Cardiac performance in relation to age of onset of menopause

It is well known that post menopausal women are more prone to cardiovascular diseases, osteoporosis and cancer. This study was done to detect the effect of early onset of menopause on the cardiac performance in postmenopausal women. The cardiac functions were evaluated by the noninvasive technique of measuring systolic time intervals (STI) in the form of total electromechanical systolic time (OS2), left ventricular ejection time (LVET), pre-ejection period (PEP) and PEP/LVET ratio. The study included 50 postmenopausal women with age at the onset of menopause ranging from 29 years to 55 years, divided into three groups I, II and III with mean age at onset of menopause being 36.80 +/- 2.97, 43.97 +/- 2.97 and 52.05 +/- 1.61 years, respectively. In group I, there was a highly significant increase in QS2, PEP and PEP/LVET ratio and in group II, there is a significant decrease in LVET with a highly significant increase in PEP and PEP/LVET ratio. This signifies asymptomatic and subclinical cardiac systolic dysfunction in groups I and II as compared to group III. Early onset of menopause could thus be considered as a risk factor for increased cardiovascular morbidity; hence efforts should be made to timely detect and prevent these diseases in the postmenopausal stage.

Evaluation of left ventricular performance in menopausal women

The incidence of ischemic heart disease is well documented in the literature in post menopausal women but the degree of deterioration of left ventricular performance in estrogen deficient state in women is not very clear. The present study was conducted to find the left ventricular performance by recording systolic time intervals (STIs) in 50 post menopausal women having either natural or surgical menopause and that was compared with 25 premenopausal controls. There was significant (P < 0.01) increase in QS2-I, PEP-I and PEP/LVET ratio but significant (P < 0.01) decrease in LVET-I in surgical menopause group whereas the natural menopause group showed less increase in QS2-I (P < 0.05), PEP/LVET ratio (P < 0.01) and decrease (P<0.01) in LVET-1. Thus, the performance of left ventricle is more affected in surgical menopause group as compared to natural menopause group. The ventricular dysfunction was observed by STIs prior to the appearance of clinical signs and symptoms.

Status of lipid peroxidation and plasma iron level in bronchial asthmatic patients

Low antioxidant levels and oxidative stress due to airway inflammation may be determinant of asthma severity. The study was conducted to find the extent of lipid peroxidation and change in the levels of plasma iron in asthmatic patients with severity of disease. Study included 155 asthmatic and 156 healthy volunteers of the age groups 18-45 of either sex. Asthmatic patients were grouped into mild, moderate and severe groups on the basis of Forced Expiratory Volume in first second percent (FEV1%). Level of plasma malondialdhyde (MDA) was used as index of lipid peroxidation. A significant increase (P<0.01) in plasma MDA and plasma iron levels was found in asthmatic subjects as compared to controls. There was maximum increase in plasma MDA and iron levels in moderate asthmatic group. A positive correlation between plasma MDA and iron (r = +0.3) has been found in asthmatic patients. An increased plasma iron levels in asthmatics may contribute to aggravate lipid peroxidation.

Effect of exercise on rate pressure product in premenopausal and postmenopausal women with coronary artery disease

Incidence of coronary artery disease (CAD) increases sharply after menopause in women. Rate pressure product (RPP) is a major determinant of cardiac oxygen consumption. It is an important indicator of ventricular function. RPP varies with exercise. The peak rate pressure product (PRPP) which gives an accurate reflection of the myocardial oxygen demand and myocardial workload is the RPP at peak of exercise. The higher the PRPP, the more will be myocardial oxygen consumption (MVO2). The ability to reach higher PRPP is associated with more adequate coronary perfusion. Thus the low value of PRPP suggests significant compromise of coronary perfusion and decreased left ventricular function. In the present study effect of exercise on RPP of pre and postmenopausal women with CAD was compared. The percentage increase in RPP was significantly more in postmenopausal women with CAD (62%) as compared to premenopausal women with CAD (54%) indicating more compromised coronary perfusion in postmenopausal women.

Lipid peroxidation in haemorrhagic shock and after transfusion of blood in dogs

The present study was carried out on mongrel dogs. Haemorrhagic shock of different severities and duration was produced by exsanguination from an artery. After the required duration of shock, two third of the volume of blood withdrawn was transfused back into the animal. Effect of haemorrhage and reperfusion of blood after haemorrhagic shock on lipid peroxidation was assessed by measuring plasma malondialdehyde (MDA). Severity of shock was assessed from the haematocrit values. There was a significant increase (P < 0.05) in plasma MDA level after blood transfusion in a group having 40 mm Hg blood pressure as magnitude of shock and one hour as duration of shock (Group II) only. Haemotocrit value was also significantly low (P < 0.05) in this group after haemorrhagic shock. Results are suggestive of lipid peroxidation with ischaemic reperfusion in severe and long duration of shock.

Vitamin E administration and reversal of neurological deficits in protein-energy malnutrition

Neurological signs including posterior column, spinocerebellar, retinal, and peripheral nerve deficits are being increasingly recognized in vitamin E deficiency states. Children suffering from protein-energy malnutrition (PEM) revealed significantly reduced serum alpha-tocopherol levels compared to age-matched normal children, the deficient subjects also exhibited the widely recognized signs of tocopherol deficiency. In this prospective therapeutic intervention study moderate PEM subjects were administered aqueous oral vitamin E supplementation for 6 weeks and compared with control PEM subjects. The parameters studied included pre- and post-therapy serum alpha-tocopherol levels, alpha-tocopherol lipid ratio, lipid profile, creatine phosphokinase levels, and electroneurophysiological studies. Vitamin E supplementation normalized serum alpha-tocopherol levels (p < 0.001), alpha-tocopherol lipid ratio (p < 0.001), reduced creatine phosphokinase levels (p < 0.01), and reduced neurological signs in PEM subjects (p < 0.001). The observed improvement in neurological dysfunction among PEM subjects is of great interest, especially in developing countries. While larger studies are recommended, the importance of vitamin E administration in PEM is being reported.

Effect of cold pressor test on visual reaction time and auditory reaction time

Influence of stress (cold) on visual reaction time (VRT) for red, green and yellow colours and auditory reaction time (ART) for high and low pitched sounds was studied in 60 healthy subjects (17-19 years) by digital display response time apparatus. Pain threshold and pain tolerance time were 23.02 +/- 8.11 and 249.35 +/- 64.88 sec. respectively. During the standard cold pressor test (CPT), there was significant increase (P < 0.01) in VRT for all the three colours, the increase being the least for the red colour. There was significant increase (P < 0.01) in ART for both high and low pitched sounds. There was increase in heart rate and respiratory rate as compared to controls. This increase in VRT and ART with CPT was probably due to decreased conduction velocity of nerves, which could be due to vasoconstriction attributed to increased sympathetic activity caused by cold and pain.

Interictal brain 99m Tc-HMPAO SPECT study in cases of epilepsy with single ring enhancing CT lesion

BACKGROUND

Contrast enhancing single ring or disc lesion (CESRL), a frequent finding in the CT scan of Indian patients with seizures, has a diverse etiology. Underlying cause in many of these cases remains conjectural. Some of these ring lesions show spontaneous resolution without any specific treatment and in others their temporal profile remains unpredictable.

MATERIAL AND METHODS

In a prospective study we studied 17 cases of epilepsy, with the CT scan finding of single contrast enhancing ring lesion. Detailed clinical evaluation and interictal EEG was performed. CT scan and SPECT study was done initially and were then repeated.

RESULTS

On the second CT, one lesion disappeared and 2 reduced in size, three showed no change in size. Third CT showed complete disappearance in one case and no change in the second case. Initial SPECT study was abnormal in all 17 cases, showing areas of hypoperfusion corresponding to the anatomical location of ring lesion. On follow up, patients with decreased ring size on CT showed decrease in area of perfusion deficit on the SPECT, but cases in which the lesion disappeared on the CT, the SPECT perfusion abnormality continued to persist, though to a lesser extent.

CONCLUSION

Persistence of perfusion defects suggest the presence of altered underlying physiology. Hence, early withdrawal of antiepileptic drugs after disappearance of ring lesion on CT may lead to seizure recurrence. SPECT studies repeated after 3 months may help to prognosticate cases with CESRL and also help in deciding the optimum duration of antiepileptic therapy in individual cases.

Effect of selegiline on cognitive functions in Parkinson's disease

BACKGROUND

Selegiline hydrochloride, a selective MAO-B inhibitor is known to improve motor functions in Parkinson's disease (PD). The present study was undertaken to study the effect of selegiline on memory and intelligence of PD patients.

MATERIAL AND METHOD

Thirty two patients of PD were divided in two groups: selegiline group (n = 17) received 10 mg selegiline per day and control group (n = 15) did not receive selegiline. Patients receiving trihexyphenidyl and selegiline were excluded. All other treatment remained unchanged. All patients were examined at baseline and after three months for change in UPDRS score, WAIS score, memory test and P300.

RESULTS

Patients in selegiline group had less severe disease (UPDRS score 24.11 +/- 14.07) as compared to controls (UPDRS score 40.53 +/- 18.52). There was significant improvement in UPDRS score (p < 0.05), WAIS (p < 0.001) and memory (p < 0.001) in selegiline group. In the control group there was a significant prolongation of P300 latency (p < 0.05).

CONCLUSION

The study suggests that selegiline improves memory functions and intelligence in PD patients in addition to motor functions. It also prevents prolongation of P300 latency which is a marker of cognitive function.

Vitamin E deficiency and associated neurological deficits in children with protein-energy malnutrition

Vitamin E is important in maintaining normal neurological structure and function. In this study, 100 children with protein-energy malnutrition (PEM) were studied and compared to a suitably age-matched control group. Posterior column deficits, cerebellar deficits, and problems with fine motor coordination were present to a significant degree in the PEM subjects. The presence of neurological signs was correlated with various parameters of vitamin E deficiency, including low serum alpha-tocopherol levels and a low tocopherol/total lipid ratio which was present in 92 per cent of subjects. There was good concordance between vitamin E levels and vitamin E to serum lipid ratio in assessing vitamin E deficiency. We conclude that vitamin E deficiency is prevalent, to a hitherto unsuspected degree, in children with PEM and that these malnourished children have significant neurological deficits attributable to low vitamin E levels. This observation is of clinical significance as the neurological deficits are potentially reversible with vitamin E supplementation.

Wilson's disease: clinical and radiological features

BACKGROUND

Wilson's disease is a treatable movement disorder with autosomal recessive inheritance which is associated with severe morbidity and mortality if not treated early.

MATERIAL AND METHODS

The clinical and radiological features of 22 cases of Wilson's disease seen during January 1984 to December 1993 were analysed for clinical presentation and common radiological features.

RESULTS

Among all the patients extrapyramidal features were the commonest (19/22 patients), followed closely by impaired higher mental functions (17/22 patients) and cerebellar signs (11/22 patients). In patients with onset of symptoms before 20 years, the common presentations were impaired higher mental functions, speech disturbance, dystonia and choreo-athetosis; whereas in patients with onset after 20 years cerebellar signs were commonest. The commonest CT head abnormality was basal ganglion hypodensity (10 patients) followed by brain stem hypodensity (6 patients).

CONCLUSIONS

The clinical and CT scan features are evaluated and compared with reported series. Hypodensities of brain stem earlier reported a rarity, was seen in 6 out of 22 cases.

Interictal brain 99m Tc-HMPAO SPECT study in chronic epilepsy

We performed interictal brain 99m Tc-HMPAO study in eight cases of chronic epilepsy. SPECT (single photon emission computed tomography) study showed abnormality in seven cases. As compared to computed tomography (CT) scan and electroencephalogram (EEG) which were positive in 25% and 62% cases respectively it showed abnormality in 87%. In two cases where CT scan and EEG both were normal, SPECT showed areas of hypoperfusion. In one case where EEG indicated a bilateral focus, SPECT study showed a clearly defined unilateral focal hypoperfusion defect. Areas of hyperperfusion were not seen in any of our cases. Our results indicate that HMPAO SPECT is more sensitive than CT scan and EEG, in localising an epileptogenic focus in cases of chronic epilepsy.

Prognostic value of facial nerve latency and blink reflex in Bell's palsy

Twenty six patients of Bell's palsy, 16 men and 10 women, with the mean age of 27?0.2 years were enrolled for the study. An equal number of age and sex matched normal healthy individuals formed the control group. Clinical assessment and electrophysiological tests like facial nerve latency (FNL), blink reflex (BR), and peripheral nerve conduction studies were done to assess the prognostic value of these electrophysiological tests early in the disease. Clinical severity of weakness in the first week correlated positively with the outcome at 8 weeks. The mean FNL did not bear prognostic relation to the outcome, it being significantly prolonged in both partial and full recovery groups. BR proved to be of prognostic value. Though the amplitudes of various components of BR were low in all patients, significant prolongation of latencies was seen only among those with partial recovery. Nerve conduction studies of peripheral nerves were normal in all the patients. Clinical examination and early blink reflex abnormalities are of prognostic value in Bell's palsy patients.

Multiple sclerosis in India: a case-control study of environmental exposures

OBJECTIVES

To compare the rate of prior environmental exposures between Indian multiple sclerosis (MS) patients and controls in order to identify potential disease triggering factors.

MATERIAL AND METHODS

A standard self-administered questionnaire regarding prior exposures was presented to 56 Indian MS patients and 147 other neural disease and healthy controls at two large medical centers in India.

RESULTS

The rate of prior foreign travel, surgeries, blood transfusions, clinical chicken pox and mumps infections and exposure to cats and farm animals was not significantly different between MS patients and controls. However, clinical measles infection and dog exposure occurred significantly more often in the MS patients.

CONCLUSION

These findings are consistent with but do not prove an association between prior measles infection, dog exposure and MS.

Multiple sclerosis in India: A.I.I.M.S. experience

Fifty patients of multiple sclerosis were reviewed. The commonest initial neurologic symptom was motor weakness (30%) followed by visual impairment (26%). Absence of internuclear opthalmoplegia was noted in addition to the infrequent occurrence of optic nerve involvement and Devic's disease. Evoked potential studies and radiological investigations were in agreement with others series reported.

Clinical and demographic features of Meige's syndrome

Fifty five patients with Meige's syndrome were examined for clinical and demographic features. The mean age of onset was 52.3 years. The peak age of onset was in the sixth decade with a male to female ratio of 1.11:1. The mean duration of illness was 3.7 years. Commonest initial symptom was increased blinking, seen in 30 cases (54.5%). Twenty five patients (45.4%) had complete syndrome of blepharospasm with oromandibular dystonia, whereas 24 patients (43.6%) had blepharospasm alone and the rest (6 patients, 10.9%) had oromandibular dystonia. The extension of spasm beyond cranial muscles was observed in 10 patients (18.1%). Eleven patients had family history of dystonia or other extrapyramidal disorders. Incidence of depression was high in these cases.

Evaluation of polymerase chain reaction for rapid diagnosis of clinically suspected tuberculous meningitis

SETTING

Since conventional bacteriological methods rarely detect Mycobacterium tuberculosis in cerebrospinal fluid (CSF) and are of limited use in the diagnosis of tuberculous meningitis (TBM), clinical features suggestive of TBM supported by indirect evidence such as CSF examination and computerized tomography (CT) of the head have been used for the early diagnosis of TBM.

OBJECTIVE

We evaluated the efficacy of polymerase chain reaction (PCR) in the diagnosis of TBM.

METHODS

Coded CSF samples from 40 patients with TBM and from 49 patients with other neurological disorders were processed. In the absence of a reliable sensitive and specific test for M. tuberculosis in CSF, we used a set of established clinical criteria as the gold standard. Accordingly, the patients were divided into definite, highly probable, probable and possible TBM. The samples were decoded only after completion of the laboratory tests.

RESULTS

PCR was positive in 2/4, 19/20, 13/16 patients with highly probable, probable and possible TBM respectively. None of the samples were positive by conventional bacteriological methods. However, 3/49 CSF samples from non-TBM patients were also found positive by PCR. PCR detected M. tuberculosis genomic DNA in the CSF of 85% of clinically suspected TBM cases and 6.1% of non-tuberculous controls.

CONCLUSION

PCR, along with the suggested clinical criteria, offers a rapid and fairly accurate diagnosis of TBM.

Bilateral basal ganglia lucencies following acute febrile illness

Bilateral striatal necrosis in children without damage elsewhere in the brain can present as an acute neurological disorder or as a progressive disorder. Three children of 6, 7 and 12 years age developed dystonic posture of limbs without any cranial nerve involvement or alteration of sensorium soon after recovery from acute high grade febrile illness of 3-4 days duration. Computerized tomographic scan of head showed bilateral necrosis of basal ganglia. We think that these patients probably constitute a clinically and radiologically distinct subgroup of disorder that produce bilateral striatal necrosis in children. The cause of the syndrome is unknown.

Thermosensitive and pH mechanisms regulating urine formation

The study was undertaken to investigate the effect of infusion of isotonic saline of different pH (2, 3, 9 and 10) and different temperatures (cold 4 degrees and warm 40 degrees C) in urinary bladder on rate of renal urine formation. The volume of fluid (isotonic saline) infused was 100 ml in all the cases. Presence of alkaline saline (pH-9 and pH-10) and warm saline in urinary bladder, decreased the rate of urine flow whereas acidic and cold saline increased the rate of urine flow significantly. (P < 0.05 and < 0.0001 respectively). The observed effects disappeared when 4% xylocaine in 100 ml saline was infused and evacuated prior to infusion of fluids of different pH and temperature. The observation suggests existence of chemosensitive and thermosensitive mechanisms in the vesical mucosa regulating urine formation by the kidney.

Comparison between multiple sclerosis in India and the United States: a case-control study

The prevalence of MS in India is low, and it is unclear whether the manifestations of the disease in India are similar to the United States. We carried out a case-control study to compare the disease in the two populations and used clinical, evoked potential, and MRI criteria to assess similarities and differences. Our results indicate that the rate of disease progression and frequency of involvement of the cerebral hemispheres, cerebellum, spinal cord, and brainstem were similar in the two populations. The visual system was more frequently involved in Indian patients. No Indian patient had a family history of MS; this suggests an environmental disease-triggering agent.

Albendazole in neurocysticercosis

BACKGROUND

In India, parenchymatous cysticercus cysts are more common than the meningeal racemose variety which are seen frequently in Latin America. Reports from Mexico suggest that albendazole is effective in the treatment of neurocysticercosis. We, therefore, studied whether this drug changed the natural course of neurocysticercosis in India.

METHODS

In a randomized, double-blind, placebo controlled study, we allocated 29 consecutive patients (22 men and 7 women) with multiple cystic lesions on computed tomography (CT) of the head suggestive of cysticercosis to 7 days treatment with albendazole (15 mg/kg/day) or placebo. CT scans were repeated at the end of treatment and 1 and 3 months later to assess the number of cysts and extent of oedema.

RESULTS

Sixteen patients received albendazole and 13 placebo. No change was seen at the end of one week. At 3 months, 14 patients in the albendazole group and 10 in the placebo group showed more than 25% reduction in the number of lesions. The difference between the two groups was not significant.

CONCLUSION

Albendazole given in a dose of 15 mg/kg/day for 1 week does not change the natural course of neurocysticercosis.