Obstructive sleep apnea induced bilateral tonic- clonic seizure of unknown origin: A case series of a novel association

Background

Obstructive sleep apnea is a highly prevalent disorder, characterized by recurrent events of upper airway obstruction during sleep and associated with recurrent cycles of desaturation and re-oxygenation, sympathetic hyperactivity, and intra-thoracic pressure fluctuations, resulting in fragmentation of sleep and subsequent daytime fatigue with excessive sleepiness. Obstructive sleep apnea-induced bilateral tonic-clonic seizures are unheard of. We aimed to report 3 patients with previously undiagnosed obstructive sleep apnea who presented to the emergency department with new onset bilateral tonic-clonic seizure without any evidential neurological or metabolic cause.

Methods

Patient data were obtained from medical records from the Department of Internal Medicine, IPGMER and SSKM Hospital, Kolkata, and Belle Vue Clinic, Kolkata, India.

Results

Three male patients (67, 58, and 44 years old) presented with bilateral tonic-clonic seizure disorder without any underlying cause of seizures after rigorous investigations except for moderate to severe obstructive sleep apnea on polysomnography. All 2 patients were seizure-free after being treated with levetiracetam, chronic continuous positive airway pressure therapy in 2, and only continuous positive airway pressure in the other. The patients remained seizure-free on continuous positive airway pressure, even when levetiracetam was withdrawn, suggesting obstructive sleep apnea's causality in their new-onset acute seizures.

Conclusion

Although further investigation is required to clarify this association, underlying obstructive sleep apnea should be ruled out in patients with a first-ever bilateral tonic-clonic seizure. Whether or not continuous positive airway pressure alone could effectively treat hypoxia and deranged cortical excitability, which may lead to seizures in cases with longstanding obstructive sleep apnea, is yet to be explored.

Expression profile, transcriptional and post-transcriptional regulation of genes involved in hydrogen sulphide metabolism connecting the balance between development and stress adaptation in plants: a data-mining bioinformatics approach

Recent research focused on novel aspects of sulphur and sulphur-containing molecules in fundamental plant processes has highlighted the importance of these compounds. Currently, the focus has shifted to the efficacy of hydrogen sulphide (H₂ S) as signalling compounds that regulate different development and stress mitigation in plants. Accordingly, we used an in silico approach to study the differential expression patterns of H₂ S metabolic genes at different growth/development stages and their tissue-specific expression patterns under a range of abiotic stresses. Moreover, to understand the multilevel regulation of genes involved in H₂ S metabolism, we performed computation-based promoter analysis, alternative splice variant analysis, prediction of putative miRNA targets and co-expression network analysis. Gene expression analysis suggests that H₂ S biosynthesis is highly influenced by developmental and stress stimuli. The functional annotation of promoter structures reveales a wide range of plant hormone and stress responsive cis-regulatory elements (CREs) that regulate H₂ S metabolism. Co-expression analysis suggested that genes involved in H₂ S metabolism are also associated with different metabolic processes. In this data-mining study, the primary focus was to understand the genetic architecture governing pathways of H₂ S metabolism in different cell compartments under various developmental and stress signalling cascades. The present study will help to understand the genetic architecture of H₂ S metabolism via cysteine metabolism and the functional roles of these genes in development and stress tolerance mechanisms.

Trends in rifampicin and isoniazid resistance in patients with presumptive TB

BACKGROUND: Early diagnosis of drug-resistant TB (DR-TB) is crucial in preventing the spread of the disease in the community. Introduction of upfront decentralised drug susceptibility testing to district-level as part of universal drug susceptibility testing (UDST) policy increased the feasibility of rapid and early testing for drug resistance closer to the patient and has resulted in reduced circumstances for transmission. The introduction of the first-line line-probe assay (FL-LPA), GenoType^® MTBDRplus v2, has had an extensive impact on the management of multidrug-resistant TB (MDR-TB) in India.MATERIALS and METHODS: Sputum samples of patients with presumptive TB and DR-TB from selected districts of Tamil Nadu received through National TB Elimination Programme (NTEP) were subjected to FL-LPA as per programme guidelines. In this study, we present trends in genotypic resistance to isoniazid (INH) and rifampicin (RIF) during the 4 years (2016-2019) among these patients. Band patterns were analysed as per the updated GLI (Global Laboratory Initiative) LPA interpretation and reporting guidelines.RESULTS: A total of 26,349 samples were received during the study period. Smear-positive samples (n = 20231) were directly subjected to FL-LPA; smear-negative samples were cultured in liquid media and M. tuberculosis-positive cultures were tested using FL-LPA. A total of 18,441 were MTB-positive on FL-LPA. INH monoresistance, RIF monoresistance and MDR-TB was observed in respectively 8.7%, 1.1% and 3.3% of the samples. There was a decreasing trend in all types of resistance observed particularly after 2017 (P < 0.001). MDR-TB showed a steady decrease from 5.6% to 1.8%. S531L (19.5%) and S315T (61.1%) were the most common mutations identified in the rpoB and katG genes, respectively. The percentage of inhA-c-15t promoter mutation, indicating low-level INH resistance, showed a consistent increase (P < 0.001).CONCLUSION: The impact of the UDST policy on the NTEP may have led to this decreasing trend in RIF and INH resistance observed in the study period. The increase in low-level INH resistance mutation inhA-c-15t may be associated with ethionamide/prothionamide resistance, and this should be taken into account when designing DR-TB regimen.

Identification of natural flavonoids as novel EGFR inhibitors using DFT, molecular docking, and molecular dynamics

The quantum mechanical descriptors from DFT, molecular docking, molecular dynamics, and NCIplot methodology have been utilized to find a potential anti-EGFR flavonoid.

Towards Molecular Understanding of the pH Dependence Characterizing NhaA of Which Structural Fold is Shared by Other Transporters

Na⁺/H⁺ antiporters comprise a super-family (CPA) of membrane proteins that are found in all kingdoms of life and are essential in cellular homeostasis of pH, Na⁺ and volume. Their activity is strictly dependent on pH, a property that underpins their role in pH homeostasis. While several human homologues have long been drug targets, NhaA of Escherichia coli has become the paradigm for this class of secondary active transporters as NhaA crystal structure provided insight into the architecture of this molecular machine. However, the mechanism of the strict pH dependence of NhaA is missing. Here, as a follow up of a recent evolutionary analysis that identified a 'CPA motif', we rationally designed three E. coli NhaA mutants: D133S, I134T, and the double mutant D133S-I134T. Exploring growth phenotype, transport activity and Li⁺-binding of the mutants, we revealed that Asp133 does not participate directly in proton binding, nor does it directly dictate the pH-dependent transport of NhaA. Strikingly, the variant I134T lost some of the pH control, and the D133S-Il134T double mutant retained Li⁺ binding in a pH independent fashion. Concurrent to loss of pH control, these mutants bound Li⁺ more strongly than the WT. Both positions are in close vicinity to the ion-binding site of the antiporter, attributing the results to electrostatic interaction between these residues and Asp164 of the ion-binding site. This is consistent with pH sensing resulting from direct coupling between cation binding and deprotonation in Asp164, which applies also to other CPA antiporters that are involved in human diseases.

Recent developments in the diagnosis and treatment of extrapulmonary non-tuberculous mycobacterial diseases

Diseases due to pathogenic mycobacteria cause significant health and economic impact on humans worldwide. Although mycobacterial diseases primarily affect the lungs, the involvement of extrapulmonary organs has also gained ground, particularly among individuals with co-existing medical conditions. Besides Mycobacterium tuberculosis complex organisms, non-tuberculous mycobacteria (NTM) are also known to cause pulmonary and extrapulmonary diseases. Primary and disseminated extrapulmonary mycobacterial infections affect the brain, eye, mouth, tongue, lymph nodes of the neck, spine, bones, muscles, skin, pleura, pericardium, gastro-intestinal, peritoneum and genito-urinary system. The clinical presentation of extrapulmonary mycobacterial diseases, including systemic symptoms, of M. tuberculosis-infected cases and NTM-infected cases is similar. Moreover, extrapulmonary mycobacterial diseases are complicated by the involvement of diverse bacterial species as aetiological agents. Culture and molecular techniques are used to differentiate NTM from Mycobacterium tuberculosis and to classify sub-species of the pathogens. As sub-speciation and drug susceptibility profiling are critical factors in treating extrapulmonary NTM diseases, there are often significant delays in initiating treatment and customising the therapeutic regimen. Here, we summarise the clinical symptoms of NTM diseases in various extrapulmonary organs, and discuss the recent trends in diagnosing and treating these diseases. We also highlight the complications associated with the management of extrapulmonary NTM disease.

In silico fight against novel coronavirus by finding chromone derivatives as inhibitor of coronavirus main proteases enzyme

Novel coronavirus, 2019-nCoV is a danger to the world and is spreading rapidly. Very little structural information about 2019-nCoV make this situation more difficult for drug designing. Benzylidenechromanones, naturally occurring oxygen heterocyclic compounds, having capability to inhibit various protein and receptors, have been designed here to block mutant variety of coronavirus main protease enzyme (SARC-CoV-2 M^pro) isolated from 2019-nCoV with the assistance of molecular docking, bioinformatics and molecular electrostatic potential. (Z)-3-(4'-chlorobenzylidene)-thiochroman-4-one showed highest binding affinity to the protein. Binding of a compound to this protein actually inhibits the replication and transcription of the virus and, ultimately, stop the virus multiplication. Incorporation of any functional groups to the basic benzylidenechromanones enhances their binding ability. Chloro and bromo substitutions amplify the binding affinity. ADME studies of all these compounds indicate they are lipophilic, high gastro intestine absorbable and blood-brain barrier permeable. The outcome reveals that the investigated benzylidenechromanones can be examined in the case of 2019-nCoV as potent inhibitory drug of SARC-CoV-2 M^pro, for their strong inhibition ability, high reactivity and effective pharmacological properties.

Diagnostic Evaluation of Isotropic 3D MRCP Images in the Diagnosis of Cholangiocarcinoma

This is a cross sectional study to establish that Magnetic resonance cholangiopancreatography (MRCP) could be accepted as the most effective imaging modality for the diagnosis of cholangiocarcinoma. Cholangiocarcinoma is the most common malignant tumor of the bile duct. It is much less common than hepatocellular carcinoma, accounting for 5-30% of all hepatic malignancies. Clinically suspected patients with obstructive jaundice due to cholangiocarcinoma were referred to the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was carried out in 60 patients, of which 38(63%) were male and 22(37%) were female. Out of 60 cases 56 cases were truly diagnosed by MRCP, 4 were normal, among these 1 case was diagnosed as cholangiocarcinoma as compared with histopathology. Forty four (44) patients (73.2%) of the patients were in sixth decade of life. The overall sensitivity and specificity were found to be 98.2% and 75%. The diagnostic accuracy was 96.7% & positive predictive value was about 98%.

Bone Age Determination by Radiology & Imaging in Bangladesh Perspective

Determination of age is one of the most important and vital demand in legal affairs, court and young sports, especially from 7-21 years. There is no established age determination table in our county. So we are dependent upon Galstaun, Bashu & Bashu and other European tables, which sometimes provide misinterpretation and variation of opinion. We should have our own table suitable for our nation. So, this prospective study was carried out in the Department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2010 to June 2014 (five years) to assess the general skeletal maturity. Three hundred boys and girls of known date of birth were selected on random basis from Dhaka. Ages were limited within 7 to 21 year. Every 20 person for each age group, of them 10 were male and 10 were female. To observe the bony maturity, radiographs were taken at the end of their age belongs to. Thus a growth table is to be prepared for further evaluation.

A highly sensitive non-enzymatic hydrogen peroxide and hydrazine electrochemical sensor based on 3D micro-snowflake architectures of α-Fe2O3

In the present work, well crystalline 3D micro-snowflake structured α-Fe₂O₃ has been successfully synthesized on a large scale via a simple hydrothermal reaction by hydrolysis of a K₃Fe(CN)₆ precursor.

Stable room temperature magnetic ordering and excellent catalytic activity of mechanically activated high surface area nanosized Ni0.45Zn0.55Fe2O4

Mechanosynthesized nanometric Ni_0.45Zn_0.55Fe₂O₄ exhibit stable magnetic ordering at room temperature, excellent catalytic property and memory effect in dc magnetization profile.

Electronic and optical properties of pristine and boron–nitrogen doped graphyne nanotubes

The band gaps and optical responses of graphyne nanotubes can be engineered through the selection of the BN doping site and the chirality.

Prevalence of ESBL producing Escherichia Coli and Klebsiella species with their co-resistance pattern to antimicrobials

Extended spectrum β-lactamase producing bacteria are potential emerging pathogens and continue to be a major challenge in clinical setup worldwide. In the present study an attempt was made to study the prevalence of extended spectrum β-lactamase producing Escherichia coli and Klebsiella species from clinical isolates in a rural tertiary care hospital in West Bengal, India with their antimicrobial susceptibility as well as co-resistance pattern to different antimicrobials. A total of 179 Escherichia coli and 62 Klebsiella isolates recovered from various clinical samples of urine, pus, aural swabs and respiratory secretions (including sputum) for a period of six months were subjected to routine antimicrobial susceptibility testing and also tested for extended spectrum β-lactamase production as per NCCLS recommendations. Extended spectrum β-lactamase was detected in 32.40% of Escherichia coli and 40.32% of Klebsiella species isolates. Urine, pus and respiratory samples were common source of extended spectrum β-lactamase producers and resistance rate of these organisms to third generation cephalosporins were more than 30 to 40%. Co-resistance pattern of these extended spectrum β-lactamase producers to other commonly used antimicrobials were also statistically significant (p≤0.05). From the study it is concluded that indiscriminate use of third generation cephalosporins may be responsible for the selection of extended spectrum β-lactamase producing multidrug resistant strains in hospital setup and amikacin is a reliable drug against them.

Comparative analysis between objective structured clinical examination (OSCE) and conventional examination (CE) as a formative evaluation tool in Pediatrics in semester examination for final MBBS students

BACKGROUND

The use of objective structured clinical examination in pediatrics is not common in undergraduate evaluation process.

OBJECTIVE

To evaluate the effectiveness of objective structured clinical examination as compare to conventional examination as formative assessment tool in Pediatrics.

METHODS

We conducted a cross sectional comparative study in defined population of 9th semester MBBS students to evaluate the effectiveness of objective structured clinical examination as comparison to conventional examination as formative assessment tool in Pediatrics. We analyzed the perception of objective structured clinical examination among the students.

RESULTS

Fifty-two students appeared for the objective structured clinical examination evaluation on the first day and 42 turned up for conventional examination on the next day. The 42 students who turned up for both examinations were asked to respond to the perception evaluation questionnaire. Comparison of the two examination styles showed that students fared better in objective structured clinical examination than in conventional examination both with respect to mean total score (p less than 0.001) as well as mean percentage score. Out of the 42 subjects who appeared in both examinations, all passed in objective structured clinical examination and 35 passed in conventional examination, this difference was significant by McNemar chi-square test (p = 0.016). 73.8% of the students opined in favor of objective structured clinical examination as a better formative assessment tool whereas 9.5% students preferred conventional examination.

CONCLUSIONS

Objective structured clinical examination a statistically significant better evaluation tool with comparison to conventional examination.

Human papillomavirus testing for suspected cervical cancer patients from Southern Assam by fast-PCR

World-wide epidemiological studies have shown that cancer of the uterine cervix is the second most common malignant disease in women. Virtually every cervical cancer (99.7%) is HPV-positive, indicating that the presence of HPV is an obligatory element in their development. The present study was conducted by Fast-PCR (within 15 min.) based diagnosis of HPV 16 and HPV 18 infection amongst patients of suspected cervical cancer, confirmed by cytological methods. Twelve women, out of a total of fifty studied cases who had positive cervical pap smears (24%) were found to be positive for HPV 16/HPV 18 infection when PCR based technique was applied. The results indicate, perhaps, a greater specificity of PCR based diagnosis, or presence of other HPV subtypes as etiological factors in the present study group confined to Southern Assam.

Analysis of molecular alterations in chromosome 8 associated with the development of uterine cervical carcinoma of Indian patients

OBJECTIVES

We have been done the detailed deletion mapping of chromosome (chr.) 8p21.3-23 to localize the candidate tumor suppressor gene(s) (TSGs) loci as well as studied the mechanism of activation of c-myc gene, located at chr.8q24.1, by analyzing the amplification/rearrangement/HPV integration within approximately 580 kb of c-myc locus in uterine cervical carcinoma (CaCx) of Indian patients. The association between the deletions in chr.8p21.3-23 and alterations in the c-myc locus has also been analyzed.

METHODS

The deletion mapping of chr.8p21.3-23 was done by 15 microsatellite markers and the alterations in the c-myc locus were analyzed by Southern hybridization using the pal-1/c-myc/mlvi-4/HPV 16/18 probes in seven cervical intraepithelial neoplasia (CIN) and 55 primary uterine cervical carcinoma. The alterations in chr.8p/q have been correlated with the different clinicopathological parameters.

RESULTS

Three discrete minimal deleted regions with high frequencies of loss of heterozygosity (LOH) (37-43%) were identified in the chr.8p23.1-23.2 (D1), 8p23.1 (D2), and 8p 21.3-22 (D3) regions within 0.41-4.62 Mb. The deletion in the D1 region was significantly associated with the deletion in the D2 region (P = 0.03), whereas the deletion in D2 was marginally associated with the deletion in the D3 region (P = 0.07). The alterations in the c-myc locus were seen in 43% of the samples. About 35% of the samples showed coalterations in both arms of chr.8. No significant association was observed with the alterations in chr.8p/q as well as with the different clinicopathological parameters.

CONCLUSIONS

The deletions in chr.8p21.3-23 and the alterations in the c-myc locus are independently associated with the development of CaCx. The D1-D3 regions in chr.8p21.3-23 could harbor candidate TSGs associated with the development of this tumor. The c-myc gene was activated by amplification/rearrangement at the pal-1/c-myc/mlvi-4 loci as well as HPV integration in the pal-1 locus in this tumor.

Generalized lymphadenopathy caused by Trichosporon asahii in a patient with Job's syndrome

Of the six species of Trichosporon known to cause human infections, T. asahii is the main agent of invasive trichosporonosis. We describe an unusual case of generalized lymphadenopathy due to T, asahii in a 10-year-old boy with Job's syndrome (markedly elevated IgE with eosinophilia). The diagnosis was based on the presence of blastic conidia and hyphal elements breaking into arthroconidia in biopsied tissue of the cervical lymph node and isolation of the causal agent T, asahii in pure culture. The patient responded initially to amphotericin B therapy, but the infection recurred within 4 weeks and did not respond to therapy of liposomal amphotericin B and 5-fluorocytosine for 10 days. The patient left the hospital against medical advice.

Stress induced phosphate solubilization in bacteria isolated from alkaline soils

Phosphate solubilizing bacteria NBRI0603, NBRI2601, NBRI3246 and NBRI4003 were isolated from the rhizosphere of chickpea and alkaline soils. All four strains demonstrated diverse levels of phosphate solubilization activity under in vitro conditions in the presence of various carbon and nitrogen sources. Acid production may have contributed to phosphate solubilization, but was not the only reason for phosphate release into the medium. Among the four strains, NBRI2601 was the most efficient strain in terms of its capability to solubilize phosphorus in the presence of 10% salt, pH 12, or 45 degrees C. The strains showed varied levels of phosphate solubilization when the effects of different sources of nitrogen were examined during growth. The presence of low levels of Ca(2+) and EDTA in the medium enhanced phosphate solubilization.