Ipsilateral Stroke with Uncrossed Pyramidal Tracts and Underlying Right Internal Carotid Artery Stenosis Treated with Percutaneous Transluminal Angioplasty and Stenting

We present a unique case of ipsilateral stroke in a 55-year-old right-handed hypertensive man with proven uncrossed pyramidal tract demonstrated by tractography. Diffusion-weighted imaging disclosed small acute ischemic infarcts in the right corona radiata with MR angiography showing narrowing of the right internal carotid artery. Significant carotid stenosis of right internal carotid artery (ICA) was detected on digital subtraction angiography as the underlying cause and subsequently treated with percutananeous transluminal angioplasty and stenting with good outcome. The presence of uncrossed pyramidal tract was confirmed by diffusion tensor imaging tractography. To our knowledge there are few reports of ipsilateral stroke with proven uncrossed pyramidal tracts described in the literature. This is the first documented report of ipsilateral stroke with uncrossed fibre tracts due to underlying critical stenosis of the ICA treated successfully with a good recovery.

BRCA1 protein expression and its correlation with ER/PR status in sporadic and familial breast cancer in Eastern Indian patients--a hospital based study

BRCA1 gene expression in familial breast cancer is mainly focused on mutational analysis. However in sporadic cancers BRCA1 protein expression is the main area of interest because somatic inactivation of one allele of the gene is likely to occur during the oestrogen mediated proliferation at puberty and subsequent tumourigenic events take place in the same cell. Standard immunohistochemical analysis was used to assess BRCA1 and oestrogen/progesterone receptor (ER/PR) status in familial and sporadic breast cancer patients and correlation of BRCA1 protein expression with histopathological features ER/PR status was studied in these tumours. One hundred and seventy-seven sporadic tumours (group A) and 28 familial tumours (patients with history of breast cancer in first or second degree relative ie, group B) were studied. In group A, 61 tumours had absent/reduced BRCA 1 protein expression; 30 (49%) out of these were negative for ER/PR receptors. In group B, 18 patients had absent/reduced BRCA1 protein expression, and 10 (55.6%) out of these, were ER/PR negative. Overall in 2 groups, 82 tumours were of grade 1, 61 tumours of grade 2 and 62 tumours were of grade 3 differentiation. Test of proportion showed that percentage of ER/PR negativity is significantly higher than ER/PR positivity in sporadic as well as in familial tumours with absent/ reduced BRCA 1 protein expression (p < 0.05). Sporadic tumours with deranged BRCA1 protein expression like familial tumours have more unfavourable histopathological characteristics and are likely to be of higher grade and oestrogen receptor negative

Piperine protects epilepsy associated depression: a study on role of monoamines

BACKGROUND AND OBJECTIVES

In patients with epilepsy, a common comorbidity diagnosed is depression. Temporal lobe epilepsy or post status epilepticus (SE) animal model establish and validate the co morbidity and common pathogenesis of depression and epilepsy. Elevation in serotonin concentration gives an inhibitory response to epileptic discharge and stabilizes the depressed mood disorder. Piperine is a potent monoaminooxidase inhibitor and stimulates the synthesis of serotonin. So the present work is undertaken to investigate the effect of piperine on depression associated with by status epilepticus induced by pilocarpine in rats.

MATERIALS AND METHODS

Status epilepticus was induced in the rats by administration of pilocarpine 350 mg/kg i.p.. Behaviour tests like forced swimming test (FST), saccharin consumption test, actophotometer test and rotarod test were conducted. Antidepressant effect and neuroprotective effect of piperine (25 mg/kg, p.o. for 10 days) in post status epilepticus animal model was evaluated. Brain serotonin concentration was also estimated. Fluoxetine (20 mg/kg p.o.) was used as standard.

RESULTS

Only piperine but not fluoxetine significantly increased the decrease in number of rotations of wheel in FST, and decrease volume of saccharine consumption caused by pilocarpine. Both fluoxetine and piperine significantly increase the pilocarpine induced decrease in activity score in actophotometer, time taken to fall in rotarod and concentration of serotonin in brain.

DISCUSSION

The underlying mechanism behind depression in epilepsy may be alteration in monoaminergic pathways and GABAergic pathways. The antidepressant activity of piperine in post-SE rats may be attributed to its MAO inhibitor activity and neuroprotective activity.

Functional characterization and signal transduction ability of nucleotide-binding site-leucine-rich repeat resistance genes in plants

Pathogen infection in plants is often limited by a multifaceted defense response triggered by resistance genes. The most prevalent class of resistance proteins includes those that contain a nucleotide-binding site-leucine-rich repeat (NBS-LRR) domain. Over the past 15 years, more than 50 novel NBS-LRR class resistance genes have been isolated and characterized; they play a significant role in activating conserved defense-signaling networks. Recent molecular research on NBS-LRR resistance proteins and their signaling networks has the potential to broaden the use of resistance genes for disease control. Various transgenic approaches have been tested to broaden the disease resistance spectrum using NBS-LRR genes. This review highlights the recent progress in understanding the structure, function, signal transduction ability of NBS-LRR resistance genes in different host-pathogen systems and suggests new strategies for engineering pathogen resistance in crop plants.

Classification of Non-Aneurysmal Subarachnoid Haemorrhage: CT Correlation to the Clinical Outcome

To propose a new computed tomography (CT)-based classification system for nonaneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with nonaneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1 e 4) was devised based on the topography of the initial haemorrhage pattern. Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of 1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of 1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1 (1a and 1b) and type 2 (p 1/4 0.003); type 2 and type 3 (p 1/4 0.002); type 3 and type 4 (p 1/4 0.001). Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause.

Manganese biomining: A review

Biomining comprises of processing and extraction of metal from their ores and concentrates using microbial techniques. Currently this is used by the mining industry to extract copper, uranium and gold from low grade ores but not for low grade manganese ore in industrial scale. The study of microbial genomes, metabolites and regulatory pathways provide novel insights to the metabolism of bioleaching microorganisms and their synergistic action during bioleaching operations. This will promote understanding of the universal regulatory responses that the biomining microbial community uses to adapt to their changing environment leading to high metal recovery. Possibility exists of findings ways to imitate the entire process during industrial manganese biomining endeavor. This paper reviews the current status of manganese biomining research operations around the world, identifies factors that drive the selection of biomining as a processing technology, describes challenges in exploiting these innovations, and concludes with a discussion of Mn biomining's future.

A set of five microsatellite markers linked to F8 gene can detect haemophilia A carriers across India

  Haemophilia A (HA) is an X-linked recessive bleeding disorder, primarily because of defects in the 186-kb long factor VIII gene (F8) affecting 1-2 men per 10,000 worldwide. Available markers for carrier detection are not effective in all populations, especially in India. In this study, we have chosen a set of five microsatellite markers, namely, DSX9897, DSX1073, intron 1 (GT)(n) , intron 22 (CA)(n) and intron 25 (CA)(n) , in and around the F8 gene to achieve better sensitivity for carrier detection. Each marker locus has been PCR amplified in the individual DNA samples using fluorescent markers followed by genotyping experiment in automated sequencer. Genotype calls have been made by GeneMapper Software (version 4). Allele frequency of each microsatellite marker was calculated manually. Heterozygosity was determined by counting the heterozygotes in the female subset. We have shown that in 253 normal individuals from 20 different ethnic groups of India, the heterozygosity for the markers ranged from 0.25 to 0.54; and for the entire subset of 102 female samples we could successfully discriminate between the two X-chromosomes using these five markers. These markers could also discriminate between the two X-chromosomes for each of 39 obligate carriers included in this study. In conclusion, this panel of five markers around the F8 locus can be used for carrier detection of HA with higher sensitivity across India for families affected with the disease.

Intervention in Stroke. The Future Ahead

The treatment for acute stroke is evolving and we present the initial results of 18 patients presenting to our institution over a period of eight months with acute stoke where CTA confirmed the presence of a thrombus. These patients were resistant to IV rtPA and underwent partial to complete clot retrieval with IA thrombolysis or in conjunction with mechanical thrombectomy. 13 of the 18 patients underwent mechanical thrombectomy and Solitaire AB device was used in 12 of these patients. Efficacy was assessed radiologically by post-treatment thrombolysis in myocardial infarction (TIMI) scores and clinically by a 30-day Modified Rankin Scale (MRS) score A TIMI score of 3 was achieved in 91% of patients undergoing mechanical thrombectomy with Solitaire AB device. 61% of our patient group had a discharge MRS of ≤ 2.

Treatment of acute middle cerebral artery occlusion with a Solitaire AB stent: preliminary experience

We report our initial experience with a Solitaire AB neurovascular remodeling stent device in performing cerebral embolectomy in seven patients presenting to our institution with acute stroke who were resistant to iv thrombolytic drug treatment. The main inclusion criteria were: National Institutes of Health Stroke Scale (NIHSS) score ≥10; treatment performed within 8 h from the onset of symptoms and no large hypodensity on CT; and occlusion of a major cerebral artery on the CT angiogram. An admission and a post-interventional NIHSS score were calculated for all patients by two different neurologists. Efficacy was assessed radiologically by post-treatment thrombolysis in myocardial infarction (TIMI) scores and clinically by a 30-day Modified Rankin Scale (MRS) score. The mean duration of neurointerventional treatment was 84 min. All interventions were successful, with TIMI scores of 2 or 3 achieved in 100% of patients. There was one procedural complication in our series owing to a self-detached stent and one patient had a small asymptomatic basal ganglia haemorrhage. There was improvement of more than 4 points on the NIHSS score in 5 (72%) of the patients following treatment, of whom 4 (57%) had a 30-day MRS score of ≤2. The use of a Solitaire stent in acute stroke was safe, time-efficient and encouraging; however, a larger sample size will be required to further evaluate the use of this device, which could benefit a significant number of stroke patients.

Neoadjuvant and adjuvant therapy with imatinib for locally advanced gastrointestinal stromal tumors in eastern Indian patients

BACKGROUND

Imatinib mesylate is able to at least modify the course of gastrointestinal stromal tumours (GISTs). Neoadjuvant use for locally advanced lesions is evolving as a new treatment paradigm in this hitherto universally fatal disease.

METHODS AND RESULTS

The study patients with locally advanced GIST received neoadjuvant and adjuvant imatinib mesylate. Response was noted as per the RECIST protocol and overall progression free survival was reported. Of 19 patients (mean age 38.5 years, range 26 yrs to 64 yrs) studied, 13 achieved partial response (PR) and 6 a stationary disease (SD) on preoperative imatinib. Histopathological evaluation and grading of responses revealed only moderate and low grade pathological response after imatinib. R0 resection was possible in 13/19 and R1 in 6/19. Imatinib was well tolerated and adverse reactions were minimal. Post operative complications of surgery were not out of the ordinary for a surgical series featuring extensive abdominal surgery.

CONCLUSION

Preoperative imatinib in locally advanced GIST seems to be a reasonable option for locally advanced GIST patients and enough downstaging to allow a resection with microscopically negative margins can be expected in a fairly good proportion of patients.

Learning and memory-enhancing effect of Bacopa monniera in neonatal rats

OBJECTIVE

The aim of this study was to evaluate the learning and memory-enhancing effect of Bacopa monniera in neonatal rats.

BACKGROUND

Learning is an acquisition and storage of information as a consequence of experience. Memory is a relatively permanent storage form of the learned information. In the process of 'learning', activation of neurons occurs in specific areas or specific memory systems of the brain concerned with the processing of the specific modality of sensory information. Rasayana plants are said to prevent ageing, re-establish youth, strengthen life, brain power and prevent diseases. Bacopa monniera (BM) is shown to be very useful in improving learning and memory.

METHODS

In the present study neonatal rat pups (10 days old) were given different doses of BM extract orally for different periods of time. These rats were then subjected to spatial learning (T- Maze) and passive avoidance tests along with the age matched normal and gum acacia control rats. The data were compared with those of control rats.

RESULTS

The results showed improvement in spatial learning performance and enhanced memory retention in neonatal rats treated with extract of BM.

CONCLUSION

We conclude that treatment with BM extract during growth spurt period of neonatal rats enhances learning and memory (Tab. 3, Fig. 3, Ref. 45). Full Text in free PDF www.bmj.sk.

Can the skin smear examination in NLEP be reconsidered?

Slit and skin smear examination is an important laboratory test which was made optional in the NLEP. In a laboratory managed by LEPRA Society, this test was provided to voluntary reporting cases and those referred by the general health service institutions of the area. Total cases tested were 1180, out of which 152 (12.9%) were positive. Of the 152 smear reports, 121 were from Koraput district and constitute the sample for this study. Regarding the spread of site wise highest BI, 56% cases had BI of 3.1+ to 6+. Of the 121 cases, 112 (92.6%) cases completed 12 doses of MDT. Seventy patients, from whom detailed information was collected by personal contact, responded well to MDT resulting in regression of lesions. Out of them, 46 cases had repeat smear showing negative smear in 39% and decline of 81 in the rest of cases. There are 16 contact cases with 2 family clusters. A rough block-wise mapping showed 4 strata with a dense clustering in the urban area where the laboratory facility is available. The probable reasons for uneven distribution of cases and causes for late diagnosis were discussed. The study reflects the leprosy problem in urban pockets which high infection pool. Together these two factors remain unexposed due to winding up of smear labs and pose a potential threat to elimination. The paper also emphasized on the reasons for past failure of the test along with suggestions to revive this facility with minor modifications.

Anomalous branching pattern of the aortic arch and its clinical applications

The aortic arch gives rise to three classical branches, namely the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. We report a rare variation of the left common carotid artery and the right vertebral arteries originating from the brachiocephalic trunk, and the left vertebral artery that was arising from the arch of the aorta, proximal to the origin of the left subclavian artery. Variations in the branching pattern of the arch of aorta can alter the cerebral haemodynamics that leads to cerebral abnormalities. Knowledge of the variations in the classical branches of the arch of aorta is important in the diagnosis of intracranial aneurysm after subarachnoid haemorrhage.

Isolation and characterization of NBS-LRR- resistance gene candidates in turmeric (Curcuma longa cv. surama)

Turmeric (Curcuma longa), an important asexually reproducing spice crop of the family Zingiberaceae is highly susceptible to bacterial and fungal pathogens. The identification of resistance gene analogs holds great promise for development of resistant turmeric cultivars. Degenerate primers designed based on known resistance genes (R-genes) were used in combinations to elucidate resistance gene analogs from Curcuma longa cultivar surama. The three primers resulted in amplicons with expected sizes of 450-600 bp. The nucleotide sequence of these amplicons was obtained through sequencing; their predicted amino acid sequences compared to each other and to the amino acid sequences of known R-genes revealed significant sequence similarity. The finding of conserved domains, viz., kinase-1a, kinase-2 and hydrophobic motif, provided evidence that the sequences belong to the NBS-LRR class gene family. The presence of tryptophan as the last residue of kinase-2 motif further qualified them to be in the non-TIR-NBS-LRR subfamily of resistance genes. A cluster analysis based on the neighbor-joining method was carried out using Curcuma NBS analogs together with several resistance gene analogs and known R-genes, which classified them into two distinct subclasses, corresponding to clades N3 and N4 of non-TIR-NBS sequences described in plants. The NBS analogs that we isolated can be used as guidelines to eventually isolate numerous R-genes in turmeric.

Identification of upregulated immune-related genes in Vibrio harveyi challenged Penaeus monodon postlarvae

A subtracted cDNA library was constructed and analyzed to elucidate the response of Penaeus monodon postlarvae challenged with Vibrio harveyi. As many as 960 randomly selected cDNA fragments generated through suppression subtractive hybridization were single pass sequenced. Forty five genes and 20 hypothetical proteins were identified, a few being first reports from shrimps. The most abundant immune relevant genes were ferritin, hemocyanin, and TCTP (translationally controlled tumor protein) indicating their upregulation as also confirmed through qPCR. Post-infection qPCR analyses confirmed 2.04, 2.09, 3.28, 5.49, 6.47, and 11.63 fold rise respectively in ferritin, penaeidin, MnSOD, lysozyme, TCTP, and hemocyanin genes. These genes may be involved in the regulation of the host defense against V. harveyi.

Rediscovering cyanobacteria as valuable sources of bioactive compounds

Cyanobacteria are a simple, but primitive and diverse group of microorganisms, with characteristics in common to both bacteria and algae. Their success as a group in a wide range of habitats has been attributed to their unique physiological characters and high adaptive ability under a wide range of environmental conditions. The potential of cyanobacteria as a source of a variety of compounds such as polysaccharides, lipids, proteins, vitamins, sterols, enzymes, pharmaceuticals and other fine chemicals is well recognized, and their demand is now on an increasing trend. This compilation reviews the salient advances in the discovery of bioactive compounds from cyanobacteria and their significance in agriculture and industry.

Results of Treatment of Squamous Cell Carcinoma of Maxillary Sinus: A 26-Year Experience

BACKGROUND

Five-year survival in squamous cell carcinoma of maxillary antrum is low. This article examines the results of various approaches to treatment as given in our hospital in past 26 years.

METHODS

From 1979 to 2005, 379 patients with squamous cell carcinoma of maxillary antrum managed with curative intent were studied. Twenty-eight patients had T2, 237 patients had T3, and 114 had T4 tumors. The N classification was N0 in 316 patients, N1 in 21 patients, N2a in 28 patients and N2b in 14 patients. Treatment to the primary site comprised of surgery (Sx) and radiation therapy (RT) in 284 patients, RT alone in 57 patients and chemotherapy (CTx) with radiotherapy in 38 patients.

RESULTS

There was a difference in survival between patients who underwent Sx with RT compared with patients who received RT alone or CTx with RT. The most common pattern of recurrence was in the primary site, 187 (49.3%) patients. Local control at 3 and 5 years was 71% and 63.8% respectively in Sx with RT, 31.6% and 28% respectively in RT, and 28.9% and 26% in CTx with RT group.

CONCLUSIONS

The type of treatment to the primary site is an important determinant of survival and local control. Surgery with radiation is a better treatment option.