The newer unconventional indications of permanent pacemakers

In recent years, the indications for permanent pacemakers have expanded. The interest has focussed on hypertrophic cardiomyopathy, dilated cardiomyopathy and a new entity called hypertensive hypertrophy with cavity obliteration (HHCO). Pacemaker therapy is establishing itself for the prevention of atrial fibrillation. Pacing for neurocardiogenic syncope with newer pacing mode has encouraging datas. Pacemaker for long QT syndrome, after cardiac transplant and for haemodynamic improvement in occasional cases of first degree atrio-ventricular block is getting attention. The AHA and ACC guidelines updated in 1998 for implantation of cardiac pacemakers, now include several of these newer indications.     

Cytokines: the yin and yang of vitiligo pathogenesis

Introduction: Dysregulation of melanocyte function is associated with vitiligo, an idiopathic autoimmune hypopigmentary skin disorder, caused by the selective destruction of melanocytes. Cytokines, the key mediators of immune response, which are pivotal in maintaining immune homeostasis, are crucial in vitiligo pathogenesis. Several studies indicate that there is an imbalance between pro- and anti-inflammatory cytokines in the skin and serum of vitiligo patients.

Areas covered: In this comprehensive review, we have summarized the correlation of cytokine imbalance and vitiligo pathogenesis, its role in melanocyte biology, and its impact on vitiligo treatment. We have integrated various published reports on the levels of major cytokines from skin and serum samples of vitiligo patients. We have also discussed the role of endoplasmic reticulum and oxidative stress on cytokine imbalance and vice versa leading to destruction of melanocytes.

Expert commentary: The review reflects that dysregulation of cytokines is multifactorial, ranging from genetic predisposition to altered protein expression relevant to vitiligo pathogenesis. We emphasize that cytokine imbalance in systemic and skin microenvironment plays a crucial role in vitiligo pathogenesis and has promising potential as therapeutic targets for vitiligo.     

Community Based Assessment of Unintentional Injuries in a Community Development Block of Purba Bardhaman District,West

BackgroundInjuries are a focus of public health practice because they pose a serious health threat and are preventable. Currently, injury accounts for 14% of all Disability Adjusted Life Years (DALYs) losses for the world''s entire population. In India, unintentional injuries within the home environment have not so far been recognized to the same extent as traffic and work-related injuries among all age groups. With this background, a community based epidemiological study was conducted with the aim to find out the prevalence and epidemiology of unintentional injuries.MethodsA cross-sectional study was conducted during July 2018 - June 2019 in Bhatar block of Purba Bardhaman District. Cluster random sampling was applied to select required sample of 555 individuals from 24 villages. The study tools used were a predesigned and pretested schedule developed by the researchers with the help of Guidelines for conducting community surveys on injuries by World Health Organization (WHO) and a checklist for assessing household level injury hazard. The study had approval from Institutional Ethics Committee. Chi square test and multivariable logistic regression were performed using SPSS V16.ResultsPrevalence of unintentional injury was 8.8 % in the preceding three months. Multivariable logistic regression revealed that those who were below 18 years of age, severely vulnerable to unintentional injuries and belonged to nuclear families had significantly higher odds of developing unintentional injuries at home.ConclusionUnintentional injury is prevalent in West Bengal. Dissemination of injury prevention information with special focus on household modification is an effective strategy to prevent unintentional injuries.     

Juvenile dermatomyositis associated with autoantibodies to small ubiquitin-like modifier activating enzyme: a report of 4 cases from North India and a review of literature

Immunologic Research - Juvenile dermatomyositis (JDM) is the commonest inflammatory myositis in children. The clinical phenotype is often characterized by the presence of myositis-specific...     

Effect of premenstrual stress on audiovisual reaction time and audiogram

A study of weight, auditory reaction time (ART), visual reaction time (VRT) and audiogram was carried out on 105 healthy female subjects between the age of 17-20 years during the premenstrual and post-menstrual phase. A significant increase in weight and prolongation in auditory reaction time (ART) and visual reaction time (VRT) were observed during premenstrual phase. A slight increase in decibel loss was also observed during premenstrual phase in audiogram though not significant. These changes could be attributed to fluid and salt retention due to overain steroids leading to decrease in the processing capability of central nervous system.     

Co-cultivation of Niemann-Pick disease type C fibroblasts belonging to complementation groupsα andβ stimulates LDL-derived cholesterol esterification

Summary Niemann-Pick disease type C (NPC) is a neurovisceral storage disorder with an unknown primary deficiency. Somatic cell hybridization experiments using human cultured fibroblasts have shown that two complementation groups (NPC- and NPC-) are associated with the biochemical and clinical phenotypes comprising NPC. We identified the rarer complementation group NPC- originally using the technique of filipin staining as a marker for complementation. In this study we show that the esterification of cholesterol derived from the LDL pathway can be used as an isotopic assay. However, multinuclear hybrids exhibit a delayed induction in this pathway. Furthermore, we discovered that, in the presence of an LDL source, co-cultivation of fibroblasts belonging to NPC- and NPC- stimulated cholesterol esterification.     

Randomized comparison between fluconazole and itraconazole for the treatment of candidemia in a pediatric intensive care unit: a preliminary study.

OBJECTIVE: Candida bloodstream infections have shown an increase in hospitalized patients, especially those receiving intensive care. The effectiveness of various azoles, especially itraconazole, in treatment of candidemia has not been fully evaluated. Our objective was to compare the efficacy and safety of enterally administered itraconazole vs. fluconazole in treatment of candidemia. DESIGN: Randomized, double-blind, controlled trial. SETTING: Pediatric intensive care unit of a referral and teaching hospital. SUBJECTS: Forty-three pediatric patients with candidemia, INTERVENTION: Patients received either fluconazole (n = 22) or itraconazole (n = 21), about 10 mg/kg orally or through a gastric tube, and were monitored for clinical and mycological cure (sterile fungal blood culture), blood counts, and liver and renal functions. MEASUREMENTS AND MAIN RESULTS: The clinical characteristics of two groups were comparable. The cure rate was similar in both the groups: itraconazole 17 of 21 (81%) and fluconazole 18 of 22 (82%). Crude mortality rate (itraconazole 9.5% and fluconazole 13.6%) was also comparable in two groups of patients. The frequency of electrolyte disturbance was very low and similar in both the groups. Blood urea, creatinine, liver enzymes, and serum bilirubin were not adversely affected. CONCLUSIONS: Itraconazole was as effective as fluconazole in nosocomial candidiasis in children receiving intensive care and was devoid of serious side effects.     

STRUCTURAL CHARACTERISATION OF AN IMMUNOMODULATING POLYSACCHARIDE ISOLATED FROM AQUEOUS EXTRACT OF PLEUROTUS FLORIDA FRUIT-BODIES

The water-soluble glucan was obtained from Pleurotus florida fruit bodies by hot water extraction, ethanol precipitation, DEAE cellulose dialysis and Sephadex G-75 gel filtration. The structural information of the glucan was achieved by chemical (hydrolysis, methylation, periodate oxidation) and spectroscopic (¹H and ¹³C) analyses, indicated a repeating unit built up of (1→6)-linked D-glucose. The following structure has been determined for the repeating unit: →6)-α-D-Glcp-(1→ This fraction exhibited significant macrophage activity through the release of nitric oxide     

Tumor growth inhibition through targeting liposomally bound curcumin to tumor vasculature

Increasing number of Phase I/II clinical studies have demonstrated clinical potential of curcumin for treatment of various types of human cancers. Despite significant anti-tumor efficacies and bio-safety profiles of curcumin, poor systemic bioavailability is retarding its clinical success. Efforts are now being directed toward developing stable formulations of curcumin using various drug delivery systems. To this end, herein we report on the development of a new tumor vasculature targeting liposomal formulation of curcumin containing a lipopeptide with RGDK-head group and two stearyl tails, di-oleyolphosphatidylcholine (DOPC) and cholesterol. We show that essentially water insoluble curcumin can be solubilized in fairly high concentrations (~ 500 μg/mL) in such formulation. Findings in the Annexin V/Propidium iodide (PI) binding based flow cytometric assays showed significant apoptosis inducing properties of the present curcumin formulation in both endothelial (HUVEC) and tumor (B16F10) cells. Using syngeneic mouse tumor model, we show that growth of solid melanoma tumor can be inhibited by targeting such liposomal formulation of curcumin to tumor vasculature. Results in immunohistochemical staining of the tumor cryosections are consistent with tumor growth inhibition being mediated by apoptosis of tumor endothelial cells. Findings in both in vitro and in vivo mechanistic studies are consistent with the supposition that the presently described liposomal formulation of curcumin inhibits tumor growth by blocking VEGF-induced STAT3 phosphorylation in tumor endothelium. To the best of our knowledge, this is the first report on inhibiting tumor growth through targeting liposomal formulation of curcumin to tumor vasculatures.     

Pigmented malignant teratoid medulloepithelioma of ciliary body – An extremely rare intraocular tumor in adult

Malignant teratoid medulloepithelioma of ciliary body is an extremely rare tumor usually occurring in children younger than 5 years of age and is usually amelanotic. Here, we report a very rare case of pigmented malignant teratoid medulloepithelioma in a 20-year old male patient who presented initially with pain, redness and proptosis of right eyeball. The right eyeball was enucleated. A histopathological diagnosis of orbital teratoma was made and no further treatment was given. Four months later, the patient developed another swelling in the same area. A review of the previous histopathology slides revealed a pigmented malignant teratoid medulloepithelioma. No nerve involvement was seen. MRI did not show any intracranial extension. The mass along with rest of the orbital tissue was removed. No adjuvant chemotherapy or radiotherapy was given due to the lack of intracranial extension. The patient was symptom free at 2-year follow-up and the repeat MRI also showed no evidence of recurrence.