An Unusual Presentation of Adult Onset Still's Disease

Adult onset still's disease usually presents with high grade intermittent fever, polyarthritis, salmon pink evanescent rash and hepatosplenomegaly. Pulmonary involvement in the form of pneumonitis, as a presenting feature is very rare. We report a case of a young lady who presented with fever, cough and respiratory distress. Chest X-ray revealed patchy infiltration in left upper lung zone. She was subsequently diagnosed as Adult onset Still's disease. There was no improvement in clinical condition despite five days of antibiotics. On trans-bronchial lung biopsy (TBLB) proved she had interstitial pneumonitis and responded dramatically to steroid treatment.

Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge

BACKGROUND

Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol.

AIM

To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart.

METHODS

Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n=530) and after (n=509) the intervention.

RESULTS

For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637-1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362-1.1101) (p=.005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88-23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45-36.99). There was an absolute risk reduction for SAE's within 120h after ICU discharge of 2.2% (95% C.I. -0.4-4.67%) from 5.7% to 3.5%.

CONCLUSION

The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance.

Decision forests for tissue-specific segmentation of high-grade gliomas in multi-channel MR

We present a method for automatic segmentation of high-grade gliomas and their subregions from multi-channel MR images. Besides segmenting the gross tumor, we also differentiate between active cells, necrotic core, and edema. Our discriminative approach is based on decision forests using context-aware spatial features, and integrates a generative model of tissue appearance, by using the probabilities obtained by tissue-specific Gaussian mixture models as additional input for the forest. Our method classifies the individual tissue types simultaneously, which has the potential to simplify the classification task. The approach is computationally efficient and of low model complexity. The validation is performed on a labeled database of 40 multi-channel MR images, including DTI. We assess the effects of using DTI, and varying the amount of training data. Our segmentation results are highly accurate, and compare favorably to the state of the art.

The Turbid Crystal Ball: Life Plans Affected by MS

Since multiple sclerosis (MS) has its onset at a young age, it is valuable to know how it affects life plans and future perspectives of patients. Through two narratives, this aspect is discussed in this article. The first is the autobiographical journal: The Journal of a Disappointed Man by WNP Barbellion, published in 1920, and the other one is from a contemporary patient. Despite the fact that both narratives are derived from different centuries, clear similarities have been perceived in the patients life plans and future perspectives. The narratives show that the life plans of both patients were adjusted due to physical limitations. Additionally, both patients experienced sorrows for losing the ability to perform passionate hobbies during their life. Moreover, a strong sense of uncertainty was expressed in both narratives concerning their future.

Effects of intrathecal midazolam in spinal anaesthesia: a prospective randomised case control study

INTRODUCTION

Subarachnoid block with local anaesthetics and adjuvants has been extensively used for surgery. Intrathecal midazolam produces antinociception and potentiates the effect of local anaesthetics. We compared intrathecal bupivacaine with and without midazolam to assess its effect on the duration of sensory block, motor block and pain relief.

METHODS

A total of 100 patients scheduled for elective lower abdominal, lower limb and gynaecological procedures were selected to participate in this prospective, randomised, double-blind study. Patients were randomly allocated into two groups for intrathecal drug administration. Group B received 3 mL 0.5 percent bupivacaine with 0.4 mL saline, and group BM received 3 mL 0.5 percent bupivacaine and 0.4 mL (2 mg) midazolam mixture. The onset, duration of sensory/motor block, time to first rescue analgesia and side effects were noted.

RESULTS

Demographic profile and duration of surgery were comparable between the two groups. The onset of sensory (4.8 versus 4.6 min) and motor block (5.9 versus 6 min) was also comparable between the groups. The duration of sensory blockade was prolonged in the midazolam group (90.8 versus 115.8 min, p-value is 0.001), while the duration of motor blockade was comparable (151.8 versus 151.3 min, p-value is 0.51). The duration of effective analgesia was significantly longer in the midazolam group compared to the control group (121.3 versus 221.1 min, p-value is 0.001). Sedation score was comparable in the two groups.

CONCLUSION

The addition of preservative-free midazolam to bupivacaine intrathecally resulted in prolonged postoperative analgesia without increasing motor block.

Neuroimaging reveals dual routes to reading in simultaneous proficient readers of two orthographies

Orthographic differences across languages impose differential weighting on distinct component processes, and consequently on different pathways during word-reading tasks. Readers of transparent orthographies such as Italian and Hindi are thought to rely on spelling-to-sound assembly and show increased activation in phonologically tuned areas along the dorsal pathway, whereas reading an opaque orthography such as English is thought to rely more on lexically mediated processing associated with increased activation of semantically tuned regions along the ventral pathway. To test if biliterate Hindi/English readers exhibit orthography-specific reading pathways, we used behavioural measures and functional neuroimaging. Reaction times and activation patterns of monolingual English and Hindi readers were compared to two groups of adult biliterates; 14 simultaneous readers who learnt to read both languages at age 5 and 10 sequential readers who learnt Hindi at 5 and English at 10. Simultaneous, but not sequential readers demonstrated relative activation differences of dorsal and ventral areas in the two languages. Similar to native counterparts, simultaneous readers preferentially activated the left inferior temporal gyrus for English and left inferior parietal lobule (L-IPL) for Hindi, whereas, sequential readers showed higher activation along the L-IPL for reading both languages. We suggest that early simultaneous exposure to reading distinct orthographies results in orthography-specific plasticity that persists through adulthood.

Obstructive sleep apnoea and anaesthesia

Obstructive sleep apnoea (OSA) correlates positively with obesity and age, both of which are becoming increasingly prevalent. Obstructive sleep apnoea occurs much more frequently in clinical practice than formerly diagnosed, and that this condition represents complex challenges for difficulty in mask ventilation, laryngoscopic intubation, accelerated arterial desaturation, postoperative monitoring and discharge status. In this review article pathophysiology, diagnosis, and perioperative management of this group of patients have been discussed in detail.

Blue rubber bleb nevus syndrome causing refractory anaemia

Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare angiomatosis characterized by distinctive cutaneous and gastrointestinal venous malformations that result in gastrointestinal haemorrhage and iron-deficiency anaemia secondary to the bleeding episodes. We hope to emphasize the possibility of recurrent melaena in BRBNS and heighten physicians' awareness about the disease to contribute to its early detection.

Bioleaching of low-grade uranium ore using Acidithiobacillus ferrooxidans

Bioleaching of uranium was carried out with Turamdih ore sample procured from Uranium Corporation of India Limited, Jaduguda. The bacterial strain that was used in the leaching experiments was isolated from the Jaduguda mine water sample. Efficiency of bioleaching was studied by varying parameters like pulp density and initial ferrous concentration as source of energy. It is observed that the efficiency of bioleaching was 49% at 10% pulp density (w/v) and initial pH 2.0. Addition of external has no effect on efficiency of bioleaching showing domination of direct leaching mechanism over indirect.

Acclimation of Anabas testudineus (Bloch) to three test temperatures influences thermal tolerance and oxygen consumption

Teleost fish have developed their own specific adaptive mechanism, both behavioral and physiological, to maintain homeostasis in response to unfavorable temperatures. Therefore, this study was aimed at assessing the critical thermal maxima (CT(Max)), critical thermal minima (CT(Min)), and oxygen consumption rate of Anabas testudineus (17.03 +/- 1.2 g) after acclimating to three preset temperatures (25, 30, and 35 degrees C) for 30 days. The CT(Max) and CT(Min) were 40.15, 41.40, 41.88 degrees C and 12.43, 13.06, 13.94 degrees C, respectively, and were significantly different (P < 0.05). The thermal tolerance polygon for the specified temperatures was 278.30 degrees C(2). The oxygen consumption rate (117.03, 125.70, 198.48 mg O(2) kg(-1) h(-1), respectively) increased significantly (P < 0.05) with increasing acclimation temperatures. The overall results indicate that the thermal tolerance and oxygen consumption of A. testudineus are dependent on acclimation.

A novel [109Pd] palladium labeled porphyrin for possible use in targeted radiotherapy

The preferential accumulation of porphyrins in malignant tumor cells has been adequately documented. Hence, porphyrin derivatives radiolabeled with a suitable therapeutic radionuclide could be envisaged as potential agents for targeted tumor radiotherapy. Working in this direction, we have radiolabeled a porphyrin derivative, namely, 5,10,15,20-tetrakis[3,4-bis(carboethoxymethyleneoxy)phenyl]-porphyrin, synthesized in-house, with 109Pd [E β(max)=1.12 MeV, E γ=88 keV 3.6(%), T 1/2 = 13.7 h]. The envisaged rationale towards designing of this agent is based on the assumption that 109Pd would complex with the tetrapyrrole donor array constituting the porphyrin core, thereby providing a highly stable chelated complex, and the peripheral ester groups would impart optimum lipophilicity needed for sufficiently high tumor accumulation and retention therein. 109Pd was produced with a specific activity of ∼1.85 GBq/mg and radionuclidic purity of 100% by the thermal neutron bombardment of enriched (98% in 108Pd) metallic Pd target at a flux of 3×1013 n/cm2s1 for 3 d. The porphyrin derivative was synthesized by a multi-step reaction and characterized by normal spectroscopic techniques. 109Pd complex of the synthesized porphyrin derivative was prepared with excellent radiochemical purity (>98%) and the complex was observed to be stable upto 24 h at room temperature. Biodistribution studies carried out in Swiss mice bearing fibrosarcoma tumors revealed good tumor uptake [(5.28±1.46)% injected activity (IA)/g] within 30 min post-injection (p.i.). The complex exhibited favorable tumor/blood and tumor/muscle ratios [1.69±0.23 and 5.00±1.54, respectively at 3 h p.i.], albeit with high liver uptake throughout the time of study (>20% IA).

Stenotrophomonas maltophilia endogenous endophthalmitis: clinical presentation, sensitivity spectrum and management

Stenotrophomonas maltophilia is gaining importance as a community-acquired pathogen, after becoming firmly established as a nosocomial pathogen. Here we report a case of endogenous endophthalmitis due to S. maltophilia. Antibiotic-susceptibility testing of the isolate was performed by the Kirby-Bauer disc diffusion method. The organism was resistant to aminoglycosides, imipenem, ticarcillin and cotrimoxazole and was sensitive to ceftazidime and chloramphenicol. The patient was successfully treated with a sensitivity-based intravitreal antibiotic regimen.

Biochemical and stress responses of rohu Labeo rohita and mrigal Cirrhinus mrigala in relation to acclimation temperatures

The biochemical and stress responses of two Indian major carps, rohu Labeo rohita and mrigal Cirrhinus mrigala were studied after acclimating them to four preset temperatures (26, 31, 33 and 36 degrees C) for 30 days. The blood glucose and liver glycogen levels showed an inverse trend in both the species and were significantly different in L. rohita at higher temperatures. The decrease in the liver glycogen level of C. mrigala, however, was not significant. Plasma cortisol levels increased significantly whereas the ascorbic acid content in the brain and kidney of both the species decreased significantly with increasing temperatures. Total lipid content in the liver of both the species decreased significantly with increasing acclimation temperatures. The phospholipid concentration decreased in L. rohita with increasing acclimation temperatures, and in C. mrigala the values decreased up to 33 degrees C and increased at 36 degrees C. In C. mrigala, the cholesterol level decreased up to 33 degrees C and then increased at 36 degrees C, but the absolute value was lower in comparison to L. rohita. The cholesterol levels, however, were not significantly different in L. rohita. Triglycerides and free fatty acids concentrations decreased significantly with increasing acclimation temperatures in both the species. The present study indicates species-specific metabolic responses of L. rohita and C. mrigala to thermal acclimation.

Conversion from mycophenolate mofetil to enteric-coated mycophenolate sodium in renal transplant recipients with gastrointestinal tract disorders

OBJECTIVE

The objective of this prospective study was to evaluate the effect of conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) in renal transplant recipients with gastrointestinal tract (GI) reverse effects using patient-reported outcomes instrument.

METHODS

A multicenter, open-label, prospective study was undertaken in renal transplant recipients treated with MMF. In patients experiencing GI tract symptoms, treatment was changed to equimolar EC-MPS (myfortic). At baseline and visit 2 (4-6 weeks after baseline), patients completed the Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI), and physicians completed the Overall Treatment Effect (OTE) scale at visit 2. A difference of 0.5 or greater in the OTE score is indicative of clinical relevance.

RESULTS

Of 154 patients screened, 118 fulfilled the inclusion or exclusion criteria. Eighty-five men and 33 women with a mean age of 41.6 years participated in this study. Median time since transplantation was 12 months. Mean (SD) dose of MMF reported at baseline was 1209.4 (422.89) mg/d. More than 50% of patients reported MMF-associated nausea, dyspepsia, and abdominal pain. After conversion to an equimolar dose of EC-MPS, patients showed improvement in GI symptoms. This benefit was predominantly observed in patients with moderate to severe symptoms at baseline. On the GSRS, patients reported a significant (P < .05) reduction in symptom burden across all parameters (reflux, 36%; diarrhea, 38%; indigestion, 36%; constipation, 28%; and abdominal pain, 40%). On the GIQLI also, significant (P < .05) improvement was reported (symptoms, 18%; emotional status, 22%; physical functioning, 21%, and use of medical treatment, 18%). On the OTE scale, 84.7% of patients reported improvement in GI symptoms.

CONCLUSION

In patients with moderate to severe GI symptoms, changing treatment from MMF to EC-MPS significantly reduces GI-related symptom burden and improves GI-specific quality of life.

Persistent sub-lethal chlorine exposure augments temperature induced immunosuppression in Cyprinus carpio advanced fingerlings

Apart from increased temperature, thermal effluents discharged through cooling systems of nuclear power plants may often contain chlorine (used against bio-fouling), which may affect the immune status of fish. Therefore, a 28-day trial was undertaken to delineate the effect of high temperature and a persistent sub-lethal chlorine exposure on immunomodulation in Cyprinus carpio advanced fingerlings. Fish were acclimated to four different temperatures (26, 31, 33 and 36 degrees C) and maintained for 30 days in two different groups. One group was exposed to persistent chlorine (0.1mgL(-1)) and was compared with their respective temperature control groups (without chlorine exposure). Expression of heat shock proteins (hsp 70) was tested in muscle after 28 days using Western blotting. Haematological parameters (erythrocyte count, leucocyte count, haemoglobin), serum parameters (total protein, albumin, globulin, A/G ratio) and respiratory burst activity were tested to assess immuno-competence of C. carpio in response to temperature and chlorine exposure. Results indicated that hsp 70 was induced at 36 degrees C in temperature control groups but not in their respective temperatures in the presence of chlorine. Haematological parameters such as haemoglobin, erythrocyte and leucocyte counts appeared depressed in chlorine treated groups as compared to their respective temperature control groups. Serum protein and globulin were affected due to chlorine exposure at different acclimation temperatures. A decrease in NBT activity was recorded in chlorine treated groups as compared to their respective temperature control groups. Overall results indicate that increasing acclimation temperatures alters the immune status of C. carpio advanced fingerlings and persistent sub-lethal exposure to chlorine augments this temperature induced immunosuppression.

Patient satisfaction with nurse-led telephone consultation for the follow-up of patients with prostate cancer

Prostate cancer is being diagnosed earlier and in higher numbers than ever before. The nature of the disease means many patients have to be monitored regularly and for a prolonged period leading to increased pressure on urology outpatient resources and inconvenience for the patient. Here we investigate patient satisfaction with a nurse-led telephone-based follow-up clinic and compare it to satisfaction with traditional outpatient consultations. A Consultation Satisfaction Questionnaire (CSQ) evaluating four domains, namely General Satisfaction (GS), Professional Care (PC), Depth of Relationship (DR) and Perceived Time (PT) was used to assess satisfaction in three groups. Group 1 consisted of 299 patients attending the outpatient department before commencing telephone consultations; Group 2 consisted of 163 men attending outpatients after commencement of the telephone consultations; and Group 3 was the telephone group (234 men). We demonstrated no significant difference in GS or PC between Group 1 and Group 3 or Group 2 and Group 3, although DR and PT was significantly lower in the telephone group compared with Group 1. We also found that waiting times were significantly shorter in the telephone group. In conclusion, telephone follow-up appears to be an acceptable alternative to outpatient follow-up in terms of GS and PC and appears to be more convenient for the patient, although these benefits come at the expense of loss of DR and PT with the clinician.

Biocompatibility of diamond-like nanocomposite thin films

Diamond-like nanocomposite (DLN) films consist of network structure of amorphous carbon and quartz like silicon. In the present work, DLN films have been synthesized on pyrex glass and subsequently, their biocompatibility have been investigated through primary and secondary cell adhesion, cytotoxicity, protein adsorption and murine peritoneal macrophage activation experiments. Variable degree of cell and protein response have been found based on variable film synthesis parameters but in overall, required biocompatibility has been established for all types of film-coating.

Preparation and preliminary biological evaluation of a novel 109Pd labeled porphyrin derivative for possible use in targeted tumor therapy

AIM

The labeling of a porphyrin, a tumor-avid agent, with a beta-emitting radionuclide for evaluating its potential as an agent for targeted tumor therapy is reported. A novel water soluble porphyrin viz. 5,10,15,20-tetrakis[3,4-bis(carboxymethyleneoxy)phenyl]porphyrin radiolabeled with(109)Pd (E(beta(max))=1.12 MeV, Eg=88 keV (3.6%), T1/2=13.7 h) has been prepared. The designing of this agent is based on the speculation that (109)Pd would complex with the tetrapyrrole donor array constituting the porphyrin core, resulting in a species with peripheral hydrophilic residues for facilitating renal excretion.

METHODS

Palladium-109 was produced by thermal neutron bombardment on enriched metallic Pd target at a flux of 3 x 10(13) n/cm(2) x s for 3 days and the porphyrin derivative was synthesized by a multi-step reaction using 3,4 dihydroxybenzaldehyde and pyrrole. The labeling parameters were optimized for obtaining maximum complexation yield and the biological behavior of the radiolabeled porphyrin was studied in Swiss mice bearing fibrosarcoma tumors.

RESULTS

Palladium-109 was produced with a specific activity of approximately 1.85 GBq/mg and approximately 100% radionuclidic purity. Lead-109 complex of the synthesized porphyrin derivative was prepared with excellent radiochemical purity (approximately 98%) and the complex was observed to be stable upto 24 h at room temperature. Results of the biodistribution studies revealed good tumor uptake (2.8+/-0.57%/g) within 30 min post-injection and it remained almost constant till 24 h post-injection. The complex showed predominantly renal clearance (88.68+/-4.01% at 24 h post-injection).

CONCLUSIONS

The high tumor/blood and tumor/muscle ratios (4.36 and 38 at 24 h post-injection) exhibited by the radiolabeled porphyrin indicate its potential for using in targeted tumor therapy.

Involvement of nitric oxide in neurodegeneration: a study on the experimental models of Parkinson's disease

The present study was undertaken to explore involvement of nitric oxide (NO) in the experimental models of Parkinson's disease. Neurodegeneration was induced by unilateral injections of 6-hydroxydopamine (6-OHDA) or lipopolysaccharide (LPS) in the right striatum. Lesions were functionally evaluated by amphetamine-induced asymmetrical behaviour and by decrease in the tyrosine hydroxylase (TH) immunostaining. An induction in the expression of iNOS and augmentation in nitrite content was observed in both the models. The extent of increase in iNOS expression was, however, different but the elevation in the nitrite content was comparable in both the models. The increase in iNOS expression inversely correlated with the tyrosine hydroxylase (TH) immunolabeling. Animals pretreated with a NOS inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), exhibited complete protection against amphetamine induced rotations in both the models. Thus, augmented NO availability subsequent to iNOS induction seems to play an important role in the initial phase of neurodegeneration.

Dietary high protein and vitamin C mitigate stress due to chelate claw ablation in Macrobrachium rosenbergii males

Stress due to claw ablation was tested in Macrobrachium rosenbergii males. Dietary high protein and vitamin C were supplemented for amelioration of stress. We used four different treatments: fed with 25% protein and a normal dose (0.12%) of vitamin C (T(1)); 35% protein and a normal dose (0.12%) of vitamin C (T(2)); 25% protein and a high dose (0.24%) of vitamin C (T(3)); and high protein 35% and a high dose (0.24%) of vitamin C (T(4)) for 30 days. All test prawns (T(1) to T(4)) were subjected to ablation of their second chelate legs after the 15th day of the feeding trial. A control treatment was maintained without claw ablation and fed with 25% protein. Haemolymph glucose, hepatopancreatic glycogen, muscle ascorbate and enzyme activities (glucose 6 phosphatase (G6Pase), fructose-1,6-bisphosphatase (FBPase), lactate dehydrogenase (LDH), Alanine aminotransferase (ALT) in hepatopancreas) were tested at different recovery periods (0, 6, 24 h, 7 and 14 days). Results indicate a high glucose level immediately after claw ablation and a concomitant increase in gluconeogenic enzymes (G6Pase and FBPase). However, glycogen reserves were regained in the treatments due to claw ablation stress after 24 h. LDH and ALT activity decreased in the hepatopancreas of M. rosenbergii up to 24 h after claw ablation. Overall results indicate that claw ablation is stressful to M. rosenbergii and high protein and vitamin C diet may mitigate stress due to claw ablation.

Is social support sometimes a mixed blessing?

BACKGROUND

Child behavioural problems in epilepsy originate from a poorly understood interplay between intrinsic, family and social factors.

METHODS

We re-analysed data from a randomized controlled trial of antiepileptic treatment in rural India, using regression analysis to find risk factors for behavioural problems.

RESULTS

Parental satisfaction with social support was positively and independently correlated with child behavioural problems (P=0.03).

CONCLUSION

Our findings suggest parents' interactions within their informal social support network, contrary to expectation, may increase risk for behavioural problems in their children. We suggest a possible explanation for this correlation as well as follow-up studies to investigate the social support-as-risk factor hypothesis.

A comparative study of epiretinal membranes associated with Eales' disease: a clinicopathologic evaluation

AIM

To study the histopathologic features and clinical correlation of epiretinal membranes (ERM) obtained from patients of Eales' disease and compare with other vasoproliferative disorders.

METHODS

Retrospective analysis of epiretinal membranes submitted for histological evaluation between January 1995 and June 2001, from the patients of diabetic retinopathy and vascular occlusions (Group 1; vaso-occlusive disorders) and of Eales' disease (Group 2; vasoinflammatory disorders). Demographics, pre and postoperative visual acuity, and anatomic and histologic characteristics of membranes were studied. Histopathologic features and clinical outcomes were correlated between the groups. The results were analysed statistically by Student's t-test, Fisher's exact test and Kruskal-Wallis test.

RESULTS

This study consisted of 42 patients, 24 in Group 1 and 18 in Group 2. Patients in Group 2 (33.0+/-9.2 years) were significantly younger than the patients in Group 1 (49.9+/-7.6 years) (P< or =0.0001). Final visual acuity of >20/400 was attained in 79.2% (19/24) patients in Group 1 and 83.3% (15/18) in Group 2 (P=1.0). Inflammatory membranes were significantly associated with presumed Eales' disease (94.4 vs 0%) (P< or =0.0001) and fibrovascular membranes with Group 1 (70.8% vs 33.3%) (P=0.028). Mast cells and eosinophils were observed as special features in epiretinal membranes of patients with Eales' disease.

CONCLUSIONS

Histological features of ERM in Eales' disease are comparable to other vasoproliferative disorders except for features of inflammation. Presence of mast cells and eosinophils in epiretinal membranes of Eales' disease needs further investigation.

Desmin-related myopathy: Report of a rare case

The Protein Surplus Myopathies (PSM) are characterized by accumulation of protein aggregates, identifiable ultrastructurally, resulting due to mutations of the encoding genes. Desmin-related myopathies (DRM) are a form of PSM characterized by mutations of the desmin gene resulting in the formation of protein aggregates comprising mutant protein desmin and disturbance of the regular desmin intermediate network in the muscle fibers. We describe a rare case of DRM in a 23-year-old man who presented with complaints of difficulty in climbing stairs and running since the age of 5 years. EMG studies revealed a myopathic pattern. Muscle biopsy showed the features of muscular dystrophy with bluish rimmed vacuoles and sarcoplasmic inclusions, which were immunoreactive to desmin. Ultrastructural examination showed sarcoplasmic bodies and granulofilamentous inclusions. Although rare, the possibility of DRM/desminopathy should be considered in the presence of bluish rimmed vacuoles on light microscopy and characteristic ultrastructural inclusions. To the best of our knowledge this is the first case of DRM/desminopathy reported from India.

A randomized single-blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: a preliminary report

BACKGROUND

Use of letrozole, a selective inhibitor of aromatase, reduces the gonadotrophin dose required to induce follicular maturation. We evaluated whether incorporation of letrozole could be an effective low-cost IVF protocol for poor responders.

METHODS

A randomized, controlled, single-blind trial was conducted in the Assisted Reproduction Unit, Institute of Reproductive Medicine, Kolkata, India. Thirty-eight women with a history of poor ovarian response to gonadotrophins were recruited. Thirteen women (Let-FSH group) received letrozole 2.5 mg daily from day 3-7, and recombinant FSH (rFSH) 75 IU/day on days 3 and 8; and 25 women (GnRH-ag-FSH group) underwent long GnRH agonist protocol and stimulated with rFSH (300-450 IU/day). Ovulation was triggered by 10,000 IU of HCG followed by IVF-embryo transfer. The main outcome measures were total dose of rFSH (IU/cycle), terminal estradiol (E2) (pg/ml), numbers of follicles, oocytes retrieved and transferable embryo, endometrial thickness (mm), and pregnancy rate.

RESULTS

Compared with the GnRH-ag-FSH group (2865 +/- 228 IU), the Let-FSH group (150 +/- 0 IU) received a significantly (P < 0.001) lower total dose of FSH. Except for terminal E2, which was significantly higher (P < 0.001) in the GnRH-ag-FSH group (380 +/- 46 pg/ml) than the Let-FSH group (227 +/- 45 pg/ml), the treatment outcomes in all other respects, including pregnancy rate, were statistically comparable.

CONCLUSIONS

Adjunctive use of letrozole may form an effective means of low-cost IVF protocol in poorly responding women.

Predictors of parental adjustment to children's epilepsy in rural India

BACKGROUND

Negative societal attitudes towards disability affect the adjustment of parents when their child is diagnosed with epilepsy. Recent studies have suggested that parental and child outcomes, including adjustment, can be influenced by non-directed social support to mothers of children with disability. The objective of our study was to test the hypothesis that maternal satisfaction with social support, measured at the beginning of treatment, would predict parental adjustment to the child's epilepsy after 1 year of treatment.

METHODS

We enrolled 46 mothers of children aged 6-18 years with epilepsy in the study. We measured social support using the modified Dunst family support scale, and parental adjustment using a locally validated instrument (S-PAM). Correlation was tested using a multiple linear regression model, allowing for confounding variables.

RESULTS

Parental adjustment at outcome was positively independently correlated with satisfaction with social support at baseline,and negatively with severity of the child's epilepsy. The regression model explained 34% of the total variance.

CONCLUSIONS

Taken together with evidence from previous studies, this finding supports the idea that helping parents to find more satisfaction within their (new or existing) social networks will promote adjustment to their child's disability.

Protein A-activated macrophages induce apoptosis in Ehrlich's ascites carcinoma through a nitric oxide-dependent pathway

Protein A (PA) of Staphylococcus aureus has been demonstrated to possess anti-tumor activity against a wide variety of tumors. In the current study we endeavored to obtain a mechanistic insight into PA-mediated Ehrlich's ascites carcinoma (EAC) killing. Our results indicate that PA stimulates generation of nitric oxide (NO) from murine peritoneal macrophages. Nitric oxide in turn induces cytotoxic damage to the tumor cells. Analysis of the morphological features and cell cycle phase distribution pattern of nuclear DNA revealed an induction of apoptosis (appearance of sub-G0/G1 population) in EAC after PA treatment. We have further elaborated the alterations in the expressions of the proto-oncoproteins p53 and Bax, together with a change in the ratio of Bcl-2/Bax in the treated tumor cells, which favor apoptosis. PA-induced apoptosis and changes in the expression of oncoproteins in the tumor cells was prevented by the suppression of NO release by the addition of L-NAME, the competitive NOS inhibitor, suggesting a possible mechanism by which PA exerts its anti-tumor activities involving nitric oxide through the alteration in the expressions of pro-apoptotic proteins.

Solitary plasmacytoma of the skull bone

Solitary plasmacytoma of the bone is an uncommon variety of plasma cell tumour. Here an interesting case of solitary plasmacytoma of the skull bone, which is extremely rare, is being reported.