Invasive sino-nasal pseudallescheriasis in a non-immunocompromised patient

Pseudallescheriasis is a spectrum of clinical diseases involving Pseudallescheria boydii, a soil and water inhabiting fungus. The organism is of low virulence, but is a fungal opportunist able to elicit infections similar in terms of variety and pre disposing factors to those of Aspergillus species³. Involvement of the nose and the sinuses is very rare⁷. Here we present a case of invasive Pseudallescheriasis involving the nose, paranasal sinuses and orbit in a non-immunocompromised person. Surgical debridement followed by systemic antifungal therapy was given. The fungus resembles hyaline moulds like Aspergillus very closely in tissue sections and can be a diagnostic challenge to the pathologist.     

Death due to atypical urinothorax following percutaneous nephrolithotomy

Urinothorax is a cause of pleural effusion that is often missed due to its perceived rarity. Here, we present a case of urinothorax secondary to percutaneo     

Early revascularization improves survival in cardiogenic shock complicating acute myocardial infarction.

The effects of coronary revascularization by percutaneous transluminal coronary angioplasty or coronary bypass grafting, or both, on survival were evaluated in 81 patients with cardiogenic shock complicating acute myocardial infarction. Thirty-two patients had successful revascularization and 49 patients had unsuccessful or no revascularization. Revascularization was achieved by coronary angioplasty in 22 patients, coronary bypass surgery in 2 and angioplasty followed by bypass surgery in 8. No significant differences were noted between the two groups with regard to baseline clinical or hemodynamic variables. Intraaortic balloon counterpulsation was employed in 27 (84%) of the 32 patients in the group with revascularization and in 19 (39%) of the 49 patients without revascularization (p = 0.0006). The in-hospital survival was significantly better in the patients with--18 (56%) of 32--than in the patients without revascularization--4 (8%) of 49 (p less than 0.0001). At a mean follow-up period of 21 +/- 15 months, this survival difference persisted--16 (50%) of 32 patients with revascularization survived versus 1 (2%) of 49 patients without revascularization (p less than 0.0001). The mean time from the onset of shock to revascularization differed significantly between survivors (12.4 +/- 15 h) and nonsurvivors (58.5 +/- 93 h) in the group with revascularization (p = 0.0004). In the revascularization group, the in-hospital survival rate was 77% (17 of 22) when revascularization was performed within 24 h but only 10% (1 of 10) when it was performed after 24 h (p = 0.0006).(ABSTRACT TRUNCATED AT 250 WORDS)     

Stem cell therapy-present status

Stem cell research is a new field that is advancing at an incredible pace with new discoveries being reported from all over the world. Scientists have for years looked for ways to use stem cells to replace cells and tissues that are damaged or diseased. Stem cells are the foundation cells for every organ, tissue, and cell in the body. Stem cells are undifferentiated, "blank" cells that do not yet have a specific function. Under proper conditions, stem cells begin to develop into specialized tissues and organs. They are self-sustaining and can replicate themselves for long periods of time. Embryonic stem cells are pluripotent cells, isolated from the inner cell mass of the blastocyst-stage mammalian embryo. They have the ability to differentiate into several somatic or somatic-like functional cells such as neurons, hepatocytes, cardiomyocytes, and others. Adult stem cells are specialized cells found within many tissues of the body where they function in tissue homeostasis and repair. They are precursor cells capable of differentiation into several different cells. The knowledge of stem cells from various sources offered a new hope for the treatment of various diseases.     

Analysis of mutations within the 5' untranslated region, interferon sensitivity region, and PePHD region as a function of response to interferon therapy in hepatitis C virus-infected patients in India

Mutations in several subgenomic regions have been implicated in influencing response to interferon therapy; however, a comprehensive picture of Indian patients was lacking. Based on the viral load and clinical factors, 10 out of 15 patients were found to be complete responders, whereas 5 patients were nonresponders. The pretreatment viral RNA load of the patients was found to be between 5.20 and 6.13 log10 IU/ml, which eventually fell to 2.77 log10 IU/ml after 24 weeks of treatment, whereas in the case of nonresponders, the average was 5.38 log10 IU/ml. In order to study the influence of the hepatitis C virus genotype on the response to interferon therapy, the 5' untranslated region sequences of the samples were analyzed, which showed that genotype 3 patients responded better than genotype 1 patients. Additionally, the mutations in the interferon sensitivity-determining region (ISDR) of the NS5A protein and the double-stranded RNA-activated protein kinase-eukaryotic initiation factor 2 alpha phosphorylation homology domain (PePHD) of the E2 envelope protein, before and after treatment, were compared with nonresponder prototype J. Although, no clear correlation was found in the case of the mutated ISDR, some significant changes in residues were observed in the PePHD region, which could be helpful in understanding the molecular basis of resistance to therapy. Interestingly, analysis of the quasispecies variations showed a change in genotype in one sample during treatment, which might have contributed to the resistance. The results suggest that the mutations in different regions of the viral genome might have a concerted effect on the response to interferon therapy.     

Influence of cAMP and protein kinase A on neurite length from spiral ganglion neurons

Regrowth of peripheral spiral ganglion neuron (SGN) fibers is a primary objective in efforts to improve cochlear implant outcomes and to potentially reinnervate regenerated hair cells. Cyclic adenosine monophosphate (cAMP) regulates neurite growth and guidance via activation of protein kinase A (PKA) and Exchange Protein directly Activated by Cylic AMP (Epac). Here we explored the effects of cAMP signaling on SGN neurite length in vitro. We find that the cAMP analog, cpt-cAMP, exerts a biphasic effect on neurite length; increasing length at lower concentrations and reducing length at higher concentrations. This biphasic response occurs in cultures plated on laminin, fibronectin, or tenascin C suggesting that it is not substrate dependent. cpt-cAMP also reduces SGN neurite branching. The Epac-specific agonist, 8-pCPT-2′-O-Me-cAMP, does not alter SGN neurite length. Constitutively active PKA isoforms strongly inhibit SGN neurite length similar to higher levels of cAMP. Chronic membrane depolarization activates PKA in SGNs and also inhibits SGN neurite length. However, inhibition of PKA fails to rescue neurite length in depolarized cultures implying that activation of PKA is not necessary for the inhibition of SGN neurite length by chronic depolarization. Expression of constitutively active phosphatidylinositol 3-kinase, but not c-Jun N-terminal kinase, isoforms partially rescues SGN neurite length in the presence of activated PKA. Taken together, these results suggest that activation of cAMP/PKA represents a potential strategy to enhance SGN fiber elongation following deafness; however such therapies will likely require careful titration so as to promote rather than inhibit nerve fiber regeneration.