Isolated lipid abnormalities in rural and urban normotensive and hypertensive north-west Indians

BACKGROUND

Lipid abnormalities are common in patients with hypertension. The prevalence of isolated lipid abnormalities is not known in normotensive and hypertensive population of north-west India.

METHODS

We studied the prevalence of isolated low high density lipoprotein cholesterol (IL-HDLC), isolated high low density lipoprotein cholesterol (IH-LDLC) and isolated high triglycerides (IH-TG) abnormalities among rural and urban normotensive and hypertensives of north-west India.

RESULTS

The prevalence of lipid abnormalities was 47.6% and 51.4% in rural normotensives and hypertensives and 43.8% and 46.8% in urban normotensives and hypertensives respectively. The prevalence of IL-HDLC varied from 3.8% to 23.7% among hypertensives and 19.4% to 30.4% among normotensives. The prevalence of IH-TG abnormalities was 11.8% to 18.8% among hypertensives and 7.0% to 15.4% among hypertensives. The prevalence of isolated high LDLC abnormalities was low (0.8-9.2%). There was no significant difference in these abnormalities in relation to age and sex except IH-LDLC in male hypertensives.

CONCLUSION

Isolated low HDLC and isolated high TG were the commonest isolated lipid abnormalities among rural and urban population of north-west India whereas isolated high LDLC was uncommon.

Cytomegalovirus co-infection in patients with HIV/AIDS in north India

BACKGROUND & OBJECTIVES

Cytomegalovirus (CMV) is a frequent opportunistic infection in immunocompromised individuals particularly those receiving organ transplants and harbouring HIV infection. The classical CMV syndrome may be seen in only a small percentage of patients and tissue diagnosis is cumbersome, costly and requires hospitalization. Hence there is an urgent need to establish accurate and early diagnosis for proper institution of therapy. An attempt was made to detect active CMV co-infection in patients with HIV/AIDS using three assays and the positivity rates in the 2 groups compared.

METHODS

In the present study, we used a highly sensitive polymerase chain reaction (PCR) for immediate early gene of CMV, pp65 antigenaemia assay and IgM ELISA assay to detect the presence of CMV co-infection in 37 patients with AIDS and 32 healthy HIV seropositives. Thirty healthy laboratory workers served as normal controls.

RESULTS

Of the 37 patients with AIDS, 12 (32.4%) showed a positive reaction by PCR and only 4 patients were positive by the antigenaemia assay. Of the 32 HIV seropositives, only one was positive by PCR (3%), and all were negative for antigen assay. None of the controls showed positivity by any of the tests. The difference in PCR positivity rates between HIV seropositives and patients with AIDS was significant (P < 01). IgM antibodies were positive in four (10.3%) AIDS patients and only one (3%) HIV seropositive, the difference was insignificant. The difference in antigen positivity between IIIV seropositives and AIDS patients was also insignificant.

INTERPRETATION & CONCLUSION

CMV appears to be an important co-infection in patients with AIDS in India and PCR is a powerful tool for detection of CMV in blood and is superior to the antigenaemia assay. PCR can be performed with a small volume of blood avoiding any invasive procedure, and can provide quick information for timely institution of therapy.

BDNF overexpression increases dendrite complexity in hippocampal dentate gyrus

There is increasing evidence that brain-derived neurotrophic factor (BDNF) modulates synaptic and morphological plasticity in the developing and mature nervous system. Plasticity may be modulated partially by BDNF's effects on dendritic structure. Utilizing transgenic mice where BDNF overexpression was controlled by the beta-actin promoter, we evaluated the effects of long-term overexpression of BDNF on the dendritic structure of granule cells in the hippocampal dentate gyrus. BDNF transgenic mice provided the opportunity to investigate the effects of modestly increased BDNF levels on dendrite structure in the complex in vivo environment. While the elevated BDNF levels were insufficient to change levels of TrkB receptor isoforms or downstream TrkB signaling, they did increase dendrite complexity of dentate granule cells. These cells showed an increased number of first order dendrites, of total dendritic length and of total number of branch points. These results suggest that dendrite structure of granule cells is tightly regulated and is sensitive to modest increases in levels of BDNF. This is the first study to evaluate the effects of BDNF overexpression on dendrite morphology in the intact hippocampus and extends previous in vitro observations that BDNF influences synaptic plasticity by increasing complexity of dendritic arbors.

Tattoo ink darkening of a yellow tattoo after Q-switched laser treatment

The popularity of tattoos is burgeoning with 20-30 million tattooed individuals in the Western World. Requests for removal can be expected to rise concurrently with increased applications. Laser removal of tattoos is potentially a more cosmetically acceptable method of removing tattoos than surgical excision or dermabrasion. Nevertheless, complications and side-effects can result from laser treatment and include scarring, hypopigmentation, hyperpigmentation, partial removal, infection, bleeding and tattoo ink darkening. The latter has been reported for flesh-toned and red tattoos. Such a complication has never been reported for the laser treatment of a yellow tattoo in the dermatological literature. We describe a case of tattoo ink darkening of a yellow tattoo after treatment with the 532 nm quality-switched Neodymium : Ytrrium-Aluminium Garnet laser to highlight clinicopathological features. The mechanism by which some tattoos darken after laser treatment is not clearly understood. We review darkening of tattoos after laser treatment to raise awareness of this important complication. This paper will help to facilitate discussions with the patient and in obtaining informed consent prior to commencing treatment. Tattoo ink darkening of a yellow tattoo adds to the growing list of complications resulting from attempts at tattoo removal.

Epidural abscess and Staphylococcus aureus endocarditis - a rare association

Epidural abscess is a relatively uncommon disorder. Although the surgical management is the mainstay of treatment, there are case reports of it being managed conservatively in selected patients. We report a patient who presented with quadreparesis due to epidural abscess and had infective endocarditis due to Staphylococcus aureus septicemia. Both epidural abscess and infective endocarditis were managed conservatively with intravenous antibiotics given for four weeks, with complete recovery of patient.

Structure, chromosomal location, and analysis of the canine Cu/Zn superoxide dismutase (SOD1) gene

Mutations in Cu/Zn superoxide dismutase (SOD1), a major cytosolic antioxidant enzyme in eukaryotic cells, have been reported in approximately 20% of familial amyotrophic lateral sclerosis (FALS) patients. Hereditary canine spinal muscular atrophy (HCSMA), a fatal inherited motor neuron disease in Brittany spaniels, shares many clinical and pathological features with human motor neuron disease, including FALS. The SOD1 coding region has been sequenced and cloned from several animal species, but not from the dog. We have mapped the chromosomal location, sequenced, and characterized the canine SOD1 gene. Extending this analysis, we have evaluated SOD1 as a candidate for HCSMA. The 462 bp SOD1 coding region in the dog encodes 153 amino acid residues and exhibits more than 83% and 79% sequence identity to other mammalian homologues at both the nucleotide and amino acid levels, respectively. The canine SOD1 gene maps to CFA31 close to syntenic group 13 on the radiation hybrid (RH) map in the vicinity of sodium myo/inositol transporter (SMIT) gene. The human orthologous SOD1 and SMIT genes have been localized on HSA 21q22.1 and HSA 21q21, respectively, confirming the conservation of synteny between dog syntenic group 13 and HSA 21. Direct sequencing of SOD1 cDNA from six dogs with HCSMA revealed no mutations. Northern analysis indicated no differences in steady-state levels of SOD1 mRNA.

Audit of a melanoma screening day in the U.K.: clinical results, participant satisfaction and perceived value

BACKGROUND

The incidence of cutaneous malignant melanoma (MM) has risen significantly over the last 50 years in caucasian populations. Mortality is related to the Breslow thickness of the lesion, and early detection followed by complete surgical excision is crucial to reducing this. Skin screening events have been advocated as a means of detecting greater numbers of MMs in the earlier and thinner stages.

OBJECTIVES

To assess the feasibility and effectiveness of this approach in the U.K.

METHODS

The Department of Dermatology, Singleton Hospital, Swansea, U.K. offered a 1-day melanoma screening event in summer 1998 at which 832 consecutive individuals were seen. A postal questionnaire 1 year after the event audited participant perceived value and satisfaction.

RESULTS

Three MMs were identified (yield 1 : 277), all < 0.75 mm in thickness. Despite high participant satisfaction and perceived value, the pick-up rate of malignancy was significantly lower than at rapid access pigmented lesion clinics.

CONCLUSIONS

In a country such as the U.K., with comprehensive health coverage and a low incidence of MM, triage for melanoma and referral to specialists by general practitioners may be more cost and time effective.

VEGF increases permeability of the endothelial cell monolayer by activation of PKB/akt, endothelial nitric-oxide synthase, and MAP kinase pathways

VEGF is a key regulator of vascular permeability. However, its signaling pathways are incompletely understood. We tested the hypothesis that VEGF regulates endothelial cell (EC) permeability by activating PKB/akt, NOS, and MAP kinase dependent pathways using human umbilical vein EC (HUVEC). Permeability was measured from FITC-dextran 70-kDa flux across the EC monolayer at baseline and after VEGF at 0.034, 0.068, 1, 10, and 100 nM. VEGF increased HUVEC permeability to FITC-dextran in a dose-dependent manner. VEGF (1 nM) increased permeability from 3.9 x 10(-6) +/- 0.7 x 10(-6) to 14.0 x 10(-6) +/- 1.7 x 10(-6) cm/s (mean +/- SEM; P < 0.001). Permeability changes were also assessed after treatment with 1, 10, and 100 nM wortmannin (PI 3-kinase inhibitor); 0.01, 0.1, and 1.0 nM LY294002 (PI 3-kinase inhibitor); 200 microM l-NMMA (NOS inhibitor); 2.7 microM AG126 (p42/44(MAPK) inhibitor); and 0.006, 0.06, and 0.6 microM SB203580 (p38(MAPK) inhibitor). All inhibitors blocked VEGF-induced permeability changes. Our data demonstrate that (1) VEGF increases permeability of EC monolayers in a dose-dependent fashion, and (2) VEGF-induced permeability is mediated through PI-3 kinase-PKB, NOS, and MAP-kinase signaling cascades. These observations suggest that microvascular hyperpermeability associated with inflammation and vascular disease is mediated by activation of these EC signaling pathways.

The first case of exophytic pilomatricoma in an Asian male

Pilomatricomas are benign cutaneous neoplasms that occur frequently in children and usually present as slow-growing, firm, dermal nodules. They are the second most common skin lesion excised from children. A rare exophytic variety has been described, but to our knowledge this has not previously been reported in Asian children. We present this case to highlight the clinical features and to affirm that race may not play a role in the etiology of pilomatricomas. We also illustrate how these lesions can be effectively treated by shave excision.

Celiac disease presenting as iron-deficiency anemia in northern India

BACKGROUND

Adult celiac disease is infrequent in India. Iron-deficiency anemia as its presenting manifestation is still rarer.

METHODS

We investigated patients with refractory iron-deficiency anemia attending the hematology clinic of a tertiary-care hospital for celiac disease. The diagnosis of celiac disease was based on histology, serology and response to treatment.

RESULTS

Of 19 patients with refractory iron-deficiency anemia seen from April 1998 to March 2000, 11 were diagnosed to have celiac disease. Four of these had abnormal D-xylose test and 3 had fat malabsorption. All 11 patients responded to gluten-free diet with improvement in hematological parameters.

CONCLUSION

Patients with refractory iron-deficiency anemia of unknown cause should be investigated for subclinical celiac disease.

Hyposplenism in alcoholic cirrhosis, facts or artifacts? A comparative analysis with non-alcoholic cirrhosis and extrahepatic portal venous obstruction

BACKGROUND AND AIMS

Hyposplenism has been described in patients with alcoholic cirrhosis (AC). However, no data are available regarding hyposplenism in patients with non-alcoholic cirrhosis (NAC) and other forms of portal hypertension such as extrahepatic portal venous obstruction (EHPVO). The aim is to study the splenic functions in patients with AC, NAC, and EHPVO.

METHODS

Splenic functions were assessed consecutively in 22 patients with AC, 21 with NAC, and 23 with EHPVO. The tests included pitted red blood cells (RBC; %) and Howell-Jolly bodies in the peripheral smear. Pitted RBCs > 2% with or without the presence of Howell-Jolly bodies were taken as indicators of hyposplenism. The splenic function in each group was compared with age-matched controls.

RESULTS

Hyposplenism was found in 10 (45.45%) patients with AC, six (28.57%) with NAC and one (4.34%) with EHPVO. The mean pitted RBCs were significantly increased in patients with AC (mean 4.93 +/- 1.36% vs control 1.22 +/- 0.17%, P < 0.05), but not so with NAC (2.01 +/- 0.69%) and EHPVO (mean 0.99 +/- 0.1% vs control 0.66 +/- 0.1%, P > 0.05). Howell-Jolly bodies were seen in only four patients. The mean pitted RBCs were significantly higher among patients who were actively consuming alcohol (9.14 +/- 3.35%) compared to those who abstained at least for more than 24 weeks (2.0 +/- 1.3%, P < 0.05).

CONCLUSION

Hyposplenism is more common in AC patients, particularly those who are actively consuming alcohol compared with those who abstain. Patients with NAC have a lower incidence of hyposplenism, while in EHPVO patients, it is uncommon.

Safety and efficacy of moxonidine in mild to moderate hypertension

AIMS

Moxonidine, a new imidazoline II receptor agonist was evaluated in patients with essential hypertension.

METHODOLOGY

After an informed consent, 16 patients with essential hypertension were recruited. After a wash out period, the patients received increasing doses of Moxonidine (maximum dose 0.6 mg) for four weeks to control the blood pressure.

RESULTS

The mean reduction in blood pressure (systolic/diastolic) was 17.6/14.5 mm Hg in supine position and 18.2/12.6 mm Hg in standing position. The significant side effect was observed only in one patient.

CONCLUSIONS

Moxonidine thus appears to be safe and effective antihypertensive drug in patients with essential hypertension.

Pheochromocytoma: a 10-year experience in a tertiary care North Indian hospital

BACKGROUND

The study was carried out to highlight the clinical and biochemical profile of patients with pheochromocytoma in a tertiary care center of North India.

METHODS AND RESULTS

Thirty consecutive cases of pheochromocytoma admitted over a period of 10 years to our Institute were analyzed. The chief clinical complaints of these 30 patients (17 males and 13 females, mean age 24+/-7 years) were palpitation (80%), headache (77%), sweating (60%), breathlessness (67%) and flushing (56%). The clinical triad of headache, flushing and sweating occurred in 26.7% of cases. On clinical examination, 97% of the patients were hypertensive and 16.6% presented with malignant hypertension. Laboratory measurements showed that the levels of 24-hour urinary vanillylmandelic acid were elevated in 80% of cases. Levels of plasma adrenaline and noradrenaline were raised in 78% and 79% of cases, respectively. Anatomical localization of the tumor on computerized tomographic scan showed the presence of an adrenal tumor in 80% and extra-adrenal tumor in 20%. Surgical removal of the tumor could be carried out in 28 cases following control of the blood pressure with antihypertensive drugs including alpha and beta adrenoreceptor blockers.

CONCLUSIONS

Pheochromocytoma should be suspected in all young hypertensive persons. The appropriate therapy for this tumor is surgical removal preceded by adequate blood pressure control including the use of alpha and beta adrenoreceptor antagonists.