Relation between Acute Ischemic Stroke and Left Ventricular Systolic Dysfunction

Stroke is one of the leading causes of mortality and morbidity all over the world. The economic cost for stroke disability and post stroke rehabilitation is a growing concern. Ischemic stroke comprises 80.0 - 85.0% of total stroke cases caused by thrombotic or embolic occlusion of cerebral arteries. The source of embolism may be a larger artery or cardiac. Overt heart failure is an independent predictor of long term unfavorable functional outcome in stroke patients. However, there is little research whether the acute ischemic stroke risk is associated with mild to moderate degree of Left Ventricular Systolic Dysfunction (LVSD). This study was aimed to investigate the relation between LVSD and acute ischemic stroke (AIS) and to evaluate the relation between left ventricular systolic dysfunction and severity of neurological deficits after acute ischemic stroke. This case-control study was carried out in the Department of Neurology and Department of Medicine, Mymensingh Medical College and Hospital, Bangladesh from January 2019 to December 2020. One hundred twenty (120) patients of first ever AIS and 120 age and sex matched apparently healthy controls were enrolled in the study. Severity of stroke was measured by National Institute of Health Stroke Scale (NIHSS). Left ventricular (LV) systolic function was assessed by transthoracic 2-dimensional echocardiography. Mean±SD age was 58.23±9.34 years and 55.92±9.72 years respectively in cases and controls. Male to female ratio was 1.86:1. Left ventricular systolic dysfunction of any degree was more frequent in stroke patients (23.3%) than in controls (5.8%; p<0.001). The mean±SD of LVEF were 59.21±9.68 and 63.54±6.84 among case and control groups respectively. Mild LV dysfunction was observed 16.7% in AIS patients and 5.8% in control group. Moderate LV dysfunction was found in 6.7% in AIS patients. Participants with mild LVSD had significantly higher odds of being in the cases compared to participants with no LVSD (OR: 3.48; 95% CI: 1.41-8.59). Similarly, participants with moderate LVSD were 9.74 times more likely to be in ischemic stroke group compared to participants with no LVSD (OR: 9.74; 95% CI:1.19-19.29). LVSD was associated with AIS even after adjusting for other stroke risk factors (OR: 2.7462; 95CI for OR: 1.0204, 7.3906; p=0.0435). The NIHSS was significantly negatively correlated with LVEF (r=-0.443; p<0.001). The study may conclude that Left ventricular systolic dysfunction of mild to moderate degree, is associated with acute ischemic stroke. AIS patients with higher neurological deficit also had lower LVEF.

Comparing the profile of respiratory fungal pathogens amongst immunocompetent and immunocompromised hosts, their susceptibility pattern and correlation of various opportunistic respiratory fungal infections and their progression in relation to the CD4+T-cell counts

Introduction

Invasive fungal infections are increasingly common in the nosocomial setting.

Materials and Methods

The patients were divided into two groups immunocompetent and immunocompromised that is, patients with significant neutropenia <500 neutrophils/μl for longer than 10 days. microscopy, culture, identification of isolates were done and some specilised tests on serum and BAL for antigen detection were performed.

Results

Majority of the patients were young adult males in this study. A higher prevalence of 26.7% was seen in immunocompromised patients. Amongst yeasts, Candida albicans was the predominant species followed by the National AIDS Control that is, Candida glabrata, Candida dubliniensis, Candida parapsilosis and Candida tropicalis in the same order. Amongst moulds, Aspergillus fumigatus was the most common species followed by Aspergillus flavus and Aspergillus niger. Mucor and Penicillium marneffei were seen in a lower prevalence. By Broth microdilution method, isolates of Candida spp. were most sensitive to caspofungin, amphotericin B, ketoconazole and fluconazole in the same order. Isolates of Aspergillus spp. were most sensitive to caspofungin, amphotericin B and itraconazole in the same order. By disc diffusion method, resistance to fluconazole was observed in 6.9% isolates of C. albicans. 50% of C. dubliniensis and 20% of C. glabrata showed resistance to fluconazole. A total mortality of 27.7% was observed during this study. This was distributed as 24.1%, 26.7%, 50%, 50%, 100% and 0% among by patients of candidiasis, aspergillosis, cryptococcosis, pneumocystosis, mucormycosis and penicilliosis. Fifteen per cent were lost to follow-up.

Conclusion

Patterns of invasive fungal infections are changing in many ways. In the midst of these evolving trends, IFI of the respiratory tractcontinue to remain important causes of morbidity and mortality. Diagnostic tools can be adequately used only if the treating physician is aware of the propensity of patients to acquire a fungal infection. Thus, continuous awareness and education is crucial for successful management of patients. Judicious use of antifungal medications as prophylactic measures must be employed, particularly in the critically ill and patients of HIV.

Hox C6 expression during development and regeneration of forelimbs in larval Notophthalmus viridescens

A central theme concerning the epimorphic regenerative potential of urodele amphibian appendages is that limb regeneration in the adult parallels larval limb development. Results of previous research have led to the suggestion that homeobox containing genes are "re-expressed" during the epimorphic regeneration of forelimbs of adult Notophthalmus viridescens in patterns which retrace larval limb development. However, to date no literature exists concerning expression patterns of any homeobox containing genes during larval development of this species. The lack of such information has been a hindrance in exploring the similarities as well as differences which exist between limb regeneration in adults and limb development in larvae. Here we report the first such results of the localization of Hox C6 (formerly, NvHBox-1) in developing and regenerating forelimbs of N. viridescens larvae as demonstrated by whole-mount in situ hybridization. Inasmuch as the pattern of Hox C6 expression is similar in developing forelimb buds of larvae and epimorphically regenerating forelimb blastemata of both adults and larvae, our results support the paradigm that epimorphic regeneration in adult newts parallels larval forelimb development. However, in contrast with observations which document the presence of Hox C6 in both intact, as well as regenerating hindlimbs and tails of adult newts, our results reveal no such Hox C6 expression during larval development of hindlimbs or the tail. As such, our findings indicate that critical differences in larval hindlimb and tail development versus adult expression patterns of this gene in these two appendages may be due primarily to differences in gene regulation as opposed to gene function. Thus, the apparent ability of urodeles to regulate genes in such a highly co-ordinated fashion so as to replace lost, differentiated, appendicular structures in adult animals may assist, at least in part, in better elucidating the phenomenon of epimorphic regeneration.

A novel family of T-box genes in urodele amphibian limb development and regeneration: candidate genes involved in vertebrate forelimb/hindlimb patterning

In certain urodeles, a lost appendage, including hand and foot, can be completely replaced through epimorphic regeneration. The regeneration process involves cellular activities similar to those described for embryogenesis. Working on the assumption that the morphological pattern specific for a forelimb or a hindlimb is controlled by different gene activities in the two limbs, we employed a mRNA differential display screen for the detection of candidate limb identity genes. Using this approach, we have isolated a newt gene which in regenerating and developing limbs reveals properties expected of a gene having a role in controlling limb morphology: (1) it is exclusively expressed in the forelimbs, but not hindlimbs, (2) during embryonic development its expression is co-incident with forelimb bud formation, (3) it has an elevated message level throughout the undifferentiated limb bud and the blastema, respectively, and (4) it is expressed only in mesenchymal, but not in epidermal tissues. This novel newt gene shares a conserved DNA-binding domain, the T-box, with putative transcription factors including the Brachyury (T) gene product. In a following PCR-based screen, we used the evolutionarily conserved T-box motif and amplified a family of related genes in the newt; their different expression patterns in normal and regenerating forelimbs, hindlimbs and tail suggest, in general, an important role of T-domain proteins in vertebrate pattern formation.

Emotional and behavioural problems among school children in Pakistan

The prevalence of emotional and behavioural problems in school children using Rutters children behavioural questionnaire was 9.3% with antisocial disorders being the commonest one. These disorders are not only present in this culture but also differ in terms of psychopathology with different levels of schooling. The findings are discussed in terms of their relevance to mental health of children with comparison of results from other countries.

Chemical extraction of the cytosol using osmium tetroxide for high resolution scanning electron microscopy

Detailed examination of subcellular structures in three dimensions (3D) by high resolution scanning electron microscopy (HRSEM) is now possible due to improvements in the design of the scanning electron microscope and the introduction of methods of specimen preparation using chemical removal of the cytosol and cytoskeleton by dilute osmium tetroxide. Cells which have been fixed, frozen, cleaved, thawed, and subjected to cytosol extraction display intact intracellular structures in 3D including nuclear chromatin, endoplasmic reticulum, mitochondria, and the Golgi complex at a resolution close to that of conventional biological transmission electron microscopy (TEM). Small changes in the 3D structure of subcellular components can be conveniently examined in this way in development, in a variety of physiological processes and in disease. Broad areas of the specimen can be quickly surveyed by HRSEM since sectioning is not required and specimens of comparatively large size (up to 5 mm3) can be placed in the microscope. Extraction of the cytosol with dilute osmium tetroxide (OsO4) exposes subcellular structures in relief, permitting their examination in 3D from several aspects. However, the OsO4 extraction technique is limited, since significant intracellular structures, such as the cytoskeleton, vesicles, and antibody binding sites can be removed or inactivated during the cytosol removal steps.

Age-related changes in catalase and peroxidase activities in the excised leaves of Eleusine coracana Gaertin. cv PR 202 during senescence

Changes in the activities of the enzymes catalase and peroxidase were studied in the excised leaves of ragi (Eleusine coracana Gaertn. cv PR 202) plants belonging to different ages. Catalase exhibited a positive and peroxidase a negative correlation with the changes in chlorophyll. Catalase and peroxidase were negatively correlated with each other. Peroxidase exhibited an age-related drift in its activity. Kinetin could maintain the levels of chlorophyll and catalase, and also caused an increase in peroxidase activity. Both indoleacetic acid and gibberellic acid had no effect on the changes of chlorophyll but increased peroxidase activity. Catalase levels were maintained by indoleacetic acid but gibberellic acid had no effect on this enzyme.