Correlation of serum phosphate with carotid intimal-medial thickness in chronic kidney disease patients

While increased serum phosphate concentration is a significant risk factor for vascular calcification, it is unclear whether serum phosphate is also a risk factor for increased arterial wall thickness in chronic kidney disease (CKD) patients. Using B-mode ultrasonography, we examined carotid intimal-medial thickness (CIMT) of CKD patients and analyzed risk factors for increased IMT with regard to the effect of serum phosphate. One hundred patients were enrolled (73 patients without diabetes, 27 patients with diabetes; 57 men, 43 women; age, 46.2 ± 15.3 years). CIMT of patients with diabetes was significantly greater than that of patients without diabetes (0.78 ± 0.250 versus 0.66 ± 0.178 mm; P < 0.0001). For the group of all patients, CIMT correlated strongly and significantly with serum phosphate (r = 0.911; P < 0.001). In multiple regression analysis serum phosphate level (β = 0.356; <0.0001) was found to be a significant independent risk factor for increased CIMT, in addition to other independent risk factors, including advanced age, higher systolic blood pressure, urinary albumin and the presence of diabetes (R2 = 0.956; P < 0.00001). In conclusion, high serum phosphate level is a significant and independent factor associated with advanced arteriosclerosis in CKD patients with and without diabetes in addition to advanced age.

Arabic version of the Global Mental Health Assessment Tool-Primary Care version (GMHAT/PC): a validity and feasibility study

Mental health services are far from satisfactory in the Eastern Mediterranean Region. The Global Mental Health Assessment Tool-Primary Care version (GMHAT/PC) is a semi-structured, computerized clinical assessment tool that was developed to assist health workers in making quick, convenient and comprehensive standardized mental health assessments. A study was carried out in the United Arab Emirates to evaluate the validity and feasibility of the Arabic version of the GMHAT/PC. Mental health nurses administered the GMHAT/PC Arabic version to 50 patients in mental health and rehabilitation settings and their GMHAT/PC diagnosis was compared with the psychiatrist's independent ICD-10 based clinical diagnosis on the same patients. The nurses found GMHAT/PC easy to administer in an average of 16 minutes. The GMHAT/PC-based diagnosis had a good agreement with the psychiatrist's diagnosis (kappa = 0.91) and a high sensitivity (97%) and specificity (94%).

Genetic architecture underlying morning and evening circadian phenotypes in fruit flies Drosophila melanogaster

Circadian rhythms are perhaps among the genetically best characterized behaviours. Several mutations with drastic effects on circadian processes have been identified and models developed to explain how clock genes and their products generate self-sustained oscillations. Although natural variations in circadian phenotypes have been studied extensively, the genetic basis of such adaptive variations remains largely unknown. Here we report the results of a preliminary genetic analysis of adaptive divergence of circadian phenotypes in populations of fruit flies Drosophila melanogaster. Two sets of populations, 'early' and 'late', were created in a long-term laboratory selection for morning and evening emergence, with four independent replicates each. Over the course of ∼55 generations, the early flies evolved increased morning emergence and a shorter circadian period, whereas late flies evolved increased evening emergence and longer period. To examine the genetic basis of circadian phenotypes, we set up crosses between early and late flies, and monitored emergence and activity/rest rhythms in the F1, backcrossed and F2 progeny. Our analysis suggests that the genetic basis of divergent circadian phenotypes in early and late stocks is primarily autosomal. Line-cross analysis revealed that additive and non-additive genetic effects contribute to the divergence of circadian phenotypes in early and late flies.

A clinical study of the spectrum of photodermatoses in dark-skinned populations

BACKGROUND

Photodermatoses are characterized by an abnormal cutaneous response to 'ordinary' light exposure.

AIM

To study the spectrum of photodermatoses in populations with dark skin (skin types IV-VI) at a tertiary referral centre.

METHODS

Consecutive patients with skin lesions confined to or predominantly located on photoexposed parts of the body and/or with photosensitivity were enrolled in the study, and their clinical details were recorded. Diagnosis was made on clinical grounds, and relevant investigations were carried out if required. Patch and photopatch testing were carried out in patients with chronic actinic dermatitis (CAD). Selected patients with CAD also underwent phototesting with UV (ultraviolet) A and broadband UVB light.

RESULTS

We enrolled 362 patients (146 men, 216 women; mean age 35.6 ± 13.6 years), with mean disease duration of 3.4 years. The Fitzpatrick skin types were IV and V (52.8% and 47.2% of patients, respectively). Polymorphic light eruption (PMLE) was the commonest photodermatosis seen, affecting 59.7% of patients, followed by CAD (13.8%), collagen vascular disorders (7.7%), photoaggravated atopic dermatitis (6.1%), actinic lichen planus (ALP; 2.2%) and lichen planus pigmentosus (LPP; 1.6%). The majority (84.5%) of patients were involved in indoor work. Papular PMLE (37%) was the most common variant of PMLE, followed by pinpoint (31%), eczematous (22.2%), lichenoid (5.5%) and plaque-type (4.1%) PMLE.

CONCLUSIONS

The spectrum of photodermatoses in Indian patients with dark skin phototypes (IV and V), is similar to that reported from other parts of the world. PMLE was the commonest photodermatosis seen, with the pinpoint and lichenoid variants accounting for over one-third of the PMLE cases. ALP and LPP were also not uncommon in our dark-skinned population.

Dynamics of water in synthetic saponite clays: effect of trivalent ion substitution

Saponite clay belongs to the phyllosilicate family and is comprised of layers of Si(IV) tetrahedra and Al(III) or Mg(II) octahedra with definite interlayer spacing. In these systems, the trivalent ion substitutions in the tetrahedral layers lead to negative charge on the layers. Here we report the dynamics of water contained in [Si(6.97)Al(1.03)][Ni(6.00)]O(20)(OH)(4)[Na(1.03)]·28H(2)O (SAP-1) and [Si(7.13)Fe(0.86)][Ni(6.00)]O(20)(OH)(4)[Na(0.86)]·14H(2)O (SAP-2) saponite clays in the temperature range 200-310 K as studied by quasielastic neutron scattering technique. Particularly the effect of the ion substitution towards the dynamics of water is addressed here. Data analysis is carried out using the relaxing cage model. The existence of distribution in relaxation times indicated that the water molecules in saponite clay have a different local environment which leads to complex diffusion behavior. It is found that water exists in a supercooled state in the temperature range up to 235 K. However, some of the water molecules are found to be immobile in the temperature range 240-285 K. The fraction of immobile water decreases with increase in temperature. At higher temperatures, some of the water molecules in the hydration shells or those near the surface start participating in the diffusion process and at 293 K, almost all water molecules contribute to the dynamics. Diffusivity of water in both SAP-1 and SAP-2 are found to be lower in comparison to the bulk, and within the two samples of saponite clay diffusivity in SAP-1 is found to be lower compared to SAP-2; this has been explained on the basis of the charge on the tetrahedral layers and the charge balancing cations in the interlayer spacing.

Dynamics in anionic micelles: effect of phenyl ring

Micellar dynamics in sodium dodecyl benzene sulfonate (SDBS) is studied using quasi-elastic neutron scattering (QENS) technique. Results are compared with sodium dodecyl sulfate (SDS), a very similar surfactant except for the presence of a phenyl ring in SDBS. SDBS is a very important system for various industrial usages and variety of other applications. The aim here is to investigate the effect of molecular architecture of the surfactant molecule on micellar dynamics. Analysis of the QENS data showed that there exists two distinct motions in both of the micellar systems: whole micellar motion or global motion and the internal motion of the monomer within the micelles. The global diffusion associated with the whole micelle is found to be Fickian in nature. The diffusion coefficient corresponding to the global motion is found to be significantly lower for SDBS than SDS micelles. As far as internal motion is concerned, the structure factor indicates that the alkyl chains are more flexible in SDS compared with SDBS. Similar behavior is also reported in a recent molecular-dynamics simulation study. Detailed analysis showed that a localized translational diffusion model in which the hydrogen atoms undergo diffusion within a sphere could describe the internal motions in both the micelles. Diffusion coefficients corresponding to internal motions is found to be lower in the case of SDBS micelles compared with SDS micelles, implying that internal motions in SDBS micelles are relatively hindered vis-a-vis SDS micelles. This could be understood in terms of denser packing in SDBS micelles due to the presence of π-stacking.

Emergence of decreased susceptibility to extended-spectrum cephalosporins in Neisseria gonorrhoeae in India

BACKGROUND

In the past, Neisseria gonorrhoeae has developed resistance to antimicrobial agents used for its treatment. Consequently, extended-spectrum cephalosporins form the mainstay of treatment for gonorrhoea.

METHODS

Samples from 88 patients attending the sexually transmitted diseases clinics from December 2009 to January 2011 in two referral hospitals in New Delhi were studied. Antimicrobial susceptibility testing was done using the disc diffusion method as per the calibrated dichotomous sensitivity technique against the following antibiotics: penicillin (0.5 i.u.), tetracycline (10 μg), nalidixic acid (30 μg), ciprofloxacin (1 μg), spectinomycin (100 μg), ceftriaxone (0.5 μg) and cefpodoxime (10 μg) (Oxoid UK). Azithromycin (15 μg) (Oxoid, UK) was tested as per the guidelines of the Clinical and Laboratory Standards Institute. Minimum inhibitory concentrations were determined using the Etest for penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin and azithromycin as per the manufacturer's instruction (Biomerieux, France).

RESULTS

Eighteen isolates of Neisseria gonorrhoeae were obtained. Three of these had decreased susceptibility to ceftriaxone and cefpodoxime by the disc diffusion method. The minimum inhibitory concentrations of ceftriaxone for two isolates were 0.064 μg/ml and for one isolate it was 0.125 μg/ml.

CONCLUSION

Higher minimum inhibitory concentrations to extended-spectrum cephalosporins is of concern as it has been shown to precede treatment failure. This may warrant its use in increased/multiple dosages alone or possibly in combination (dual therapy), thereby complicating effective disease control. Our report is in accordance with earlier reports from different parts of the world. Therefore, a continuous surveillance of antimicrobial resistance is crucial to tailor treatment schedules for Neisseria gonorrhoeae in a particular geographical region.

In patients with mild hypertension, does exercise and a gradual rather than abrupt increase in fatty acid and salt intake cause less rise in cardiovascular risk factors?

In a randomised, single blind controlled trial, 58 patients with mild essential hypertension were administered either a normal diet with a gradual increase in salt and fatty acid consumption (Group A, 30 cases), or an abrupt increase (Group B, 28 cases) for a period of 24 weeks. Group A patients also did more physical activity from weeks 12-24 of the study. At entry to the study, age, sex, risk factors, previous drug therapy and nutrient intakes were comparable between the 2 groups. Adherence to nutrient intakes and exercise was assessed by questionnaires. After 12 weeks, a comparison of changes in mean blood pressure and blood lipids in groups A and B showed no significant difference. However, group B patients showed a significant increase in mean total cholesterol, diastolic pressure and heart rate compared to initial levels. There were no such changes in group A. After 24 weeks, while salt, fatty acids and cholesterol intakes were similar in both groups, there were significantly higher levels of mean total cholesterol, triglycerides, serum sodium, systolic and diastolic blood pressure, and heart rate in group B compared with group A. This may have been due to exercise or to a gradual rather than abrupt increase in salt and fatty acids consumption allowing the body to adapt. Increased physical activity appears to have a positive influence on adaptation leading to prevention of the adverse effects induced by fatty acids and salt loading.

An improved plant regeneration and Agrobacterium - mediated transformation of red pepper (Capsicum annuum L.)

Capsicum annuum (red pepper) is an important spice cum vegetable crop in tropical and subtropical countries. Here, we report an effective and reproducible auxin free regeneration method for six different red pepper cultivars (ACA-10, Kashi Anmol, LCA-235, PBC-535, Pusa Jwala and Supper) using hypocotyl explants and an efficient Agrobacterium-mediated transformation protocol. The explants (hypocotyls, cotyledonary leaves and leaf discs) collected from axenic seedlings of six red pepper cultivars were cultured on either hormone free MS medium or MS medium supplemented with BAP alone or in combination with IAA. Inclusion of IAA in the regeneration medium resulted in callus formation at the cut ends of explants, formation of rosette leaves and ill defined shoot buds. Regeneration of shoot buds could be achieved from hypocotyls grown in MS medium supplemented with different concentrations of BAP unlike other explants which failed to respond. Incorporation of GA3 in shoot elongation medium at 0.5 mg/l concentration enhanced the elongation in two cultivars, LCA-235 and Supper, while other cultivars showed no significant response. Chilli cultivar, Pusa Jwala was transformed with βC1 ORF of satellite DNA β molecule associated with Chilli leaf curl Joydebpur virus through Agrobacterium tumefaciens. Transgene integration in putative transformants was confirmed by PCR and Southern hybridization analysis.

Study of clinical, biochemical and immunological factors determining stability of disease in patients with generalized vitiligo undergoing melanocyte transplantation

BACKGROUND

Stability is considered the most important parameter before performing any melanocyte transplantation procedure in vitiligo; however, current criteria rely on the history given by the patients.

OBJECTIVE

This study was undertaken to determine the clinical, biochemical and immunological factors determining stability of disease in patients with generalized vitiligo to facilitate better patient selection for melanocyte transplantation and to understand immunological mechanisms for disease activity.

METHODS

Thirty-three patients with generalized vitiligo with < 10% body surface area involved were allocated to three clinical stability groups: Group 1 (stability > 3 months but < 1 year), Group 2 (≥ 1 year but < 2 years) and Group 3 (≥ 2 years). Melanocyte transplantation was done using suction blister epidermal grafting (SBEG) on a single patch. Blood was drawn for catalase estimation from all patients and from 10 healthy control subjects. A 3-mm punch biopsy was taken on the day of transplantation from the margin of the macule in the first five patients in each group for the immunohistochemistry of CD4, CD8, CD45RO, CD45RA and FoxP3. Those with ≥ 75% repigmentation at 6 months were labelled as responders.

RESULTS

The success rate was 0% in Group 1, 37·5% in Group 2 and 77·8% in Group 3. The difference in the success rate between the groups was statistically significant (P = 0·005). The median period of stability was significantly higher in the responders compared with that in the nonresponders (P = 0·001). Catalase levels were not significantly different between patients in the three groups of cases and in controls, or between responders and nonresponders. Lesional CD8 cells were significantly higher in Group 1 compared with Group 3. The percentages of CD8 and CD45RO cells were significantly higher in the nonresponders compared with the responders.

CONCLUSION

Along with clinical stability, the proportion of CD8 and CD45RO cells in skin biopsies might help to determine the stability of the disease and thereby predict the success of transplantation.

Interleukin-4 genetic variants correlate with its transcript and protein levels in patients with vitiligo

BACKGROUND

Vitiligo is an acquired pigmentary disorder resulting from loss of melanocytes. Interleukin (IL)-4 has been shown to stimulate B-cell proliferation, to regulate immunoglobulin class switching (IgG1 and IgE) and to promote T-cell development. Polymorphisms in the IL4 gene are known to increase its expression, thereby implicating its role in vitiligo susceptibility.

OBJECTIVES

To explore intron 3 VNTR (IVS3) and -590 C/T (rs2243250) promoter polymorphisms in the IL4 gene and to correlate them with the IL4 transcript, serum IL-4 and IgE levels to achieve genotype-phenotype correlation in patients with vitiligo from Gujarat. A replication study was done in a North Indian population.

METHODS

The case-control study was performed to investigate these polymorphisms in 505 patients and 744 controls in Gujarat, and 596 patients and 397 controls in North India by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism analysis. IL4 transcript levels were monitored by real-time PCR. Serum IL-4 and IgE levels were measured by enzyme-linked immunosorbent assay and electrochemiluminescence immunoassay, respectively.

RESULTS

The genotype frequencies differed significantly between patients with generalized vitiligo and controls for both the polymorphisms in both populations. Allele frequencies significantly differed between patients with generalized vitiligo and controls for both the polymorphisms in the population from Gujarat. Interestingly, genotype and allele frequencies for -590 C/T single nucleotide polymorphism were significantly different between patients with localized vitiligo and controls in both the populations. The study revealed significantly increased IL4 mRNA, serum IL-4 and IgE levels in patients from Gujarat. Age of onset analysis of disease in patients suggested that the TTR2R2, TTR1R2 and CTR2R2 haplotypes had a profound effect in the early onset of the disease.

CONCLUSIONS

Our results suggest that these polymorphisms of the IL4 gene may be genetic risk factors for susceptibility towards vitiligo and the upregulation of the IL4 transcript, protein and IgE levels in individuals with susceptible haplotypes reveal the crucial role of IL-4 in the pathogenesis of vitiligo.

Dynamical features in cationic micelles of varied chain length

Chain length is one of the parameters controlling the structural arrangement of micelle monomers, such that one can tailor the monomers for different applications, but the effect of chain length on the dynamical behavior of micelles is unknown. In this article, we report a study on the effect of varying chain length on the dynamical behavior of alkyltrimethylammonium bromide (C(n)TAB) micelles (n = 10, 12, 14, and 16) using incoherent quasielastic neutron scattering (QENS). The data analysis clearly shows the presence of two distinct motions: global motion of whole micelles and faster internal motions of the C(n)TAB monomers. The global diffusion is Fickian in nature, whereas the internal motions can be described with a model that considers the motions of the headgroup and the hydrophobic alkyl chain separately. Methyl groups in the headgroup undergo 3-fold jump rotations, and the hydrogen atoms belonging to the alkyl chain undergo localized translational diffusion. The hydrogen atoms belonging to the alkyl chain are confined within spherical volumes that increase linearly along the C(n)TAB chain: the hydrogen atoms closer to the headgroup move within smaller spheres with lower diffusion coefficients than those farther from the headgroup. The main result is that, with increasing chain length, the dynamics of the C(n)TAB monomer is greatly affected: diffusion is reduced and occurs in smaller spheres, and residence times are increased. Global motion is also hindered with increased chain length.

Thermo-magnetic history effects in the giant magnetostriction across the first-order transition and minor hysteresis loops modeling in Fe0.955Ni0.045Rh alloy

Results of temperature- and magnetic field-dependent strain measurements across the first-order antiferromagnetic to ferromagnetic phase transition in Fe(0.955)Ni(0.045)Rh are presented. Distinct thermal and magnetic field hystereses are observed in the measured strain across the phase transition. The minor hysteresis loops inside the hysteretic regime across the temperature-driven transition are modeled using the Preisach model of hysteresis. The applicability of the Preisach model to explain the general features of minor hysteresis loops is discussed for a disorder influenced first-order transition. The minor hysteresis loops show the property of retaining the memory of the starting or end point of the temperature cycle followed within the hysteretic region. A larger temperature excursion within the hysteretic region wipes out the memory of a smaller temperature cycle which contains one of the extrema of the larger cycle. The end-point memory and the wiping-out property of the minor hysteresis loops can be described quite well within the Preisach model, irrespective of the temperature history followed to reach a particular starting point. Thermo-magnetic history effects across the magnetic field-induced transition are explained, which will enable the choice of the starting point of an experimental cycle in the field-temperature phase space so as to achieve the desired functionality. Our results highlight the necessity to understand the influence of disorder on a first-order phase transition so as to achieve a repeatable performance of materials whose functionalities are based on such a transition.

The role of a commercial enzyme immuno assay antigen detection system for diagnosis of C. trachomatis in genital swab samples

In the present pilot study, endocervical and urethral swabs collected from 100 patients attending sexually transmitted disease (STD) clinics and regional centre for STD in two referral hospitals in New Delhi were analyzed by enzyme immune assay (EIA), polymerase chain reaction (PCR) and direct fluorescent antibody (DFA) for detection of C. trachomatis. It was found that EIA could detect a very low number of cases (3/100) as against DFA (11/100) and PCR (9/100). Thus, in spite of the widespread availability, lower cost and ease of performance of the enzyme-linked-immunosorbent serologic assay, the present study highlights the need to employ sophisticated diagnostic tools like DFA and PCR for detection of Chlamydia trachomatis in STD patients.

Clinical and bacteriological profile and outcome of sepsis in dermatology ward in tertiary care center in New Delhi

BACKGROUND

There is paucity of data regarding the clinical and bacteriological profile of sepsis in dermatology in-patients.

AIMS

To study the frequency, etiology, and outcome of sepsis dermatology in-patients.

METHODS

The study was conducted in a 30-bedded dermatology ward of a tertiary care center. Sepsis was defined by presence of ≥2 SIRS (systemic inflammatory response syndrome) criteria along with evidence of infection (clinically obvious/culture proven infection of skin or internal organs). Patients were also assessed for known (common) risk factors of sepsis. In suspected sepsis patients, at least two samples of blood cultures by venepuncture were taken. Pus, skin swab, urine, and sputum samples were also collected for culture as needed with avoidance of contamination.

RESULTS

Among 860 admitted patients studied from November 2004 to July 2006, 103 (12%) fulfilled SIRS criteria. Of these, 63 had nonsepsis causes of SIRS positivity, while 40 (4.65%) had sepsis. Majority of the sepsis patient had vesicobullous diseases (42.5%), erythroderma (25%), toxic epidermal necrolysis (TEN) (22.5%). Severe sepsis developed in 17 (42.5%) patients, while 15 (37.5%) died. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest organism isolated (99; 25.9%) in all culture specimens followed by Acinetobacter spp. (52; 13.6%), Pseudomonas spp. (40; 10.5%), Methicillin-sensitive S. aureus (MSSA: 33; 8.7%), and Klebsiella spp. (22; 5.8%). Various risk factors affecting mortality and sensitivity patterns for various isolates were also analyzed.

CONCLUSION

Sepsis occurred in 40 (4.65%) inpatients in dermatology ward. The frequency of sepsis was highest in TEN (90%), followed by drug-induced maculopapular rash (20.0%), erythroderma (17.5%), and vesicobullous diseases (8.5%). MRSA, acinetobacter, pseudomonas, MSSA, and Klebsiella were important etiological agents involved in sepsis in dermatology in-patients.

Diffusion of water in molecular magnet Cu(0.75)Mn(0.75)[Fe(CN)6]·7H2O

Here we report the dynamical behaviour of water in Prussian blue analogue (PBA) Cu(0.75)Mn(0.75)[Fe(CN)(6)]·7H(2)O molecular magnet in the temperature range 260-360 K as studied using the quasielastic neutron scattering technique. While significant quasielastic broadening is observed in the hydrated sample, no broadening was observed in the dehydrated one. Data analysis showed that the observed quasielastic broadening in Cu(0.75)Mn(0.75)[Fe(CN)(6)]·7H(2)O corresponds to the dynamics of the non-coordinated water molecules at the 32f site and the coordinated water molecules at the 24e site, existing in the cavities created by the absence of Fe(CN)(6) units. The non-coordinated water molecules at 8c interstitial sites do not contribute to the broadening, suggesting that they are immobile at least within the time window of the spectrometer used. Behaviour of the elastic incoherent structure factor is consistent with the model where the water molecules undergo translational diffusion localized within the cavity of 5.1 Å. While all the non-coordinated water molecules at the 32f site are dynamic over the entire range of temperatures, the coordinated ones at the 24e site become progressively dynamic with temperature. The water molecules were found to undergo hindered (~1.16 × 10(-5) cm(2) s(-1) at 300 K) diffusion compared to bulk water and the diffusivity followed Arrhenius behaviour within the measured temperature range with an activation energy of 1.26 kcal mol(-1).

The effect of external pressure on the magnetocaloric effect of Ni-Mn-In alloy

The martensitic transition in Ni(50)Mn(34)In(16) alloy has been studied by measuring the magnetization of the alloy as a function of temperature, magnetic field and pressure. Magnetic field and pressure have opposite effects on the martensitic transition in this alloy; the martensitic transition temperature decreases with increasing magnetic field but it increases with increasing pressure. The effect of pressure on the magnetocaloric properties of this large magnetocaloric effect alloy has been investigated in detail. The magnitude of the peak in the isothermal magnetic entropy change in Ni(50)Mn(34)In(16) increases with pressure. The temperature at which the magnetocaloric effect reaches the peak value in this alloy increases from near 240 K under ambient pressure to near 280 K under an external pressure of 9.5 kbar. The temperature corresponding to the peak in the isothermal magnetic entropy change increases with increasing pressure at a rate which matches the rate of increase of the martensite start temperature with increasing pressure. The temperature dependence of the isothermal magnetic entropy change under different pressures is found to follow a universal curve for a particular magnetic field change. These results show that pressure as a control parameter can be used to tune the temperature regime of the magnetocaloric effect in the alloy. The effect of pressure on the martensitic transition also gives a clue as regards the possibility of tuning this temperature regime with elemental substitution.

Brain attack: needing resuscitation

The brain is extremely susceptible to focal ischaemia. Following vascular occlusion, a core of severely damaged brain tissue develops, surrounded by an ischaemic penumbra. This potentially-salvageable penumbra may be estimated by advanced neuroimaging techniques, particularly by diffusion-perfusion mismatch. Clinical trials have demonstrated the efficacy of intravenous thrombolysis within three hours of onset of ischaemic stroke in reducing short-term disability. Recanalisation is enhanced by intra-arterial thrombolysis, sonothrombolysis and clot-retrieval devices. Occasionally, reperfusion injury may lead to clinical deterioration. The search continues for effective neuroprotectants. Brain perfusion needs to be maintained through blood and intracranial pressure management. Hemicraniectomy for 'malignant' cerebral oedema reduces death and disability. Elevated glucose should be controlled and hypoxia alleviated. Public education of symptoms and the need for immediate presentation to a medical facility is needed. Stroke unit care reduces death and disability with little increase in cost. Current evidence supports urgent efforts to resuscitate the brain after stroke.

Antimicrobial evaluation of mangiferin analogues

The naturally occurring xanthone glycoside mangiferin has been isolated by column chromatography from the ethanol extract of stem bark of Mangifera indica. Mangiferin was further converted to 5-(N-phenylaminomethyleno)mangiferin, 5-(N-p-chlorophenylaminomethyleno) mangiferin, 5-(N-2-methylphenylaminomethyleno) mangiferin, 5-(N-p-methoxyphenylaminomethyleno) mangiferin, 5-(N, N-diphenylaminomethyleno) mangiferin, 5-(N--napthylaminomethyleno) mangiferin and 5-(N-4-methylphenylaminomethyleno) mangiferin. Mangiferin and its analogues were characterized by melting point and R(f) value determination and through spectral technique like UV, IR, and NMR spectral analysis. The synthesized compounds were screened for antimicrobial activity.

Standard guidelines of care: Keloids and hypertrophic scars

Keloids and hypertrophic scars (HTS) are the result of overgrowth of fibrous tissue, following healing of a cutaneous injury, and cause morbidity. There are several treatment modalities which are useful for the management of keloids, though no single modality is completely effective. The most commonly used modalities are pressure, silicone gel sheet, intralesional steroids, 5-fluorouracil (5 FU), cryotherapy, surgical excision, and lasers. They may be used either singly or, as is done more commonly, in combinations. Any qualified dermatologist who has attained postgraduate qualification in dermatology can treat keloids and HTS. Some procedures, such as cryosurgery and surgical excision, may require additional training in dermatologic surgery. Most modalities for keloids, including intralesional injections and mechanical therapies such as pressure and silicone gel based products, can be given/prescribed on OPD basis. Surgical excision requires a minor operation theater with the facility to handle emergencies. It is important to counsel the patient about the nature of the problem. One should realize that keloid will only improve and not disappear completely. Patients should be informed about the high recurrence rates. Different modalities carry risk of adverse effects and complications and the treating physician needs to be aware of these and patients should be informed about them.

Fatal intracerebral haemorrhage following scorpion sting

Though uncommon, scorpion stings can cause cerebrovascular accidents by various mechanisms such as venom induced autonomic storm leading to hypertension, hypotension, myocarditis, DIC or vasculitis by direct actions. We present a case of intracerebral bleed following scorpion sting, which is a rare presentation and seldom reported.

The Effects of Citrate and Phosphocitrate on the Kinetics of Mineralization of Calcium Oxalate Monohydrate

The adsorption of citrate and phosphocitrate on calcium oxalate monohydrate (COM) surfaces has been measured in saturated solutions of calcium oxalate monohydrate at 37°C. In separate adsorption experiments, the uptake of phosphocitrate was markedly greater than that of citrate. When both additives were present, the adsorption of phosphocitrate was further increased. In constant composition studies of the crystallization of CON from supersaturated solution, phosphocitrate was more effective as an inhibitor than was citrate.

Temperature and magnetic field induced multiple magnetic transitions in DyAg(2)

The magnetic properties of the rare-earth intermetallic compound DyAg(2) are studied in detail with the help of magnetization and heat capacity measurements. It is shown that the multiple magnetic phase transitions can be induced in DyAg(2) both by temperature and magnetic field. The detailed magnetic phase diagram of DyAg(2) is determined experimentally. It was already known that DyAg(2) undergoes an incommensurate to commensurate antiferromagnetic phase transition close to 10 K. The present experimental results highlight the first order nature of this phase transition, and show that this transition can be induced by magnetic field as well. It is further shown that another isothermal magnetic field induced transition or metamagnetic transition exhibited by DyAg(2) at still lower temperatures is also of first order nature. The multiple magnetic phase transitions in DyAg(2) give rise to large peaks in the temperature dependence of the heat capacity below 17 K, which indicates its potential as a magnetic regenerator material for cryocooler related applications. In addition it is found that because of the presence of the temperature and field induced magnetic phase transitions, and because of short range magnetic correlations deep inside the paramagnetic regime, DyAg(2) exhibits a fairly large magnetocaloric effect over a wide temperature window, e.g., between 10 and 60 K.

Hypothyroidism presenting as cardiac tamponade in Down syndrome

Down syndrome is the commonest chromosomal anomaly. It is often associated with hypothyroidism, which may rarely present with cardiac tamponade as the earliest manifestation and prompt treatment with L-thyroxine is life saving. A six-month-old female child diagnosed as a case of Down syndrome presented with shortness of breathing for last 1 1/2 months. Facial dysmorphism, characteristic of Down syndrome was present. Echocardiography revealed large pericardial effusion and right ventricular diagnostic collapse. A case of Down syndrome with hypothyroidism and cardiac tamponade was kept in mind. She was treated with L-thyroxine and clinical status improved.