Analysis of Evolution of Hydrocephalus in Posterior Fossa Tumors and Validation Study of the Modified Canadian Preoperative Prediction Rule for Hydrocephalus in Children and Frankfurt Grading System for Prediction of Cerebrospinal Fluid Diversion in Adults with Posterior Fossa Tumors

OBJECTIVE

We sought to analyze the evolution of hydrocephalus and enumerate its predictive factors in posterior fossa tumors in children and adults. We also validated the modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) and Frankfurt grading systems as tools to predict cerebrospinal fluid (CSF) diversion in children and adults, respectively.

METHODS

A retrospective review of patients with posterior fossa tumors operated between 2012 and 2019 was performed. Clinical, radiologic, and operative data were obtained. Validation was performed for both scores via receiver operating characteristic (ROC) curves and evaluation of the area under the curve (AUC).

RESULTS

We included 116 children and 343 adults in the study. Of the adults, 141 patients had intraaxial tumors and 172 had extraaxial tumors. The insertion of external ventricular drain (EVD), its duration, papilledema was noted to have significant influence on the need for permanent CSF diversion (P < 0.05) in children. The ROC for mCPPRH score was 0.659 (0.501-0.816), Age- 0.496 (0.334-0.658) and Evans index- 0.788 (0.654-0.922). In adults- Intraaxial tumours Age, Frankfurt score, duration of EVD, Diagnosis, Extent of resection and periventricular capping significant predictors and ROC age AUC 0.300 (0.193-0.407), Evans index 0.939 (0.888-0.990), and Frankfurt score 0.908 (0.853-0.964) (P < 0.05), whereas in extraaxial tumors Frankfurt grading, sex, duration of EVD, presence of perilesional edema and extent of resection (P < 0.05) ROC age AUC 0.439 (0.344-0.534), Evans index 0.941 (0.906-0.977), and Frankfurt score 0.847 (0.782-0.912).

CONCLUSIONS

This is the first external validation study for the 2 predictive systems in use. mCPPRH demonstrated poor predictive accuracy, and Frankfurt grading system demonstrated good accuracy. EVD insertion and its duration was significantly predictive of the need for permanent CSF diversion.

Numerical investigation of unruptured middle cerebral artery bifurcation aneurysms: influence of aspect ratio

An aneurysm is a disease condition, which is due to the pathological weakening of an arterial wall. These aneurysms are often found in various branch points and bifurcations of an artery in the cerebral circulation. Most aneurysms come to medical attention, either due to brain hemorrhages caused by rupture or found unruptured. To consider surgically invasive treatment modalities, clinicians need scientific methods such as, hemodynamic analysis to assess rupture risk. The arterial wall loses its structural integrity when wall shear stress (WSS) and other hemodynamic parameters exceed a certain threshold. In the present study, numerical simulations are carried out for unruptured middle cerebral artery (MCA) aneurysms. Three distinct representative sizes are chosen from a larger patient pool of 26 MCA aneurysms. Logically, these aneurysms represent three growth stages of any patient with similar anatomical structure. Simulations are performed to compare the three growth phases (with different aspect ratios) of an aneurysm and correlate their hemodynamic parameters. Simulations with patient specific boundary conditions reveal that, aneurysms with a higher aspect ratio (AR) correspond to an attendant decrease in both time-averaged wall shear stress (TAWSS) and spatial wall shear stress gradients (WSSG). Smaller MCAs were observed to have higher positive wall shear stress divergence (WSSD), exemplifying the tensile nature of arterial wall stretching. Present study identifies positive wall shear stress divergence (PWSSD) to be a potential biomarker for evaluating the growth of an aneurysm.

Stationary wavelet transformation based video stabilization and stitching

 Video stitching has become popular due to recent advancements in technology to provide broad views and high-resolution displays. Comprehensive view or panoramic videos and high-resolution displays are created by stitching videos captured by multiple cameras or by a single camera at different points of time. This paper proposes a video stitching technique with stabilization for moving multi-camera videos adopting the wavelet decomposition technique. This method uses only those feature points that reduce the mismatching and increase the precision in estimating the transformation from among the feature points identified by the Speed-Up Robust Features detector. This work differs from the similar work of others in two directions. Instead of using all selected feature points for the matching purpose, only significant among them are used. Unlike others, the frames are stabilized before they are stitched.

Multiple and One – Pot Synthetic Strategies for Pyrimido-Thiazine and their Derivatives

Abstract:

In the present era the use of fused heterocyclic compounds has been showing a considerable value in the development and designing of new drugs. Article flow through the synthetic strategies highlight on the application of metal-free, visible light mediated catalysis for the fusion of six-membered heterocyclic scaffolds containing nitrogen and sulfur heteroatoms. The power stratagem for the synthesis of diverse fused heterocyclic compounds is the sequencing of multicomponent reactions and subsequent cyclization reactions. The heterocyclic compounds containing Nitrogen and Sulphur atoms exhibit unique properties and are used as potential reactive materials in pharmacokinetic systems. These compounds can also be synthesized considering the high yield, low waste and green synthesis. The main aim of this review is to give an outlook about the synthetic feasibility of fused heterocyclic system and to development an innovative heterocyclic synthetic scheme that allow for different bond forming strategies which are having a significant impact in the pharmaceutical industry, especially the pyrimido-thiazine derivatives in the future synthetic heterocyclic chemistry. The future of Heterocyclic chemistry is development of robust synthetic routes which can generate bulk quantity of desired products and accelerate the drug development process.

School-Based Interventions for Promoting Sexual and Reproductive Health of Adolescents in India: A Review

In India, the prevalent stigma and taboos regarding sexuality prevent adolescents from acquiring information about sexual and reproductive health. This review assessed the school-based interventions for adolescents designed to enhance their sexual health knowledge, attitudes, and behaviors. Studies were gathered from 4 online databases: PubMed, DOAJ, Google Scholar, and ScienceDirect. Relevant studies conducted in India among adolescents, published in peer-reviewed journals between 2000 and 2020, available in the public domain and written in English, were considered for the review. 14 studies were selected through database searches that fulfilled the eligibility criteria. Findings highlighted that school-based sexuality education positively influences adolescents to develop their knowledge, attitude, and behavior related to sexual and reproductive health outcomes. Sexual and reproductive health (SRH) programs and interventions are limited to small-scale experiments conducted in a few schools. The researchers recommend educating adolescents about pregnancy prevention, sexually transmitted infections (STIs), sexual hygiene, and reproductive health. Comprehensive reproductive health education programs should be implemented in every school setting to ensure that all school-going adolescents are convinced of the importance of sexual and reproductive health.

Giant Cavernomas: Gigantic Propositions for a Lilliputian Problem?

Aim

The aim of this case series is to report two cases of giant cavernomas treated at a tertiary level centre along with a literature review on the differences between giant cavernomas and normal sized cavernomas.

Method

The first case was that of a 13-year-old male with habitual seizures since one year of age with normal examination findings. His imaging revealed a large parieto-occipital lesion which was excised microsurgically after a parieto-occipital craniotomy and a transcortical approach. The second case was a 26-year-old male who presented with generalised seizures and bilateral visual loss. Imaging was suggestive of a large left lateral ventricular lesion. A left fronto-temporo-parietal craniotomy was done followed by transventricular microsurgical excision. Histopathology of both cases were reported to be cavernomas. The first patient had transient hemiparesis post-operatively which improved within 24 hours. Eventually, both patients had an uneventful follow-up.

Conclusion

Microsurgical excision remains the treatment of choice for giant cavernomas. In toto excision may be advocated depending upon the location of the cavernoma especially with respect to eloquence and venous anatomy.

Five-year mortality and readmission rates in patients with heart failure in India: Results from the Trivandrum heart failure registry

INTRODUCTION

Heart failure (HF) has emerged as an important and increasing disease burden in India. We present the 5-year outcomes of patients hospitalized for HF in India.

METHODS

The Trivandrum Heart Failure Registry (THFR) recruited consecutive patients admitted for acute HF among 16 hospitals in Trivandrum, Kerala in 2013. Guideline-directed medical therapy (GDMT) was defined as the combination of beta-blockers (BB), renin angiotensin system blockers (RAS), and mineralocorticoid receptor antagonists (MRA) in patients with HF with reduced ejection fraction (HFrEF, EF < 40%) at discharge. We used Cox proportional hazards models and Kaplan-Meier survival plots for analysis. The MAGGIC risk score variables were included as exposure variables.

RESULTS

Among 1205 patients [69% male, mean (SD) age = 61.2 (13.7) years], HFrEF constituted 62% of patients and among them, 25% received GDMT. The 5-year mortality rate was 59% (n = 709 deaths), and median survival was 3.1 years. Sudden cardiac death and pump failure caused 46% and 49% of the deaths, respectively. In the multivariate Cox model, components of GDMT associated with lower 5-year mortality risks were discharge prescription of BB, RAS blocker, and MRA. Older age, lower systolic blood pressure, NYHA class III or IV, and higher serum creatinine were also associated with higher 5-year mortality.

CONCLUSIONS

Three out of every 5 patients had died during 5-years of follow-up with a median survival of approximately 3 years. Lack of GDMT in patients with HFrEF and frequent readmissions were associated with higher 5-year mortality. Quality improvement programmes with strategies to improve adherence to GDMT and reduction in readmissions may improve HF outcomes in this region.

MutT Homolog1 has multifaceted role in glioma and is under the apparent orchestration by Hypoxia Inducible factor1 alpha

AIMS

The study focused on the expression and role of a recent potential cancer therapeutic target protein, MutT Homolog1 (MTH1). MTH1 gets activated in an increased reactive oxygen species (ROS) environment and removes the oxidized nucleotides from the cell. The study aimed to check the role of MTH1 in DNA damage and apoptosis, migration and angiogenesis and also to examine its regulation in glioma.

MAIN METHODS

The experiments were carried out in human glioma tissue samples and brain tissues of epilepsy patients (non-tumor control). We used two human glioblastomas cell lines, U87MG and U251MG cells. In order to study the role of MTH1 in glioma and to analyze the relation of MTH1 with Hif1α, we have used MTH1 siRNA and Hif1α siRNA respectively.

KEY FINDINGS

We found an increased expression of MTH1 in glioma tissues compared to the non-tumor brain tissues. Correlation analysis revealed that those samples showing reduced expression of MTH1 also had high levels of DNA damage and apoptotic markers, while diminished expression of angiogenesis regulators and levels of migration. MTH1 knockdown in vitro by siRNA in tumor cell lines corroborates the above observation. This justifies the emergence of MTH1 inhibitors as potential first-in-class drugs. Mechanistically, our observations suggest that Hif1α may modulate MTH1 expression.

SIGNIFICANCE

We found elevated MTH1 expression in glioma irrespective of their grades, while its inhibition affects multiple tumor progression pathways, and that targeting Hif1α could simulate the same.

Enhancement of Fatigue Strength on SAE 1541 Steel Link Plate with Slip Ball Burnishing Technique

This research paper describes a technique for the enhancement of the fatigue strength of the chain link plate in the drive system of a military armoured vehicle. SAE 1541 steel link plates of chains were subjected to cyclical tensile stress due to repeated loading and un-loading conditions. The crack was getting originated from the pitch hole and growth perpendicular to the chain pulling load, due to fatigue mechanism. In general plate holes are manufactured using the conventional process. An additional novel technique called the slip ball burnishing (SBB) method is applied for improving the hole properties. The improvement is made by producing local plastic deformation, improving surface finish and compressive residual stress throughout in the pierced hole. Both the conventional process (CP) and the SBB technique have been evaluated by optical, profile, surface roughness and micro harness tests. Experimental fatigue test validations were done in both chain samples using the Johnson-Goodman method. SBB chains passed 3x106 cycles at the load of 17.61 kN and CP chains passed 3x106 cycles at the load of 13.92 kN. The conclusion was that SBB made a significant improvement of 26.51 per cent of fatigue strength compared to CP.

Spinal angiolipoma-a rare but reversible cause of paraplegia in a child

PURPOSE

Spinal angiolipomas are benign spinal epidural tumors consisting of mature fat cells with angiomatous components. These tumors are rare in children and there are no definite management guidelines.

METHOD

To the best of our knowledge, only five cases of spinal angiolipomas have been reported in children below 12 years. This article discusses the presentation, diagnostics, and surgical tips for the management of a case of spinal angiolipoma.

RESULT

In this paper, we present a one and half-year-old child presenting with a spontaneous spinal epidural hematoma from a spinal angiolipoma and underscore the importance of early surgery in a benign disease for a good outcome.

CONCLUSION

Overall neurological recovery and prognosis following timely intervention for spinal angiolipomas are good.

Oral health care system analysis: A case study from India

OBJECTIVES

The health system of Kerala, India has won many accolades in having health indicators comparable to developed countries. But oral health has not received its due importance at the policy level. With the burden of oral diseases on the rise in the state, a critical introspection of the existing system is warranted. The objective of this review was to assess the oral health care system in Kerala to provide policy solutions.

METHODS

This study adopted a mixed methodological approach that gathered information from the primary and secondary sources, which included health facility surveys, key informant interviews, review of published literature, and websites of governmental and non-governmental bodies. The WHO framework of health system building blocks was adapted for the assessment.

RESULTS

A review of epidemiological studies conducted in Kerala suggests that the prevalence of oral diseases is high with the prevalence of dental caries at the age of 12 years ranging from 37-69%. The state has a dentist population ratio of 1:2200 which is well within the prescribed ratio by WHO (1:7500). Only 2% of dentists in Kerala work with government sector catering to 0.6 million of the approximately 33.4 million population. This point to the absence of oral care in first contact levels like primary health centers. Service delivery is chiefly through the private sector and payment for dental care is predominantly through out-of-pocket expenditure.

CONCLUSION

Despite having the best health indicators, the oral health system of Kerala is deficient in many aspects. Reorientation of oral health services is required to combat the burden of diseases.

A cost-effective colourimetric assay for quantifying hydrogen peroxide in honey

Honey is a natural product with many beneficial properties including antimicrobial action. Production of hydrogen peroxide (H₂O₂) in diluted honey is central to this action. Here, we describe an optimized method for measuring levels of H₂O₂ in honey. This method is based on established methods, with the level of dilution, the time between dilution and reading the assay, and aeration of the samples during the assay identified as critical points for ensuring reliability and reproducibility. The method is cost-effective and easy to perform using common laboratory equipment. Using this method, we quantified the hydrogen peroxide content of five different, unprocessed polyfloral honeys collected in NC, USA. Our results show that H₂O₂ production by these honeys varies greatly, with some samples producing negligible levels of H₂O₂. We assessed the effect of colour on the assay by measuring the recovery of spiked H₂O₂ from light and dark honey and from serially diluted dark corn syrup, and found the amount of H₂O₂ that could be detected was lower in dark corn syrup and darker honey samples.

Vitamin B Complex and Homocysteine Levels - A Trend Study Among Asian Indians

Background: Vitamin B complex levels have been strongly correlated with homocysteine status and many studies suggest supplementation with vitamin B to lower cardiovascular risk among adults. However, this relationship does not show a direct trend with many studies concluding otherwise. Aims and Objective: Our report is an attempt to study association between levels of vitamin B6, folate and B12 in relation to homocysteine in a Pan-India cohort of over 5000 individuals.  Materials & Methods: Data from a total of 5487 Asian Indians including 2942 males and 2545 females were considered for this study. Analysis for levels of vitamins B6 and folate was done using the technology of Liquid Chromatography - Mass Spectrometry (LC-MS), while that for Vitamin B12 and homocysteine was done using the Chemiluminescence Immunoassay (CLIA). Results: Our analysis identified a clear correlation between vitamin B12 status and levels of homocysteine, while no such trend was observed with vitamin B6 and folate. The total frequency of vitamin B12 deficiency was detected to be 25% of which 50% exhibited clinically high homocysteine levels. The frequency among males was found to be high at 61.6% in comparison to females at 32.3% with the difference being statistically significant at p<0.0001. Conclusion: Our report is one of the first few to document levels of vitamin B6, folate and B12 in relation to homocysteine in a large Asian Indian cohort. Low levels of vitamin B12 was found to have a greater impact on Hcy levels in comparison to other B-vitamins studied.

Neem oil-loaded cross-linked biodegradable polymeric capsules: Its larvicidal activity against Culex quinquefasciatuss larvae

Background:

Pesticide delivery system has been formulated in the form of emulsifiable concentrates, water solutions, aerosols, or spray formulations. However, such formulations showed health hazards. Encapsulation technique is the more suitable method to reduce health hazard and to deliver and release the pesticides. Natural biopolymers have been widely studied for encapsulation of pesticide compounds, as they are biodegradable, biocompatible, and low toxic to mammalian. Neem oil has been reported for controlling of the mosquitoes and more eco-friendly insecticide than synthetic insecticides. The present study was designed to prepare a cross-linked polymeric network capsules loaded with neem oil as effective controlled release formulation against Culex quinquefasciatus larvae.

Materials and Methods:

Neem oil-loaded chitosan/alginate/gelatin capsules were prepared by cross-linking method. Neem oil-loaded capsules were characterized with respect to their capsule size, scanning electron microscopy (SEM) analysis, and swelling property. In vitro larvicidal activity of neem oil-loaded polymeric capsules was studied against C. quinquefasciatus larvae.

Results:

The cross-linking method produced spherical shape of neem oil-loaded capsules. Ultraviolet spectroscopy analysis indicated that 10% of neem oil was loaded with capsule. A swelling study indicated that swelling of the loaded capsules tends to be more stable. SEM analysis showed that loading of the neem oil with the capsules fills all pores and capsules were found with good compatibility between chitosan, alginate, and gelatin due to the uniform shape of the capsule. Formulated neem oil-loaded capsules showed potential larvicidal activity (100% of mortality) against C. quinquefasciatus larvae in an in vitro model.

Conclusion:

Formulated neem oil-loaded capsules showed a simple method of preparation and eco-friendly. These polymeric capsule containing neem oil exhibited potential larvicidal activity against C. quinquefasciatus larvae.

Cerebral vascular effects of loading dose of dexmedetomidine: A Transcranial Color Doppler study

Background:

Dexmedetomidine has been widely used in critical care settings because of its property of maintaining stable hemodynamics and inducing conscious sedation. The use of dexmedetomidine is in increasing trend particularly in patients with neurological disorders. Very few studies have focused on the cerebral hemodynamic effects of dexmedetomidine. This study is aimed to address this issue.

Methods:

Thirty patients without any intracranial pathology were included in this study. Middle cerebral artery flow velocity obtained from transcranial color Doppler was used to assess the cerebral hemodynamic indices. Mean flow velocity (mFV), pulsatility index (PI), cerebral vascular resistant index (CVRi), estimated cerebral perfusion pressure (eCPP), and zero flow pressure (ZFP) were calculated bilaterally at baseline and after infusion of injection Dexmedetomidine 1 mcg/Kg over 10 min.

Results:

Twenty-six patients completed the study protocol. After administration of loading dose of dexmedetomidine, mFV and eCPP values were significantly decreased in both hemispheres (P < 0.05); PI, CVRi, and ZFP values showed significant increase (P < 0.05) after dexmedetomidine infusion.

Conclusion:

Increase in PI, CVRi, and ZFP suggests that there is a possibility of an increase in distal cerebral vascular resistance (CVR) with loading dose of dexmedetomidine. Decrease in mFV and eCPP along with an increase in CVR may lead to a decrease in cerebral perfusion. This effect can be exaggerated in patients with preexisting neurological illness. Further studies are needed to evaluate the effect of dexmedetomidine on various other pathological conditions involving brain like traumatic brain injury and vascular malformations.

The phylogenetic position of Lepidopygopsis typus (Teleostei: Cyprinidae), a monotypic freshwater fish endemic to the Western Ghats of India

Lepidopygopsis, known as the peninsular-Indian hill trout, is a monotypic genus endemic to the Periyar stream-reservoir system, in the Western Ghats. Due to the morphological similarity of its only species, L. typus, with the Himalayan schizothoracine fishes, it was considered to be a relict species and a classic example of disjunct distribution. Using mitochondrial and nuclear gene sequence datasets, we show that L. typus is not allied to the schizothoracine fishes. Phylogenetic hypothesis-testing unequivocally supports a scenario in which L. typus and a clade comprising various genera of Asian and African barbins such as Tor Gonoproktopterus, Kosswigobarbus and Varicorhinus are sister groups. Based on our results, we suggest that the sheath of tile-like scales covering the anal-fin base of schizothoracine fishes and Lepidopygopsis typus could be a symplesiomorphy or a homoplasy.

EC-IC bypass for cavernous carotid aneurysms: An initial experience with twelve patients

AIMS

Need for performing a bypass procedure prior to parent artery occlusion in patients with good cerebral vascular reserve is controversial. We analyze our experience of 12 giant internal carotid artery aneurysms treated with extracranial-intracranial (EC-IC) bypass and proximal artery occlusion.

MATERIALS AND METHODS

Retrospective analysis of the case records of all complex carotid aneurysms operated in our institute since January 2009.

RESULTS

The study included eleven cavernous carotid aneurysms and one large fusiform cervical carotid aneurysm reaching the skull base. Preoperative assessment of cerebral vascular reserve was limited to Balloon test occlusion with hypotensive challenge. Eleven patients who successfully completed a Balloon test occlusion (BTO) underwent low flow superficial temporal artery to middle cerebral artery (STA-MCA) bypass, while one patient with a failed BTO underwent a high flow bypass using a saphenous vein graft. Parent artery ligation was performed in all patients following the bypass procedure. Check angiogram revealed thrombosis of the aneurysm in all patients with a graft patency rate of 81.8%. We had one operative mortality, probably related to a leak from the anastomotic site. The only patient who had a high flow bypass developed contralateral hemispheric infarcts and remained vegetative. All the other patients had a good recovery and with a Glasgow outcome score of 5 at last follow-up.

CONCLUSION

We feel that combining EC-IC bypass prior to parent vessel occlusion helps in reducing the risk of post operative ischemic complications especially in situations where a complete mandated cerebral blood flow studies are not feasible.

Tumefactive demyelinating lesions: a clinicopathological correlative study

Tumefactive demyelinating (TDL) lesions are focal zones of demyelination in the central nervous system and they often mimic the neuroimaging features of an intraxial neoplasm. In this report we describe the clinical, neuroimaging and neuropathological features of six cases of TDL. Only in two patients the neuroimaging features in MRI (magnetic resonance imaging) scans were suggestive of TDL while in the other four cases a diagnosis of glioma was suggested. In order to establish a confirmatory diagnosis neuronavigation/stereotactic biopsy was undertaken and the diagnosis of TDL was established in all six cases at histopathology. Two out of six patients did not respond to the conventional corticosteroid therapy and they were treated with plasma exchange. It is being concluded that neuronavigation biopsy, though provide only a small amount of tissue, and is extremely useful in making the diagnosis of TDL.

Effect of Mangiferin and Mahanimbine on Glucose Utilization in 3T3-L1 cells

Background:

Stem barks of Mangifera indica contain a rich content of mangiferin (xanthone glucoside), whereas Murraya koenigii leaves contain rich sources of mahanimbine (carbazole alkaloid) and used traditionally for the treatment of diabetes.

Objective:

To investigate the effects of mangiferin (xanthone glucoside) and mahanimbine (carbazole alkaloid) on glucose utilization in 3T3-L1 cells.

Materials and Methods:

Mangiferin was isolated from stem barks of Mangifera indica and mahanimbine was isolated from Murraya koenigii leaves. These isolated compounds were subjected to MTT assay and glucose utilization test with 3T3-L1 cells.

Results:

Treatment of the 3T3-L1 cells with mangiferin and mahanimbine increased the glucose utilization in a dose-dependent manner. At a concentration of 1 mM, mangniferin showed 2-fold increase in glucose utilization compared with untreated control. In case of mahanimbine, the observed effect at 1 mM was almost equivalent to positive control (insulin at 1 μM). Moreover, MTT assay showed that both of these compounds were less toxic at a concentration of 1 mM (nearly 75% cells are viable).

Conclusion:

The present results indicated that these natural products (mangiferin and mahanimbine) exhibited potential ethnomedical uses in management of diabetes.

1,5-Dimethyl-2-phenyl-4-[phenyl(pyri-din-2-ylamino)methyl]-1H-pyrazol-3(2H)-one

In the title compound, C(23)H(22)N(4)O, the pyrazole ring makes dihedral angles of 45.57 (11)° with the attached phenyl ring, and 83.98 (10) and 67.85 (10) °, respectively, with the other phenyl ring and the pyridyl ring. The pyridyl ring makes a dihedral angle of 80.15 (10)° with the adjacent phenyl ring. In the crystal, N-H⋯O hydrogen bonds supplemented by weak C-H⋯O hydrogen bonds link the mol-ecules into chains which run parallel to the a-axis direction.

Integrated approach for demarcating subsurface pollution and saline water intrusion zones in SIPCOT area: a case study from Cuddalore in Southern India

This paper deals with a systematic hydrogeological, geophysical, and hydrochemical investigations carried out in SIPCOT area in Southern India to demarcate groundwater pollution and saline intrusion through Uppanar River, which flows parallel to sea coast with high salinity (average TDS 28, 870 mg/l) due to back waters as well as discharge of industrial and domestic effluents. Hydrogeological and geophysical investigations comprising topographic survey, self-potential, multi-electrode resistivity imaging, and water quality monitoring were found the extent of saline water intrusion in the south and pockets of subsurface pollution in the north of the study area. Since the area is beset with highly permeable unconfined quaternary alluvium forming potential aquifer at shallow depth, long-term excessive pumping and influence of the River have led to lowering of the water table and degradation of water quality through increased salinity there by generating reversal of hydraulic gradient in the south. The improper management of industrial wastes and left over chemicals by closed industries has led surface and subsurface pollution in the north of the study area.

Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study

Background:

Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP) among neurosurgical patients are scarce.

Aim:

To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures.

Materials and Methods:

An interventional study using a “before–after” design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival.

Results:

A total of 352 patients were on mechanical ventilator for a varying period of 1–125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6%) of 177 in the control group and 73 (41.7%) of 175 among the intervention group (P = 0.195). The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08). The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control) and 92% (intervention).

Conclusion:

Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant.

Bilateral thalamic lesions

OBJECTIVE

Bilateral thalamic lesions are rare and relatively obscure neoplasms. We present our experience with nine cases of bilateral thalamic lesions and attempt to analyse them in the background of available literature.

MATERIALS AND METHODS

Retrospective analyses of the case records of 9 cases of bilateral thalamic lesions treated in our department since January 2002, which have a minimum of 1 year follow-up.

RESULTS

The study group included four males and five females with a mean age of 14.6 years (5 years to 29 years). Seven of these patients had radiological evidence of bilateral thalamic lesions at presentation and 2 patients had involvement of the opposite thalamus at a later stage of the disease. All patients except one presented with raised intracranial pressure symptoms. Focal motor deficits (4/9), behavioral and memory disturbances (3/9) were the other major presenting symptoms. Biopsy confirmation was possible in six patients and histopathology was suggestive of low grade fibrillary astrocytoma in all six patients. Seven patients required CSF diversion procedure for associated hydrocephalus. Eight of our nine patients underwent radiotherapy. On last follow-up, 3 patients were clinically stable with images suggestive of arrested disease, four patients had evidence of progressive disease both clinically and radiologically and there were two recorded cases of mortality.

CONCLUSION

Primary bilateral thalamic lesions have characteristic neuroradiological properties and are distinct from unilateral thalamic tumours with bilateral progression. Almost all of these lesions on histology prove to be gliomas but decompressive surgery is seldom feasible. Surgical intervention is limited to biopsy and CSF diversion for hydrocephalus. Bilateral thalamic lesions remain unresponsive to adjuvant therapy and generally carry a poor prognosis.

Subfrontal gangliocytoma masquerading as olfactory groove meningioma

We describe a rare case of an unusually located gangliocytoma. The conventional magnetic resonance imaging (MRI) appearance was suggestive of an olfactory groove meningioma. However, advanced MRI sequences (diffusion-weighted imaging--DWI; perfusion MRI; susceptibility-weighted imaging--SWI; MR spectroscopy--MRS) revealed features more consistent with a glial neoplasm.

Dissecting intracranial aneurysms presenting as subarachnoid haemorrhage: report of two cases and review of literature

Subarachnoid haemorrhage due to intracranial non-traumatic dissecting aneurysms is rare. Most of the published reports refer to dissecting aneurysms in the vertebrobasilar territory. Anterior circulation dissecting aneurysms are rare and their pathogenesis, clinical features, angiographic findings and management are a matter of debate. Management of patients with intracranial arterial dissection is unclear. Unlike the well-established proximal occlusion and trapping approaches to vertebral artery dissections, choices of interventions for anterior circulation and basilar dissecting aneurysms are limited, and most reports have been limited to wrapping techniques for arterial wall reinforcement. The role of anticoagulation therapy in the presence of subarachnoid haemorrhage is also a matter of debate. As no clear-cut guidelines are available, treatment should be tailored to the individual patient. We describe two cases of intracranial dissecting aneurysms, which presented as subarachnoid haemorrhage (SAH) and discuss the management issues.

New era in health care: tissue engineering

Tissue engineering is a rapidly expanding field, which applies the principles and methods of physical sciences, life sciences and engineering to understand physiological and pathological systems and to modify and create cells and tissues for therapeutic applications. It has emerged as a rapidly expanding ‘interdisciplinary field’ that is a significant potential alternative wherein tissue and organ failure is addressed by implanting natural, synthetic, or semi synthetic tissue or organ mimics that grow into the required functionality or that are fully functional from the start. This review presents in a comprehensive manner the various considerations for the reconstruction of various tissues and organs as well as the various applications of this young emerging field in different disciplines.

Synthesis and valuation of mannich bases of certain novel nitro hydroxy 1, 2 - pyrazolines

A study was conducted to synthesise and evaluate the anti-inflammatory and anti-microbial activities of mannich bases from 1, 2 - hydroxy pyrazolines. For this, vanillin was reacted with substituted acetophenones and different vanillinyl chalcones were obtained which when coupled with phenyl hydrazine, produced hudroxy 1, 2 - pyrazolines. The hydroxyl pyrazolines were reacted with sulpha drugs and other compounds of biological interest containing free amino group in the presence of formaldehyde when mannich bases of 1, 2- hydroxyl pyrazolines were obtained. The compounds were characterized by elemental analysis, Ultra Violet (UV), Infra Red (IR) and Nuclear Magnetic Resonance (NMR) studies. All the newly synthesized compounds have been screened for Anti-inflammatory and Anti-microbial activity. Out of six compounds, para nitro hydroxy pyrazolines of sulphadiazine mannich base (A), nitrohydroxy pyrazoline of sulphacetamide (B) substituted nitro hydroxyl pyrazoline of amino anti-pyrine mannich (F) exhibited significant or oedema in habiting oedem activity. Out of six compounds, para nitro hydroxyl pyrazoline of sulphadiazine mannich base (A) also exhibited anti-microbial activity.

A comparative study of antioxidants S-allyl cysteine sulfoxide and vitamin E on the damages induced by nicotine in rats

The dietary consumption of antioxidant-rich fruits and vegetables is inversely correlated with the incidence of various diseases like cardiovascular diseases and lung cancer. We have tried to find out how far the S-allyl cysteine sulfoxide (SACS) isolated from garlic (Allium Sativum L.) can combat the nicotine-induced peroxidative damage in rats. The effects have been compared with the standard antioxidant vitamin E. Administration of SACS or vitamin E (100 mg/kg) to nicotine (0.6 mg/kg) treated rats for 21 days showed decreased concentrations of thiobarbituric acid reactive substances, hydroperoxides, and conjugated dienes in liver, lungs, and heart as compared with the values found in rats treated with nicotine alone. The activities of catalase and superoxide dismutase increased. The levels of the antioxidants like vitamins A, C, and E in the liver and glutathione in all tissues increased significantly in SACS-treated or vitamin E fed rats. However, the antioxidant status was higher when vitamin E was administered as compared with SACS administered to nicotine-treated rats.

Antioxidant effect of onion oil (Allium cepa. Linn) on the damages induced by nicotine in rats as compared to alpha-tocopherol

The beneficial effects of onion oil as an antioxidant has been assessed in nicotine administered rats by studying whether the peroxidative damage caused by nicotine can be effectively combated with the onion oil and the effects compared to vitamin E, a highly efficient antioxidant. Lipid peroxidation products and antioxidant defence system have been studied in liver, lungs, and heart. The rats were injected with nicotine (0.6 mg/kg body wt.) and simultaneously given onion oil (100 mg/kg body wt.) or vitamin E (100 mg/kg body wt.) for 21 days. Concentration of free fatty acids, TBA reactive substances (TBARS), conjugated dienes and hydroperoxides were significantly increased in the tissues of nicotine treated rats as compared to normal rats. Onion oil supplemented to nicotine treated rats showed increased resistance to lipid peroxidation and the effect was near to that of vitamin E fed rats. The activity of catalase and superoxide dismutase decreased in nicotine treated rats. Antioxidants-glutathione content, vitamin C and retinol showed no significant difference but liver vitamin E content significantly decreased in nicotine treated rats. On onion oil or vitamin E supplementation, the concentration of antioxidants were significantly raised in all the tissues studied, however, a significantly increased concentration of glutathione, vitamin E and retinol was noticed in vitamin E+nicotine treated rats. Thus, these results indicate that onion oil is an effective antioxidant against the oxidative damage caused by nicotine as compared to vitamin E.

Anti-peroxidative and hypoglycaemic activity of salacia oblonga extract in diabetic rats

Hypoglycaemic activity of a petroleum ether extract of the root bark of Salacia oblonga Wall. (Celastraceae) (SOB) was studied in streptozotocin (STZ) hyperglycaemic rats. In addition, the anti-lipid peroxidative activity of SOB was studied in hyperglycaemic rats. The extract showed significant hypoglycaemia ( p &lt; 0.001), which was supported by an insulin assay. A detailed biochemical study (thiobarbituric acid reactive substances, hydroperoxides, conjugated dienes, glutathione, superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase) in the renal tissue of diabetic animals treated with SOB demonstrated promising anti-lipid peroxidative activity. These results suggest that S. oblonga root bark possesses anti-diabetic and anti-peroxidative principles, and may be of value in the treatment of diabetes and associated renal complications.

Antioxidant role of oils isolated from garlic (Allium sativum Linn) and onion (Allium cepa Linn) on nicotine-induced lipid peroxidation

Nicotine, a major component of tobacco, is partly responsible for the development of atherosclerosis. It has been suggested that antioxidant nutrients are protective against degenerative diseases. So we have studied the antioxidant effect of oils isolated from onion and garlic on nicotine-induced lipid peroxidation in rat tissues. The lipid peroxidation products and scavenging enzymes were assessed in liver, lungs, heart and kidney. The rats were treated with 0.6 mg nicotine/kg bw and simultaneously given 100 mg garlic or onion oils/kg bw for 21 d. Thiobarbituric acid reactive substances, conjugated dienes and hydroperoxides concentrations were significantly increased in the tissues of nicotine-treated rats. Both the garlic oil and onion oil supplementation to nicotine-treated rats increased resistance to lipid peroxidation. The activities of catalase, superoxide dismutase and glutathione peroxidase decreased in nicotine-treated rats, but there was a trend to increased glutathione content. With garlic oil or onion oil supplementation, nicotine-treated rats had increased activities of antioxidant enzymes and increased concentrations of glutathione. These results indicate that oils of garlic and onion are effective antioxidants against the oxidative damage caused by nicotine.

Hypoglycaemic and anti-oxidant activity of Salacia oblonga Wall. extract in streptozotocin-induced diabetic rats

The petroleum ether extract of the root bark of S. oblonga Wall. (Celastraceae) (SOB) was studied in streptozotocin (STZ) diabetic rats and anti-lipid peroxidative activity of the same was studied in the cardiac tissue. SOB prevented significantly the streptozotocin-induced hyperglycaemia and hypoinsulinaemia. It also produced a significant decrease in peroxidation products viz. thiobarbituric acid reactive substances (P < 0.001), conjugated dienes (P < 0.05), hydroperoxides (P < 0.001). The activity of antioxidant enzymes such as superoxide dismutase (P < 0.001), catalase (P < 0.001), GSHPxase and GSSGRase was found to be increased in the heart tissue of diabetic animals treated with SOB. These results suggest that S. oblonga root bark extract possesses anti-diabetic and anti-oxidative activity in streptozotocin-diabetic rats.