The presence and possible role of monocyte infiltration in human chronic proliferative glomerulonephritides. Light microscopic, immunofluorescence, and histochemical correlations.

Twenty-seven cases of chronic glomerulonephritis with proliferative pattern (11 cases of primary mixed IgG-IgM cryoglobulinemia, 8 cases of SLE, and 8 cases of primary membranoproliferative glomerulonephritis) were studied with particular attention to the glomerular monocyte infiltration. The latter, detected by means of nonspecific esterase technique, was compared with the presence of hyaline thrombi and intraluminal immunoglobulin lumps. Monocyte infiltration was heavy and almost constant in cryoglobulinemia, less important in SLE, and practically absent in membranoproliferative glomerulonephritis. By means of immunofluorescence technique on paraffin embedded material, monocytes are shown to contain IgG and IgM, suggesting a phagocytic activity on some types of immune complexes. Since monocytes are migrant cells, and therefore easily removable from the glomeruli by the bloodstream, it seems that they could be responsible for regression of glomerular hypercellularity as reported in some patients with cryoglobulinemia showing clinical improvement.     

Paradoxical reaction in tubercular meningitis resulting in involvement of optic radiation

A 25-year-old woman was diagnosed to have tubercular meningitis (TBM) with a right parietal infarct. She responded well to four-drug anti-tubercular treatment (ATT), systemic steroids and pyridoxine. Steroids were tapered off in one and a half months; she was put on two-drug ATT after two months. Six months after initial diagnosis she presented with sudden, bilateral visual loss. Vision was 3/200 with afferent pupillary defect and un-recordable field in the right eye; vision was 20/60 in the left eye, pupillary reaction was sluggish and the field showed a temporal hemianopia. On reintroduction of systemic corticosteroids vision improved (20/120 in right eye and 20/30 in left eye) within three days; the field defects improved sequentially to a left homonymous hemianopia, then a left homonymous inferior quadrantonopia. A diagnosis of TBM, on treatment, with bilateral optic neuritis, and right optic radiation involvement was made. Since the patient had been off ethambutol for four months, the optic neuritis and optic radiation lesion were attributed to a paradoxical reaction to tubercular allergen, corroborated by prompt recovery in response to corticosteroids. This is the first report of optic radiation involvement in a paradoxical reaction in neuro-tuberculosis in a young adult.     

Is there an irritable bladder in the irritable bowel syndrome?

In this prospective case controlled study 16 premenopausal women with documented irritable bowel syndrome were recruited from the gastroenterology clinic and 16 premenopausal controls without symptoms of irritable bowel syndrome were recruited from the gynaecology clinic. All women answered a standardised bowel and urinary symptom questionnaire and underwent twin channel subtracted cystometry. Women with irritable bowel syndrome also underwent oesophageal balloon distension studies for perception and pain. Oesophageal and bladder sensory thresholds were compared. Urinary frequency and urgency and the urodynamic finding of detrusor instability were significantly more common in women with irritable bowel syndrome (P < 0.05). We were unable to demonstrate a relationship between first sensation of bladder fullness and oesophageal perception or between maximum bladder capacity and oesophageal pain thresholds. These findings suggest that there is an irritable bladder in the irritable bowel syndrome and support the concept that irritable bowel syndrome is part of a generalised disorder of smooth muscle.     

Hdac1 Regulates Differentiation of Bipotent Liver Progenitor Cells During Regeneration via Sox9b and Cdk8

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Design Strategies,Chemistry and Therapeutic Insights of Multi-target Directed Ligands as Antidepressant Agents

Depression is one of the major disorders of the central nervous system worldwide and causes disability and functional impairment. According to the World Health Organization, around 265 million people worldwide are affected by depression. Currently marketed antidepressant drugs take weeks or even months to show anticipated clinical efficacy but remain ineffective in treating suicidal thoughts and cognitive impairment. Due to the multifactorial complexity of the disease, single-target drugs do not always produce satisfactory results and lack the desired level of therapeutic efficacy. Recent literature reports have revealed improved therapeutic potential of multi-target directed ligands due to their synergistic potency and better safety. Medicinal chemists have gone to great extents to design multi-target ligands by generating structural hybrids of different key pharmacophores with improved binding affinities and potency towards different receptors or enzymes. This article has compiled the design strategies of recently published multi-target directed ligands as antidepressant agents. Their biological evaluation, structural-activity relationships, mechanistic and in silico studies have also been described. This article will prove to be highly useful for the researchers to design and develop multi-target ligands as antidepressants with high potency and therapeutic efficacy.     

Urology practice patterns after residency training in laparoscopy

PURPOSE: Laparoscopic training has been incorporated into many urology residency programs. Although the impact of laparoscopic training courses has been examined, the impact of residency training in laparoscopy on subsequent urology practice patterns has not been assessed. MATERIALS AND METHODS: Urologists completing their residency from 1977 through 1999 at Tulane University and the University of California-San Diego were sent anonymous questionnaires in September 2000. The questionnaires evaluated practice demographics, operative experience in laparoscopy during residency, and the role of laparoscopy in the urologist's current practice. Factors impacting the decision to perform or not perform laparoscopy were evaluated. RESULTS: Sixty-one former residents (67%) responded to the questionnaire. Urologists were more likely to perform laparoscopic procedures if they had been trained during their residency (69%) than if they had no experience during residency (34%; p < 0.025). Intensity of laparoscopic experience in residency did not appear to correlate with ongoing practice, with 73% of residents having <15 cases during residency training continuing to perform laparoscopy compared with 67% of residents doing 15 to 80 laparoscopic cases. Urologists who had been trained in laparoscopy during residency cited the need for more training (47%) and inadequate case volume (47%) as reasons for not currently performing laparoscopy. Among those who had received residency training, the most common reasons given were inadequate case volume (61%) and increased operative time (57%). CONCLUSIONS: This survey suggests that laparoscopic procedures are more likely to be performed by physicians who have received training during residency. As the number of urologists who have been trained in laparoscopy during residency increases, shifts in practice patterns will continue to evolve, along with advances in urologic laparoscopy.     

Changing bacteriological patterns in neonatal septicaemia

The various organisms responsible for septicaemia and their changing sensitivity patterns were studied. The incidence of neonatal septicaemia was 26·3%. Group I comprised of 242 cases in 1981–1982 and group II 150 cases in 1984. Gram negative organisms were isolated in the majority of blood cultures, 52·5% and 43·4% in group I and II respectively. Klebsiella though showing a fall in incidence, still remained the commonest Gram negative organism isolated. The incidence of E. coli, pseudomonas and staphylococcal infections also doubled in group II as compared to group I. An alarming trend was the increasing resistance of the isolates to commonly used penicillins and aminoglycosides. The incidence of organisms resistant to all commonly used antibiotics has also increased from 13% to about 40%. This problem could be combated by rotating the commonly used antibiotic combinations, as well as discouraging the unnecessary use of antibiotics.