Lyme disease in a Shimla boy

A patient with Lyme disease is described. He presented with meningitis-like picture, arthritis, and carditis (congestive cardiac failure and variable AV blocks without valvular lesions). Borrelia was present in the peripheral blood smear.

Course and prognosis of ulcerative colitis

A study of 50 patients (23 males and 27 females) of ulcerative colitis, who were on follow-up showed that maximum number of patients had the disease before the age of 50 years. At the onset, the activity of the disease was severe in 44%, moderate in 32% and mild in 24% of cases. The commonest clinical course of the disease was chronic intermittent type (48%), followed by single attack with subsequent remission (42%). Chronic continuous type was seen in 10% patients only. There was no correlation of the extent of the bowel involvement with the clinical course. The precipitating factors for the onset or reactivation of the disease appeared to be emotional disturbances in 18% and pregnancy in 8%. The complications, both local and systemic, were not frequent. Serious complications like massive haemorrhage, perforation, toxic megacolon and carcinoma colon were not seen at all.

Effect of denervation on loss of ions in chick skeletal muscle

Leaching behaviour of chick gastrocnemius muscle has been studied with respect to the loss of Na+, K+ and Ca2+ ions in a donor-solvent (muscle-water) system under normal as well as denervated conditions. An attempt has been made to explain the alterations in the rate of electrolytic loss in terms of membrane dysfunctions induced as a result of loss of neural control.

Antenatal sonographic diagnosis of chorioangioma of placenta

A rare case of chorioangioma of the placenta with unusual sonographic pattern diagnosed antenatally is presented. Another unusual feature of the case is the associated raised maternal serum alphafetoprotein level.

Jaundice in Plasmodium falciparum

Thirty-two patients of smear positive Plasmodium falciparum malaria having jaundice were analysed retrospectively. Majority of the cases were in the age group of 31-40 years. Serum bilirubin levels ranged from 2 mg to 40 mg%. Fourteen (42.6%) had serum bilirubin above 10 mg%. Conjugated bilirubinaemia was found in twenty one patients (65.5%), unconjugated in 4 (12.5%) while 7 patients (21.8%) had a mixed pattern. Serum transaminases were high in 21.8% patients. Twenty five patients (78%) had associated azotaemia, 11(34.3%) had intravascular haemolysis and 3(9.3%) had possible cerebral malaria. Hepatosplenomegaly was seen in all the 32 patients. Mortality was 21% but none died of hepatic encephalopathy. Histologically the most consistent finding in liver biopsies was reticulo-endothelial cell hyperplasia. Pigmentation in kupffer cells, fatty change, sinusoidal and portal infiltration and cholestasis were the other features seen.

Changes in leaching properties of chick skeletal muscles on denervation

The leaching of electrolytes in normal and denervated chick gastrocnemius muscle has been studied by recording electroconductivity changes in donor-solvent (muscle-water) system at 11 intervals leading to a total immersion of 5 hr 15 min, at days 1,5,10,21 and 28, post-hatching. The results show age related changes in the permeability properties of normal muscle membrane system. The loss of neural control induces a blocking of electrolytes 10 days post-denervation. The possible nature of blocking mechanism has been related to the non-availability of neuro-trophic factors in the tissue.

Effect of chronic opioid administration on glycosylated haemoglobin levels in heroin addicts

Levels of stable form of HbA1 in blood were estimated in 20 male heroin addicts, so as to assess the effect of chronic opioid use on glucose metabolism. No significant difference in the levels of stable form of HbA1 was observed in the heroin addicts as compared to controls, indicating absence of any long-term impairment of glucose tolerance in heroin addicts.

Hypolipidemic activity of trimethylamine-carbomethoxyborane and related derivatives in rodents

A number of substituted amine-carboxyborane esters were examined for their hypolipidemic activity in rodents. Trimethylamine-carbomethoxyborane, Me3NBH2C(O)OMe, was observed to be the most effective hypolipidemic agent in the rodent at the low dose of 8 mg/kg/d. This agent effectively increased the high density lipoprotein (HDL) cholesterol content and lowered the low density lipoprotein (LDL) cholesterol and triglyceride contents of rat lipoproteins. Furthermore, the agent accelerated cholesterol excretion from the body of the rat and reduced the activity of the rate-limiting enzyme involved in the de novo synthesis of lipids in the liver. The agent has a safe therapeutic index, and appeared to have more promise as a therapeutic agent than other borane esters.

Gene expression: chemical synthesis of E. coli ribosome binding sites and their use in directing the expression of mammalian proteins in bacteria

Mammalian genes, when inserted into bacterial plasmid or phage DNAs, will not be expressed into the corresponding specific proteins in E. coli unless proper initiations signals required for recognition by E. coli ribosomes are provided. We have studied these signals and chemically synthesized two DNA duplexes each containing different initiation signals. These have been inserted in front of the Simian virus 40 (SV40) small tumor antigen gene (SV40 t gene) at varying distances from the ATG initiation codon prior to its cloning into pBR322 plasmid DNA. Plasmid containing clones carrying either of these two synthetic ribosome binding sites (RBS) at varying distances from the SV40 t gene all produced a 17K protein identical to authentic t antigen by immunologic, electrophoretic and proteolytic digestion analyses. This provides a novel method to ensure the specific expression of any contiguous mammalian gene to be cloned to bacteria, and also a unique in vivo method for studying the structure-function (efficiency) relationship of RBS with specific base changes.

Observations on the vitamin D state of pregnant Asian women in London

Vitamin D nutrition in pregnancy was investigated in 115 Asian women living in London, and in 50 of their newborn infants. Mean serum 25-hydroxy cholecalciferal (25-OHD) concentration at the beginning of the last trimester was 20.2 nmol/l, and fell to 16.0 nmol/1 post partum. Thirty-six per cent of the women post partum and 32 per cent of the infants had undetectable 25-OHD concentrations (less than 3 nmol/l). Such low values are commonly associated with osteomalacia and rickets. The bone isoenzyme of alkaline phosphatase was elevated in 20 per cent of the women post partum, and in 50 per cent of the infants, indicating the presence of sub-clinical bone disease. Five infants had symptomatic hypocalcaemia. Vitamin D deficiency was most likely to occur in Pakistanis, Hindu Indians and East African Asians, and in vegetarians. All British Asians should receive supplementary Vitamin D during pregnancy.

Vitamin D binding globulin levels and affinity in various clinical conditions

The approximate association constants of the plasma vitamin D binding globulin (Gc-globulin) for 25-hydroxycholecalciferol (25(OH)D3) and the plasma 25(OH)D3 binding capacities were measured in samples from 123 patients with a variety of disorders. No gross differences in binding affinities were observed between different groups of patients and controls. Many patients, however, had moderately reduced, and several had grossly reduced, plasma binding capacities. The changes in Gc-globulin relative to some other proteins are also described in detail in three patients during the course of their illness. Gc-globulin concentration and hence plasma vitamin D binding capacity can undergo rapid and marked changes during illness.

Vitamin D binding globulin phenotypes in liver disease

The binding properties towards vitamin D metabolites of plasma from individuals with the three common Gc-globulin phenotypes, Gc-1, Gc-2 and Gc-2-1, have been found to be identical. In patients with liver disease there is a good correlation between the levels of Gc-globulin andalbumin in plasma. In addition the Gc-globulin levels correlate well with the ability of plasma to bind 25-hydroxycholecalciferol. Patients with the Gc-2-1 phenotype showed a significantly smaller depression in plasma Gc-globulin than those with the Gc-2 and Gc-1 phenotypes. The relation of these findings to the pathogenesis of disorders of calcium metabolism in liver disease is discussed.

Primary amoebic meningoencephalitis due to Naegleria fowleri

The genus Naegleria comprises of free living ameboflagellates found in soil and fresh water. More than 30 species have been isolated but only N. fowleri has been associated with human disease. N. fowleri causes primary amoebic meningoencephalitis (PAM), an acute, often fulminant infection of CNS. Here we report a rare and first case of PAM in an immunocompetent elderly patient from this part of the country. Amoeboid and flagellate forms of N. fowleri were detected in the direct microscopic examination of CSF and confirmed by flagellation test in distilled water, demonstrating plaques /clear areas on 1.5% non nutrient agar and its survival at 42°C. Keywords: Meningitis; Naegleria fowleri; primary amoebic meningoencephalitis DOI: http://dx.doi.org/10.3126/joim.v32i2.4949 Journal of Institute of Medicine, August, 2010; 32: 56-59