Evaluation of the motor cortical excitability changes after ischemic stroke

Background:

We evaluated progressive changes in excitability of motor cortex following ischemic stroke using Transcranial Magnetic Stimulation (TMS).

Materials and Methods:

Thirty-one patients (24 men, 7 women; age 37.3 ± 8.2 years) were recruited and TMS was performed using Magstim 200 stimulator and a figure-of-eight coil. Resting motor threshold (RMT) was recorded from affected and unaffected hemispheres and motor evoked potential (MEP) was recorded from contralateral FDI muscle. Central motor conduction time (CMCT) was calculated using F wave method. All measurements were done at baseline (2^nd), 4^th, and 6^th week of stroke.

Results: Affected hemisphere:

MEP was recordable in 3 patients at baseline (all had prolonged CMCT). At 4 weeks, MEP was recordable in one additional patient and CMCT remained prolonged. At 6 weeks, CMCT normalized in one patient. RMT was recordable (increased) in 3 patients at baseline, in one additional patient at 4 weeks, and reduced marginally in these patients at 6 weeks.

Unaffected hemisphere:

MEP was recordable in all patients at baseline, and reduced significantly over time (2^nd week 43.52 ± 9.60, 4^th week 38.84 ± 7.83, and 6^th week 36.85 ± 7.27; P < 0.001). The CMCT was normal and remained unchanged over time.

Conclusion:

The increase in excitability of the unaffected motor cortex suggests plasticity in the post-stroke phase.     

The use of HE4 in the prediction of ovarian cancer in Asian women with a pelvic mass

ObjectiveThe purpose of this study was to evaluate the performance of human epididymis protein 4 (HE4) and the Risk of Ovarian Malignancy Algorithm (ROMA) for distinguishing between benign and malignant pelvis masses in Asian women.MethodsThis was a prospective, multicenter (n = 6) study with patients from six Asian countries. Patients had a pelvic mass on imaging and were scheduled to undergo surgery. Serum CA125 and HE4 were measured on preoperative samples. CA125, HE4, and ROMA were evaluated for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).ResultsA total of 414 women with an adnexal mass were evaluated, of which 65 had epithelial ovarian (EOC) cancer, 16 had borderline tumors and 11 had other malignant diseases. Compared to CA125, HE4 had lower sensitivity (56.9% vs 90.8%) and NPV (91.8% vs 97.3%), but improved specificity (96.9% vs 67.1%) and PPV (78.7% vs 35.8%) for differentiating between benign pelvic mass and EOC. ROMA had similar sensitivity (89.2% vs 90.8%) and NPV (97.6% vs 97.3%) as CA125, but showed improved specificity (87.3% vs 67.1%) and PPV (58.6% vs 35.8%). ROMA accurately predicted 87.3% of benign cases as low risk, and 82.6% of stage I/II EOC and 89.2% of all EOC as high risk.ConclusionROMA showed similar sensitivity as CA125 but improved specificity and PPV, especially in premenopausal women. Using ROMA may help predict if a pelvic mass is benign or malignant and facilitate subsequent management planning.     

Acute and subacute toxicity of chloroform and hexaneextracts of root of Xanthium strumarium

Xanthium strumarium Linn. is used in Indian and Chinese complementary medicines for its various therapeutic properties. There are reports stating that the plant is toxic and lethal to cattle and swine. We have studied the oral toxicity of chloroform and hexane soluble fractions of root extract of X. strumarium in Wistar rats. The toxicity determination was done according to the Organization for Economic Cooperation and Development guidelines. In the acute study with a single oral dose of extracts at 5?g/kg body weight, there was no mortality or signs of toxicity. In the subacute study, none of the blood elements were significantly affected in male and female rats after 28?days. Acute and subacute administration of chloroform and hexane soluble fractions of root did not produce any adverse reactions or any significant changes in organ weight, mortality, and the body weights as compared to untreated controls. Administration of these extracts did not alter the hepatic and renal function, and did not produce any change in the hematological parameters. The study indicates that acute and subacute administration of X. strumarium did not produce any toxicity to rats as evident from weight change, mortality, and limited biochemical and histopathological analysis. Hence, the extracts are considered as unclassified and are found to be safe.     

Autopsy study of fatal deliberate self harm

A retrospective autopsy study of fatal deliberate self harm (FDSH) was undertaken in the mortuary of Kasturba Hospital, Manipal, Southern India over a period of 12 years (1993-2004). Out of 1917 cases autopsied, 21.2% were deaths due to deliberate self harm (DSH). The male sex (66.1%) and victims in the third decade of life (35.9%) predominated. More than two-thirds of the decedents were married. More fatalities were observed during the winter season (35.8%) and in the day time (62.2%). Dispair with life (61.9%) was the most common motive for FDSH. The majority of fatalities were due to poisoning (73.5%), where organophosphorous compounds topped the list (71.9%). About one-third of the victims survived for 18 to 24 hours after DSH.     

Predicting anti-HIV activity of 1,3,4-thiazolidinone derivatives: 3D-QSAR approach

HIV-1 (human immunodeficiency virus type-1) is the pathogenic retrovirus and causative agent of AIDS. HIV-1 RT is one of the key enzymes in the duplication of HIV-1. Inhibitors of HIV-1 RT are classified as NNRTIs and NRTIs. NNRTIs bind to a region that is not associated with the active site of the enzyme. Within the NNRTIs category, there is a set of inhibitors commonly referred to as thiazolidinone derivatives. The present 3D-QSAR study attempts to explore the structural requirements of thiazolidinone derivatives for anti-HIV activity. Based on the structures and biodata of previous thiazolidinone analogs, 3D-QSAR studies have been performed with a training set consisting of 96 molecules, which resulted in two reliable computational models, CoMFA and CoMSIA with r(2) values of 0.931 and 0.972, standard error of estimation (SEE) of 0.173 and 0.089, and q(2) values of 0.663 and 0.784, respectively, with the number of partial least-squares (PLS) components being six. It is shown that the steric and electrostatic properties predicted by CoMFA contours and the hydrogen bond acceptor, hydrogen bond donor, and hydrophobic properties predicted by CoMSIA contours are related to anti-HIV activity. The predictive ability of the resultant model was evaluated using a test set comprising of 17 molecules and the predicted r(2) values of CoMFA and CoMSIA models were 0.861 and 0.958, respectively. These models are more significant guide to trace the features that really matter especially with respect to the design of novel compounds.     

Postural orthostatic tachycardia syndrome: anesthetic implications in the obstetric patient

We report the anesthetic management of a parturient with postural orthostatic tachycardia syndrome. This syndrome is associated with hemodynamic instability, which can be worsened by the physiology of labor and delivery. We discuss anesthetic concerns with this disease in the parturient and suggest approaches for management of this disease.     

Reversible parkinsonism following ventriculoperitoneal shunt in a patient with obstructive hydrocephalus secondary to intraventricular neurocysticercosis

Parkinsonism with evidence of midbrain dysfunction has been reported in a few patients with aqueductal stenosis after placement of ventriculoperitoneal (VP) shunt. The response to levodopa is variable. We report a patient with neurocysticercosis of the fourth ventricle who developed transient parkinsonism without evidence of midbrain dysfunction after placement of a VP shunt. The frequency of tremor was 5-5.5 Hz. Though the response to levodopa was initially slow, later it was significant, and after 3 months he was asymptomatic without levodopa. The exact pathophysiology of parkinsonism in our patient remained obscure.     

Early expression of E-selectin,tumor necrosis factor α, and mast cell infiltration in the salivary glands of patients with systemic sclerosis

Objective. To assess the predictive value of early endothelial E-selectin and tumor necrosis factor α (TNFα) expression, as well as mast cell infiltration, in the subsequent progression to systemic sclerosis (SSc) in patients with Raynaud's phenomenon (RP) and abnormal nailfold capillaroscopic findings. Methods. Clinical criteria were evaluated, and immunostaining was performed on lip biopsy samples from 22 patients with RP and abnormal capillaroscopic results. None of these patients initially fulfilled the American College of Rheumatology criteria for SSc. Results. E-selectin, TNFα, and mast cell infiltration were found in 9, 10, and 8 of 11 patients, respectively, whose disease progressed to SSc, and in 0, 2, and 1 of 11 patients, respectively, whose disease did not progress to SSc (P < 0.001, P < 0.01, and P < 0.01, respectively). Conclusion. E-selectin, TNFα, and mast cell infiltration are detectable in the very early stages of SSc, prior to the onset of skin changes.