Absence of mutations in the survival motor neuron cDNA from labrador retrievers with an inherited myopathy

The clinical phenotype of hereditary myopathy of labrador retrievers is consistent, but the pathological changes within muscle biopsy specimens can vary from type 1 fibre predominance (type 2 fibre deficiency) to dystrophic changes or overt neurogenic atrophy. The condition shares many clinical and pathological features with the mildest form of human childhood spinal muscular atrophy, and the survival motor neuron gene was therefore evaluated in dogs with the disease. Direct sequencing and comparisons of cdna from the gene in seven labrador retrievers homozygous for the disease and four control dogs revealed no nucleotide mutations leading to changes in the deduced amino acid sequences. A single polymorphism was detected in two of the seven affected dogs, which was characterised by a nucleotide substitution at amino acid position 1155 within the non-coding 3' untranslated region of exon 8. Northern blot analysis indicated that there were no differences in the steady state levels of mrna from the gene of the affected labrador retrievers and control dogs.

Two squamous cell carcinomas arising in a linear epidermal naevus in a 28-year-old female

The development of a squamous cell carcinoma (SCC) in a linear epidermal naevus is a rare event previously reported in long-standing and often extensive lesions of middle-aged to elderly patients. To the best of our knowledge, this case appears to be only the second report of an SCC arising in a linear epidermal naevus in a young patient and the first report of two SCCs developing in a small epidermal naevus, over a short time, in a young patient with no other risk factors.

Nucleotide -88 (C-T) promoter mutation is a common beta-thalassemia mutation in the Jat Sikhs of Punjab, India

A study of beta-gene mutations in Jat Sikhs, a subcaste of Punjabis, revealed a very high prevalence (46%: 41/88) of the mild beta++ promoter region mutation -88 (C-T). Sixteen individuals presenting in homozygous form were clinically mild. Un-transfused patients had characteristic hematological findings: high Hb F (38.1-68.6%, mean 47.4%), high Hb A2 (5.7-9.8%, mean 6.88%), and the rest had adult hemoglobin. The 19 subjects with compound heterozygosity for -88 (C-T) and another beta-gene mutation presented both as thalassemia intermedia (four cases) and as thalassemia major (15 cases). One of the four patients with the milder phenotype had a second mild mutation, CAP+1 (beta++). In the other three cases with the milder phenotype, the second mutation was associated with the presence of the XmnI Ggamma polymorphism. Notably, the XmnI Ggamma was negative in all the -88 (C-T) alleles. None of the patients had associated alpha-thalassemia even in the thalassemia intermedia group. Haplotype analysis of the -88 (C-T) homozygous cases showed a single haplotype (+ - - - - + -) in all but two individuals. This haplotype is distinct from those described in the Africans with homozygous -88 (C-T), suggesting that the mutation in our population occurred independently.

Small cell carcinoma of the ovary presenting as bone marrow metastasis: a rare presenting feature

Small cell carcinoma (SCC) of ovary-hypercalcaemic type is a rare cancer of young pre-menopausal women of unclear histogenesis. Bone metastasis and bone marrow infiltration by ovarian carcinomas is a rare feature and only a few case reports are available in the literature. Herein we report a case of small cell carcinoma-hypercalcaemic type of both the ovaries with bone marrow infiltration and features of metastatic calcification in various organs.

Coinfection with epstein barr virus in north Indian patients with HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) has emerged as a serious health problem in India. Although tuberculosis appears to be the commonest opportunistic infection, studies pertaining to opportunistic viruses are scant In the present study co infection with EBV was evaluated in patients with AIDS using a highly sensitive polymerase chain reaction besides anti Zebra antibody assays for diagnosis of an active EBV infection in 37 patients of full-blown AIDS and 32 healthy seropositives. Thirty healthy laboratory workers were used as controls. Out of 37 patients with AIDS, 12 were positive for anti Zebra antibodies and 23 were positive for EBV by the PCR reaction. Out of the 32 seropositives, 3 were positive for anti Zebra antibodies and 4 were positive by PCR assay. The difference between seropositives and AIDS was significant (p < .05). None of the controls were positive for an active EBV infection. It is concluded that active EBV infection is an important co infection in patients with AIDS and may contribute significantly to morbidity and mortality in these patients.

Vapor-phase photo-oxidation of methanol over nano-size titanium dioxide clusters dispersed in MCM-41 host material part 2: catalytic properties and surface transient species

We report in this paper on the ultraviolet-assisted vapor-phase oxidation of methanol at room temperature, with the help of nano-size clusters of titanium dioxide dispersed in an MCM-41 silicate matrix. The surface species formed during the adsorption/oxidation of methanol and the transformation that they undergo as a result of ultraviolet irradiation were monitored using in-situ Fourier transform infrared and thermal desorption spectroscopy techniques. Parallel experiments conducted on TiO2/MCM, bulk titania, and pristine MCM-41 samples helped in identifying the individual role of titanium dioxide and host matrix in these processes. The photo-catalytic oxidation of methanol, at concentrations of 0.1 to 1.1 mol% in air, gave rise to formation of CO2 and H2O as products, for both the TiO2/MCM and bulk TiO2 samples. No such reaction occurred on titania-free MCM. Furthermore, the rate of reaction depended upon the TiO2 content of a sample and also on the concentration of methanol in reaction mixture. Thus, the rate of conversion increased progressively with the increase in TiO2 loading from 5 to 21 wt% in TiO2/MCM samples, particularly for the experiments with high concentration of methanol. For low methanol concentration (0.1 mol%) in air, the effect of titania content in MCM was very small. The specific activity (per g of titania) of a sample, on the other hand, showed an inverse relationship with the loading of titanium dioxide in a sample. Infrared and temperature-programmed desorption results revealed that the mode of CH3OH adsorption and the reactivity of the transient species formed during the oxidation process were independent of the size of dispersed titania particles. Thus, the particles of approximately 2-6 nm size, present in TiO2/MCM, exhibited a chemisorption behavior similar to that of the bulk titania. The results of the present study provide strong evidence that the hydroxyl groups, both on the host matrix and at the titania sites, participate independently in the formation of methoxyl groups and at the same time promote the heterogeneous photo-catalytic oxidation of methanol molecules via formation of transient formate groups. Our results also show that the effect of titania crystallite size in the photo-catalytic properties relate mainly to the larger surface area and hence to the enhanced number of chemisorption sites, rather than to the changes in electronic properties.

Extensive arterial and venous thrombosis in a patient with ulcerative colitis--a case report

BACKGROUND

Vascular thrombosis is a rare but well-recognized extraintestinal manifestation of ulcerative colitis. Thrombosis usually involves the peripheral veins and less commonly the cerebral veins and the arterial system.

CASE REPORT

A case of a 22-year-old woman is reported who presented with an exacerbation of ulcerative colitis and developed extensive arterial and venous thrombosis. Good clinical improvement was achieved after treatment with steroids, sulfasalazine, and anticoagulation with enoxaparin followed by long-term warfarin.

CONCLUSION

Early recognition of thrombotic complications is essential in initiating lifesaving therapy.

Snake envenomation in a north Indian hospital

OBJECTIVES

To study the clinical profile of snake envenomation in a tertiary referral north Indian hospital.

METHODS

Retrospective case note analysis of all cases of snakebite admitted to the medical emergency from January 1997 to December 2001.

RESULTS

Of a total of 142 cases of snakebite there were 86 elapid bites presenting with neuroparalytic symptoms and 52 viper bites having haemostatic abnormalities. Some 60.6% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.7 and male to female ratio was 4.25:1. Median time to arrival at our hospital after the bite was nine hours and mean duration of hospital stay was eight days. Twenty seven cases had acute renal failure and 75% of all elapid bites required assisted ventilation. Seventeen of 119 patients who received antivenom had an adverse event. The average dose of antivenom was 51.2 vials for elapid bites and 31 vials for viper bites. Overall mortality rate was 3.5%.

CONCLUSION

Snakebites are common in the rural population of developing countries. There is a need to educate the public about the hazards of snakebite, early hospital referral, and treatment.

Cryptococcal meningitis in acute lymphoblastic leukemia

The occurrence of cryptococcal meningitis in acute lymphoblastic leukemia (ALL), despite being immunosuppresed state is uncommon. We report a 28-year gentleman in the maintenance treatment phase of ALL developing cryptococcal meningitis. The diagnosis was made by positive India ink staining and detection of cryptola antigen by latex agglutination. The patient was successfully treated with amphotericin B. The rarity of this condition in ALL is briefly discussed.

Post-operative delayed bleeding from the superficial temporal artery

We present three patients who experienced late, severe bleeding from the superficial temporal artery (STA) following uncomplicated removal of basal cell carcinoma (BCC) from the temple. This is a common site for BCC and the risk of damage to the temporal branch of the facial nerve and the STA are well known. However, delayed bleeding as described in these individuals is potentially dangerous but poorly reported.

Tropical pyomyositis (myositis tropicans): current perspective

Tropical pyomyositis, a disease often seen in tropical countries, is characterised by suppuration within skeletal muscles, manifesting as single or multiple abscesses. The most common organism implicated is Staphylococcus aureus. In 20%-50% of cases there is a history of trauma to the affected muscles. Commonly involved muscles are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal and spinal muscles. Early diagnosis is often missed because of lack of specific signs, unfamiliarity with the disease, atypical manifestations, and a wide range of differential diagnosis. Diagnostic techniques like ultrasound and computed tomography/magnetic resonance imaging are very useful in diagnosis. The diagnosis is confirmed either by biopsy or aspiration of pus from the affected muscles. The initial antibiotic of choice is cloxacillin. Incision and drainage are important components of management. Treatment for Gram negative or anaerobic organisms should be instituted, whenever indicated. Physicians should become more familiar with this potentially life threatening but curable infective disease entity.

Unconscious learning during surgery with propofol anaesthesia † †This article is accompanied by Editorial II

BACKGROUND

Learning during anaesthesia has been demonstrated, but little is known about the circumstances under which it may occur. This study investigated the hypothesis that learning during anaesthesia occurs during, but not before, surgical stimulation.

METHODS

Words were played through headphones to 64 day-surgery patients during propofol anaesthesia. Fourteen words were played repeatedly (15 times) for 1 min each either before (n=32) or during (n=32) surgical stimulation. The depth of anaesthesia was estimated using the bispectral index (BIS). Heart rate, ventilatory frequency, mean arterial pressure, end-tidal carbon dioxide concentration, and infusion rate of propofol were recorded at 1 min intervals during word presentation. On recovery, memory was assessed using an auditory word stem completion test and word recognition test.

RESULTS

The mean BIS, arterial pressure, end-tidal carbon dioxide and heart rate during word presentation did not differ between the groups. The infusion rate of propofol and the ventilatory frequency were significantly greater in the during-surgical stimulation group. There was no evidence for explicit recall or recognition, nor of awareness during anaesthesia (median mean-BIS=38 in the before-surgical stimulation group and 42 in the during-surgical stimulation group). Only patients who were played words during surgical stimulation showed significant implicit memory on recovery (mean score=0.08, P<0.02) However, their scores were not significantly higher than those of the before-surgical stimulation group (mean score=0.01).

CONCLUSIONS

Learning during anaesthesia seems more likely to occur during rather than before surgical stimulation at comparable anaesthetic depth. We hypothesize that surgical stimulation facilitates learning during anaesthesia, independently of its effects on anaesthetic depth.

Prevalence of anemia in adult rural population of north India

OBJECTIVES

To find the prevalence of anemia in adult males and non-pregnant females of rural north Indian population.

METHODS

During an epidemiological survey on hypertension in rural population of north India (n=2559), a random sample of 215 individuals underwent blood investigations including hemoglobin estimation.

RESULTS

The overall prevalence of anemia in 16-70 years of age group was 47.9% (n=215), being 50% (n= 136) among females and 44.3% (n=78) among males. Low socioeconomic status, illiteracy and lower body mass index, were associated with higher prevalence of anemia.

CONCLUSIONS

The finding of higher prevalence of anemia in adult males need further investigation and corroboration in other studies. The intervention for anemia should be directed on the community as a whole.

Agreement among Ayurvedic practitioners in the identification and treatment of three cases of inflammatory arthritis

OBJECTIVE

To conduct a preliminary investigation into the consistency of approach between three Ayurvedic medicine experts on treatments for inflammatory polyarthritis.

METHODS

A convenience sample of three experienced Ayurvedic practitioners was recruited. These practitioners independently assessed three subjects with inflammatory polyarthritis for health status, treatment history, and lifestyle, conducted a physical examination, and then independently determined the treatment plan. The treatment plan was recorded on standardized collection forms. The subject examination order was randomized for each practitioner. Following completion of the assessments, a facilitated discussion among the practitioners permitted each to discuss all aspects of the recommended therapies. Proceedings were audio-taped and the content analyzed.

RESULTS

All three practitioners agreed upon a unified concept of Ayurvedic disease origin, disease diagnosis, and treatment approach for each patient. Seven specific treatment groupings (i.e. modalities) emerged: diet, exercise, relaxation, analgesic, anti-inflammatory, immune-enhancing, and detoxification/cleansing. Based on the single visit, the practitioners agreed upon 17 of 21 treatment groups for the three patients.

CONCLUSION

Despite Ayurvedic medicine's individualized approach, considerable agreement existed among the practitioners studied. The identified Ayurvedic treatment approaches require investigation in a controlled clinical setting.