Population based study of hypertension among the elderly in northern India

The study was conducted in the urban and rural areas of Chandigarh during 1998-1999 among 362 elderly subjects above 65 y of age. The sample, selected by stratified random technique, covered a population of 7937 family members in 1882 houses. Methodology comprised of interviews, clinical examination and laboratory investigations such as ECG. The study revealed that 210 (58%) of the elderly were hypertensives. Of the hypertensives, only 39% are on medication. Fewer calories were consumed by the hypertensives. Further, 82.4% of the obese subjects were hypertensives as compared to 52.4% of the non-obese subjects (P<0.001). Only 56 subjects (27.6%) were both diabetic and hypertensive. One third of the elderly had some abnormality in ECG revealing associated coronary heart disease. Forty subjects (11.05%) had complications such as MI and stroke. The prevalence of complications was slightly higher (11.9%) in the hypertensives as compared to the non-hypertensives (9.9%). Thus health education campaigns should be started to increase awareness regarding the risk factors and bring about changes in lifestyle for the control of hypertension and reduction of its complications.

DOTS versus self administered therapy (SAT) for patients of pulmonary tuberculosis: a randomised trial at a tertiary care hospital

Tuberculosis is a major public health problem in a developing country like India, it is made worse by poor adherence to and frequent interruption of treatment. Treatment of tuberculosis requires strict discipline in order to eradicate mycobacteria and to cure the disease. In the present study we have conducted a randomized control trial, to compare the effectiveness of Directly Observed Therapy Short Course (DOTS) versus Self Administered Therapy (SAT) in a tertiary care hospital.

Antibacterial activity of Urena lobata root

The methanol extract of Urena lobata root showed a broad spectrum of antibacterial activity.

Creutzfeldt-Jakob disease : report of 10 cases from North India

Creutzfeldt-Jakob disease (CJD) is increasingly being reported over the last three decades as a result of heightened awareness of the disease. Various studies have reported annual incidence of 0.5-1.5 cases of CJD per million of general population. In India, the disease is still under reported. Over the period spanning from 1968-1997, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore recorded 69 cases of CJD from different parts of India in the CJD registry. This paper describes the clinical experience with cases of CJD managed at the Department of Neurology, G.B. Pant Hospital, New Delhi from 1990-1998. In this series, the mean age of the patients was 53.80 (+/- 7.32) years and there were 5 females and 5 males. Myoclonus was present in all the cases and abnormal behaviour with or without other features was the presenting complaint in 7 of the 10 patients, while one patient of CJD had cerebellar ataxia as the presenting feature. One patient with occipital variant of CJD presented with acute onset cortical blindness and myoclonic jerks. One of the patients had acute psychosis precipitated by emotional stress at the onset. Extrapyramidal features were noted in 7 of the 10 patients before death. The mean duration of symptoms from the onset of disease to death was 6.6 (+/- 6.11) months. Classical EEG changes were observed in all the patients, except in one possible case of occipital variant of CJD, where we did not have access to EEG record. Brain biopsy could be undertaken in 3 patients, and in 2 patients the features of subacute spongiform encephalopathy (SSE) were noted.

Long-term results of the treatment of complete distal ureteral stenosis using a cutting balloon catheter device

PURPOSE

We evaluated the long-term efficacy of endoscopic treatment of complete distal ureteral stenosis using a cutting balloon catheter.

MATERIALS AND METHODS

We performed a total of 10 procedures in 9 patients with complete distal ureteral stenosis at or near the ureterovesical junction. Depending on presenting anatomy cases were treated with a retrograde only (6), antegrade only (1) or combined antegrade and retrograde (3) endoscopic technique.

RESULTS

At a mean followup of 36 months (range 24 to 43) 9 of the 10 procedures (90%) were successful. Stenosis recurred in 1 of the 9 patients (10%) but a repeat procedure was successful. There were no intraoperative complications and no procedures required open surgical conversion. Although all patients noticed a various degree of hematuria postoperatively, none required blood transfusion or further intervention. Mean hospitalization was 1.1 days.

CONCLUSIONS

Endoscopic repair of distal ureteral stenosis using a cutting balloon catheter is a viable option in patients with complete ureteral obstruction. This technique results in low morbidity, a short hospital stay and excellent long-term patency. Endoscopic treatment using a cutting balloon catheter may be a therapeutic option in many patients with complete distal ureteral obstruction at or near the ureterovesical junction.

Function and inhibition sensitivity of the N-terminal segment of surfactant protein B (SP-B1-25) in preterm rabbits

BACKGROUND

Surfactant protein B (SP-B) is an essential component of pulmonary surfactant, but shorter SP-B sequences may exert equivalent surface activity.

METHODS

We synthesised a peptide based on the amino-terminal domain of SP-B (SP-B1-25), a full length SP-B1-78, and a full length palmitoylated SP-C peptide (SP-C1-35) and compared the in vivo function and sensitivity to plasma inhibition of preparations consisting of mixtures of phospholipids with SP-B1-25 or SP-B1-78 and/or SP-C1-35 to Survanta. Preterm rabbits born at 27 days of gestation were treated at birth with surfactant and ventilated for 60 minutes. At 15 minutes half of them received plasma intratracheally. Dynamic compliance was monitored every 15 minutes and postmortem pressure-volume curves were measured to define lung mechanics.

RESULTS

Dynamic compliance and postmortem lung volumes were highest after treatment with a surfactant consisting of an SP-B peptide and SP-C1-35 or Survanta. Plasma instillation decreased dynamic compliance and lung volumes sharply, but the most effective activity was by prior instillation of surfactants containing SP-B1-25.

CONCLUSION

These experiments suggest that the N-terminal domain of SP-B (SP-B1-25) exhibits in vitro and in vivo surface activity and is relatively insensitive to plasma inhibition.

Role of nitric oxide in experimental models of psychosis in rats

The aim of our study was to investigate the effects of the NO precursor L-arginine and the nitric oxide synthase inhibitor N omega-nitro-L-arginine (L-NORAG) on amphetamine-induced stereotypy, haloperidol-induced catalepsy and conditioned avoidance response (CAR) in rats. Amphetamine (3 mg/kg i.p.) was used for the induction of stereotypy, while for the induction of catalepsy and CAR, haloperidol (2 mg/kg i.p.) was used. This study was divided into 2 parts--acute administration of L-arginine (150 mg/kg i.p.) and L-NOARG (50 mg/kg i.p.) and chronic administration of L-arginine (150 mg/kg/day i.p.) and L-NOARG (50 mg/kglday i.p.) for 5 days. We found that L-arginine inhibited amphetamine-induced stereotypy and haloperidol-induced catalepsy, but intensified CAR. On the other hand, L-NOARG intensified stereotypy and catalepsy but inhibited CAR. Also, there was no significant difference between the scores of acute and chronic administration of L-arginine and L-NOARG. It is concluded from our study that nitric oxide produces conflicting results on various models of psychosis. L-arginine might be useful as an antipsychotic without causing extrapyramidal symptoms.

Pharmacologic rescue of lethal seizures in mice deficient in succinate semialdehyde dehydrogenase

Succinate semialdehyde dehydrogenase (ALDH5A1, encoding SSADH deficiency is a defect of 4-aminobutyric acid (GABA) degradation that manifests in humans as 4-hydroxybutyric (gamma-hydroxybutyric, GHB) aciduria. It is characterized by a non-specific neurological disorder including psychomotor retardation, language delay, seizures, hypotonia and ataxia. The current therapy, vigabatrin (VGB), is not uniformly successful. Here we report the development of Aldh5a1-deficient mice. At postnatal day 16-22 Aldh5a1-/- mice display ataxia and develop generalized seizures leading to rapid death. We observed increased amounts of GHB and total GABA in urine, brain and liver homogenates and detected significant gliosis in the hippocampus of Aldh5a1-/- mice. We found therapeutic intervention with phenobarbital or phenytoin ineffective, whereas intervention with vigabatrin or the GABAB receptor antagonist CGP 35348 (ref. 2) prevented tonic-clonic convulsions and significantly enhanced survival of the mutant mice. Because neurologic deterioration coincided with weaning, we hypothesized the presence of a protective compound in breast milk. Indeed, treatment of mutant mice with the amino acid taurine rescued Aldh5a1-/- mice. These findings provide insight into pathomechanisms and may have therapeutic relevance for the human SSADH deficiency disease and GHB overdose and toxicity.

Percutaneous resection of renal cysts

Symptomatic renal cysts can be managed endoscopically via retrograde ureterorenoscopy, antegrade percutaneous nephroscopy, or laparoscopy. Although all three methods are minimally invasive and effective, the retrograde approach is limited by the size and location of the cyst. Laparoscopy is also effective but is associated with multiple port sites, extensive dissection, and technical difficulty. We utilize percutaneous trans-parenchymal endocystolysis as a first-line therapy. The technique is described in detail.

Indocyanine green augmented transpupillary thermotherapy in the management of choroidal metastasis from breast carcinoma

PURPOSE

To demonstrate the efficacy of indocyanine green augmented transpupillary thermotherapy (TTT) in the management of choroidal metastasis from breast carcinoma.

METHODS

A retrospective study was performed on 4 women aged 39-59 years with solitary choroidal metastasis from breast carcinoma in whom choroidal metastasis was managed using mTT. All patients had undergone indocyanine green (ICG) augmented TTT using a diode laser (810 nm) treatment to these lesions and had a mean post-treatment follow-up of 13.2 months.

RESULTS

In all the patients there was a gradual regression of the lesion over a mean follow-up of 13.2 months with retention of good visual acuity.

CONCLUSION

Indocyanine green augmented transpupillary thermotherapy is a viable alternative for management of solitary choroidal metastasis from breast carcinoma.

Topiramate: a new safe and effective antiepileptic

Twenty patients of either sex, with refractory partial epilepsy with or without secondary generalisation were entered in an open label study to evaluate the efficacy and safety of topiramate in them. Topiramate was used as an adjunctive therapy with an initial starting dose of 50 mg/day. The dose was then titrated upwards with increments of 50 mg per week, till a time the most effective and the best tolerated dose was reached. This most effective/tolerated dose was then continued for 6 months. Of the 17 patients entering the maintenance phase, 4 patients (24%) became seizure free, while a total of 14 patients (83%) out of 17 cases responded with a reduction in monthly seizures rate by 50% or more. Mean reduction of 68.9% was observed in monthly seizure rate during the maintenance phase. The median effective dose of topiramate was 600 mg per day. Five patients dropped out of the study due to adverse events such as anxiety, aggressiveness, rash, lethargy, etc. The central nervous system (CNS) related side effects such as dizziness, headache, and tremor were reported, which are commonly seen with other presently available antiepileptics like carbamazepine, phenytoin sodium, sodium valproate, etc, as well. Most adverse events, however, were mild and transient and did not interfere with the day to day activity of the patients. Topiramate was not associated with any abnormality in laboratory or neurological examination findings. The excellent response with topiramate therapy in Indian patients, uncontrolled with the available antiepileptics, as well as its good safety profile endorse the international efficacious and safe image of topiramate.

Comparison of apoptosis and terminal differentiation: the mammalian aging process

Apoptosis is the ordered chain of events that lead to cell destruction. Terminal differentiation (denucleation) is the process in which cells lose their nuclei but remain functional. Our group examined cell death in three tissues using two different fixatives and a postfixation procedure, involving young (5 months) and old (2 years) guinea pigs. The data reveal that B-DNA and Z-DNA content decreases, whereas single-stranded (ss-) DNA increases, in older tissues undergoing apoptosis (skin and cornea) and terminal differentiation (ocular lens). We speculate that some of the factors that contribute to the aging process might also be responsible for the enhanced amount of damaged DNA in older tissues undergoing cell death. (J Histochem 49:929-930, 2001)

Lipid peroxidation and glutathione peroxidase in ischemic heart disease

With the growing interest in the concept of free radicals in the pathogenesis of myocardial ischemia, it was thought worthwhile to study the changes in lipid peroxides and antioxidant enzyme glutathione peroxidase (GPx) in ischemic heart disease (IHD). The study was carried out on 76 patients of IHD-38 of acute myocardial infarction (AMI) and 38 of stable ischemic heart disease (SIDH). They were age and sex matched with 38 normal healthy controls. A significant increase (p<0.001) in lipid peroxides as malondialdehyde (MDA) (5.9±0.7 mmol/L) and a decrease in GPx (24.6±2.2 U/gmHb) was found in patients of AMI when compared with controls. There was no significant difference in these values in SIHD. Thus this study confirms the earlier findings that MDA and GPx are useful parameters in IHD and their magnitude is dependent on severity and/or duration of ischemia. We suggest that these tests would be of use in smaller institutions with limited facilities.

Monocyte-derived human macrophages and peripheral blood mononuclear cells infected with ebola virus secrete MIP-1alpha and TNF-alpha and inhibit poly-IC-induced IFN-alpha in vitro

Ebola virus infection of humans is associated with high levels of circulating inflammatory chemokines and cytokines. We demonstrate that direct infection of human PBMC results in the induction of MCP-1, MIP-1alpha, RANTES, and TNF-alpha as early as 24 h p.i. in response to live virus. Monocyte-derived macrophages infected with live Ebola-virus secreted MIP-1alpha and TNF-alpha specifically while RANTES and MCP-1 were secreted by with both live or inactivated virus stimulation and do not require viral replication. Type I interferons (IFN-alpha and -beta), IL-1beta and IL-10, were not induced by Ebola virus. Furthermore, live virus infection of both PBMCs and monocytes-derived macrophages inhibited IFN-alpha induced by double-stranded RNA in vitro. These data provide the first direct evidence of a role for macrophages in the pathogenesis to Ebola virus and suggest that Ebola virus can inhibit cellular antiviral mechanisms mediated by type I interferons.

Cytokine modulation with immune gamma-globulin in peripheral blood of normal children and its implications in Kawasaki disease treatment

Intravenous immune gamma-globulin (IVIG) is used successfully in the treatment of Kawasaki disease, with dose-dependent rapid resolution of symptoms such as fever and irritability and a decrease in ESR, WBCs, and platelets. The mode of action of IVIG in reducing this inflammatory response is not clearly understood. Recently anticytokine antibodies in IVIG have been demonstrated. Serum levels of proinflammatory cytokines have been shown to be elevated in patients with Kawasaki disease. The cytokine interleukin-6 (IL-6) is involved in the de novo production of acute-phase proteins by hepatocytes and cause thrombocytosis and fever in response to tissue injury. Patients receiving parenteral recombinant human IL-6 have dose-dependently experienced fever, malaise, chills, and acute-phase reaction. With high IL-6 concentrations, central nervous system toxicity has also been reported and IL-6 has been thought to mediate endothelial damage. We evaluated the response of stimulated blood cells of 12 normal children to IVIG in the release of the cytokines IL-6, IL-8, TNF-alpha. and IL-6 receptor (sIL-6R). The levels of cytokines IL-6, IL-8, and TNF-alpha (but not sIL-6R) in peripheral blood induced by stimulation with LPS were markedly reduced (P < 0.008) within 3 hr when incubated with IVIG compared to without IVIG. Thus we demonstrated that cells of normal children respond to IVIG in vitro by reducing cytokines such as IL-8, TNF-alpha, and IL-6 without affecting the level of receptor sIL-6R during an acute inflammatory response. We also found significantly higher IL-6 levels in children with Kawasaki disease compared to children with blood culture-negative febrile illnesses. In five children with Kawasaki disease we measured serum IL-6 before and after IVIG and assessed the clinical response to IVIG therapy. Therapy with IVIG was followed by a rapid resolution of symptoms in Kawasaki disease, with a significant decrease in serum IL-6. The attenuation of proinflammatory cytokine responses, especially IL-6, following infusions of IVIG may play an integral role in the rapid resolution of symptoms and decrease in the acute-phase proteins in children with Kawasaki disease. Cells of normal children were found to respond to the IVIG in a manner similar to that of the Kawasaki children.