Dysregulation of miR-146a is associated with exacerbated inflammation, oxidative and endoplasmic reticulum stress in the progression of diabetic foot ulcer

Recent evidence has implicated the role of microRNA-146a (miR-146a) in regulating inflammatory responses. In the present study, we investigated the role of miRNA-146a in the progression of diabetic foot ulcer (DFU) in type 2 diabetes mellitus patients (T2DM) and studied its correlation with stress mediators such as Endoplasmic Reticulum (ER) and oxidative stress. Ninety subjects were enrolled and evenly distributed among three groups: Controls (n = 30), T2DM without complications (n = 30) and T2DM with foot ulcers (n = 30). Subsequently, each group was further subdivided based on the University of Texas classification. Peripheral blood was collected from all the study subjects, while tissue biopsies were taken only from DFU patients. Total RNA from both PBMCs and wound tissues were isolated using miRNA isolation kit and qPCR was performed to check the expression of miR-146a, ER stress and oxidative stress markers. Our findings revealed a significant decrease in miR-146a expression among T2DM patients with Grade 2 and Grade 3 DFUs compared with those with Grade 0 and Grade 1 DFUs. Notably, inflammatory genes regulated by miR-146a, including TRAF6, IRAK-1 and ADAM, were all upregulated in T2DM patients with Grade 2 and Grade 3 DFUs. Moreover, reduced miR-146a levels were correlated with increased markers of ER stress and oxidative stress in Grade 2 and Grade 3 DFU patients. Furthermore, our in vitro experiment using mouse 3T3 fibroblasts demonstrated a downregulation of miR-146a following induction of hyperglycaemia, ER stress and oxidative stress in these cells. These findings suggest a potential link between diminished miR-146a expression and heightened oxidative and ER stress in T2DM patients with more severe grades of DFUs. Our results imply that targeting miR-146a may hold therapeutic promise for managing disease progression in DFU patients, as it could help alleviate oxidative and ER stress associated with diabetic complications.

Exploring Lactoferrin as a novel marker for disease pathology and ferroptosis regulation in gestational diabetes

Iron overload is linked to heightened susceptibility to ferroptosis, a process increasingly implicated in diabetes pathogenesis. This present study aims to assess the utility of Lactoferrin in predicting different stages of GDM and explore its association with disease pathology and ferroptosis. In this observational study, 72 pregnant women were recruited and categorized into three groups: healthy pregnant women without diabetes (NGDM, n = 24), early gestational diabetes (eGDM, n = 24), and established gestational diabetes (GDM, n = 24), all receiving standard antenatal care at 12 weeks of gestation. Circulating levels of ferritin, soluble transferrin receptor (sTFR), and Lactoferrin using multiplexed bead-based cytokine immunoassay. Gene expression analysis focused on analyzing crucial ferroptosis regulators, SLC7A11 and GPX4, in isolated peripheral blood mononuclear cells (PBMCs). A significant elevation in ferritin levels and a decrease in the sTFR: Ferritin ratio supported iron overload and disrupted iron homeostasis in GDM subjects. Notably, Lactoferrin levels were significantly lower in women with GDM than in the control group and those with eGDM. This decline in Lactoferrin correlated with increased hyperglycemia indicators and reduced expression of ferroptosis regulators among GDM patients. Furthermore ROC curve analysis demonstrated that Lactoferrin shows promise as a valuable marker for distinguishing individuals with GDM from those with eGDM. Lactoferrin shows promise as a biomarker for detecting GDM. These findings indicate its role as a potential biomarker and highlight Lactoferrin as a critical regulator of hyperglycemia and ferroptosis in women with GDM.

Crosstalk between inflammasomes, inflammation, and Nrf2: Implications for gestational diabetes mellitus pathogenesis and therapeutics

The role of inflammasomes in gestational diabetes mellitus (GDM) has emerged as a critical area of research in recent years. Inflammasomes, key components of the innate immune system, are now recognized for their involvement in the pathogenesis of GDM. Activation of inflammasomes in response to various triggers during pregnancy can produce pro-inflammatory cytokines, such as interleukin-1β (IL-1β) and interleukin-18 (IL-18), contributing to systemic inflammation and insulin resistance. This dysregulation not only impacts maternal health but also poses significant risks to fetal development and long-term health outcomes. Understanding the intricate interplay between inflammasomes and GDM holds promise for developing novel therapeutic strategies and interventions to mitigate the adverse effects of this condition on both mothers and their offspring. Researchers have elucidated that targeting inflammasomes using anti-inflammatory drugs and compounds can effectively reduce inflammation in GDM. Furthermore, the addition of nuclear factor erythroid 2-related factor 2 (Nrf2) to this complex mechanism opens novel avenues for therapeutics. The antioxidant properties of Nrf2 may potentially suppress inflammasome activation in GDM. This comprehensive review investigates the intricate relationship between inflammasomes and GDM, emphasizing the pivotal role of inflammation in its pathogenesis. It also sheds light on potential therapeutic strategies targeting inflammasome activation and explores the role of Nrf2 in mitigating inflammation in GDM.

Dysfunctions, molecular mechanisms, and therapeutic strategies of pancreatic β-cells in diabetes

Pancreatic beta-cell death has been established as a critical mediator in the progression of type 1 and type 2 diabetes mellitus. Beta-cell death is associated with exacerbating hyperglycemia and insulin resistance and paves the way for the progression of DM and its complications. Apoptosis has been considered the primary mechanism of beta-cell death in diabetes. However, recent pieces of evidence have implicated the substantial involvement of several other novel modes of cell death, including autophagy, pyroptosis, necroptosis, and ferroptosis. These distinct mechanisms are characterized by their unique biochemical features and often precipitate damage through the induction of cellular stressors, including endoplasmic reticulum stress, oxidative stress, and inflammation. Experimental studies were identified from PubMed literature on different modes of beta cell death during the onset of diabetes mellitus. This review summarizes current knowledge on the crucial pathways implicated in pancreatic beta cell death. The article also focuses on applying natural compounds as potential treatment strategies in inhibiting these cell death pathways.

New Frontiers in Three-Dimensional Culture Platforms to Improve Diabetes Research

Diabetes mellitus is associated with defects in islet β-cell functioning and consequent hyperglycemia resulting in multi-organ damage. Physiologically relevant models that mimic human diabetic progression are urgently needed to identify new drug targets. Three-dimensional (3D) cell-culture systems are gaining a considerable interest in diabetic disease modelling and are being utilized as platforms for diabetic drug discovery and pancreatic tissue engineering. Three-dimensional models offer a marked advantage in obtaining physiologically relevant information and improve drug selectivity over conventional 2D (two-dimensional) cultures and rodent models. Indeed, recent evidence persuasively supports the adoption of appropriate 3D cell technology in β-cell cultivation. This review article provides a considerably updated view of the benefits of employing 3D models in the experimental workflow compared to conventional animal and 2D models. We compile the latest innovations in this field and discuss the various strategies used to generate 3D culture models in diabetic research. We also critically review the advantages and the limitations of each 3D technology, with particular attention to the maintenance of β-cell morphology, functionality, and intercellular crosstalk. Furthermore, we emphasize the scope of improvement needed in the 3D culture systems employed in diabetes research and the promises they hold as excellent research platforms in managing diabetes.

Role of ferroptosis inhibitors in the management of diabetes

Ferroptosis, the iron-dependent, lipid peroxide-mediated cell death, has garnered attention due to its critical involvement in crucial physiological and pathological cellular processes. Indeed, several studies have attributed its role in developing a range of disorders, including diabetes. As accumulating evidence further the understanding of ferroptotic mechanisms, the impact this specialized mode of cell death has on diabetic pathogenesis is still unclear. Several in vivo and in vitro studies have highlighted the association of ferroptosis with beta-cell death and insulin resistance, supported by observations of marked alterations in ferroptotic markers in experimental diabetes models. The constant improvement in understanding ferroptosis in diabetes has demonstrated it as a potential therapeutic target in diabetic management. In this regard, ferroptosis inhibitors promise to rescue pancreatic beta-cell function and alleviate diabetes and its complications. This review article elucidates the key ferroptotic pathways that mediate beta-cell death in diabetes, and its complications. In particular, we share our insight into the cross talk between ferroptosis and other hallmark pathogenic mediators such as oxidative and endoplasmic reticulum stress regulators relevant to diabetes progression. Further, we extensively summarize the recent developments on the role of ferroptosis inhibitors and their therapeutic action in alleviating diabetes and its complications.

Serum levels of matrix metalloproteinases as prognostic markers for severe dengue with plasma leakage

BACKGROUND

Plasma leakage is a major pathogenic manifestation of severe dengue and is a precursor of life-threatening complications associated with dengue. Accumulating evidence indicates the role of Matrix Metalloproteinases (MMPs) in mediating vascular permeability and plasma leakage following induction by the dengue virus. This study aims to investigate the utility of MMP-2, MMP-3, and MMP-9 in predicting the severity of dengue infection and further explore the relationship of these markers with the pathogenic factors associated with plasma leakage.

METHODS

The dengue-positive subjects were classified into mild and severe dengue groups based on the manifestation of warning signs. The samples in each group and healthy controls were quantified for basic laboratory characteristics. The levels of MMP-2, MMP-3, MMP-9, and Macrophage migration inhibitory factor (MIF) were estimated in all serum samples using a multiplex bead-based assay.

RESULTS

MMP-2 and MMP-9 were markedly elevated in severe dengue patients compared to mild dengue patients and healthy controls. No alteration in the circulating levels of MMP-3 was observed between the study groups. ROC curve analysis indicated that MMP-2 and MMP-9 exhibited good potential for predicting severe dengue. Notably, an increase in MMP-9 was associated with increased MIF and Hematocrit levels in severe dengue patients.

CONCLUSION

MMP-2 and MMP-9 could serve as prognostic biomarkers for severe dengue. These findings also identify the association of MMP-9 with markers of plasma leakage, thereby encouraging further studies to explore the therapeutic potential of targeting MMP-9 in managing plasma leakage in severe dengue.

Tobacco use and exposure to second-hand smoke among high school students in Ernakulum district, Kerala: A cross-sectional study

Objectives

Tobacco use and exposure to second-hand smoke (SHS) in the home setting are major health hazards for adolescents. The objectives of this study were to estimate tobacco use and exposure to SHS among high school students in Ernakulam district of Kerala, India, and to investigate associated factors.

Study design

Cross-sectional study.

Methods

A school-based cross-sectional study was carried out in 25 randomly selected high schools from 210 schools in the Ernakulam educational district of Kerala, India. The minimum calculated sample size for ever-use of tobacco and SHS exposure was determined to be 2500, with 95% confidence interval (CI) and 10% relative precision. Data were collected using a semi-structured, pre-tested questionnaire from 2585 high school students. Data analyses were performed using SPSS version 20.

Results

The ever-use of tobacco was reported to be 3.9% (95% CI 3.16 to 4.54) and the mean age of the participants was 13.97 ± 0.77 years. One-fifth of participants had tried a tobacco product before the age of 10 years. SHS exposure at home was reported by one in every 5 respondents (20.3%). Male gender (adjusted odds ratio [aOR] 8.79; 95% CI 3.16, 24.53), presence of a family member who smokes within the home (aOR 4.28; 95% CI 2.58, 7.12), lack of awareness about the harmful effects of SHS exposure (aOR 2.47; 95% CI 1.41, 5.18) and having seen an advertisement or promotion at point of sale (aOR 2.16; 95% CI 1.29, 3.60) were found to be independent predictors for tobacco use.

Participants with respiratory infections were three times more likely to have experienced SHS exposure at home (aOR 2.87; 95% CI 2.21, 3.74), there was an 86% protective effect of SHS exposure for participants with a father in a professional occupation compared with unskilled profession (aOR 0.14; 95% CI 0.02, 0.67; p < 0.15) and participants with ever-use of tobacco were two times more likely to have experienced SHS exposure at home (aOR 1.63; 95% CI 3.13, 8.98).

Conclusions

SHS exposure in the home environment continues to be high. Urgent innovative measures are necessary for the implementation of tobacco smoke-free homes and to reduce tobacco use in this vulnerable population. Further studies are necessary to determine ways to reduce smoking within homes and to increase population awareness.

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This study estimates the ever use of tobacco among adolescents to be low at 3.5%.

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However, alarmingly one fifth of the students continue to be exposed to secondhand smoke at home this is associated with increasing respiratory infections.

Characterization of anthocyanin from red sorghum (Sorghum bicolor) bran by liquid chromatography-electron spray ionization mass spectrometry analysis

In the present study, anthocyanin pigments from red sorghum (Sorghum bicolor) bran were identified and characterized by Liquid Chromatography-Electron Spray Ionization Mass Spectrometry. The individual anthocyanins were identified by comparing their mass spectrometric data and retention times, published data. 3-deoxyanthocyanidins and methyl 3-deoxyanthocyanidins were identified in red sorghum bran. This paper presents complete LCMS profile and MS spectrometric data of red sorghum bran.

Severe acute respiratory syndrome coronavirus-2 infection and the gut-liver axis

Patients affected by coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, manifest various gastrointestinal and hepatic abnormalities alongside respiratory disorders. The identification of this virus in the feces of more than 50% of infected individuals indicates the possibility of viral shedding and fecal-to-oral transmission. Preliminary reports have also identified alterations in the intestinal microbiota profile in infected individuals. Moreover, COVID-19 patients manifest various degrees of liver injury characterized by alterations in liver enzymes. Digestive symptoms and liver abnormalities correlate with disease severity, the incidence of critical outcomes and patient's recovery. However, the pathogenic mechanisms behind COVID-19-induced abnormalities in the gut-liver axis seem to be multifactorial in origin. This review compiles current knowledge sourced from preclinical and clinical research and summarizes gastrointestinal and hepatic dysfunctions observed following SARS-CoV-2 infection, and also explores the possible mechanisms generating abnormalities in the gut-liver axis. Furthermore, this review sheds light on possible therapeutic targets against these disorders.

Pregnane X receptor activation by its natural ligand Ginkgolide-A improves tight junction proteins expression and attenuates bacterial translocation in cirrhosis

BACKGROUND AND AIMS

Pregnane X receptor (PXR) is a ligand-activated transcription factor and nuclear receptor expressed ubiquitously along gut-liver-axis. Inflammatory bowel disorders have been reported to implicate PXR in maintaining tight junction (TJ) integrity and countering inflammation. However, the hepatoprotective role of PXR activation in soothing bacterial translocation in liver cirrhosis has not been explored. Ginkgolide A (GA), a terpene trilactone from Ginkgo Biloba extract, is a natural ligand of rodent and human PXR. This study aims to investigate the effect of GA in activating PXR and improving associated tight junction integrity and reducing bacterial translocation in gut-liver axis of CCl₄ induced cirrhosis model.

METHODS

Swiss albino mice were administered with CCl₄ (0.5 ml/kg body weight, i.p) in corn oil for 12 weeks at an interval of two times a week. Following ascites induction, mice were randomized & administered 100 mg/kg body weight of GA through oral gavage for 2 weeks. At termination, blood, gut and liver tissues were collected for biochemical and molecular studies.

RESULTS

When compared to naïve mice, protein expression of hepatic and small intestinal PXR, CYP3A, ZO-1 and occludin were found to be significantly (p < 0.01) decreased in CCl₄ induced cirrhotic mice. Treatment with GA to cirrhotic mice significantly (p < 0.05) induced the expression of both hepatic and small intestinal PXR, CYP3A, ZO-1 and Occludin. Furthermore, increased (p < 0.01) hepatic and small intestinal NFκB was observed in CCl₄ induced cirrhotic mice that was significantly (p < 0.05) lowered following GA treatment. Over expression of TLR4/MyD88/NFκB axis and its downstream pro-inflammatory mediators TNF-α, IL6 and IFN-γ were observed in CCl₄ induced mice, and these indices were abrogated significantly after GA treatment. Furthermore, significantly increased plasma levels of bacterial translocation markers LBP and procalcitonin were found in CCl₄ mice, which were reduced significantly (p < 0.05 & p < 0.0001) after GA treatment.

CONCLUSION

In conclusion, our data supports the hypothesis that, GA treatment to CCl₄ induced cirrhotic mice, activated hepatic and small intestinal PXR and diminished inflammation, thereby improving tight junction integrity and attenuating bacterial translocation.

Involvement of dual serotypes during a severe dengue outbreak in Wadi area, Nagpur district, Maharashtra 2017

BACKGROUND & OBJECTIVES

An outbreak of dengue-like illness was reported from Wadi area within the Nagpur Municipal Corporation during September-October 2017 with five deaths. Major symptoms reported were high fever (103-106 ^oF), acute joint pains, myalgia, drowsiness, breathlessness, etc. An investigation was conducted to confirm the etiological agent, its characterization and the vectors involved in the outbreak.

METHODS

Serological analysis was conducted to detect dengue (DEN)/chikungunya IgM antibodies in 158 sera samples. Nested-PCR was carried out to serotype eight ELISA positive samples. Adult and larval mosquito collections were conducted in the affected areas to determine species composition and mosquito density.

RESULTS

Dengue IgM antibodies were detected in 44 sera samples. Molecular typing revealed involvement of DEN-2 and DEN-3 serotypes. Dengue hemorrhagic fever symptoms were observed in two patients. Aedes aegypti breeding was found rampant with Breteu index and house index ranging from 23 to 70 and 17 to 56, respectively. Major breeding habitats encountered were, used tyres, cement tanks and refrigerator trays.

INTERPRETATION & CONCLUSION

Clinical symptoms, detection of anti-DEN IgM antibodies in high number of samples and heavy breeding of Ae. aegypti confirmed it was a dengue outbreak.

Role of pregnane X-receptor in regulating bacterial translocation in chronic liver diseases

Bacterial translocation (BT) has been impeccably implicated as a driving factor in the pathogenesis of a spectrum of chronic liver diseases (CLD). Scientific evidence accumulated over the last four decades has implied that the disease pathologies in CLD and BT are connected as a loop in the gut-liver axis and exacerbate each other. Pregnane X receptor (PXR) is a ligand-activated transcription factor and nuclear receptor that is expressed ubiquitously along the gut-liver-axis. PXR has been intricately associated with the regulation of various mechanisms attributed in causing BT. The importance of PXR as the mechanistic linker molecule in the gut-liver axis and its role in regulating bacterial interactions with the host in CLD has not been explored. PubMed was used to perform an extensive literature search using the keywords PXR and bacterial translocation, PXR and chronic liver disease including cirrhosis. In an adequate expression state, PXR acts as a sensor for bile acid dysregulation and bacterial derived metabolites, and in response shapes the immune profile beneficial to the host. Activation of PXR could be therapeutic in CLD as it counter-regulates endotoxin mediated inflammation and maintains the integrity of intestinal epithelium. This review mainly focuses PXR function and its regulation in BT in the context of chronic liver diseases.

Postcholecystectomy syndrome (PCS)

The term postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. Although rare, these patients may present with abdominal pain, jaundice or dyspeptic symptoms. Many of these complaints can be attributed to complications including bile duct injury, biliary leak, biliary fistula and retained bile duct stones. Late sequelae include recurrent bile duct stones and bile duct strictures. With the number of cholecystectomies being performed increasing in the laparoscopic era the number of patients presenting with PCS is also likely to increase. We briefly explore the syndrome and its main aetiological theories.

Pathology of fungal infections of the central nervous system: 17 years' experience from Southern India

AIMS

To describe the pathology of central nervous system (CNS) fungal infections with particular reference to India.

METHODS AND RESULTS

This was a retrospective study from 1988 to 2004 constituting 130 cases. The diagnosis was based on morphology of biopsy/autopsy material. These included aspergillosis (n=73), zygomycosis (n=40), cryptococcosis (n=2), rhodotorulosis (n=1), candidiasis (n=5), maduramycosis (n=1), pheohyphomycosis (n=3) and mixed infections (n=5). Predisposing risk factors were present in 49 (38%) patients only. The majority of the patients were immunocompetent. The commonest risk factor was diabetes mellitus, the commonest route of infection was from a contiguous site and the commonest pathology was granuloma. Culture positivity was seen in only 31%.

CONCLUSION

Environmental factors in tropical countries such as India play a significant role in the pathogenesis of CNS fungal infections.

Clinical and electroencephalographic study of first-degree relatives and probands with juvenile myoclonic epilepsy

PURPOSE

Juvenile myoclonic epilepsy (JME) is a common, well-defined epileptic syndrome. This study aims to examine the clinical and EEG features of probands with JME and to identify the incidence of different types of idiopathic generalized epilepsies (IGEs) and IGE trait in first-degree relatives.

METHODS

Clinical and EEG data were collected from 132 first-degree relatives and 31 probands with JME. The data were analyzed using descriptive statistics, chi-square test, t-test and ANOVA.

RESULTS

All probands had a history of generalized tonic clonic seizures (GTCS) and myoclonic jerks; 25.8% had a history of absence seizures. Family history of epilepsy was noted in 42% and epilepsy in first-degree relatives was reported in 38.7%. We found JME in 44% of the symptomatic first-degree relatives. The incidence of epilepsy was higher in siblings (19%) than in offspring (8%) or parents (4%), the difference between the groups being significant (p < 0.05). IGE trait was noted in 6% of the asymptomatic first-degree relatives. Finally, IGE features were found in 61%. Subjects with IGE features were younger (mean age 19.6 years) than those without IGE features (mean age 32.4 years) and the difference between the groups was significant.

CONCLUSION

The incidence of different kinds of IGEs and typical EEG trait is high in first-degree relatives of JME probands. IGE features were noted in 61% of the families. JME is the most common type of IGE and IGE features were found to be more frequent among siblings than parents. These findings confirm familial susceptibility to IGE.

Cerebral zygomycosis

Fifty-six patients with cerebral zygomycosis (mucormycosis) were seen during the period 1971-2001 in two tertiary care hospitals located in south India with tropical climate and catering to neurological diseases. Forty-four patients had rhinocerebral and twelve patients had isolated central nervous system (CNS) zygomycosis. Of these, ten were culture proven (Rhizopus oryzae in eight and Mucor in two); 30 were diagnosed as probable and 16 were diagnosed possible; mixed infections were seen in three patients. Diabetes mellitus was the predisposing condition in a majority (31/44) of patients with the rhinocerebral form of zygomycosis. The tissue obtained at biopsy/autopsy in either form showed necrotic/infarcted tissue with neutrophilic infiltration with broad non-septate hyphae showing irregular branching. The outcome was poor despite surgical excision and antifungal therapy. The high concentration of spores in a mouldy environment, the bird population and improper disposal of hospital waste may facilitate healthy hosts presenting with primary CNS disease.

Genetic association analysis of KCNQ3 and juvenile myoclonic epilepsy in a South Indian population

Juvenile myoclonic epilepsy (JME) is a common subtype of idiopathic generalized epilepsy that shows a complex pattern of inheritance. We have tested the association between JME phenotype and an intragenic marker in KCNQ3 by using the transmission disequilibrium test in 119 probands and their parents. Mutations in KCNQ3 are known to cause benign familial neonatal convulsions and are involved in the physiologically important M current in neurons. Our results provide suggestive evidence of allelic association between JME and KCNQ3 ( P-value=0.008) and raise an interesting possibility of a genetic contribution to JME, viz., of a gene that causes a monogenic form of human epilepsy.

Magnetic resonance imaging in rabies

Rabies encephalitis has a classical clinical presentation and its diagnosis is unmistakable. In about a fifth of cases rabies occurs as its paralytic form, which lacks the classic symptoms and may mimic other diseases, especially acute disseminated encephalomyelitis (ADEM). Magnetic resonance imaging of the brain in rabies shows a distinct abnormal pattern that differentiates it from ADEM. Hence it may be a useful tool in diagnosis of paralytic rabies. Failure to administer post-exposure rabies immunoglobulin along with the rabies vaccine may result in vaccine failure.

Subacute encephalopathy with seizures in alcoholism

Generalised seizures are a common manifestation of acute alcohol intoxication. Alcohol is known to precipitate generalised seizures in patients with focal brain pathology. A rare case of secondarily generalised seizures precipitated by alcohol in a patient without an underlying focal brain lesion is reported. Electroencephalopgraphy (EEG) showed periodic lateralised epileptiform discharges (PLEDs) on the side contralateral to the focal motor fits.

Recurrent Miller fisher syndrome: a case report

Miller fisher syndrome (MFS) is a variant of Guillain-Barre syndrome characterized by the triad of ophthalmoplegia, ataxia and areflexia. Recurrences are exceptional with MFS. A case with two episodes of MFS within four years is reported. He presented with findings of ophthalmoplegia, ataxia, areflexia, and oropharyngeal weakness and mild distal sensory impairment during both episodes. Electrophysiological findings showed reduced compound muscle action potentials and sensory nerve action potentials with no evidence of conduction blocks. Nerve biopsy showed segmental demyelination. MRI of brain was normal. He responded well to immunoglobulins during both episodes suggesting that immunomodulating drugs have a role in the treatment of MFS.

Quantitative ELISA for platelet m-calpain: a phenotypic index for detection of carriers of Duchenne muscular dystrophy

In order to measure the amount of m-calpain in platelets from Duchenne muscular dystrophy (DMD) patients, carriers and controls, an enzyme linked immunosorbent assay (ELISA) has been developed using polyclonal antibodies raised against m-calpain (Calcium dependent neutral protease), purified from human placenta. Compared to controls a nine-fold increase in the level of m-calpain was observed in all 25 DMD patients and eight obligate carrier mothers studied. Serum creatine kinase (SCK) values of four of these obligate carriers were found to be overlapping with that of normal values, limiting its usefulness. Since calpain levels were found to be raised in all DMD patients and obligate carriers, the estimation of calpain in all female relatives of the ones affected with DMD (with or without raised serum CK) would prove a facile index. Population screening for carrier females using this cost and labour effective index may help in assessing the carrier status and counselling the at risk families.

Delayed onset generalised dystonia after cyanide poisoning

A 27 year old female developed delayed onset of persistent generalized dystonia following a suicidal attempt with potassium cyanide. Cranial CT scan showed bilateral putaminal hypodensities which were also seen on MRI scans to be hypointense on T1 and hyperintense on T2 weighted images. Multimodality evoked potentials were normal. An improvement was noted with levodopa.

Hemiballismus due to an ipsilateral striatal haemorrhage: an unusual localization

Hemiballismus has been correlated clinico-anatomically with lesions of the contralateral side, most commonly of the subthalamic nucleus. Hemiballismus due to an ipsilateral lesion is extremely rare. We report the case of a 55 year old female who developed a right sided hemiballismus due to a right striatal haemorrhage, which simultaneously caused a left hemiplegia. The hemiballismus subsided on treatment with dopamine-blockers over the next two weeks.

Bilateral cavernous sinus thrombosis causing Korsakoff's amnesic syndrome

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A rare presentation of posterior communicating artery aneurysm

This is a report of a successfully treated case of a 55-year-old woman with posterior communicating artery aneurysm who had a partial 3rd nerve palsy with pupillary sparing, temporal lobe intracerebral hematoma and a subdural hematoma. Such an association has not been reported earlier.

Visual evoked potentials and visual acuity after transurethral resection of the prostate

Changes in visual evoked potentials, visual acuity, blood ammonia levels and serum electrolytes (Na+ and K+) after transurethral resection of the prostate using glycine as an irrigating fluid performed under subarachnoid block were studied in 12 patients, in the pre-operative and immediate postoperative periods. Visual evoked potentials (p100 latency), recorded by shift of a checkerboard pattern, increased significantly from a pre-operative value of mean (SEM) 101.18 (1.63) msec in the right eye, and 102.5 (1.47) msec in the left eye to 108.91 (1.8) msec (p less than 0.01) and 108.08 (2.53) msec (p less than 0.01) respectively in the postoperative phase. There were no changes in visual acuity as assessed by a Snellen's chart, blood ammonia levels and serum electrolyte concentrations. The amount of glycine used intra-operatively for irrigation ranged from 3 to 31 litres.

Eating epilepsy

Three young male patients are described in whom the attacks of epilepsy were precipitated by eating. The interictal EEG was abnormal in 2 cases. One showed generalized seizure discharges; the other unilateral and generalized seizure discharges. The attacks could only partially be controlled with anticonvulsants. Various mechanisms which may be responsible in precipitating the seizures are discussed.

Aspergillosis of the central nervous system

Aspergillosis of the central nervous system is rare. The spread to the CNS is usually from the lungs and uncommonly from paranasal sinuses. Four cases of CNS aspergillosis with spread of infection from the paranasal sinuses are described. Two patients had meningitis, one intracranial granuloma and one presented with subarachnoid haemorrhage resulting from a fungal mycotic aneurysm. Difficulties in establishing the diagnosis are discussed.