Clinical characterization and evaluation of DYT1 gene in Indian primary dystonia patients

OBJECTIVES

Dystonia is a common movement disorder. The purpose of this study is to examine the relative distribution of the primary dystonia subtypes and identify mutation (s) in the DYT1 gene in Indian patients.

MATERIALS AND METHODS

Primary dystonia patients (n = 178) and controls (n = 63), lacking any symptoms of the disease, were recruited for the study from eastern India. The nucleotide variants in the DYT1 gene were identified by carrying out polymerase chain reaction, single stranded conformation polymorphism, and DNA sequencing.

RESULTS

Unlike other reports, pain and/or tremor was more common in our sporadic patients than in familial cases. Three reported and two novel changes were identified in this gene. The homozygous genotype (G,G) for a missense variant (c.646G > C; Asp216His) was significantly over-represented in the patients compared with controls (P < 0.05). However, the commonly reported 3 bp deletion (904-906delGAG) was not detected.

CONCLUSION

Our results suggest that the DYT1 gene might have a limited role in causation of dystonia in the Indian population.

The use of fish community structure as a measure of ecological degradation: a case study in two tropical rivers of India

Fish community structure and water chemistry of two tropical rivers of West Bengal, an eastern province of India, were studied for two annual cycles (January 2003-December 2004) and a higher degree of pollution was found in one river (the Churni) than in the other river (the Jalangi). This was reflected in the water quality as well as in fish community structure of the rivers. We observed that 63.6% of fish species appeared to have been eliminated from the polluted Churni river since 1983 in 20 years. For the protection of fish biodiversity and enhancement of fish production, a rational management program should be implemented for the Churni river.

A random sample survey for prevalence of major neurological disorders in Kolkata

BACKGROUND & OBJECTIVES

Large scale epidemiological studies on neurological disorders are very few in India. We therefore planned to conduct a cross-sectional population-based epidemiological study on a stratified randomly selected sample from the city of Kolkata to study the prevalence of major neurological disorders such as epilepsy, stroke, dementia and Parkinsonism.

METHODS

The method of case ascertainment was two- stage house-to-house survey; the first stage was undertaken by a field team consisting of four field workers and a neuropsychologist. Screening questionnaire based on National Institute of Mental Health and Neuro Sciences (NIMHANS) protocol was used. In the second stage a neurologist examined all the screened positive cases.

RESULTS

A total of 52,377 subjects participated in the study. The crude prevalence rates (per 100,000 population) of major neurological disorders with 95 per cent confidence intervals (95% CI) and age adjusted rates (AAR) based on US 2000 population were 557.5 (95% CI 496.17-624.40 and AAR - 516.77) in epilepsy, 486.85 (95% CI 377.0 to 551.11 and AAR-765.68) in stroke, 87.82 (95% CI 64.02-117.50 and AAR-168.4) in dementia and 45.82 (95% CI 29.64-67.63 and AAR-71.64) in Parkinsonism. The weighted prevalence rates (per 100,000) of the whole population based on re-screening of 10 per cent of negative samples were 763.89 (95% CI 690.55- 842.57) in epilepsy, 624.32 (95% CI 555.64-699.24) in stroke and 139.37 (95% CI 108.71-176.06) in dementia.

INTERPRETATION & CONCLUSION

A high rate of stroke and overall lower prevalence of Parkinsonism and dementia was recorded as compared to western studies. High prevalence rate of stroke emphasizes the need to study incidence, morbidity and mortality profile of stroke including its socio-economic impact and also case-control analysis to determine the underlying risk factors.

Cardiac pumping capability in patients with peripheral vascular disease

INTRODUCTION

Peripheral vascular disease (PVD) is a condition characterized by atherosclerotic occlusive disease of the lower extremities, low functional capacity and low exercise tolerance. Less empirical data are available concerning the cardiovascular response to maximum exercise tests in patients with PVD. The purpose of this study was to examine cardiovascular variables in patients with peripheral vascular disease.

METHODS

Fifty patients (67 +/- 9 years) completed an incremental exercise test (2 min stages, 3.2 km h(-1), with increases of 2% every 2 min) to maximum claudication pain. Maximal oxygen consumption (VO2) was assessed on a breath-by-breath basis by online expiratory gas analysis (CardiO2, Medical Graphics Co.). Blood pressure was recorded at peak exercise. Following a 30-min rest period, patients exercised at the highest level attained during the first test and cardiac output (QT) was measured using the exponential non-invasive rebreathing method. Cardiac power output peak (CPOpeak) in Watts (W), was then computed.

RESULTS

Mean +/- SD values were; 13.85 +/- 4.14 ml kg min(-1); maximal walk time 357 +/- 227 s; peak mean arterial pressure 127 +/- 15 mmHg; 9.8 +/- 2.39 (l min(-1)); CPO 2.86 +/- 0.87 W.

CONCLUSION

Patients with peripheral vascular disease demonstrate attenuated levels of cardiovascular capacity. This group of patients should be given exercise therapy in order to improve cardiovascular status and ambulatory function.

An estimate of the monthly cost of two major mental disorders in an Indian metropolis

BACKGROUND

THE COMPONENTS OF HIGH COST OF TREATING A CHRONIC PSYCHIATRIC ILLNESS ARE: long-term continuous treatment consisting of consultation and medication costs, traveling to the treatment centre and taking time off from work for both patient and caregiver. Apart from direct treatment costs, expenditure of time in care-giving results in indirect costs. All these costs are borne by families as the sufferer may be unable to work.

AIM

To estimate the cost of treatment of chronically ill patients at home, in terms of the above parameters.

METHODS

The sample consisted of 117 subjects of either sex in the age range of 18 to 60 years, ill for at least one year, diagnosed as schizophrenia (n=95) or bipolar disorder (n=22, a comparison group) who agreed to participate in the study along with at least one caregiver. The tools used were the Diagnostic Interview of Genetic Studies and Economic Burden Questionnaire administered to both the subject and the caregiver.

RESULTS AND CONCLUSIONS

The costs of treatment were found to be high but with wide variations in the range. Costs for bipolar disorder were somewhat higher than those for schizophrenia at least for the period of study. Demographic differences between subjects and caregivers were present.

Development of water buffalo (Bubalus bubalis) embryos from in vitro matured oocytes reconstructed with fetal skin fibroblast cells as donor nuclei

The present study was carried out to explore the feasibility of using buffalo fetal skin fibroblasts as donor nuclei and to find out the developmental competence of embryos following transfer of these nuclei to in vitro matured enucleated buffalo oocytes. Skin cells were isolated from 1 to 2-month-old fetuses obtained from slaughterhouse, by enzymatic digestion (0.5% w/v trypsin +0.05% w/v collagenase in Dulbecco's PBS) for 15-20 min. The cells were washed 4 times with Dulbecco's PBS and then once with RPMI-1640+10% FBS by centrifugation at 600 x g. The cells were then cultured in the same medium in a CO2 incubator (5% CO2 in air) at 38.5 degrees C for 2-3 days. Cumulus-oocyte complexes (COCs) collected from slaughterhouse buffalo ovaries were subjected to IVM in the IVM medium (TCM-199 + 5 microg/ml FSH-P + 10 microg/ml LH+10% FBS) for 20-22 h in a CO2 incubator (5% CO2 in air) at 38.5 degrees C. Oocytes were denuded with 0.1% trypsin followed by repeated pipetting and then enucleated by aspirating the first polar body with 10-15% of nearby cytoplasm with a micromanipulator. Two different types of donor cells (growing cells and those arrested with cytochalasin-B) were used for reconstruction of oocytes. The reconstructs were electro fused and incubated in the activation medium (TCM-199 + 8 microg/ml cytochalasin-B+10% FBS) for 4 h. These were then cultured in IVC medium (TCM-199+10% FBS) in a CO2 incubator (5% CO2 in air) at 38.5 degrees C for 48 h. The cleaved embryos were then co-cultured with buffalo oviduct cells in embryo development media (EDM). Out of 119 denuded matured oocytes which were enucleated and reconstructed with growing cells, 78 (65.5%) were electro fused, activated and cultured, out of which 4 (5.1%) reconstructs cleaved and developed to 2-cell stage, 3 (3.8%) reached to 4-cell stage and 3 (3.8%) reached to 8-cell stage. In the synchronized group, out of 62 denuded matured oocytes which were reconstructed with cytochalasin-B blocked cells, 40 (65%) were electrofused, activated and cultured, out of which 4 (10%) developed to 2-cell stage, 3 (7.50%) to 4-cell stage, 2 (5.0%) to early morula stage and 1 (2.50%) to blastocysts stage. These results suggest that buffalo fetal skin fibroblasts could be used as donor nuclei for the production of buffalo embryos after nuclear transfer to enucleated in vitro matured buffalo oocytes.

Adsorption of cadmium on husk of Lathyrus sativus: Physico-chemical study

Adsorption of cadmium (II) from aqueous solution by low-cost biosorbents was investigated. Husk of Lathyrus sativus (HLS) was found to be the most efficient in this respect and removed approximately 95% of the metal. The influence of pH, temperature, contact time and metal ion concentration on the adsorption process by HLS was studied. Hydrogen ion concentration of the solution greatly influenced the process with an optimum at pH 5.0-6.0, whereas temperature had no significant effect. The process was very fast and more than 90% of the total adsorption took place within the first 5 min and was found to follow pseudo-second order rate kinetics. The adsorption data can better be explained by Langmuir isotherm model and the calculated maximum adsorption capacity was 35 mg/g of HLS at pH 5.0 and 30 degrees C. Scanning electron micrographs showed that cadmium was present as micro precipitate on the surface of the adsorbent. Cadmium replaced calcium of the biomass as revealed from the EDX analysis indicating that the adsorption proceeds through ion exchange mechanism. Cadmium could be desorbed from the loaded biomass by lowering pH approximately 1.0 with mineral acid.

Parametrial invasion in carcinoma of cervix: role of MRI measured tumour volume

The aim of the study was to determine the correlation between MRI measured tumour volume and parametrial invasion on histology in the evaluation of carcinoma of the cervix showing full thickness stromal invasion (FTSI). Original MR images of 159 surgical cases of carcinoma of the cervix retrieved from the MR image bank of the department were analysed retrospectively. Tumour volume from the maximum tumour diameters in each case was computed using the standard formula for an ellipse and correlated with parametrial invasion on histology. Of 105 cases showing FTSI on axial T(2) weighted MRI, tumour volume between the two groups of cases, with parametrial invasion (n=27) and without parametrial invasion (n=78), shows a statistically significant difference (p=0.006). Best accuracy of 60.95%, sensitivity 59.26% and specificity 61.54% was found for tumour volume of 36.39 cm(3). The study concludes that MRI measured tumour volume is associated with low accuracy in the evaluation of parametrial invasion in carcinoma of cervix showing FTSI in axial T(2) weighted MR images and may not help as an additional diagnostic criterion to predict parametrial invasion pre-operatively.

Studies on diagnostic potential of secretory antigens of Mycobacterium bovis

Culture filtrate proteins (CFPs) of M. bovis were produced by culturing the organism for a period of 3 weeks. These CFPs elicited a good delayed hypersensitivity (DTH) reaction in cattle and guinea pig. However, CFPs showed least cross-reactivity when tested in guinea pigs sensitized with M. bovis BCG and M. phlei. CFPs were found to be well recognized by T-cells of single intradermal test (SIDT) positive cattle and were also sero-reactive. Lymphocyte transformation assay revealed the culture filtrate antigens as major T-cell antigens. CFPs induced a good interferon gamma release as compared to conventional antigen, PPD, thereby highlighting their diagnostic capabilities.

Quality of life in Parkinson's disease--Indian scenario

The subjective sense of well being is central to the concept of quality of life (QoL) and a good QoL should be the ultimate goal to any therapeutic measure. In Parkinson's disease (PD), several rating scale are in vogue to measure the QoL, namely PDQ-39, PDQ-8, SF-36, Likert scale etc. Parkinson's Impact Scale (PIMS) has been used in this study to assess the QoL which includes 10 items.

METHODOLOGY

Thirty two patients of Parkinson's disease satisfying the UK Parkinson's disease brain bank diagnostic criteria, ranging from HY stage I to IV have been recruited. UPDRS was also administered to them. Statistical analysis was performed using Spearman rank correlation and multivariate stepwise regression analysis using SPSS for windows.

RESULT

Seventy two percents were male, all getting levodopa, 72% got anticholinergics. Monthly income varied from Rs.800 (US dollars 17.10) to Rs.15,000 (US dollars 320) pm. Eighty eight percent belonged to HY II-III. UPDRS score ranged from 3-85 (40.4 +/- 18.6). PIMS total score ranged from 1-22 (10.4 +/- 6.1). DISCUSSION AND CONSLUSION: The QoL deteriorates with H-Y staging, the UPDRS score, not with advancing age as seen in other studies. It is also significantly influenced by duration of the disease and financial security. Surprisingly, the family and community relations were not significantly affected with advancing disease, perhaps due the close family and social tie up among Indians. So, measurement of QoL should be made an essential part to the routine assessment of PD patients to get a complete scenario of the problem. PIMS can serve as a comprehensive tool for the same suitable for use in the OPD.

Molecular pathogenesis of Wilson disease: haplotype analysis, detection of prevalent mutations and genotype-phenotype correlation in Indian patients

Wilson disease (WD) is an autosomal recessive disorder caused by defects in the copper-transporting P-type ATPase gene (ATP7B) resulting in the accumulation of copper in the liver and the brain. We identified prevalent mutations in the ATP7B of Indian WD patients and attempted to correlate those with the disease phenotype. Patients from 62 unrelated families and their first-degree relatives comprising 200 individuals were enrolled in this study. Three dinucleotide repeat markers flanking WD locus and a few intragenic SNPs were used to determine the genotypes and construct haplotypes of the patients. Seven recurring haplotypes accounting for 58% of the total mutant chromosomes were identified, and four underlying defects in the ATP7B representing 37% of WD chromosomes were detected. In addition, five other rare mutations were characterized. Thus a total of nine mutations including five novel changes were identified in the ATP7B of WD patients. Interestingly, homozygotes for different mutations that would be expected to produce similar defective proteins showed significant disparity in terms of organ involvement and severity of the disease. We also observed WD patients with neurological symptoms with little or no manifestation of hepatic pathogenesis. In one WD family, the proband and a sib had remarkably different phenotypes despite sharing the same pair of mutant chromosomes. These findings suggest a potential role for yet unidentified modifying loci for the observed phenotypic heterogeneity among the WD patients.

Psychotherapy Improves Compliance with Tuberculosis Treatment

BACKGROUND

Low treatment completion rate in tuberculosis (TB) patients is a major concern. Physicians have always been striving for better treatment adherence in such patients. The present study is one such attempt in this direction.

OBJECTIVES

The study was aimed to evaluate the role of behavior modification by psychotherapy in improving compliance with short-course anti-TB chemotherapy in India.

METHODS

It was a prospective controlled trial involving patients with confirmed pulmonary and extrapulmonary TB enrolled in the National Tuberculosis Program. The intervention group underwent pretreatment psychological assessment followed by regular psychotherapy sessions.

RESULTS

The intervention group had a demographic profile comparable to that of the control group. The patients were mostly from low- and middle-income backgrounds from urban and semi-urban areas. They consistently showed poor knowledge about the nature of the disease, low motivation, and had considerable apprehensions. Following the sessions, the intervention group showed improved compliance compared with the control group, reflected in significantly higher treatment completion and cure rates.

CONCLUSIONS

The study suggests that psychological intervention is effective in improving compliance with anti-TB treatment, and may reduce the incidence of treatment failure, relapse and drug resistance.

A new method for isolation of leukocytes from the peripheral blood of amphibians [Bufo himalayanus, (Gunther)] and study of their surface morphology by scanning electron microscopy

Using percoll as the density gradient, a new single step method to isolate leukocytes from the peripheral blood of amphibians (B. himalayanus) has been described. Isolated leukocytes were photographed under the scanning electron microscope and an attempt has been made to characterize the leukocyte population on the basis of surface morphology. Apart from regular blood cell types, B. himalayanus have slender, elongated and slightly curved leukocyte type cells in their peripheral blood. Such slender elongated cells were absent in the blood of a related species B. stomnaticus and hence could not be categorized under the known blood cell types.

Experience with radiofrequency closure of varicose veins (VNUS)

Objective: The aim of this study was to reproduce the results of VNUS closure in our setting; to minimize the cost associated with the procedure; and to reduce the need for an experienced ultrasonographer during the procedure.

Methods: Over a two-year period, 26 patients (42 limbs) were treated. A VNUS radio-frequency machine was used and assisted by intraoperative localization using Sonosite ultrasound, which was operated by the surgeon. All patients were treated under general anaesthetic. Nine patients were operated as a day case and 17 others stayed overnight. Median follow-up period was seven months.

Results: The mean age of the patients was 37 years (range 19–69). Eighteen patients had primary and eight had recurrent varicose veins. Sixteen patients underwent bilateral and 10 underwent the unilateral procedure. Long saphenous vein (LSV) closure was performed in 41 limbs and short saphenous vein closure in two limbs. The LSV was accessed at the ankle in 36 and at knee in three limbs. In two other limbs, groin exploration with retrograde closure of the LSV was achieved. One patient developed numbness at phlebectomy site. None of the patients had deep vein thrombosis and all the treated veins were closed at the one-week scan. In bilateral cases, one catheter was used instead of two for closure in 12 of the 16 limbs. Using our approach, we were able to make a cost savings of £8,600.00.

Conclusion: Technical success in radiofrequency vein closure can be achieved without the need for an additional ultrasonographer. We have shown that our approach is safe, effective and less expensive to deliver.

Bilateral intracerebral haemorrhages: an atypical presentation of Japanese encephalitis

Japanese encephalitis is common human endemic encephalitis seen over various parts of the world. Usual presenting features include an encephalitic syndrome, symptoms of frontal lobe, basal ganglia and thalamic involvement. Characteristic radiological picture is bilateral thalamic and basal ganglia hypo density in the CT scan and hypo-intensity in T1 and hyperintensity in T2 weighted image in MRI. Very rarely occurrence of bilateral hemorrhage may be seen in these regions. This radiological change may be early indicator of the disease before serological confirmation by the available diagnostic modalities. In this communication, we have reported a case of Japanese encephalitis presented with bilateral basal ganglia hemorrhages.

Involuntary jerking of lower half of the body (spinal myoclonus)

A 55 years old, hypertensive, diabetic lady presented with sudden onset jerky movement of lower trunk and legs. It was present both in awake and sleep and got aggravated by mental stress as well as sensory stimulation. Examination revealed rhythmic jerks affecting muscles of lower abdomen and legs. The lower limbs had normal muscle bulk and power, increased tone, exaggerated deep tendon reflexes, bilateral flexor plantar response with normal sensory autonomic and cerebellar function. Investigations including CSF study, MRI of dorsal spine and NCV were normal. A combination therapy with tizanidine, baclofen and clonazepam induced gradual improvement within 6 weeks.

Henoch-Schonlein purpura with intracerebral haemorrhage

Henoch-Schonlein purpura is a leucocytoclastic vasculitis commonly seen among children and young adults. Neurological complications, though rare, include focal cerebral deficit, coma, convulsion, subarachnoid hemorrhage and chorea. We are reporting a 12 years boy with Henoch-Schonlein purpura who developed a large intracerebral hematoma in right occipital lobe. He made an uneventful recovery with conservative treatment and one year follow up revealed no major neurological sequelae.

Feasibility of optimizing the dose distribution in lung tumors using fluorine-18-fluorodeoxyglucose positron emission tomography and single photon emission computed tomography guided dose prescriptions

The information provided by functional images may be used to guide radiotherapy planning by identifying regions that require higher radiation dose. In this work we investigate the dosimetric feasibility of delivering dose to lung tumors in proportion to the fluorine-18-fluorodeoxyglucose activity distribution from positron emission tomography (FDG-PET). The rationale for delivering dose in proportion to the tumor FDG-PET activity distribution is based on studies showing that FDG uptake is correlated to tumor cell proliferation rate, which is shown to imply that this dose delivery strategy is theoretically capable of providing the same duration of local control at all voxels in tumor. Target dose delivery was constrained by single photon emission computed tomography (SPECT) maps of normal lung perfusion, which restricted irradiation of highly perfused lung and imposed dose-function constraints. Dose-volume constraints were imposed on all other critical structures. All dose-volume/function constraints were considered to be soft, i.e., critical structure doses corresponding to volume/function constraint levels were minimized while satisfying the target prescription, thus permitting critical structure doses to minimally exceed dose constraint levels. An intensity modulation optimization methodology was developed to deliver this radiation, and applied to two lung cancer patients. Dosimetric feasibility was assessed by comparing spatially normalized dose-volume histograms from the nonuniform dose prescription (FDG-PET proportional) to those from a uniform dose prescription with equivalent tumor integral dose. In both patients, the optimization was capable of delivering the nonuniform target prescription with the same ease as the uniform target prescription, despite SPECT restrictions that effectively diverted dose from high to low perfused normal lung. In one patient, both prescriptions incurred similar critical structure dosages, below dose-volume/function limits. However, in the other patient, critical structure dosage from the nonuniform dose prescription exceeded dose-volume/function limits, and greatly exceeded that from the uniform dose prescription. Strict compliance to dose-volume/ function limits would entail reducing dose proportionality to the FDG-PET activity distribution, thereby theoretically reducing the duration of local control. Thus, even though it appears feasible to tailor lung tumor dose to the FDG-PET activity distribution, despite SPECT restrictions, strict adherence to dose-volume/function limits could compromise the effectiveness of functional image guided radiotherapy.