Effect of mineralocorticoid receptor antagonist on insulin resistance and endothelial function in obese subjects

AIM

Obese individuals have high aldosterone levels that may contribute to insulin resistance (IR) and endothelial dysfunction leading to obesity-induced cardiovascular disease. We conducted a study to evaluate the effect of mineralocorticoid receptor antagonism on IR and endothelial function in obese individuals. This was a placebo-controlled, double-blind, randomized, parallel-group study (NCT01406015).

METHODS

Thirty-two non-diabetic, obese subjects [body mass index (BMI) 30 to 45 kg/m(2) ] with no other medical problems were randomized to 6 weeks of treatment with spironolactone 50 mg daily or placebo. Insulin sensitivity index (ISI) was assessed by Matsuda method, endothelial function by flow mediated vasodilatation (FMD) of brachial artery and renal plasma perfusion by clearance of para-aminohippurate (PAH).

RESULTS

There was no change in weight, BMI or plasma potassium during the study period. Treatment with spironolactone led to increases in serum aldosterone (7.6 ± 6.6 vs. 3.2 ± 1.3 ng/dl; p < 0.02, post-treatment vs. baseline) and urine aldosterone (11.0 ± 7 vs. 4.8 ± 2.4 µg/g creatinine; p < 0.01) and decreases in systolic blood pressure (116 ± 11 vs. 123 ± 10 mmHg; p < 0.001). There were no changes in these variables in the placebo group. Neither spironolactone nor placebo treatment had a significant effect on ISI or other indices of glucose metabolism [insulin resistance by homeostatic model assessment (HOMA), area under the curve for insulin, area under the curve for glucose], brachial artery reactivity or the renal plasma perfusion values. Changes in these variables were similar in two groups.

CONCLUSIONS

We conclude that 6 weeks of treatment with spironolactone does not change insulin sensitivity or endothelial function in normotensive obese individuals with no other comorbidities.

Vaccination with the RSV fusion protein formulated with a combination adjuvant induces long-lasting protective immunity

Respiratory syncytial virus (RSV) is one of the primary causative agents of upper and lower respiratory tract infections in young children, in particular infants. Recently, we reported the protective efficacy of a RSV vaccine formulation consisting of a truncated version of the fusion (F) protein formulated with a Toll-like receptor (TLR) agonist and an immunostimulatory peptide in a carrier system (ΔF/TriAdj). To evaluate the duration of immunity induced by this vaccine candidate, we carried out long-term trials. The ΔF was formulated with triple adjuvant (TriAdj) containing either polyinosinic : polycytidylic acid (polyI : C) or cytosine-phosphate-guanosine oligodeoxynucleotides (CpG ODNs) and administered intranasally to mice. One year after the second vaccination all mice were challenged with RSV. Both ΔF/TriAdj formulations mediated the induction of high levels of IgG1, IgG2a and virus-neutralizing antibodies, and IgA in the lungs. Based on the numbers of IFN-γ- and IL-5-secreting cells in the spleen, the immune response was slightly T-helper cell type 1 (Th1)-biased. This was confirmed by the presence of F85-93-specific CD8(+) effector T cells in the lungs of both ΔF/TriAdj(polyI : C)- and ΔF/TriAdj(CpG)-immunized mice. Both ΔF/TriAdj formulations induced RSV-specific CD8(+) T cells. However, ΔF/TriAdj(polyI : C) generated significantly higher IgG affinity maturation and higher numbers of RSV-specific CD8(+) effector memory T cells in lungs and CD8(+) central memory T cells in spleen and lymph nodes than ΔF/TriAdj(CpG). After RSV challenge, no virus replication and no evidence of vaccine-induced pathology were detected in mice immunized with either of the ΔF/TriAdj formulations, demonstrating that the duration of immunity induced with these vaccines is at least one year.

Candidates for twin chiral bands in 102Rh

Excited states in 102Rh, populated in the fusion-evaporation reaction Zr94(11B,3n)102Rh at a beam energy of 36 MeV, were studied using the Indian National Gamma Array spectrometer at Inter University Accelerator Center, New Delhi. The angular correlations and the electromagnetic character of some of the gamma-ray transitions observed were investigated in detail. A new chiral candidate sister band was found. Lifetimes of exited states in both chiral candidate bands of 102Rh were measured for the first time in the A∼100 mass region by means of the Doppler-shift attenuation technique. The derived reduced transition probabilities are compared to the predictions of the two quasiparticles plus triaxial rotor model. Both experimental results and calculations do not support the presence of static chirality in 102Rh.

Coexistence of Extended Spectrum Beta-Lactamases, AmpC Beta-Lactamases and Metallo-Beta-Lactamases in Acinetobacter baumannii from burns patients: a report from a tertiary care centre of India

Multidrug-resistant Acinetobacter baumanii is a major pathogen encountered in pyogenic infections, especially from burns patients in hospital settings. Often there is also coexistence of multiple beta-lactamase enzymes responsible for beta-lactam resistance in a single isolate, which further complicates treatment options. We conducted a study on burn wound pus samples obtained from the burns unit of our hospital. Phenotypic tests were used to determine the Extended Spectrum Beta-Lactamase, AmpC Beta-Lactamase and Metallo-Beta-Lactamase producing status of the isolates. Almost half of the samples from the burn wounds yielded Acinetobacter baumanii as the predominant pathogen (54.05%). Coexistence of the three resistance mechanisms was seen in 25 of the 100 (25%) isolates of Acinetobacter baumanii. This study emphasizes the need for the detection of isolates that produce these enzymes to avoid therapeutic failures and nosocomial outbreaks.

Induction of mucosal immunity and protection by intranasal immunization with a respiratory syncytial virus subunit vaccine formulation

The majority of infections, including those caused by respiratory syncytial virus (RSV), occur at mucosal surfaces. As no RSV vaccine is available our goal is to produce an effective subunit vaccine with an adjuvant suitable for mucosal delivery and cross-presentation. A truncated secreted version of the RSV fusion (ΔF) protein formulated with polyI : C, an innate defence regulator peptide and polyphosphazene, induced local and systemic immunity, including affinity maturation of RSV F-specific IgG, IgA and virus-neutralizing antibodies, and F-specific CD8(+) T-cells in the lung, when delivered intranasally. Furthermore, this ΔF protein formulation promoted the production of CD8(+) central memory T-cells in the mediastinal lymph nodes and provided protection from RSV challenge. Formulation of ΔF protein with this adjuvant combination enhanced uptake by lung dendritic cells and trafficking to the draining lymph nodes. The ΔF protein formulation was confirmed to be highly efficacious and safe in cotton rats.

The role of magnetic resonance imaging and positron emission tomography-computed tomography combined in differentiating benign from malignant lesions contributing to vertebral compression fractures

Background:

Obtaining tissue confirmation of the underlying pathology is the gold standard for establishing the etiology of nontraumatic vertebral compression fractures. However, newer investigative modalities such as the magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) combined potentially offer the ability to distinguish between benign and malignant lesions, thereby circumventing the need for invasive tissue diagnostic/biopsy procedures.

Methods:

Twenty-four patients with nontraumatic, spontaneous vertebral compression fractures were prospectively studied. After clinical evaluation, all patients underwent MRI (with/without contrast) focusing on the spinal lesion, followed by whole-body PET-CT. This was followed by fine needle aspiration cytology (FNAC) of the lesion to confirm the diagnosis. The sensitivity and specificity of MRI and PET-CT studies were calculated for benign vs. malignant lesions.

Results:

The sensitivity/specificity of MRI for benign lesions were 78.57%/90%, while the sensitivity/specificity values of PET-CT for benign disease were 92.8%/90% respectively. Alternatively, the sensitivity/specificity of MRI for malignant lesions were 90%/78.57%, while the sensitivity/specificity of PET-CT for malignant disease were 90%/92.8%, respectively. Furthermore, the sensitivity for diagnosing malignant lesions utilizing both studies together was 100%, but the algorithm was not specific. Additionally, the specificity for MRI and PET-CT combined was 100% for benign lesions. PET-CT also helped in monitoring responses to empirical antitubercular treatment (ATT) therapy. Of interest, FNAC was inconclusive in four cases in which PET-CT findings helped further in either obtaining a tissue diagnosis from another location or institution of empirical therapy in suspected cases of tuberculosis.

Conclusions:

The specificity for MRI and PET-CT combined was 100% for benign lesions. Unfortunately, the specificity for MRI and PET-CT combined was not 100% for malignant vertebral lesions, though it was sensitive. The PET-CT scan was an extremely useful tool when FNAC from the affected site proved inconclusive. It gave additional information regarding the overall extent of disease, while identifying other locations amenable to FNAC. Furthermore, in countries where tuberculosis is endemic, the empirical response to ATT therapy could be monitored utilizing PET-CT.

A Variational Approach to Video Registration with Subspace Constraints

This paper addresses the problem of non-rigid video registration, or the computation of optical flow from a reference frame to each of the subsequent images in a sequence, when the camera views deformable objects. We exploit the high correlation between 2D trajectories of different points on the same non-rigid surface by assuming that the displacement of any point throughout the sequence can be expressed in a compact way as a linear combination of a low-rank motion basis. This subspace constraint effectively acts as a trajectory regularization term leading to temporally consistent optical flow. We formulate it as a robust soft constraint within a variational framework by penalizing flow fields that lie outside the low-rank manifold. The resulting energy functional can be decoupled into the optimization of the brightness constancy and spatial regularization terms, leading to an efficient optimization scheme. Additionally, we propose a novel optimization scheme for the case of vector valued images, based on the dualization of the data term. This allows us to extend our approach to deal with colour images which results in significant improvements on the registration results. Finally, we provide a new benchmark dataset, based on motion capture data of a flag waving in the wind, with dense ground truth optical flow for evaluation of multi-frame optical flow algorithms for non-rigid surfaces. Our experiments show that our proposed approach outperforms state of the art optical flow and dense non-rigid registration algorithms.

Enucleation of the solitary epithelial cyst of pancreatic head in an adult: a case report and review of the literature

Solitary true pancreatic cyst is a rare entity, and only a few cases are reported in the literature. We report a case of a 35-year-old woman who had a cyst in the head of the pancreas and gall stones and presented with complaints of pain in the epigastric region. The patient underwent open cholecystectomy with aspiration of the pancreatic cyst at some other private hospital. After 4 months, she presented to us with no relief in pain. Repeat contrast-enhanced computed tomography of the abdomen showed recurrence of the cyst. The patient underwent enucleation of the cyst at our hospital. During a 2-year follow-up after the enucleation, she remained asymptomatic.

Drug susceptibility pattern of Mycobacterium tuberculosis isolates from patients of category-II failure of pulmonary tuberculosis under directly observed treatment short-course from north India

The major contributing factors for the causation of treatment failure in cases of pulmonary tuberculosis under Category-II directly observed treatment short-course treatment (DOTS) are treatment after default, poor treatment compliance, and development of multi-drug resistant (MDR) tuberculosis. The objective of the present study is to find out the demographic profile and drug susceptibility pattern in Category-II failure patients of pulmonary tuberculosis under Revised National Tuberculosis Control Programme (RNTCP) of India. Two hundred and twenty four patients with Category-II treatment failure of pulmonary tuberculosis were enrolled from Department of Pulmonary Medicine, at Chatrapati Sahuji Maharaj Medical University, UP, Lucknow, India, from August 2003 to July 2008. Their complete bacteriological assessment in terms of sputum smear for acid-fast bacilli, culture for Mycobacterium tuberculosis and drug sensitivity pattern were done in the Department of Microbiology. Among 224 patients, 16 (7.1%) patients were lost to follow-up and the final analysis was done among 208 (92.8%) cases. The reasons for inclusion of these 224 cases in the Category II regimen were treatment failure in the previous regimen (n = 75, 33%), default in 57% (n = 129 cases), and relapse in 8.9% (n = 20 cases). Among 208 patients, culture was positive in 170 (81.7%) cases, negative in 17 (8.1%) cases and contaminated in 21 (10%) cases. The drug sensitivity pattern of culture positive cases of Category-II failure patients revealed that, 58.2% (n = 99) had MDR tuberculosis and 40.5% (n = 69) were resistant but were non-MDR tuberculosis and 1.1 % (n = 2) cases were sensitive to all first line antituberculosis drugs.

Anaesthetic management of a child posted for excision of lymphangioma of the tongue

Lymphangioma is a congenital malformation of the lymphatic system, often involving areas of the head and neck. Patients may require surgical excision. Anaesthetic concerns include bleeding, difficulty visualising the airway, extrinsic and intrinsic pressure on the airway causing distortion, and enlarged upper respiratory structures, including the lips, tongue and epiglottis, which make airway management challenging. We report lymphangioma of the tongue in a six-year-old patient. There is limited information on the optimal anaesthetic management for this age group. The challenges with airway management, including bleeding, laryngospasm and difficult intubation, are outlined. Awareness of potential airway involvement and possible complications is necessary in order to provide safe anaesthesia to patients with lymphangioma.

Perioperative concerns of recurrent urinary bladder phaeochromocytoma with skeletal metastasis

We report the perioperative management of a 61-year-old man diagnosed with recurrent urinary bladder phaeochromocytoma with vertebral and rib metastasis following partial cystectomy and nephrectomy. His blood pressure was controlled with antihypertensive agents. Epidural analgesia was avoided in view of vertebral metastasis; instead, analgesia was provided with fentanyl infusion. Intraoperative hypertensive episodes were managed with nitroglycerine, sodium nitroprusside and esmalol. However, after surgery, the patient required inotropic support and was moved to the intensive care unit. Analgesia was maintained with fentanyl infusion, and inotropic support was gradually weaned off. Nuclear ablative therapy was planned for bony metastasis. We recommend that recurrences of extra-adrenal phaeochromocytoma be investigated for bony metastasis and cautiously managed in the perioperative period so as to avoid neurological complications.

Optimal wrist angulation shortens time needed for radial artery catheterization: a prospective, randomized, and blinded study

INTRODUCTION

Optimal wrist position is essential for successful catheterization of the radial artery. We planned to study the success rate of radial artery catheterization at various degrees of wrist extension angulations.

METHODS

This prospective, randomized study was performed in 60 consenting patients aged between 18-65 years and undergoing variable surgeries where the anesthetic management required an arterial catheterization. All patients were randomized into three groups of 20 patients each, according to wrist angulation during radial artery catheterization : either 30 degrees (Group 30), 45 degrees (Group 45), or 60 degrees (Group 60). Three metallic angulated wrist boards with angles of 30 degrees, 45 degrees, and 60 degrees (angle measured with calipers) were prepared, on which patient's wrist was kept at the above-mentioned angles of extension. Radial artery catheterization success rate, catheterization time, and numbers of attempts were recorded.

RESULTS

The catheterization time was minimal in group 45 (30.50 +/- 16.82 sec) as compared to 36.00 +/- 14.19 sec and 43.50 +/- 13.80 sec in group 30 and 60, respectively. Radial artery was catheterized at first attempt in 60% of Group 45 and Group 60 patients, and in 50% of Group 30 patients. The arterial catheterization was successful in 14/20 patients in Group 30, 19/20 patients in group 45, and 16/20 patients in group 60.

CONCLUSION

We conclude that a wrist extension of 450 appears to be the optimal wrist joint extension for a successful radial artery cannula insertion.

Anaesthetic management of emergency caesarean section in a patient with seizures and likely raised intracranial pressure due to tuberculous meningitis

We report the anaesthetic management of a term pregnant woman with active tuberculous meningitis, who had experienced seizures, had signs of raised intracranial pressure and required emergency caesarean section. Peripartum anaesthetic management of a patient with tuberculous meningitis is a rare event.