Clinical profile of disseminated cryptococcal infection–a case series

ObjectiveTo study disseminated cryptococcal infection in a tertiary care hospital in Southern India.MethodsThe clinical profile of 12 disseminated cryptococcosis patients with the age group of 28-52 years was retrospectively analyzed.Results7(58.3%) presented with fever < 30 days and 3(25%) > 30 days whereas 2(16.7%) did not have fever. All the 12(100%) had headache, 2(16.7%) had altered sensorium, one (8%) seizure. 5(41.7%) had diarrhea and vomiting. 6(50%) had oral candidiasis, and anemia. 9(75%) had elevated erythrocyte sedimentation rate (ESR). 6(50%) had neck stiffness. Cerebrospinal fluid (CSF) pressure was elevated in all 12(100%) patients. Blood culture positive for Cryptococcus neoformans(C. neoformans) in 11(91.7%) and CSF culture positive in all 12 (100%), one (8%) had urine culture positive. India ink preparation was positive in 10(83.3%). CD4 count was less than 50/microl in 4 (33.3%), between 50-100 in 6(50%) and 2(16.7%) in the range of 100-200. 6(50%) were treated with parenteral amphotericin B (0.7 mg/kg/d) during intensive phase followed by oral fluconazole 400 mg/d for 8 weeks then maintenance oral fluconazole 200 mg/d. 5(41.6%) were treated with fluconazole alone. 8(66.7%) improved and 4(33.3%) patients died. Among those who succumbed to the illness, 2(16.7%) received amphotericin and fluconazole, 2(16.7%) patients received fluconazole alone.ConclusionsDisseminated cryptococcosis can cause considerable mortality in HIV patients and immunocompromised non- HIV individuals. At times, its presentation closely mimics that of Tuberculosis. Early diagnosis and appropriate treatment should be started as early as possible.     

Midterm Assessment of Causes and Results of Revision Total Knee Arthroplasty

Background  

There is limited information regarding revision total knee arthroplasty (TKA) with respect to etiology, outcome, and long-term survival comparing different implant types.     

The association of the Friesinger score and pulse pressure in an urban South Asian patient population: pulse pressure,an independent predictor of coronary artery disease

Increase in pulse pressure has been shown to be predisposing factor for Coronary Artery Disease (CAD) in diverse patient populations but its relationship with the severity of CAD, particularly in the South Asians immigrant population of United States has not been demonstrated. We performed a single-center, cross-sectional study. Pulse pressure was calculated by the difference between the systolic and diastolic brachial blood pressures, and the Friesinger score (FS) was used to quantify the severity of CAD with the score of 5 used as a cutoff for extensive disease. We also sought to assess the correlation between the Friesinger score and the 10-year cardiovascular event (CVD) risk as calculated by the Framingham score. Odds ratios and 95% confidence intervals for the associations between explanatory variables and a high Friesinger score were estimated using multivariate logistic regression models. P values below .05 were considered to be statistically significant. Statistical analysis was performed using STATA version 10 software package (College Station, TX). The mean pulse pressure was significantly higher in participants with an FS of ≥5 compared with participants with an FS of <5 (63 vs. 46 mm Hg; P = .004). In univariate analysis, a pulse pressure ≥40 mm Hg was associated with a five-fold increased odds of a higher FS compared with a pulse pressure <40 mm Hg (P = .039), which was unchanged in multivariate analysis. In multivariate analysis, even after adjustment for presence of hypertension, a 10 mm Hg increase in pulse pressure was associated with a 1.97-fold increased odds of a higher FS (95% CI 1.22–3.71, P = .009). The mean Framingham score was higher in participants with a higher FS, but this difference was not significant (32.7 vs. 20.3; P = .1139). Our study demonstrates that pulse pressure, a well-established marker of vascular health, is a significant independent predictor of the severity of CAD as assessed by coronary angiography in South Asians.     

Antiproliferative potential of sarcophine and its semisynthetic sulfur-containing derivatives against human mammary carcinoma cell lines

The marine-derived cembranoid sarcophine (1) and its sulfur-containing semisynthetic derivatives (2–6) were evaluated for anticancer potential using cell cycle progression markers. No effect on MCF-7 cell viability or apoptosis was seen with these derivatives at concentrations of up to 100 μM after 72 h of incubation. At 100 μM, sarcophine and its derivatives 2–5 arrested the MCF-7 cells in G0/G1 phase, with concomitant decrease in the cell populations at S and G2+M phases. MDA-MB-231 cells were not responsive to any of the derivatives. Our preliminary results suggest that the sulfur-containing derivatives of sarcophine, especially 2 and 3, show potent and cell-specific antiproliferative activity.     

Osteopenia in survivors of Wilms tumor

Diminished bone mass (osteopenia) is recognized increasingly as a consequence of therapy in survivors of cancer in childhood. It has been reported in two small series of survivors of Wilms tumor. The objectives of this study were to explore, in a larger sample of such subjects, the prevalence of osteopenia and a possible relationship between osteopenia of the lumbar spine and abdominal irradiation. All survivors of Wilms tumor (n=49) in a single institution were considered eligible for study. Thirty-one agreed to participate; the non-participants were not notably different in their demographic characteristics and diseases/treatment experience. Information was obtained about prior treatment, and usual diet, sun exposure and physical activity. Bone mineral content was measured by dual energy X-ray absorptiometry, and biochemical markers of bone turnover, calciotropic hormones and minerals were assessed in a single blood sample. By Z-scores of whole body bone mineral content, 8 subjects were osteopenic. This was unrelated to milk intake or sun exposure and was not more common in the lumbar spine of those who had been irradiated (15/31 subjects). Physical activity correlated positively with bone mineral density Z-scores (p<0.005). Normal bone formation was reflected in normal blood levels of osteocalcin. C-telopeptide levels, reflecting bone resorption, were high but approximately correlated inversely with maturity. Low serum magnesium and parathyroid hormone levels were detected in a minority of subjects. Osteopenia is present in a large minority (27%) of survivors of Wilms tumor, and an imbalance of bone turnover (with excessive resorption) may be common. Irradiation does not appear to play a causal role. It is possible that a subtle renal tubular defect exists in these individuals; a prospect worthy of further exploration.     

The cerebellum at birth in therian mammals,with special reference to rodents

The stage of cerebellar development at birth was assessed in 23 species of placental mammals. Serial histological sections were examined and five stages in the differentiation of the cerebellar cortical layers were defined. A wide diversity of conditions at birth was found. The available evidence (after parsimony reconstruction) suggests that the last common ancestor of placentals was born with an altricial cerebellum in which the molecular layer was just present between the external granular layer and the prospective Purkinje cell layer. Some placental species have an even more altricial cerebellum at birth (e.g., Muscardinus avellanarius, Sorex araneus), with Mesocricetus auratus as the most altricial species among the taxa studied. In the newborn M. auratus a cerebellar anlage was present with only a loose accumulation of cells located at the dorsal cerebellar anlage above the ventricular neuroepithelial layer. The five species of caviomorph rodents examined here are relatively precocial as far as the cerebellum is concerned. The only other rodent species that has a similarly advanced state was the murid Acomys sp. Most of the life history variables examined were not strongly correlated with the cerebellar stage at birth if at all. However, a significant positive correlation (r(2) = 0.67) was observed between the cerebellar stage at birth and the gestation length and a significant negative correlation (r(2) = 0.31) was observed between cerebellar stage and the average litter size. The weak correlation may be due to sampling among different distantly related clades. The most mature cerebella at birth still had an external granular layer, indicating that the mossy fiber-granule cell connectivity is not yet fully developed and further indicating that this connectivity may depend on external experience to fully mature. All species that have their eyes open at birth also have the most mature cerebelli. The growth of the cortical layers was also studied in a postnatal ontogenetic series of the marsupial Monodelphis domestica. As is the case with placentals, the most advanced stage of cerebellar development coincides with the opening of the eyes.     

Bilateral lipoma arborescens associated with early osteoarthritis

Lipoma arborescens is a rare disease that has generally been considered to be unilateral. We report a case of bilateral disease in a patient with associated marked premature osteoarthritis of the knees. We postulate a possible association between these two conditions and explain a possible underlying mechanism. We suggest that lipoma arborescens be considered as a rare underlying cause of young patients with bilateral premature osteoarthritis, and recommend MRI as the definitive imaging modality. Electronic Publication     

Risk factors associated with injection initiation among drug users in Northern Thailand

Background  

Circumstances surrounding injection initiation have not been well addressed in many developing country contexts. This study aimed to identify demographic factors, sexual behaviors and drug use characteristics related to injection initiation among drug users in northern Thailand.     

Single cortical neurons serve both echolocation and passive sound localization

The pallid bat uses passive listening at low frequencies to detect and locate terrestrial prey and reserves its high-frequency echolocation for general orientation. While hunting, this bat must attend to both streams of information. These streams are processed through two parallel, functionally specialized pathways that are segregated at the level of the inferior colliculus. This report describes functionally bimodal neurons in auditory cortex that receive converging input from these two pathways. Each brain stem pathway imposes its own suite of response properties on these cortical neurons. Consequently, the neurons are bimodally tuned to low and high frequencies, and respond selectively to both noise transients used in prey detection, and downward frequency modulation (FM) sweeps used in echolocation. A novel finding is that the monaural and binaural response properties of these neurons can change as a function of the sound presented. The majority of neurons appeared binaurally inhibited when presented with noise but monaural or binaurally facilitated when presented with the echolocation pulse. Consequently, their spatial sensitivity will change, depending on whether the bat is engaged in echolocation or passive listening. These results demonstrate that the response properties of single cortical neurons can change with behavioral context and suggest that they are capable of supporting more than one behavior.