A Study of Dermatoglyphic Patterns in Epileptic Patients

The aim of study was to establish a relation of dermatoglyphic patterns of palm in epileptic and normal subjects so that it may be used as a diagnostic tool for identifying cases at risk. The dermatoglyphic study was carried out on 50 patients of epilepsy and 50 normal subjects. The dermatoglyphic traits, which presented a significant difference, were a-b ridge count, lateral deviation, c-line pattern, palmar pattern and finger tip pattern. Mean values of a-b ridge count were more in epileptic patients, especially in left hand, than controls. The ratio of ulnar and radial lateral deviation in control was 1:3 while in epileptic it was 1:5. C-line pattern presented less frequency of proximal and ulnar type patterns in cases. Radial type of C-line pattern was higher in cases. On the other hand this pattern was absent in 29% of controls than cases (8%). Arch type of palmar patterns were showing a very significant difference between controls (79%) and cases (2%). Frequency of loops were much more and vestiges were absolutely absent in cases. The frequency of Arch type of finger tip pattern was more in control. These findings suggest that antenatal factors may contribute to the etiology of epilepsy. A considerable progress in dermatoglyphics has been established as a useful diagnostic and research tool in medicine.     

Colestyramine slows gastric emptying of liquids and reduces appetite in healthy subjects

Background There is evidence to suggest that the particulate resin colestyramine, a bile acid sequestrant formerly used as a cholesterol‐lowering agent, enhances secretion of the gut hormone cholecystokinin (CCK). Established physiological actions of CCK include inhibition of gastric emptying and induction of satiation. This study evaluated the hypothesis that colestyramine, which is luminally retained, would slow gastric emptying of liquids and suppress appetite in humans. Methods Nine healthy volunteers consumed 500 mL liquid test meals containing 4 g colestyramine, 12 g colestyramine, or control (water alone), on three occasions, in a randomized order. The effect of colestyramine on gastric emptying was determined non‐invasively using the ¹³C‐acetate breath test, and appetite and other gut‐centered sensations were rated using visual analog scale questionnaires. Key Results Colestyramine dose dependently slowed liquid gastric emptying compared with control (water) (4 g vs control, ～20% reduction, P < 0.05; 12 g vs control, ～35% reduction, P < 0.01). Colestyramine also significantly reduced hunger (4 g vs control, ～20% reduction, P < 0.01), and the amount of food participants felt able to eat (12 g vs control, ～32% reduction, P < 0.001), but increased bloating (both doses, P < 0.05), with no effect on ratings of nausea. Conclusions & Inferences This study provides the first evidence that colestyramine significantly slows liquid gastric emptying and reduces appetite in healthy humans. Colestyramine therefore presents an attractive gut‐brain signaling research tool in that it is not absorbed and thus lacks potentially confounding postabsorptive effects. Furthermore, with clear effects on gastric emptying and appetite, colestyramine now merits consideration as a trial therapeutic strategy for appetite suppression and weight loss.     

Antimicrobial susceptibility pattern and prevalence of extended spectrum beta-lactamase (ESBLs) producing strains of Klebsiella pneumoniae from a major hospital in New Delhi

Extended spectrum beta-lactamases (ESBLs) are plasmid mediated enzymes capable of hydrolyzing penicillins, broad spectrum-cephalosporins and monobactams. The ESBL producing K. pneumoniae strains are being reported from around the world including India. The present study was taken up to evaluate the ESBL production and in-vitro susceptibility of K. pneumoniae isolates from a hospital. The bacterial isolates collected during 2003 included 51 K. pneumoniae biochemically confirmed isolates from 395 patients admitted in various wards of a major hospital in New Delhi. The isolates were from pus, wound, pleural fluid, urine and tracheal aspirate of patients attending respiratory, urology and burns wards. Antimicrobial susceptibility was carried out by Kirby Bauer's disc diffusion technique using NCCLS criteria. A screening of ESBL production was done by Double-disc synergy test (DDST) and using E-test ESBL strips. The frequency of resistance among K. pneumoniae for the cephalosporins (cefoxitin, cefuroxime, cefotaxime, ceftazidime, and cefepime) and non-cephalosporins (aztreonam, piperacillin, chloramphenicol and trimethoprim-sulfamethoxazole) were in the range of 39.2-88.0% and 51.0-90.2% respectively. 14 different antimicrobial resistance profiles were recognized ranging from resistance to only four (n=6, 11.7%) to as many as ten (n=9, 17.7%). Among the 51 isolates of K. pneumoniae strains, a total of 36 (70.6%) could be identified as ESBL producers, that correlates with the high frequency of multi-drug resistant K. pneumoniae The study shows alarming rise in ESBL production among K. pneumoniae strains and high rate of resistance to a wide range of cephalosporin and non-cephalosporin group of antimicrobials.     

Out-of-hospital automatic cardioversion of ventricular tachycardia

A 42 year old man who survived sudden cardiac death was treated with an automatic implantable cardioverter/defibrillator. After a 5 month symptom-free interval, the patient received two internal discharges in the conscious state while wearing an ambulatory electrocardiographic recorder. Analysis of the tape revealed that both discharges were activated by two bursts of polymorphous ventricular tachycardia, the first one occurring at the end and the second at the onset of episodes of slow, hemodynamically stable monomorphous ventricular tachycardia. This case illustrates the reliability of the automatic implantable cardioverter/defibrillator as an antiventricular tachycardia device and the problem posed by its exposure to nonsustained ventricular tachycardia.     

Carotid artery occlusive disease

Stroke is the third most common cause of death and the leading cause of disability in the United States. Management of identifiable risk factors and careful selection of patients for operative intervention constitute the current approach to reducing the morbidity and mortality associated with stroke. A carefully performed carotid endarterectomy (CEA), which has a low periprocedural complication rate, is the only form of mechanical cerebral revascularization for which definitive evidence of clinical effectiveness has been reported. Recently, retrospective case reports and case series have demonstrated the feasibility of carotid angioplasty and stenting as a possible alternative to CEA. In the tradition of the two previous National Institutes of Health (NIH)-sponsored trials--the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS)--the National Institutes of Health has sponsored a clinical trial (CREST: Carotid Revascularization-Endarterectomy vs Stent Trial) that is currently under way to determine the efficacy and risks of carotid angioplasty and stenting compared with CEA.     

Safety and potential cost savings of same-setting electrophysiologic testing and placement of transvenous implantable cardioverter-defibrillators

BACKGROUND: Separately, electrophysiologic study (EPS) and placement of a transvenous implantable cardioverter-defibrillator (ICD) can be performed safely in the majority of patients. The safety and potential cost savings of same-setting procedures have not been evaluated. HYPOTHESIS: Electrophysiologic study and placement of transvenous ICDs can be performed safely in the same setting at reduced cost. METHODS: In all. 160 (mean age 65 +/- 10 years, 75% men) and 41 (mean age 66 +/- 11 years, 73% men) consecutive patients who underwent same- versus separate-setting procedures, respectively, were prospectively evaluated. RESULTS: The two groups had similar clinical characteristics and indications for EPS and ICD therapy. Complications occurred in eight patients (5.0%, 95% confidence interval [CI] 2.3-10.3) who had same-setting procedures (one hypotension during ICD testing, one pocket hematoma, two lead dislodgments, two pneumothoraces, one stroke, and one infection) and in two (4.9%, CI 0.60-16.5) who had separate-setting procedures (one pocket hematoma and one infection). There were no procedure-related deaths or long-term ICD-related complications in either group. The mean time from ICD implantation to hospital discharge was similar in the two groups (2.5 +/- 2.4 vs. 2.7 +/- 2.2 days, p = NS). The combined procedure cost was higher in patients who had separate-setting procedures ($12,403 +/- 1,386 vs. $10,242 +/- 2.256, p = < 0.001). who incurred an additional hospital cost of $2,121 +/- $2,125 for the waiting period (1.7 +/- 1.6 days) between EPS and ICD implantation. CONCLUSIONS: In patients deemed candidates for ICD therapy based on EPS results, placement of transvenous defibrillators in the same setting as EPS is as safe as separate-setting procedures and, if adopted, could further reduce the cost of providing ICD therapy.     

Neurological monitoring and sedation protocols in the Liver Intensive Care Unit

Metabolic Brain Disease - Patients with liver disease often have alteration of neurological status which requires admission to an intensive care unit. Patients with acute liver failure (ALF),...     

Enhanced diagnostic specificity in human filariasis by IgG4 antibody assessment

Phosphocholine (PC), an immunodominant molecule present on a wide range of organisms, including filariae, evokes antibody responses that lead to false-positive reactions in routine serological assays. Humans essentially do not respond to PC in the IgG4 subclass; therefore, by configuring an enzyme immunoassay to assess antibodies of the IgG4 subclass only, we were able to eliminate serological false-positive results in 32 of 34 cross-reactive sera from patients with non-filarial parasitic infections. Specificity was thus greatly enhanced with minimal loss of sensitivity. Because preadsorption of these cross-reactive sera to remove antibodies to PC eliminated only approximately 50% of the original cross-reactivity, other shared epitopes (perhaps similar to PC) are also likely to be restricted by IgG subclass.     

Interleukin-2 induction of lymphokine-activated killer (LAK) activity in the peripheral blood and bone marrow of acute leukemia patients: II. Feasibility of LAK generation in children with active disease and in remission

Activation and expansion in culture with rIL-2 of peripheral blood (PB) and/or bone marrow (BM) specimens derived from children with ALL and ANLL, with active disease (AP) and in remission were studied (RP). Baseline NK cytolytic activity from AP was found to be depressed, whereas RP-derived cells had normal NK activity, as assayed against K562 targets. Culture in rIL-2 significantly enhanced the NK activity of both AP- and RP-derived cells and generated LAK activity, as assayed by 4-hour 51Cr release, against NK-resistant Raji cell line and against fresh, allogeneic, and autologous tumor cells. Lytic activity against fresh, cryopreserved leukemia blasts was of lower than that found against cell lines. In three patients higher lytic activity against autologous than against allogeneic blasts was demonstrated. Expansion in culture with rIL-2 varied from twofold to 120-fold. rIL-2 activation and expansion was better in RP than in AP. The predominant phenotype of activated cells, as determined by flow cytometry, was [mean % (SD)]: CD3- = 54 (12), CD8+ = 55 (17), and NKH1+ = 26 (7). The consistently high level of CD8+ cells was accompanied by very low levels of CD4+ cells: mean = 11% (14). Double-marker analysis showed mean of 33% (10) for CD3+/NKH1+ cells and mean = 32 (11) for CD8+/NKH1+ cells, implying that these populations were overlapping. Kinetics of expression of cell surface markers during 2 to 3 weeks in culture showed that CD8+ and NKH1+ enrichment occurred during the first week and lasted for up to 4 weeks, whereas CD4+ expression decreased after the second week. A significant decrease in the expression of IL-2 receptors (CD25) was observed from the second week of culture. This study shows the feasibility of in vitro generation of killer cells from PB and BM of pediatric leukemia patients.