Maintaining Equity and Access: Successful Implementation of a Virtual Kidney Transplantation Evaluation

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Toxicity issues in the application of carbon nanotubes to biological systems

Carbon nanotubes (CNTs) have recently emerged as a new option for possible use in methodologies of cancer treatment, bioengineering, and gene therapy. This review analyzes the potential, through possible toxicologic implications, of CNTs in nanomedicine. Generally, proven success in other fields may not translate to the use of CNTs in medicine for reasons including inconsistent data on cytotoxicity and limited control over functionalized-CNT behavior, both of which restrict predictability. Additionally, the lack of a centralized toxicity database limits comparison between research results. To better understand these problems, we seek insight from currently published toxicity studies, with data suggesting postexposure regeneration, resistance, and mechanisms of injury in cells, due to CNTs.From the Clinical EditorCarbon nanotubes (CNTs) have recently emerged as a new option for cancer treatment, bioengineering, and gene therapy. Inconsistent data on cytotoxicity and limited control over functionalized-CNT behavior currently restrict predictability of such applications.     

On the ethnomedical significance of the Arjun tree, Terminalia arjuna (Roxb.) Wight & Arnot

Terminalia arjuna is an important cardiotonic plant described in the Ayurveda, the ancient Indian medical science. It is also believed to have the ability to cure hepatic, urogenital, venereal and viral diseases. An attempt is made here to analyse the available drug recipes using this plant from Sanskrit literature in the light of modern scientific knowledge. The chemistry and pharmacology of T. arjuna are also discussed, and areas of future investigations are identified.     

A review of perioperative complications during frameless stereotactic surgery: our institutional experience

Purpose  Frameless stereotactic neurosurgery is increasingly being used for the biopsy of intracranial tumors and the resection of deep-seated lesions where reliance on surface anatomic landmarks can be misleading, as well as in movement disorders, psychiatric disorders, seizure disorders, and chronic refractory pain. Nascent biological approaches, including gene therapy and stem-cell and tissue transplants for movement disorders, also utilize neuronavigational techniques. These procedures are complex and involve understanding of the basic principles and factors affecting neuronavigation. The procedure may appear to be simple, but serious complications may occur. Methods  The purpose of this study was to review the intraoperative and postoperative complications occurring during frameless stereotaxy at our institution from January 2003 to July 2007. Results  Seventy-eight patients underwent various neurosurgical procedures under general anesthesia. Intraoperative complications seen were intraoperative brain bulge (n = 3), seizures (n = 3), failure to extubate (n = 4), and fresh neurodeficits (n = 6). No hemodynamic disturbances such as hypertension or hypotension or bradycardia or tachycardia requiring active intervention were observed. Conclusion  Awareness and vigilance can help in the early identification and better management of the above intraoperative complications.     

Bacterial meningitis and epilepsy

The high incidence and prevalence of epilepsy in developing countries has partly been attributed to an increased frequency of central nervous system (CNS) infections. Of the CNS infections, bacterial meningitis is endemic in many countries and several epidemics have also been reported in these regions. Unprovoked seizures and epilepsy (recurrent unprovoked seizures) can be long-term sequelae of bacterial meningitis. The probability of developing an unprovoked seizure or epilepsy varies according to the etiologic agent responsible for meningitis and this probability appears to be higher for Streptococcus pneumoniae . The risk factors for late unprovoked seizures/epilepsy include early seizures during the acute phase of meningitis and persistent neurological deficits other than sensorineural hearing loss. The majority of unprovoked seizures occur within 5 years of the meningitis episode and tend to be recurrent. The burden of epilepsy associated with bacterial meningitis depends upon the incidence of the latter and hence is to some extent preventable. Implementing vaccination programs against the three most important meningeal pathogens can reduce the incidence of bacterial meningitis. In developed countries, a decline in the incidence of bacterial meningitis has been accomplished with the implementation of vaccination programs.     

Cancer projection by the turn of century-Indian science

This is an attempt to understand the magnitude of cancer problem in India. The incidence data generated by the three population based cancer registries at Bangalore, Bombay and Madras and the population projections of country have been utilised for estimating the present and future load of new cancer cases. It is estimated that the total number of incident cases in males increased from 0.29 million to 0.43 million by the turn of the century as a result of change in size and composition of population and when adjusted for tobacco habits the estimates increased to 0.49 million. In females the incident cases of cancer for three registries increased from 0.32 to 0.42 million by 2001, with cancer of uterine cervix and breast being the major problems. The above results show an urgent need for strengthening and augmenting the existing diagnostic/treatment facilities which are vow fully inadequate to tackle even the present load.     

Role of IG20 splice variants in TRAIL resistance.

Tumor necrosis factor receptor-related apoptosis-inducing ligand (TRAIL) can induce apoptosis primarily in cancer cells with little or no effect on normal cells; therefore, it has the potential for use in cancer therapy. TRAIL binding to death receptors DR4 and DR5 triggers the death-inducing signal complex formation and activation of procaspase-8, which in turn activates caspase-3, leading to cell death. Like FasL, TRAIL can trigger type 1 (caspase-8 --> caspase-3) or type 2 (caspase-8 --> Bid cleavage --> capsase-9 --> caspase-3) apoptotic pathways depending on the cell type. Some cancers are resistant to TRAIL treatment because most molecules in the TRAIL signaling pathway, including FLIPs and IAPs, can contribute to resistance. In addition, we have identified an essential role for splice variants of the IG20 gene in TRAIL resistance.     

Prevalence of reactive serological tests for syphilis in the Jamaican population

Serological tests for syphilis (STS) were performed on sera from 15,876 members of the general adult population, 3,039 pregnant women and 1,029 children, in order to assess the prevalence and value of reactive STS in Jamaicans; 2.7% of sera from the general adult population, 4.7% from pregnant women and 2.2% from children were reactive in the Venereal Disease Research Laboratory (VDRL) test. Reactive Fluorescent Treponemal Absorption (FTA-ABS) tests occurred in significantly higher frequency in pregnant women (4%) than in the general population (2.2%; p less than 0.001). The prevalence of reactive STS in children did not differ significantly from that of the general adult population. The predictive value of a reactive VDRL test in pregnant women (85%) was higher than that of the general population (79%). These results suggest that adequate screening with the inexpensive VDRL test would enable the early detection and treatment of syphilis, and could prevent increasing incidence of congenital syphilis in Jamaica.     

Guillain-Barré syndrome. A clinical electrophysiological and biochemical study

Fifty-six consecutive patients with Guillain-Barré syndrome representing 49% of all cases of peripheral neuropathy (except those due to diabetes mellitus and leprosy) admitted to the Postgraduate Institute of Medical Education and Research, Chandigarh over a period of three years were studied. All patients developed weakness of limbs within one day to three weeks. Attenuation of deep tendon jerks (98%) paresthesia (66%), cranial nerve involvement (41%) and antecedent infection (32%) were the common clinical features. The common patterns of motor weakness were predominantly proximal in all the four limbs (45%) or predominantly proximal in lower limbs along with distal muscles in upper limbs (29%). Electrodiagnostic studies revealed prolonged distal (motor) latency (82%), reduced motor nerve conduction velocity (74%), sensory nerve conduction abnormality (85%) and evidence of denervation (41%). Evoked motor response of median, ulnar, common peroneal and tibial nerves exhibited significant increase in duration and reduction in amplitude. The maximum incidence of electrophysiological abnormality occurred between four to 12 weeks after the onset of neurological symptoms. Four patients died and 11 showed poor recovery. Long intervals (greater than 3 weeks) between peak deficit and onset of recovery and coexistence of reduced motor nerve conduction velocity with evidence of denervation on EMG were found to be associated with poor recovery.