Valproic acid and secondary hyperammonemia

An 11-year-old girl with complex seizures was started on valproic acid (VPA) in addition to clonazepam and ethosuximide. Shortly thereafter, she developed marked hyperammonemia that was worsened by a protein load. The hyperammonemia improved somewhat when protein was not given, and it resolved on discontinuation of the valproic acid. No associated changes in serum transaminases or bilirubin were observed. Isolated hyperammonemia may occur soon after VPA ingestion and appears to be a relatively infrequent, reversible side effect. The mechanism of hyperammonemia probably differs from other manifestations of hepatotoxicity, such as elevated transaminases or frank hepatic failure.

Corn husk derived magnetized activated carbon for the removal of phenol and para-nitrophenol from aqueous solution: Interaction mechanism, insights on adsorbent characteristics, and isothermal, kinetic and thermodynamic properties

In this study, waste corn husk was used for the synthesis of an effective adsorbent (cornhusk activated carbon, CHAC) and by treating at two different temperatures, 250 °C (CHAC-250) and 500 °C (CHAC-500) to check adsorption efficiency. The synthesized adsorbents were characterized with the help of scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy, Particle size analysis and x-ray diffraction (XRD), which revealed the different properties of the two adsorbents. The synthesized adsorbents were applied for the removal of phenol and p-nitrophenol (PNP) from aqueous solution. CHAC-500 was more efficient than the CHAC-250. The maximum adsorptions of phenol and PNP by CHAC-500 were ∼96% and ∼94%, respectively, while the maximum adsorptions of phenol and PNP by CHAC-250 were ∼81% and ∼84%, respectively. The adsorption processes were best fitted with the Langmuir adsorption isotherm and the pseudo-second-order kinetic model. The adsorption of phenol was an exothermic process, while that of PNP was an endothermic process, on both adsorbents.

Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome

Myalgic encephalomyelitis, also known as chronic fatigue syndrome or ME/CFS, is a multifactorial and debilitating disease that has an impact on over 4 million people in the United States alone. The pathogenesis of ME/CFS remains largely unknown; however, a genetic predisposition has been suggested. In the present study, we used a DNA single-nucleotide polymorphism (SNP) chip representing over 906,600 known SNPs to analyze DNA from ME/CFS subjects and healthy controls. To the best of our knowledge, this study represents the most comprehensive genome-wide association study (GWAS) of an ME/CFS cohort conducted to date. Here 442 SNPs were identified as candidates for association with ME/CFS (adjusted P-value<0.05). Whereas the majority of these SNPs are represented in non-coding regions of the genome, 12 SNPs were identified in the coding region of their respective gene. Among these, two candidate SNPs resulted in missense substitutions, one in a pattern recognition receptor and the other in an uncharacterized coiled-coil domain-containing protein. We also identified five SNPs that cluster in the non-coding regions of T-cell receptor loci. Further examination of these polymorphisms may help identify contributing factors to the pathophysiology of ME/CFS, as well as categorize potential targets for medical intervention strategies.

Persistence, latency and reactivation of Japanese encephalitis virus infection in mice

Persistent and latent Japanese encephalitis virus (JEV) infection was studied in pregnant and non-pregnant mice. Following intraperitoneal inoculation into pregnant mice JEV persisted for 16 weeks in contrast to 4 weeks in non-pregnant mice. This was followed by a higher frequency of latent infection in pregnant mice. The virus could be reactivated during pregnancy or by cyclophosphamide treatment, the latter being more effective.

A new antivenom to treat eastern coral snake (Micrurus fulvius fulvius) envenoming

An Fab based ovine antivenom has been prepared and compared both in vitro and in vivo with two commercial preparations. The product was found to be at least four times more effective on a weight basis. The increased potency, combined with the low incidence of side-effects associated with ovine Fab, should result in a safer, more effective antivenom.

Anterior temporal electrodes in complex partial seizures

Anterior temporal (AT) and sphenoidal (SP) electrodes as well as standard 10-20 electrodes were used to evaluate patients with recent onset complex partial seizures. A total of 58 epileptiform foci were found in 80 patients. AT electrodes significantly improved detection of foci in comparison with 10-20 electrodes. SP electrodes resulted in a small, non-significant increase in detection in comparison to AT electrodes. AT electrodes may be substituted for basal electrodes for the purpose of diagnosis in the majority of patients with recent onset complex partial seizures.

A comparison of ovine and equine antivenoms

Commercial antivenoms produced in horses were compared with monospecific antivenoms raised in sheep against Crotalus durissus terrificus, Crotalus atrox, Crotalus adamanteus, Micrurus fulvius fulvius, Naja naja, Naja kaouthia, Echis ocellatus, Vipera lebetina deserti, Vipera berus berus and Vipera ammodytes ammodytes venom. Antibodies raised by immunizing sheep with C. d. terrificus venom were more effective than their equine counterparts in preventing lethal toxicity in mice (ED50), in inhibiting the venom's pharmacological effects (haemolysis, platelet aggregation and coagulation), and in neutralizing phospholipase A2 activity. Comparison of one ovine and three equine F(ab)2 products raised against V. a. ammodytes venom showed that all were at least 95% pure; that all protected mice; and that all contained antibody populations directed against most components of V. a. ammodytes and V. b. berus venoms. The ovine antivenoms generally contained a higher concentration of specific antibodies than the equine products. Finally, the ovine antivenoms raised against E. ocellatus, V. lebetina deserti, V. b. berus, M. f. fulvius and N. naja venoms provided better in vivo protection to mice than the equine antivenoms, but the equine antivenoms to N. kaouthia and C. atrox were more protective than the ovine product.

An imaging checklist for pre-FESS CT: framing a surgically relevant report

The reference standard for preoperative imaging in functional endoscopic sinus surgery (FESS) is multiplanar high-resolution computed tomography (HRCT). Surgeons require a precise preoperative anatomical road map, and hence it is essential for radiologists to be familiar with the normal three-dimensional sinonasal anatomy and the normal variants encountered in this region. Sagittal imaging has recently emerged as an important tool to visualize additional details in this critical anatomical region. Radiologists also need to report these examinations with special focus on the surgeon's expectations. Constant communication between the radiologist and the surgeon helps to resolve specific issues and improve the overall quality of reports. This results in better preoperative patient counselling and in predicting postoperative improvement in clinical status. This review provides a basic structured format for reporting pre-FESS CT, which can be tailored to meet individual requirements. The CT reporting format follows the order in which the sinonasal structures are approached during surgery.

Need for a national epilepsy control program

This article briefly outlines the proposed national epilepsy control program. The content of the article is based on four meetings held by invitation of the Ministry of Health. Invitees by ministry – Drs. D. C. Jain, M. Gourie Devi, V. Saxena, S. Jain, P. Satish. Chandra, M. Gupta, K. Bala, V. Puri, K. S. Anand, S. Gulati, S. Johri, P. S. Chandra, M. Behari, K. Radhakrishnan, D. Bachani. Presentations were made by Dr. M. Tripathi.The program will involve all neurologists across the country in teaching and training at state levels and a central monitoring committee.

Clinico-myocological profile of tinea capitis in North India and response to griseofulvin

There is a paucity of literature on tinea capitis from North India. The response to griseofulvin has not been studied as well. We studied 153 consecutive patients of tinea capitis for clinical patterns, causative dermatophytic species, clinico-etiological correlation, and response to griseofulvin. Culture and sensitivity were done on all patients. All patients were treated with griseofulvin for 6-8 weeks; non-responders were further treated with fluconazole. Ninety percent of the patients were less than 15 years of age, 75% belonged to poor socioeconomic groups and 19% had a family history of tinea capitis. The seborrheic variant was the commonest clinical pattern seen in 47.8% of patients, followed by grey patch, black dot, kerion, and alopecia-areata-like tinea capitis in 35.9%, 8.5%, 6.5% and 1.3% of patients, respectively. Only 66% of patients had a positive culture. T. violaceum was the commonest dermatophytic species isolated in 38% patients. M. audouinii, T. schoenleinii, T. tonsurans, M. gypseum, T. verrucosum and T. mentagrophytes were isolated in 34%, 10%, 9%, 3%, 3% and 3% of patients, respectively. Of the isolates 94% were susceptible to griseofulvin, and 100% were susceptible to fluconazole. By using griseofulvin for 6-8 weeks 97.4% of the patients were cured; nonresponders required therapy with fluconazole for cure. To conclude, tinea capitis is still a disease of younger people of poor socioeconomic status. T. violaceum and M. audouinii are the most common responsible dermatophytes. The response to griseofulvin was excellent, and it should be used as a first line therapy.

The primary structure of the acidic lectin from winged bean (Psophocarpus tetragonolobus): insights in carbohydrate recognition, adenine binding and quaternary association

The amino acid sequence of the winged bean acidic lectin (WBA II) was determined by chemical means and by recombinant techniques. From the N- and C-terminal sequence, obtained chemically, primers were designed for PCR amplification of the genomic DNA. The PCR product was cloned and sequenced to get the complete primary structure of WBA II. Peptide fragments for sequencing were also obtained by tryptic cleavages of the native lectin. The WBA II sequence showed a high degree of homology with that of WBA I and Erythrina corallodendron lectin (ECorL), especially in the regions involved in subunit association, where there is a very high conservation of residues. This perhaps implies the importance of this particular region in subunit interactions in this lectin. In addition, many of the residues, involved in carbohydrate binding in legume lectins, appear to be conserved in WBA II. The distinct differences in anomeric specificity observed amongst WBA I, WBA II, ECorL and peanut agglutinin (PNA) may be explained by subtle differences in sequence/structure of their D-loops. WBA II binds adenine quite strongly; a putative adenine binding sequence has been identified.

Development of recombinant nonstructural 1 protein based indirect enzyme linked immunosorbent assay for sero-surveillance of Japanese encephalitis in swine

Japanese encephalitis virus (JEV) causes severe neurological disease in humans, especially among children. The disease is endemic in several South Asian countries including India. Swine play a major role as amplifier host for JEV and act as a source of infection to humans through mosquito bite. Early detection of either virus or antibodies in swine will aid to undertake control measures to prevent virus spread to humans. Swine seldom show symptoms of JEV infection and the viraemic phase lasts for a short period of 3 to 4 days indicating the potential of detection of antibodies, which remain for relatively longer period, as a suitable alternative. Cost effective and sensitive assays for the detection of JEV antibodies in swine are not available indigenously. Hence, we have developed a recombinant nonstructural protein 1 (rNS1) based enzyme linked immunosorbent assay for the detection of IgG antibodies against JEV in swine. The test is robust, highly sensitive (91%), specific (97%), reproducible and affordable. Field validation of the assay was done by screening 3628 swine Serum samples collected from different parts of India. The overall sero-positivity was found to be 32.22%. The developed ELISA can be readily incorporated into surveillance programs for detection of Japanese encephalitis virus activity in swine population thereby aiding in prediction of outbreaks in humans.

Neutralization of kinin-releasing enzymes of crotalid venoms by monospecific and polyspecific antivenoms

The amounts of kinin-releasing enzymes in the venoms of Crotalus atrox, Crotalus adamanteus, Crotalus scutulatus scutulatus and Agkistrodon piscivorus piscivorus were measured by determining the amounts of kinin released from a sheep kininogen substrate by means of a specific radioimmunoassay. Four monospecific and two commercial polyspecific antivenom IgG samples were tested for their ability to reduce the kinin-releasing activities of the four crotalid venoms measured in vitro. All of the antivenom IgG samples were able to neutralize venom kininogenase activity to varying extents. On of the commercial polyspecific antivenoms was of equal or higher potency than the corresponding monospecific antivenoms for three of the venoms tested, indicating a high degree of cross-neutralization. F(ab')2 and especially Fab fragments of that polyspecific antivenom IgG were also effective in reducing the kinin-releasing activities of the four crotalid venoms.

Japanese encephalitis virus latency following congenital infection in mice

Latent Japanese encephalitis virus (JEV) infection was shown in inapparently congenitally infected Swiss albino mice after their mothers had been given JEV intraperitoneally during pregnancy. Only one of 37 (2.7%) of the baby mice showed persistence of infectious virus at 5 weeks of age. Reactivation of JEV in Swiss albino mice was demonstrated by stimulation with allogeneic spleen cells from Parks strain mice at 21 weeks of age; reactivation was demonstrated in 41% of the inapparently infected mice. The spleen cells of congenitally infected mice had depressed [3H]thymidine uptake following stimulation with concanavalin A, and depressed ability to induce a graft-versus-host response.

Evaluation of the polymerase chain reaction analysis for diagnosis of falciparum malaria in Delhi, India

Plasmodium falciparum infections are frequently fatal if untreated and hence need to be diagnosed and treated early. Malaria diagnosis, with conventional Giemsa staining as a gold standard, has had several limitations. New rapid and accurate methods are needed for diagnosis. In this study, polymerase chain reaction (PCR) analysis specific for diagnosis of P. falciparum was evaluated. For the study, blood samples were collected from 310 patients suspected of having malaria. PCR analysis for P. falciparum from venous blood and at the same time Giemsa staining of thick and thin blood smears was done. A total of 160 (51.6 %) samples were positive for malarial parasite of which 63 (39.4 %) were positive for P. falciparum by Giemsa staining while 61 (38.1 %) were positive for P. falciparum by PCR analysis. Giemsa staining was time consuming, laborious and may give poor results in cases with low parasitaemia. The PCR analysis for P. falciparum was able to detect 3 cases of low parasitaemia missed initially on Giemsa staining, was 96.8 % sensitive, 100% specific but was very costly, needed a lot of practice and standardization and was time consuming. PCR analysis can be used to supplement the conventional Giemsa staining for reliable diagnosis of falciparum malaria especially in cases with low parasitaemia.

Intracranial metastases from adenocarcinoma of cervix: a case report

Carcinoma of cervix usually spreads contiguously to the adjacent organs, by lymphatics to the pelvic and para-aortic lymph nodes and by hematogenous route to distant organs. The common sites of distant metastasis are lung, supraclavicular lymph nodes, liver, and bones. The brain is a rare site of metastasis. We report here a rare case of a 72-year-old woman with carcinoma of cervix, FIGO stage IIA, who developed metastases to the brain.

Cloning and sequencing of biofilm-associated protein (bapA) gene and its occurrence in different serotypes of Salmonella

AIMS

Salmonella spp. has the capability to form biofilm on various surfaces. Biofilm-associated protein (bapA), a large surface protein has been shown to play a leading role in the development of biofilm in Salmonella. Objective of this study was to investigate the presence of bapA gene in different serotypes of Salmonella spp. and to characterize DNA fragment encoding bapA protein of Salmonella Enteritidis.

METHODS AND RESULTS

Sixty-seven Salmonella strains belonging to 34 serovars isolated from diverse sources in India were screened for the presence of bapA gene employing a primer designed for the purpose. All the strains yielded a positive amplification indicating that the bapA gene is well conserved in Salmonella spp. The amplified gene fragment of bapA was cloned in Escherichia coli (DH5 α) cells by using pGEM-T easy cloning vector. On partial sequence analysis, the product exhibited 667 base pairs, corresponding to 218 amino acids.

CONCLUSIONS

  BapA gene was found to be highly conserved in Salmonella. Partial sequence analysis of this gene from a strain of Salm. Enteritidis revealed close association with serotypes of poultry origin and also with some other animal/zoonotic serotypes.

SIGNIFICANCE AND IMPACT OF THE STUDY

BapA gene can be targeted for the genus-specific detection of this organism from different sources. Antigenic index of bapA protein indicates its protective and diagnostic potentials.

Infections and infestations of the gastrointestinal tract. Part 2: parasitic and other infections

The purpose of this article is to provide a comprehensive review of the imaging findings of various parasitic infestations and other miscellaneous infections affecting the gastrointestinal tract. Barium examinations play an important role in the diagnostic workup of parasitic intestinal infections. Knowledge of differential diagnosis, sites of involvement, and imaging features of different infections and infestations can help in accurate diagnosis and guide treatment.

Magnetic resonance imaging in carcinoma cervix--does it have a prognostic relevance

PURPOSE

To evaluate the prognostic relevance of tumor size as determined on Magnetic Resonance Imaging (MRI) in cervical cancer.

METHODS AND MATERIALS

A total of 70 consecutive patients were included in the study. 15 patients underwent surgery alone (Group A), 27 patients underwent surgery followed by adjuvant radiation (Group B), 14 patients underwent concomitant chemo radiation (Group C), and 14 patients underwent radical radiation alone (Group D). External radiation was delivered followed by intra cavitary brachytherapy. Serial MRI scans were performed in all patients before and after completion of treatment on a 1.0 Tesla MRI scanner. Patients were divided into three groups based upon MR volumes 100 cc. A correlation between MR volume, FIGO stage, disease free survival (DFS) and overall survival (OS) was done. Disease free and overall survivals were calculated using Kaplan Meier survival curves according to stage, MR volume and treatment protocol.

RESULTS

In group I (MR volume 100 cc), 57% patients had stage II, 14% had stage III and 29% patients had stage IV disease. The DFS and OS did not achieve a level of statistical significance when evaluated as per protocol [DFS at p = 0.0685 and OS p = 0.3242], however a statistical significance was seen when DFS and OS were evaluated according to MR volumes [DFS, p = 0.0015 and OS, p = 0.0001].

CONCLUSION

In cervical cancer, the volume of disease as assessed on MRI may be a better prognostic indicator than FIGO staging and needs further evaluation.

Photocatalytic Degradation of Orange G Dye by Using Bismuth Molybdate: Photocatalysis Optimization and Modeling via Definitive Screening Designs

In the current study, Bismuth molybdate was synthesized using simple co-precipitation procedure, and their characterization was carried out by various methods such as FT-IR, SEM, and P-XRD. Furthermore, the photocatalytic degradation of Orange G (ORG) dye using synthesized catalyst under visible light irradiation was studied. Response surface Method was used for the optimization of process variables and degradation kinetics evaluated by modeling of experimental data. Based on the experimental design outcomes, the first-order model was proven as a practical correlation between selected factors and response. Further ANOVA analysis has revealed that only two out of six factors have a significant effect on ORG degradation, however ORG concentration and irradiation time indicated the significant effects sequentially. Maximum ORG degradation of approximately 96% was achieved by keeping process parameters in range, such as 1 g L-1 loading of catalyst, 50 mg L-1 concentration of ORG, 1.4 mol L-1 concentration of H2O2 at pH 7 and a temperature of 30 °C. Kinetics of ORG degradation followed the pseudo first order, and almost complete degradation was achieved within 8 h. The effectiveness of the Bi2MoO6/H2O2 photo-Fenton system in degradation reactions is due to the higher number of photo-generated e- available on the catalyst surface as a result of their ability to inhibit recombination of e- and h+ pair.