymphocytes in the PBMC population with increasing treatment cycles. However, this was not statistically significant either. Conclusions KIR expression may play role in HMA induced tumor cell killing. In our study, no significant changes were seen in the number of KIR receptors on NK cells post-treatment with hypomethylating agent despite observing a reduction in global DNA methylation in PBMC. This could be due to a number of reasons, including the small size of the study, the rapid turnover of NK cells, or that the reduced methylation was not sufficient to induce changes in KIR expression. The significance of the increase in the number of non-classical and intermediate monocytes following treatment with HMA is not well understood and needs further investigation. (The study was supported by Celgene) Disclosures No relevant conflicts of interest to declare.