Involvement of male genitalia in leprosy

Four hundred and sixty-seven male patients with leprosy were screened for genital involvement. Genital lesions were observed in 6.6% of all male cases of leprosy. They were seen most frequently in lepromatous leprosy (25.8%), followed by borderline lepromatous (13.3%) and borderline tuberculoid (1.4%) leprosy.

Identification of thyroid regulatory elements in the Na-K-ATPase alpha3 gene promoter

A -1027 bp to + 108 bp region of Na-K-ATPase alpha3 gene promoter has been searched for the presence of thyroid response elements (TRE). Computer analysis of this sequence using a consensus TRE sequence revealed the presence of four putative TRE rich regions referred to as regions I (-636 to -457 bp), II (-218 to -106 bp), III (-106 to -6 bp) and IV (-6 to +108 bp). Cotransfection of the luciferase linked full length construct as well as constructs progressively devoid of the TRE rich regions in Cos1 cells revealed that regions I and III are positively regulated by T3 whereas there are some sequences in region II which can suppress the positive regulatory effect of region III but not of region I. TRE IV seems to have no functional role. EMSA of the three functional TRE rich regions (I, II and III) showed strong and specific interaction with thyroid hormone receptor (TR) cloned and expressed in baculovirus. The overall results suggest the regulation of Na-K-ATPase alpha3 gene by T3 is complex involving several thyroidal regulatory elements.

Reduced expression and altered distribution of neurofilaments in neurons cultured in thyroid hormone-deficient medium

The effect of thyroid hormone (TH) deficiency on the expression of neurofilament (NF) proteins and their intracellular distribution has been examined in primary cultures of neurons from embryonic rat cerebra. Northern blot analysis showed that in TH-deficient (THdef) neurons, the expression of all three NF mRNAs (NF-L, NF-M and NF-H) are retarded by 50-70% at days 7, 15 and 25 of culture compared with their TH-supplemented (THsup) counterparts. Western blot analysis also showed a decline of 60-80% in the expression of all the NF-proteins at all time points. Immunofluorescent staining of neurons from THdef and THsup cultures at days 7, 15, and 25 with monoclonal anti NF-L antibody showed that with age, TH deficiency reduced the localization of NF-L in the cell body with a corresponding increase in the hillock and proximal axon region. The present neuronal culture system offers an excellent experimental model for studying the biochemical events responsible for the altered NF pathology in degenerating neurons.

A new powerful antibacterial synergistic combination of trimethoprim and trimeprazine

The antihistaminic phenothiazine trimeprazine (Tz) was found to exhibit significant antibacterial activity on the basis of in vitro and in vivo tests. For the study of synergism due to a combination between Tz and trimethoprim (Tm), drug soaked filter paper discs were placed on young culture lawns of sensitive bacteria on nutrient agar plates. Calculation of the area of inhibition zones for determining the degree of synergism between Tz and Tm showed the increase to be statistically significant (p<0.01) when compared with their individual effects. By the checkerboard assessment procedure, the fractional inhibitory concentration (FIC) index was found to be 0.18, confirming synergism. The protective capacity of this combination was then assessed in Swiss white mice using S. typhimurium as the challenge bacterium, and the level of bacterial load was determined from infected autopsied animals. Statistical analysis of the data by students 't' test finally proved that a combination of Tz+Tm was highly synergistic.

Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis

OBJECTIVES

The role of EEG and evoked potentials has not been evaluated in predicting the prognosis of tuberculous (TB) meningitis. The present study was aimed at evaluating the prognostic significance of clinical, radiological, and neurophysiological variables using multi-variable analysis.

METHODS

Patients with TB meningitis diagnosed on the basis of clinical, radiological, and CSF criteria have been prospectively evaluated. All the patients were subjected to a detailed neurological evaluation. The outcome was defined 6 months after starting treatment on the basis of the Barthel index (BI) score into poor (BI <12) and good recovery (BI> or =12). Death was included in the poor recovery group for statistical analysis. Thirteen clinical (age, sex, seizure, focal weakness, stage of meningitis, Glasgow coma scale score, methyl prednisolone therapy), CT (infarction, hydrocephalus, tuberculoma) and neurophysiological (EEG, motor and somatosensory evoked potentials) variables were evaluated employing single variable logistic regression followed by multivariable logistic regression analysis. The best set of predictors were obtained by stepdown logistic regression analysis.

RESULTS

Fifty four patients were included in the present study. Their age ranged between 5 and 62 years, 11 were children younger than 12 years and 14 were female. Nine patients were in stage I meningitis, 12 in stage II, and 33 in stage III. On single variable logistic regression analysis the significant predictors of 6 months outcome of TB meningitis included focal weakness, Glasgow coma scale (GCS), motor evoked potential (MEP) and somatosensory evoked potential (SEP). On multivariable analysis the best set of predictors comprised focal weakness, GCS, and SEP.

CONCLUSIONS

In patients with TB meningitis focal weakness, GCS, and SEP are the best predictors of 6 month outcome.

Lipoprotein(a) and coronary heart disease in Indian population

OBJECTIVE

Present study was undertaken to evaluate the role of lipoprotein(a) in coronary heart disease (CHD) patients and its relationship with other established risk factors.

METHODS

Blood samples of 67 control patients (non-cardiovascular problems) and 222 CHD patients (> or = 4 weeks post myocardial infarction) were analyzed. Lipoprotein(a) was measured in serum samples by enzyme-linked immunosorbent assay utilizing rabbit polyclonal antibodies against purified human Lp(a). Step-wise linear discriminant analysis was used to find the important parameters to discriminate CHD and non-CHD subjects.

RESULTS

The LDL to HDL cholesterol ratio (p < 0.01) and serum level of lipoprotein(a) (p < 0.01) were significantly higher in CHD patients. Levels of lipoprotein(a) were found to be higher in females compared to males (p < 0.01). Positive family history of CHD did not show significant difference in Lp(a) levels. Lp(a) level in CHD patients with positive family history of NIDDM and hypertension was higher than in with negative family history.

CONCLUSION

Clinical significance of serum level of Lp(a) and albumin in determining the risk of CHD has been observed. Lp(a) alone could correctly discriminate a CHD individual from a control subjects by 95%. Estimating of Lp(a) together with albumin provided 99% correct discrimination between control and CHD patients. These results also suggest that Lp(a) together with malnutrition could be responsible for the increased incidence of CHD in Indians. It is also indicated that in females atherothrombogenic potential of lipoprotein(a) remains suppressed before menopause but after this stage women lose this advantage.

Prognostic predictors of acute transverse myelitis

INTRODUCTION

The role of clinical, MRI and neurophysiological parameters in predicting the outcome of acute transverse myelitis (ATM) is reported.

MATERIALS AND METHODS

Thirty-one patients with ATM were subjected to clinical, MRI, somatosensory and motor evoked potential studies in both upper and lower limbs and concentric needle electromyography. The outcome was defined at the end of 6 months into poor (Barthel Index score <12) and good (> or =12). The relationship of various prognostic variables was evaluated by biserial correlation coefficient and stepwise discriminant analysis.

RESULTS

The mean age of the patients was 30.4 years and 7 were females. Fifteen patients had good and 16 had poor outcome. The variables significantly related to the outcome included severity of weakness, denervation on EMG and unrecordable central motor conduction time to tibialis anterior (CMCT-TA) and tibial somatosensory evoked potentials (SEPs). Combination of severity of weakness and EMG had 90.3% predicting power. Addition of central sensory conduction time (CSCT) or central motor conduction time (CMCT) did not offer further advantage.

CONCLUSION

Severity of weakness and denervation on EMG are most useful for predicting the outcome of ATM at 6 months although in early stage motor and somatosensory evoked potentials may be used instead of EMG.

Assessment of normal weight in males of the age group of 40-60 years with respect to height: a new formula

In the present work, 3000 male human subjects were studied for their health status and endeavour was made to establish the relation between the height and weight. Male individuals between the age group of 40 to 60 years were studied; their heights were between 140-180 cm. They were grouped as Group I-weight above (Height in cm-100 cm) x kg/ cm, Group II-weight between Group I and Group III subjects and Group III-weight below Group I subjects at least by 15%. It was found that Group II subjects were less sufferer from disease like, diabetics, coronary heart diseases, hypertension etc. than Group I subjects, Group III subjects were also similarly less affected by diseases but they are more prone to tiredness to accustomed work than Group II subjects. So it is concluded that the weight of Group II subjects should be considered standard.

Transient renal impairment in acute intracerebral haemorrhage

Transient impairment of renal function was found in 30 of 78 patients with acute intracerebral haemorrhage (ICH). Patients with a history of renal disease, dehydration, nephrotoxic drugs or septicaemia were excluded. In the 1st week, the mean serum creatinine level was 3.4 (range 1.7-7.7) mg/dl, which returned to normal in 2-4 weeks. Employing multivariate stepdown logistic regression analysis, Glasgow Coma Scale score and pulse pressure were found to be significantly related to renal impairment manifesting with a raised serum creatinine level, whereas pupillary asymmetry was of borderline significance. An acute rise in intracranial pressure following ICH may result in sympathetic overactivity, which may account for the renal impairment observed in our patients.

Prognosis of tuberculous meningitis: a multivariate analysis

Twenty-six clinical, laboratory and CT scan features in 49 patients with tuberculous meningitis (TBM) were analysed to identify the parameters of prognostic significance. Employing univariate analysis, seven variables were found to correlate with three month outcome; these variables included the stage of TBM on admission, focal weakness, Glasgow coma scale (GCS), incontinence, infarction, hydrocephalus and shunt surgery. Analysing all 26 variables, a conditional logistic regression model was derived. In this model stage of TBM, age, focal weakness, cranial nerve palsy and hydrocephalus were found to be contributing to the three month outcome of TBM patients as assessed by the Barthel index.

A study of prognostic predictors of supratentorial haematomas

The prognosis of supratentorial haematomas is based on clinical signs and radiological features. The role of evoked potentials has not been evaluated systematically. In a prospective study of supratentorial haemorrhage a number of clinical (17), radiological (3) and evoked potential (2) parameters were evaluated employing univariate logistic regression analysis in 69 patients and multivariate logistic regression stepdown analysis in 51 patients. The outcome was graded on the basis of the Barthel index (BI) score at 3 months as good (BI > or = 12) or poor (death or BI < 12) recovery. Employing univariate analysis the significant prognostic variables were Glasgow Coma Scale, Canadian Neurological Scale, tendon reflex, associated medical complications, urinary incontinence, ventricular extension of the haematoma and motor evoked potentials. Using multivariate logistic regression analysis the best set of parameters in relation to outcome included Glasgow Coma Scale (P < 0.05), Canadian Neurological Scale (P < 0.05), tendon reflex (P < 0.1), ventricular extent (P < 0.01) and motor evoked potentials (P < 0.05). From this study it is concluded that, in addition to clinical and radiological parameters, motor evoked potentials also have an important role in predicting outcome.

Epidemiology of Vibrio cholerae O139 with special reference to intrafamilial transmission in Calcutta

A total of 27 families of hospitalised patients (index case families) suffering from acute watery diarrhoea caused by Vibrio cholerae O139, and 14 neighbourhood families were bacteriologically screened for 4 consecutive days to determine the extent of V. cholerae O139 infection amongst healthy contacts and other suspected vehicles of transmission at the intrafamilial level. V. cholerae O139 was isolated from faeces of 14.6% of healthy contacts in index case families as compared to none in neighbourhood families (P = 0.002). The organism could be recovered from 3.7% of handwashings of contacts of index cases and also from stored drinking water (8.0%), open well water (28.6%), flies (3.8%) and pond water (25.0%) used by the index case families and none from neighbourhood families. The large number of asymptomatic infected persons indicate an epidemiological similarity to that of eltor cholera. The organisms may be carried on hands and may act as a potential source of infection to other inmates through contamination of stored drinking water, open wells etc. The results will be useful in formulating strategies for intervention of transmission of V. cholerae O139 at the community level.

Primary amino acid sequence and structure of human pyruvate carboxylase

Pyruvate carboxylase (PC) (pyruvate:carbon dioxide ligase (ADP-forming), EC 6.4.1.1.), a nuclear-encoded mitochondrial enzyme, catalyzes the conversion of pyruvate to oxaloacetate. We have isolated and characterized cDNAs spanning the entire coding region of human PC. The sequence of human PC has an open reading frame of 3537 nucleotides which encodes for a polypeptide with a length of 1178 amino acids. The identity of the cDNA as PC is confirmed by comparison to PC cDNAs of other species and sequenced peptide fragments of mammalian PC. The M(r) of the full length precursor protein is 129,576 and that of the mature apoprotein is 127,370. RNA blot analysis from a variety of human tissues demonstrates that the highest level of PC mRNA is found in liver corresponding to this tissue's high level of PC activity. Based on homology with other biotin-containing proteins, the ATP, pyruvate, and biotin-binding sites can be identified. One of two patients with documented PC deficiency was found to be missing PC mRNA, further confirming the identity of this cDNA.

Prevalence of diarrhoeal diseases amongst tribals of Car Nicobar Island, India

In a cross sectional study of total 14514 tribal Nicobarese people of Car Nicobar Island, an union territory of India, situated in Bay of Bengal, morbidity, mortality and treatment practices of diarrhoeal diseases of under-five children were surveyed. The incidence of diarrhoea (0.2 episode/ch.year), Crude death rate (3.6/1000) and IMR (31/1000 live births) were exceedingly low as compared to SouthEast Asian Countries including mainland of India. ORS utilisation rate was high (41%) as compared to the National figure (12.0%). This is the first study of it's kind carried out in this island and amongst the Nicobarese tribe in India. A preliminary study carried out among the mothers of the hospitalised children indicated that protective behaviours like breast feeding, hand washing, use of chlorinated water and proper disposal of stool were regularly being practiced by the community traditionally. An in-depth study on risk factors of diarrhoea in this island can yield useful clue for describing the same.

Circadian periodicity in microfilarial counts

We propose a second-order harmonic model to describe circadian periodicity in the 24-h cycle of microfilarial counts. Rhesus monkeys (Macaca mulatta) were infected with Brugia malayi. Definite evidence of circadian periodicity was found in the microfilarial counts. The estimates of the parameters, periodicity indices and peak hours were determined.

Evaluation of filarial skin test with Brugia malayi larval antigen in the field

To obtain comparable and reproducible results by filaria skin test with B. malayi larval antigen, standard procedure has been evolved. Antigen protein of 2 micrograms per test, injected intracutaneously, was found optimum for positive skin reaction. The reaction ratio based on increase of wheal area by 2 times or more was found to be statistically significant for interpreting positive results. However, in larger field trials, the simpler measurement of increase of wheal diameter by 1 1/2 times or more was found to be equally reliable. Patients treated with diethylcarbamazine citrate, antihistaminics and anti-inflammatory drugs are likely to be unresponsive to filarial antigen and will yield incorrect information.