Dipti Kumar

Seminal Plasma Proteome: Promising Biomarkers for Bull Fertility

The seminal plasma is a mixture of secretions from the testis, epididymis and male accessory sex glands. A number of seminal plasma proteins are associated with male fertility but most of these have not been studied in detail till now. Recently, proteomics has been used to show the differences in proteins profile in seminal plasma from high and low fertility bulls. For example, osteopontin, phospholipase A2, P25b, acidic seminal fluid proteins, α-l-fucosidase and cathepsin D are positively correlated with fertility of bulls and may act as useful fertility marker (s), while lipocalin-type prostaglandin D synthase, spermadhesin Z13, clusterin and ubiquitin are negatively correlated with fertility in bulls. Bovine seminal plasma proteins in seminal plasma act like a double-edged sword and showed a quadratic association with bull fertility. The physiological roles of the metalloproteinase-2 (TIMP-2), ecto-ADP-ribosyltransferase 5, nuclobindin, Niemann-Pick C2 and epididymal sperm-binding protein 1 and their relationship to bull fertility need further studies. This review summarizes the physiological functions of proteins of seminal plasma and their relation to bull fertility.

Tetanus – still a scourge in the 21st century: a paediatric hospital-based study in India

Tetanus remains endemic in India. A retrospective hospital-based study was conducted to review the profile of all children admitted with diagnosis of tetanus between January 2009 and December 2010. A total of 140 cases of tetanus were admitted; 45 cases of neonatal tetanus (NT) and 77 cases of post-neonatal tetanus (PNT) were studied. Age of presentation of NT was 9.4 ± 1.2 days. Home-delivered children accounted for 86.7% of cases, with 77.8% being attended by untrained birth attendants. Unimmunized mothers accounted for 93.4%. In PNT, otogenic route of infection and trauma were present in 58.4% and 23.3% of cases, respectively. The rate of hospital admission of tetanus remains high. Unlike previously published reports, otogenic route is the most common mode of PNT infection in this study. Improving immunization, increasing deliveries by skilled birth attendants and prompt treatment of suppurative otitis media are the main areas in which public health initiatives need to be focused.

Gilbert syndrome increasing unconjugated hyperbilirubinemia in a child with hereditary spherocytosis.

Hemolytic anemia usually gives rise to only a modest elevation of serum bilirubin. Unconjugated hyperbilirubinemia of an extreme degree should raise suspicion of additional factors. We describe a 10-year-old child suffering from hereditary spherocytosis, who had unusually high levels of unconjugated serum bilirubin and was diagnosed to have Gilbert syndrome on the basis of genetic analysis.

Transalar transphenoidal meningoencephalocele: A rare cause of respiratory distress in a neonate

Respiratory distress in an infant is a common cause of admission in neonatal intensive care facility. Obstructive lesions of the airway constitute a minority of problems in the new born but present a diagnostic challenge. We present a 30-day-old male infant admitted with respiratory distress who was diagnosed to have an oropharyngeal cystic mass which on further evaluation by computed tomography and magnetic resonance imaging revealed a transalar transsphenoidal meningoencephalocele herniating into the oral cavity through a congenital split palate. The patient was operated successfully using a transpalatal approach leading to complete resolution of respiratory distress.

Human Tail: Nature’s Aberration

Human tail refers to a congenital cutaneous appendix protruding from the lumbosacral region. It is usually associated with an underlying spina bifida occulta, a form of spinal dysraphism. A contiguous fibrolipoma can sometimes be seen extending from the subcutaneous portion of the tail into the inferior spinal cord, resulting in tethered cord syndrome. Management of such lesions includes complete neurologic examination and magnetic resonance imaging. Early diagnosis and microsurgical intervention can prevent development or progression of severe neurologic defects in later life.

Congenital rubella syndrome: an unusual cause of neonatal fulminant hepatic failure.

period of graft hypertrophy (fibular transfer) or callotasis consolidation (Ilizarov technique). To our knowledge, we are the first group to propose this technique, which has demonstrated successful reconstruction of large tibial defects that would otherwise require distraction osteogenesis. Our method does not intend to replace the Masquelet or other alternative techniques, but it does have a unique role in lowincome countries.

Enteric fever presenting as acute ataxia.

Enteric fever is a common infection of tropical countries that can have a variety of neurological complications with an incidence varying from 5% to 35%. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare with limited evidence. A 13-year-old boy presented with high-grade intermittent fever for 5 days. He also developed progressive unsteadiness in walking and difficulty in speech since the fourth day of fever. There was no associated rash, ear pain/discharge, altered sensorium, seizures, headache, vomiting or any other significant symptoms. On examination, the child was febrile, conscious, oriented, with slurred speech and stable vital signs. Abdominal examination revealed hepatosplenomegaly (liver: 2 cm; spleen: 1 cm). Cranial nerves and sensory system were normal. There was hypotonia in all four limbs, normal power and marked ataxia. Co-ordination was affected on both sides, with presence of dysmetria, dysdiadokokinesia and impaired knee-heel test. Pendular knee jerks were elicited bilaterally. He had a widebased gait, and tandem walking was not possible. There was no nystagmus. Investigations revealed haemoglobin of 11 gm/dL, total leukocyte count of 2200/cu.mm. and platelet count of 70 000/ cu.mm. Peripheral blood smear for malarial parasite was negative. Renal and liver function tests were normal. Magnetic resonance imaging of the head was normal. Widal test after 3 days (eighth day of illness) was positive with titres of Anti’O’1:320 and Anti’H’ 1:320. Blood culture isolated Salmonella typhi, which was sensitive to ceftriaxone. The child was hence diagnosed to have enteric fever with ataxia. Intravenous ceftriaxone was started, and the patient became afebrile after 4 days. The total leukocyte count and platelet count normalized over 7 days. Cerebellar signs improved over 2 weeks of hospital stay. Ceftriaxone was given for a period of 14 days. There was persistence of mild ataxia and incoordination at discharge, which gradually improved over next 4 weeks during follow-up. Acute cerebellar ataxia as an isolated neurological manifestation of enteric fever is rare. Wadia et al. described 28 cases of enteric fever with cerebellar ataxia with only two of them presenting with isolated cerebellar ataxia, the rest having a combination of ataxia with pyramidal, extrapyramidal signs, deafness or protracted confusional states. Most studies show a mean time of onset of ataxia to be around 10–14 days after the onset of fever. Enteric fever presenting with isolated cerebellar ataxia within first few days of illness, like in our case, is uncommon with only three reported cases of early onset of cerebellar ataxia in enteric fever. The most probable aetiopathogenesis appears to be typhoid encephalitis/cerebellitis due to predominant affliction of cerebellum with non-specific inflammatory changes like capillary thrombosis, haemorrhage, peri-vascular infiltration, demyelination, oedema and secondary neuronal changes. In conclusion, acute cerebellar ataxia is an uncommon neurological complication of childhood enteric fever and can appear in the first week of illness. Being a treatable condition, enteric fever should be considered in the differential diagnosis while investigating a case of fever with cerebellar ataxia.

An Unusual Presentation of Enteric Fever

Enteric fever is a very common childhood infection in tropical countries. Hematological derangements are common in enteric fever and include anemia, leukopenia, thrombocytopenia, and subclinical disseminated intravascular coagulation. Although these changes are transient and respond favorably to the appropriate antimicrobial therapy, they can lead to potentially life threatening complications, as with our case who presented with intracranial hemorrhage.