Neuroprotective effects of nitric oxide synthase inhibitors in spinal cord injury-induced pathophysiology and motor functions: an experimental study in the rat

The role of nitric oxide (NO) in spinal cord injury (SCI)-induced motor dysfunction, breakdown of the blood-spinal cord barrier (BSCB), edema formation, and cell injury was examined using a pharmacological approach. We used three types of nitric oxide synthase (NOS) inhibitors: a nonselective blocker, L-NAME; an irreversible inhibitor of all isoforms of NOS, L-NMMA; and a long-term competitive inhibitor of neuronal NOS with equal potency to inhibit endothelial NOS, L-NNA. The compounds were administered once daily in separate groups of rats for 7 days. On the 8th day, SCI was performed by making a longitudinal incision into the right dorsal horn of the T10-11 segments, and the rats were allowed to survive 5 h after injury. Long-term treatment with L-NNA attenuated SCI-induced NOS upregulation, BSCB breakdown, edema formation, and cell injury, whereas comparatively less neuroprotection is offered by L-NMMA. The magnitude of neuroprotection is much less evident in injured animals that received L-NAME. Interestingly, SCI-induced motor dysfunction measured according to the Tarlov scale showed close correlation with the magnitude of neuroprotection. Thus, an improvement in motor function was seen in animals pretreated with L-NNA, whereas rats treated with L-NAME or L-NMMA did not show any influence on motor dysfunction after SCI. This observation suggests that inhibition of neuronal NOS is important for neuroprotection, and the disturbances in motor function following SCI are associated with the state of spinal cord pathology.

Neuroprotective effects of nitric oxide synthase inhibitors in spinal cord injury-induced pathophysiology and motor functions: an experimental study in the rat

The role of nitric oxide (NO) in spinal cord injury (SCI)-induced motor dysfunction, breakdown of the blood-spinal cord barrier (BSCB), edema formation, and cell injury was examined using a pharmacological approach. We used three types of nitric oxide synthase (NOS) inhibitors: a nonselective blocker, L-NAME; an irreversible inhibitor of all isoforms of NOS, L-NMMA; and a long-term competitive inhibitor of neuronal NOS with equal potency to inhibit endothelial NOS, L-NNA. The compounds were administered once daily in separate groups of rats for 7 days. On the 8th day, SCI was performed by making a longitudinal incision into the right dorsal horn of the T10-11 segments, and the rats were allowed to survive 5 h after injury. Long-term treatment with L-NNA attenuated SCI-induced NOS upregulation, BSCB breakdown, edema formation, and cell injury, whereas comparatively less neuroprotection is offered by L-NMMA. The magnitude of neuroprotection is much less evident in injured animals that received L-NAME. Interestingly, SCI-induced motor dysfunction measured according to the Tarlov scale showed close correlation with the magnitude of neuroprotection. Thus, an improvement in motor function was seen in animals pretreated with L-NNA, whereas rats treated with L-NAME or L-NMMA did not show any influence on motor dysfunction after SCI. This observation suggests that inhibition of neuronal NOS is important for neuroprotection, and the disturbances in motor function following SCI are associated with the state of spinal cord pathology.

Zinc protoporphyrin IX attenuates closed head injury-induced edema formation, blood-brain barrier disruption, and serotonin levels in the rat

The role of heme oxygenase (HO) in closed head injury (CHI) was examined using a potent HO and guanylyl cyclase inhibitor, zinc protoporphyrin (Zn-PP) in the rat. Blood-brain barrier (BBB) permeability to Evans blue and radioiodine, edema formation, and plasma and brain levels of serotonin were measured in control, CHI, and Zn-PP-treated CHI rats. CHI was produced by an impact of 0.224 N on the right parietal bone by dropping 114.6 g weight from a height of 20 cm in anesthetized rats. This concussive injury resulted in edema formation and brain swelling 5 hours after insult that was most pronounced in the contralateral hemisphere. The whole brain was edematous and remained in a semi-fluid state. Microvascular permeability disturbances to protein tracers were prominent in both cerebral hemispheres and the underlying cerebral structures. Plasma and brain serotonin showed pronounced increases and correlated with edema formation. Pretreatment with Zn-PP (10 mg/ kg, i.p) 30 minutes before or after CHI attenuated edema formation, brain swelling, plasma and brain serotonin levels, and microvascular permeability at 5 hours. Brain edema, BBB permeability, and serotonin levels were not attenuated when the compound was administered 60 minutes post-CHI suggesting that HO is involved in cellular and molecular mechanisms of edema formation and BBB breakdown early after CHI.

Post-injury treatment with a new antioxidant compound H-290/51 attenuates spinal cord trauma-induced c-fos expression, motor dysfunction, edema formation, and cell injury in the rat

The neuroprotective efficacy of post-injury treatment with the antioxidant compound H-290/51 (10, 30, and 60 minutes after trauma) on immediate early gene expression (c-fos), blood-spinal cord barrier (BSCB) permeability, edema formation, and motor dysfunction was examined in a rat model of spinal cord injury (SCI). SCI was produced by a longitudinal incision into the right dorsal horn of the T10-11 segment under Equithesin anesthesia. Focal SCI in control rats resulted in profound up-regulation of c-fos expression, BSCB dysfunction, edema formation, and cell damage in the adjacent T9 and T12 segments at 5 hours. Pronounced motor dysfunction was present at this time as assessed using the Tarlov scale and the inclined plane test. Treatment with H-290/51 (50 mg/kg, p.o.) 10 and 30 minutes after SCI (but not after 60 minutes) markedly attenuated c-fos expression and motor dysfunction. In these groups, BSCB permeability, edema formation, and cell injuries were mildly but significantly reduced. These observations suggest that (i) antioxidants are capable of attenuating cellular and molecular events following trauma, and (ii) have the capacity to induce neuroprotection and improve motor function if administered during the early phase of SCI, a novel finding.

Upper limits on a stochastic background of gravitational waves

The Laser Interferometer Gravitational-Wave Observatory has performed a third science run with much improved sensitivities of all three interferometers. We present an analysis of approximately 200 hours of data acquired during this run, used to search for a stochastic background of gravitational radiation. We place upper bounds on the energy density stored as gravitational radiation for three different spectral power laws. For the flat spectrum, our limit of omega0 < 8.4 x 10(-4) in the 69-156 Hz band is approximately 10(5) times lower than the previous result in this frequency range.

The Metabolisable Hexoses D-Glucose and D-Mannose Enhance the Expression of IRS-2 but not of IRS-1 in Pancreatic β-Cells

D-glucose regulates maintenance and function of pancreatic beta-cells. Several studies have shown that IRS-2, but not IRS-1, is necessary to maintain and sufficient to expand functional beta-cell mass. We therefore analyzed the expression of IRS-2 and IRS-1 in beta-cells after culture in the presence of various concentrations of D-glucose and other metabolisable or non-metabolisable hexoses. D-glucose increased Irs-2 transcription and IRS-2 accumulation in a dose-dependent manner (1.6 to 25 mmol/l), with a 3-fold increased plateau after 10 h. In contrast, the expression of IRS-1 remained unaffected. D-glucose also induced phosphorylation of IRS-2 while non-metabolisable hexoses did neither affect expression nor phosphorylation. D-glucose-mediated elevation and phosphorylation of IRS-2 were independent of autocrine insulin action although insulin itself could transiently and slightly enhance IRS-2 expression.

PRODOC: a resource for the comparison of tethered protein domain architectures with in-built information on remotely related domain families

PROtein Domain Organization and Comparison (PRODOC) comprises several programs that enable convenient comparison of proteins as a sequence of domains. The in-built dataset currently consists of ∼698 000 proteins from 192 organisms with complete genomic data, and all the SWISSPROT proteins obtained from the Pfam database. All the entries in PRODOC are represented as a sequence of functional domains, assigned using hidden Markov models, instead of as a sequence of amino acids. On average 69% of the proteins in the proteomes and 49% of the residues are covered by functional domain assignments. Software tools allow the user to query the dataset with a sequence of domains and identify proteins with the same or a jumbled or circularly permuted arrangement of domains. As it is proposed that proteins with jumbled or the same domain sequences have similar functions, this search tool is useful in assigning the overall function of a multi-domain protein. Unique features of PRODOC include the generation of alignments between multi-domain proteins on the basis of the sequence of domains and in-built information on distantly related domain families forming superfamilies. It is also possible using PRODOC to identify domain sharing and gene fusion events across organisms. An exhaustive genome–genome comparison tool in PRODOC also enables the detection of successive domain sharing and domain fusion events across two organisms. The tool permits the identification of gene clusters involved in similar biological processes in two closely related organisms. The URL for PRODOC is .

Limits on gravitational-wave emission from selected pulsars using LIGO data

We place direct upper limits on the amplitude of gravitational waves from 28 isolated radio pulsars by a coherent multidetector analysis of the data collected during the second science run of the LIGO interferometric detectors. These are the first direct upper limits for 26 of the 28 pulsars. We use coordinated radio observations for the first time to build radio-guided phase templates for the expected gravitational-wave signals. The unprecedented sensitivity of the detectors allows us to set strain upper limits as low as a few times 10(-24). These strain limits translate into limits on the equatorial ellipticities of the pulsars, which are smaller than 10(-5) for the four closest pulsars.

Identification of RAPD markers, in situ DNA content and structural chromosomal diversity in some legumes of the mangrove flora of Orissa

Randomly amplified polymorphic DNA (RAPD) markers, karyotypes and 4C DNA content were analyzed in five legume mangroves belonging to the sub-family Papilinoideae (Dalbergia spinosa, Derris heterophylla and D. indica) and Caesalpinioideae (Caesalpinia crista, Cynometra ramiflora) of the family Fabaceae to establish the genetic variability and phylogenetic affinities. Somatic chromosome numbers were reported for the first time in D. spinosa (2n = 20), C. ramiflora (2n = 26) and D. heterophylla (2n = 24) with reconfirmation of the somatic chromosome number in D. indica (2n = 22) and C. crista (2n = 24). Significant intergeneric and interspecific variation of 4C DNA content was observed and that varied from 8.970 pg in C. ramiflora to 28.730 pg in D. indica. From the RAPD analysis, the dendogram showed clustering of Caesalpinia crista and Cynomitra ramiflora into one group (81.80). In the second groups Derris indica and Derris heterophylla were more similar (83.10) than Dalbergia spinosa (85.80). Species-specific DNA markers (900 bp) obtained in D. spinosa from OPN15; 700 and 2000 bp in C. ramiflora from OPN4 and 400 and 800 bp in D. heterophylla and 500 bp DNA fragment in C. crista obtained from OPN-11 were found characteristic RAPD markers of these species. C. crista found more closer affinity to C. ramiflora of the sub-family Caesalpinioideae [genetic distance (1-F) = 0.847]. Derris indica showed closer genetic relation with D. heterophylla [genetic distance (1-F) = 0.856] than D. spinosa [genetic distance (1-F) = 0.876] where Derris and Dalbergia belongs to the sub-family Papilionoideae. By employing these markers the present study has helped to resolve the relationship between the taxonomically diverse leguminous mangroves and study their ability to coexist with mangroves that would shed light on the evolution of mangroves from terrestrial species.

Overexpression of IRS2 in isolated pancreatic islets causes proliferation and protects human beta-cells from hyperglycemia-induced apoptosis

Studies in vivo indicate that IRS2 plays an important role in maintaining functional beta-cell mass. To investigate if IRS2 autonomously affects beta-cells, we have studied proliferation, apoptosis, and beta-cell function in isolated rat and human islets after overexpression of IRS2 or IRS1. We found that beta-cell proliferation was significantly increased in rat islets overexpressing IRS2 while IRS1 was less effective. Moreover, proliferation of a beta-cell line, INS-1, was decreased after repression of Irs2 expression using RNA oligonucleotides. Overexpression of IRS2 in human islets significantly decreased apoptosis of beta-cells, induced by 33.3 mM D-glucose. However, IRS2 did not protect cultured rat islets against apoptosis in the presence of 0.5 mM palmitic acid. Overexpression of IRS2 in isolated rat islets significantly increased basal and D-glucose-stimulated insulin secretion as determined in perifusion experiments. Therefore, IRS2 is sufficient to induce proliferation in rat islets and to protect human beta-cells from D-glucose-induced apoptosis. In addition, IRS2 can improve beta-cell function. Our results indicate that IRS2 acts autonomously in beta-cells in maintenance and expansion of functional beta-cell mass in vivo.

Double extradural hematoma: an analysis of 46 cases

AIMS

The authors analyze epidemiology, location, clinical profile and outcome of double extradural hematoma (EDH) or EDH at more than one site.

DESIGN

A retrospective clinical study.

MATERIALS AND METHODS

46 cases of double EDH were studied. All the cases were evaluated for their mode of injury, clinical presentation, level of sensorium at the time of injury, CT scan finding and outcome after surgery, and were compared with single EDH cases.

RESULTS

Out of 1025 cases 46 cases had 'double' EDH. There was bilateral EDH in 39 cases; multiple EDH in 3 cases and ipsilateral double EDH was present in 4 cases. The most common site was frontal (70%). The majority of the patients (80.3%) were in altered sensorium from the time of injury, similar situation was seen in 52.2% of cases with single EDH. The number of patients having a low GCS score was higher when first examined in the double EDH group and the mortality rate was 34.8% as compared to 9% in the single EDH group.

CONCLUSION

Majority of the double EDH cases presented with a low GCS and there was a relatively quick neurological deterioration in these cases.

Somatoperceptual asymmetry for cognitive stimuli: support from experimental and clinical observations

Two studies, one experimental with intact-brain subjects (Study I), and one clinical with left or right hemisphere-damaged and non-neurological general medical patients (Study II), were conducted to examine somatolateral asymmetry in the recognition of verbal (letter) and visuospatial (nonsense shapes) stimuli. Blindfolded subjects were required to explore two stimuli dichhaptically, and were instructed to haptically identify the target stimulus in a set of test stimuli. The findings of Study I indicated that fewer trials were required to recognise nonsense shapes when they were presented to the left hand, whereas fewer trials were required for letters when they were presented to the right hand. The findings of Study II indicated that performance of the hand ipsilateral to the damaged left hemisphere was better for nonsense shapes than for letters, and performance of the hand ipsilateral to the damaged right hemisphere was better for letters than for nonsense shapes.

Allergic fungal sinusitis- A clinico-pathological study

The co-existence of fungal elements in allergic nasal Polyposis, has given rise to a distinct clinical entity known as 'Allergic fungal sinusitis ' (AF'S). Many a time, these fungal elements may not be diagnosed pre-operatively by routine diagnostic nasal endoscopy or CT scan of paranasal sinuses, due to the florid presentation of nasal polyps, which usually obscure the underlying fungal pathology. The diagnosis is often made intra-operatively. The post-operative confirmation of AFS is by histopathology, fungal smear, fungal culture, allergic murin study and fungal specific IgE titres. We report a series often such cases done in our institution, which highlight that AFS should be considered as a differential diagnosis in Sinonasal Polyposis cases, for their effective management.

Karyotype analyses and studies on the nuclear DNA content in 30 genotypes of potato (Solanum tuberosum) L

The cytophotometric estimation of 4C DNA content, and karyotypic and somatic chromosome number analyses were carried out in 30 genotypes comprising seven cultivars and 23 advanced breeding lines of Solanum tuberosum. Detailed karyotype analysis revealed genotype specific chromosomal characteristics and structural alterations in chromosomes of the genome, with a rare phenomenon of aneusomatic (2n = 4x + 2 = 50) condition in cv.K. Chandramukhi. The origin of this variation could be attributed to mitotic non-disjunction in the shoots giving rise to aneusomatic roots. Highly significant variations in the genome length, volume and total form percentage were noted at the cultivar level. The total chromosome length varied from 84.56 microm in cv.K. Pukhraj to 127.62 microm in MS/89-60, with an average value of 100.94 microm +/- 1.82. Total chromosome volume varied from 57.22 microm3 in MS/92-1090 to 132.64 microm3 in JW-160. Significant variations in the 4C DNA content (7.28-15.83 pg) were recorded at the cultivar level, with an exceptionally high DNA content (22.24 pg) in cv.K. Chandramukhi. This could be due to the aneusomatic condition of this genotype. Correlation studies revealed interdependence between the chromosomal and nuclear parameters of the genotypes. Structural alterations in the chromosomes, as well as loss or addition of highly repetitive sequences in the genome, caused variations in DNA content at the cultivar level. Variations in genomic structure and nuclear DNA content of the 48-chromosome genotypes suggest a genetic drift during microevolution, leading to the development of new cultivars.

The influence of hyperbilirubinaemia on malaria-related mortality: an analysis of 1103 patients

The influence of hyperbilirubinaemia on malaria-related mortality was explored among 1103 cases of acute, Plasmodium falciparum malaria at a referral hospital in Orissa, India. Most (64.3%) of the subjects investigated had > 1.2 mg bilirubin/dl serum and were therefore considered hyperbilirubinaemic. Compared with the other patients, those with hyperbilirubinaemia were much more likely to have cerebral malaria (24.1% v. 9.4%; P < 0.0001) or acute renal failure (9.5% v. 2.3%; P < 0.0001), but not severe anaemia (5.9% v. 4.3%; P < 0.22). Mortality was 7.9% among the patients with hyperbilirubinaemia (all the deaths being attributable to cerebral malaria, acute renal failure and/or severe anaemia) but only 1% among the non-hyperbilirubinaemics. There were no deaths, however, among the 506 hyperbilirubinaemics who did not have cerebral malaria, acute renal failure or severe anaemia, even among those with high serum concentrations of bilirubin. It therefore appears that, in acute, Plasmodium falciparum malaria, hyperbilirubinaemia is not in itself a severe complication, and only appears linked with mortality when associated with at least one other complication.

Buprenorphine-Soaked Absorbable Gelatin Sponge: An Alternative Method for Postlaminectomy Pain Relief

There have been several reports of instillation of buprenorphine in the intact epidural space in an attempt to control postoperative pain, but none in which an absorbable gelatin sponge soaked with buprenorphine is placed directly in the epidural space. In the present study, carried out on 30 patients (study group) undergoing noncervical laminectomies, 0.3 mg buprenorphine diluted to 5 mL with normal saline soaked into an absorbable gelatin sponge was placed in the epidural space under direct vision. In 30 other patients (control group) undergoing laminectomies, absorbable gelatin sponge soaked with 5 mL normal saline was placed in the epidural space. Pulse rate, mean arterial pressure, respiratory rate, pain score by visual analog scale, duration of analgesia, and adverse effects, if any, were noted preoperatively and postoperatively at 1, 2, 3, 4, 5, 6, 12, 18, and 24 hours. The presence of any neurologic symptoms was also assessed at these time intervals as well as on the seventh postoperative day. The authors observed that changes in pulse rate, mean arterial pressure, and respiratory rate were not statistically significant between the control and the study groups. The pain relief score, duration of pain relief (14.8 +/- 0.77 hours in the study group vs. 0.66 +/- 0.15 hours in the control group), and sedation were significantly better in the study group. No patient demonstrated any respiratory depression (respiratory rate <12/min), bradycardia, pruritus, or neurologic pressure symptoms, although the incidence of nausea was higher in the study group.

Bacteriological and antimicrobial susceptibility profile of soft tissue infections from Northern India

BACKGROUND

Soft tissue infections require a judicious combination of antimicrobial therapy in addition to surgical debridement to limit tissue loss and preserve life.

AIMS

To study the bacterial etiology of soft tissue infections and their antimicrobial susceptibility pattern.

SETTINGS AND DESIGN

A single institutional retrospective study of one year duration from January to December 2002.

MATERIALS AND METHODS

A total of 5039 consecutive pus samples received in the Bacteriology Laboratory was analyzed from the records.

RESULTS

There were a total of 2783 bacterial isolates comprising of 1504 gram negative bacilli and 1279 gram positive cocci. Staphylococcus aureus was the commonest isolate followed by Escherichia coli and Pseudomonas species. Methicillin resistance in S. aureus was found to be 38.56%, high level aminoglycoside resistance was observed in 53.3% enterococci and 66.75% of the gram negative bacilli were extended spectrum beta-lactamase producers. Rifampicin and vancomycin showed best activity for S. aureus; for gram-negative bacilli, piperacillin-tazobactam combination showed best activity.

CONCLUSIONS

Continuous monitoring of antimicrobial susceptibility pattern in individual settings together with their judicious use is emphasized to minimize emergence of drug resistant bacteria.

Colony-Stimulating Activity of Fetal Liver Cells: Synergistic Role of Stem Cell Factor in Bone Marrow Recovery from Aplastic Anemia

Previously, we and others have shown that fetal liver infusion (FLI) leads to autologous hematopoietic improvement in 40-54% of patients with aplastic anemia. However, whether this recovery was spontaneous or the effect of the infused liver cells was not clear. To dissect the role of FLI in autologous hematopoietic recovery, the colony-supporting potential of fetal liver-conditioned medium (FLCM) was evaluated in bone marrow (BM) cells of normal adult and aplastic anemia patients. In both cases, each sample of FLCM supported the growth of colony-forming cells in semi solid culture medium. The FLCM was assayed for the presence of four principal colony-stimulating cytokines, namely stem cell factor (SCF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-3 (IL-3), and erythropoietin (Epo). While GM-CSF, IL-3, and Epo were present in insignificant amounts or were altogether absent, 50-635 pg/ml of SCF was found in 8 of the 13 FLCM samples tested. Preliminary results of bioneutralization assay indicated the possible role of SCF, secreted by the FL cells, in colony-supporting activity of aplastic anemia and normal BM cells. Overall, our in vitro study implicates the paracrine role of infused FL cells in regenerating autologous hematopoiesis in aplastic anemia patients.

Photocatalytic degradation of 2-chlorophenol: a study of kinetics, intermediates and biodegradability

The kinetics of photocatalytic (TiO(2)/UV) degradation of 2-chlorophenol (2-CP), characterization of intermediates and induction of biodegradability in treated chlorophenol solutions is reported. Approximately 95% of the 2-CP is removed in approximately 2h at pH 5 and 0.2g TiO(2)l(-1) when the 2-CP concentration is < or =100mgl(-1); the pseudo-first-order rate constant (k) is estimated to be 0.0183 min(-1). GC-MS analyses detected phenol, catechol, hydroxyhydroquinone (HHQ), and chlorohydroquinone (CHQ) intermediates during the short irradiation time (<1h); however two other higher carbon intermediates 2-hydroxy-benzaldehyde (HB) and [1.1'-biphenyl]-2,2'-diol (BPD) are found as major intermediates over longer irradiation times. The biochemical oxygen demand (BOD) of treated 2-CP solutions improved substantially. A tentative mechanistic pathway to explain formation of higher carbon intermediates is presented.

Extranasal glial heterotopia: case report

Glial heterotopia or the occurrence of isolated non-teratomatous extracranial glial tissue is rare. We report a neonate with extensive extranasal glial heterotopia involving the left buccopharyngeal region, palate and base of the skull and presenting with respiratory distress and a bleeding oral mass. A staged operative approach was adopted to excise the lesion. The literature on the subject is briefly reviewed.

Venous thrombosis associated with Salmonella: report of a case and review of literature

We describe here the first case of Salmonella paratyphi A bacteremia associated with deep vein thrombosis in a 10-year-old patient. In spite of aggressive antibiotic therapy and supportive care, the patient died of progressive respiratory distress and septic shock. Awareness of unusual clinical presentation of Salmonella infection in important. A review of the previously reported cases of Salmonella associated venous thrombosis worldwide is also presented.

Antimicrobial resistance profile of nosocomial uropathogens in a tertiary care hospital

A retrospective analysis was done of the resistance pattern of urinary tract pathogens isolated over a 4 months period in a tertiary care hospital. There were a total of 871 clinical isolates comprising of 793 gram negative bacilli and 78 gram positive cocci obtained from 5477 consecutive urine samples. Extended spectrum beta lactamase production was observed in 71.5% of the gram negative bacilli; of these 6.18% were also inhibitor resistant. High level aminoglycoside resistance was observed in 70.17% of Enterococcus isolates while methicillin resistance was documented in 23.8% of the Staphylococcus isolates. A high level of resistance was also noted for ciprofloxacin. Multidrug resistance is a common problem in hospitals which emphasizes the need for judicious use of antimicrobial agents and their continuous in vitro monitoring.

Massive falx cerebri empyema

A rare case of otogenic massive intra-falx empyema is reported. The patient presented with headache, vomiting and left lower limb weakness of 8 months duration. C.T. scan revealed two cavities in the falx. Right fronto-parietal craniectomy and drainage of massive empyema was undertaken through interhemispheric approach with wide opening of the falx, evacuation of voluminous amount of thick pus and marsupalization of flax with dura. The patient showed complete recovery. The relevant literature is briefly reviewed.

Multicentric clinical trials for safety and efficacy evaluation of alpha;beta arteether in complicated P. falciparum malaria

OBJECTIVE

To evaluate efficacy of alpha;beta arteether in patients of P. falciparum malaria presenting with complications was undertaken in a multicentric clinical trial.

METHOD

Each patient who consented to undergo clinical trial with parenteral Arteether was treated with a fixed dose schedule of Arteether given intramuscularly in a dose of 150 mg once a day on three consecutive days. Every patient was followed upto 28 days with clinical, haematological and parasitological monitoring every day upto one week and thereafter at 14, 21 and 28 days. The response was assessed in terms of fever clearance time, parasite clearance time, cure rate and parasite reappearance rate.

RESULTS

A total of 211 patients of P. falciparum malaria were included in the study from four centres (Bhilai, Guwahati, Jamshedpur and Rourkela). Results of this study showed that fever clearance time ranged between 24-168 hours, parasite clearance time ranged between 24-120 hours and overall mortality ranged between 4-8.5%. Out of 211, only 14 patients expired during the study, of these, 10 patients expired within first two days i.e. before completing the three day schedule of arteether therapy. Tolerability to arteether injection was good in all these patients and no untoward effects were experienced or reported during the study. Overall cure rate observed in these studies was 93%.

CONCLUSION

This study shows a rapid parasite and fever clearance in patients of complicated P. falciparum malaria.

High lane density slab-gel electrophoresis using micromachined instrumentation

In this paper, micromachined pipette arrays (MPAs) and microcombs were studied as a means of enabling high lane density gel electrophoresis. The MPA provide a miniaturized format to interface sub-microliter volumes of samples between macroscale sample preparation formats and microscale biochemical analysis systems. The microcombs provide a means of creating sample loading wells in the gel material on the same center-to-center spacing as the MPAs. Together, the two micromachined instruments provide an alternative to current combs and pipetting technologies used for creating sample loading wells and sample delivery in gel electrophoresis systems. Using three designs for the microcomb-MPA pair, center-to-center spacings of 1.0 mm, 500 microm, and 250 microm are studied. The results demonstrate an approximate 10-fold increase in lane density and a 10-fold reduction in sample size from 5 microL to 500 pL. As a result, the number of theoretical plates has increased 2.5-fold, while system resolution has increased 1.5-fold over the conventional agarose gel systems. An examination of changes in resolution across the width of individual separation lanes in both systems revealed dependence in the case of the conventional gels and no dependence for the gels loaded with the micromachined instrumentation.

Blockade of histamine H2 receptors attenuate blood-brain barrier permeability, cerebral blood flow disturbances, edema formation and cell reactions following hyperthermic brain injury in the rat

Role of histamine H2 receptors in blood-brain barrier (BBB) disturbances, cerebral blood flow (CBF), brain edema formation, and cell injury caused by heat stress in a rat model was examined using the pharmacological approach. Blockade of histamine H2 receptors by cimetidine or ranitidine significantly attenuated the BBB permeability to Evans blue albumin and [131]I-sodium extravasation, brain edema formation and cell injury following 4 h heat stress in rats at 38 degrees C. These drug treatments also restored the CBF to near normal values. These beneficial effects in heat stress were most marked in rats treated with ranitidine compared to cimetidine given in identical dosage. Our observations suggest that blockade of histamine H2 receptor is beneficial in hyperthermic brain injury and indicates that histamine is involved in the pathophysiology of heat stress induced brain dysfunction. Our study strongly suggests further need to develop more specific and sensitive histaminergic H2 receptor blockers for the treatment of neurological ailments.

p-Chlorophenylalanine, an inhibitor of serotonin synthesis reduces blood-brain barrier permeability, cerebral blood flow, edema formation and cell injury following trauma to the rat brain

The role of serotonin in trauma induced alterations in blood-brain barrier (BBB) permeability, cerebral blood flow (CBF), brain edema and cell changes were examined in a new model of cortical injury in the rat using a pharmacological approach. A longitudinal incision into the right parietal cerebral cortex (about 3 mm deep and 5 mm long) was associated with a profound increase in the BBB permeability to Evans blue and [131]I-sodium, brain water content, and a reduction in the CBF in both the ipsilateral and contralateral hemispheres 5 h after trauma. Nissl staining showed a profound nerve cell reaction in the parietal cerebral cortex of both hemispheres. The intensity of these pathological changes was most pronounced in the traumatised hemisphere. Pretreatment with p-CPA, a serotonin synthesis inhibitor, significantly attenuated breakdown of the BBB permeability, brain edema and the CBF disturbances. Damaged and distorted nerve cells were markedly less frequent in p-CPA treated rats. This effect of the drug was most pronounced in the contralateral hemisphere. The observations strongly suggest that serotonin is one of the important neurochemical mediators of BBB permeability disturbances and brain edema formation in the trauma induced brain damage.

A multicentric study with arteether in patients of uncomplicated falciparum malaria

Two hundred and sixty seven patients of uncomplicated P. falciparum malaria completed study in a multicentric phase III clinical trial of Arteether. Arteether was given intramuscularly in a dose of 150 mg daily for three consecutive days. Each patient was followed upto 28 days of alpha, beta arteether therapy. The cure rate was 97% with fever clearance time between 1-7 days (24-168 hours) and parasite clearance time between 1-3 days (24-72 hours). Parasite reappearance rate was found to be 3% and reported at only three of the centres. Following the treatment no adverse effect was observed on haematological, biochemical and vital clinical parameters.

Regulated protein degradation controls PKA function and cell-type differentiation in Dictyostelium

Cullins function as scaffolds that, along with F-box/WD40-repeat-containing proteins, mediate the ubiquitination of proteins to target them for degradation by the proteasome. We have identified a cullin CulA that is required at several stages during Dictyostelium development. culA null cells are defective in inducing cell-type-specific gene expression and exhibit defects during aggregation, including reduced chemotaxis. PKA is an important regulator of Dictyostelium development. The levels of intracellular cAMP and PKA activity are controlled by the rate of synthesis of cAMP and its degradation by the cAMP-specific phosphodiesterase RegA. We show that overexpression of the PKA catalytic subunit (PKAcat) rescues many of the culA null defects and those of cells lacking FbxA/ChtA, a previously described F-box/WD40-repeat-containing protein, suggesting CulA and FbxA proteins are involved in regulating PKA function. Whereas RegA protein levels drop as the multicellular organism forms in the wild-type strain, they remain high in culA null and fbxA null cells. Although PKA can suppress the culA and fbxA null developmental phenotypes, it does not suppress the altered RegA degradation, suggesting that PKA lies downstream of RegA, CulA, and FbxA. Finally, we show that CulA, FbxA, and RegA are found in a complex in vivo, and formation of this complex is dependent on the MAP kinase ERK2, which is also required for PKA function. We propose that CulA and FbxA regulate multicellular development by targeting RegA for degradation via a pathway that requires ERK2 function, leading to an increase in cAMP and PKA activity.

Role of aprotinin in the management of experimental fungal keratitis

In an experimentally induced Aspergillus fumigatus fungal keratitis in 20 rabbits, aprotinin, an antiplasmin agent, was studied to find out its role as an adjuvant when given along with other established antifungal agents like natamycin and fluconazole. The 20 rabbits included in this study were randomly divided into four equal treatment groups. Once the ulcer was produced after intrastromal injection of 0.03 ml of A. fumigatus (5.5 x 10(4) spores/ml), different drugs/agents in combination were used in a randomized manner. These were natamycin (5%) + placebo, natamycin + aprotinin (40 IU/ml), fluconazole (0.3%) + placebo and fluconazole + aprotinin. The rabbits were followed up every day to note the signs of healing which included subsidence of corneal infiltration, disappearance of stromal abscess and subsidence of corneal oedema till complete healing. Results showed that the average healing time was 28.2, 28.4, 49.8 and 49.0 days for natamycin + placebo, natamycin + aprotinin, fluconazole + placebo and fluconazole + aprotinin, respectively. It suggests that aprotinin as an adjuvant has no definite role in the management of fungal keratitis. The plasminogen activator-plasmin system which is inhibited by aprotinin may not be the pathway through which filamentous fungi like A. fumigatus cause tissue destruction.

Capnocytophaga cynodegmi cellulitis, bacteremia, and pneumonitis in a diabetic man

Capnocytophaga cynodegmi (formerly "DF-2 like organism"), a commensal organism of the canine oral cavity, is a capnophilic, gram-negative, facultative bacillus. C. cynodegmi has rarely been encountered in human diseases. We report the first known case of cellulitis, bacteremia, and pneumonitis caused by C. cynodegmi in a diabetic man from central India following a dog bite.

Botulism: An update

Botulism is a paralytic illness caused by the action of a neurotoxin elaborated by Clostridium botulinum. Other clostridial bacteria, like C.butyricum and C.baratii can also produce the toxin leading to signs and symptoms of botulism. Though rare, the illness is potentially fatal and can masquerade as other illnesses making diagnosis difficult. Physicians need to familiarize themselves with the disease as prompt recognition and early treatment can considerably curtail the fatal outcome in the affected and prevent additional cases in the unaffected. New diagnostic, therapeutic and preventive modalities to tackle the disease have come into focus. Botulinum toxin, generally considered a potent poison, is successfully being used for treatment of various neuromuscular disorders representing one of the most dramatic role reversals of modern times.

Rhinocerebral mucormycosis in a patient of acute renal failure

Mucormycosis is the name for invasive fungal infection caused by mucorales. The disease is uncommon and produces serious and rapidly fatal infection in patients with serious pre-existing illness. The classical presentation of rhinocerebral mucormycosis is involvement of nasal mucosa with invasion of paranasal sinuses and orbit. We report a case of mucormycosis in an otherwise healthy female who had developed acute renal failure following gastroenteritis.

Contre-coup extradural haematoma : a short report

An extradural haematoma contralateral to impact site is reported. Review of literature reveals that such phenomenon is extremely rare.

Stereoselective halofantrine disposition and effect: concentration-related QTc prolongation

AIMS

1) To characterize the variability of multiple-dose halofantrine pharmacokinetics over time in healthy adults, 2) to correlate the pharmacodynamic measure electrocardiographic (ECG) QT interval with (+)- and (-)-halofantrine plasma concentration and 3) to evaluate the safety and tolerance of halofantrine hydrochloride given over time to healthy adults.

METHODS

Twenty-one healthy subjects were enrolled and 13 completed the study (180 days). Subjects received either 500 mg of racemic halofantrine once daily in the fasted state for 42 days, or placebo, and then halofantrine washout was documented for the following 138 days. Pharmacokinetic and pharmacodynamic (ECG QTc) measurements were obtained.

RESULTS

Mean accumulation half-times (days) for halofantrine were: 7.0 +/- 4.8 [(+)-halofantrine] and 7.3 +/- 4.8 [(-)-halofantrine]. Mean steady-state concentrations were: 97.6 +/- 52.0 ng ml(-1) [(+)-halofantrine] and 48.5 +/- 20.8 [(-)-halofantrine]. Steady-state oral clearance was: 139 +/- 73 l h(-1) [(+)-halofantrine] and 265 +/- 135 l h(-1) [(-)-halofantrine]. Peak plasma concentrations of both (+)- and (-)-halofantrine were attained at 6 h and maximal ECG QTc prolongation was at 4-8 h following drug administration. Fourteen of 16 subjects who received active drug had ECG QTc prolongation that was positively correlated with both (+)- and (-)-halofantrine concentration. The five subjects who received placebo had no demonstrable change in ECG QTc throughout the study. Conclusions Halofantrine accumulates extensively and shows high intersubject pharmacokinetic variability, is associated with concentration-related ECG QTc prolongation in healthy subjects, and is clinically well tolerated in this subject group.

Differential sensitivity of breast cancer cells to tumor necrosis factor-alpha: involvement of protein kinase C

We have compared several breast cancer cell lines that differ in their responsiveness to TNF to determine the involvement of PKC isozymes in regulating sensitivity of breast cancer cells to TNF. While MCF-7 and BT-20 cells were responsive to TNF without any metabolic inhibitors, CAMA-1 and SKBR-3 cells responded to TNF in the presence of cycloheximide; MDA-MB-231 and Hs578t cells were resistant to TNF even in the presence of cycloheximide. Bisindolylmaleimide (BIM), an inhibitor of PKC, either alone (MCF-7 and BT-20) or in combination with cycloheximide enhanced sensitivity of these cells to TNF. The PKC isozyme profile of MCF-7 cells was similar to BT-20 cells and that of CAMA-1 cells was similar to SKBR-3 cells. MCF-7, BT-20 and MDA-MB-231 cells that were most responsive to BIM-mediated sensitization to TNF contained relatively high level of PKC epsilon and proteolytic cleavage of PKC epsilon correlated with TNF-induced cell death. BIM did not inhibit NF-kappa B activation by TNF but caused activation of caspases and enhanced cleavage of PKC delta and -epsilon. These results suggest that proteolytic cleavage of PKC epsilon may be associated with PKC inhibitor mediated sensitization of breast cancer cells to TNF.

Clinico-myocological profile of tinea capitis in North India and response to griseofulvin

There is a paucity of literature on tinea capitis from North India. The response to griseofulvin has not been studied as well. We studied 153 consecutive patients of tinea capitis for clinical patterns, causative dermatophytic species, clinico-etiological correlation, and response to griseofulvin. Culture and sensitivity were done on all patients. All patients were treated with griseofulvin for 6-8 weeks; non-responders were further treated with fluconazole. Ninety percent of the patients were less than 15 years of age, 75% belonged to poor socioeconomic groups and 19% had a family history of tinea capitis. The seborrheic variant was the commonest clinical pattern seen in 47.8% of patients, followed by grey patch, black dot, kerion, and alopecia-areata-like tinea capitis in 35.9%, 8.5%, 6.5% and 1.3% of patients, respectively. Only 66% of patients had a positive culture. T. violaceum was the commonest dermatophytic species isolated in 38% patients. M. audouinii, T. schoenleinii, T. tonsurans, M. gypseum, T. verrucosum and T. mentagrophytes were isolated in 34%, 10%, 9%, 3%, 3% and 3% of patients, respectively. Of the isolates 94% were susceptible to griseofulvin, and 100% were susceptible to fluconazole. By using griseofulvin for 6-8 weeks 97.4% of the patients were cured; nonresponders required therapy with fluconazole for cure. To conclude, tinea capitis is still a disease of younger people of poor socioeconomic status. T. violaceum and M. audouinii are the most common responsible dermatophytes. The response to griseofulvin was excellent, and it should be used as a first line therapy.

Patterns of presentation of congenital scoliosis

In analysing and investigating 66 consecutive cases of congenital scoliosis, we aimed to evaluate the clinical pattern of presentation, identify the underlying vertebral anomaly causing the deformity, and determine the frequency of associated intraspinal anomalies, cardiovascular anomalies and genito-urinary anomalies. Associated general anomalies were seen in 44% of the cases. The commonest pattern of deformity was a right-sided thoracolumbar curve. Hemivertebra was the most common vertebral anomaly (45%). Occult intraspinal anomalies were seen in 15% of cases, diastematomyelia being the commonest anomaly. Genitourinary anomalies and cardiovascular abnormalities were encountered in 6% and 15% of patients respectively. As decision making in the treatment of congenital scoliosis depends on the natural history of progression of the deformity and associated intra and extra spinal anomalies, identification of all associated anomalies is essential.