Determination of Genetic Diversity of the Morinda tinctoria Population in Historical Mandore Garden

Morinda tinctoria (Rubiaceae) commonly called as ‘Indian Mulberry’ is one of the avenue trees of historically important Mandore garden planted anthropogenically in the past. Objective of this study was to determine the genetic diversity of M. tinctoria population at Mandore garden using Random Amplified Polymorphic DNA and Inter Simple Sequence Repeat Markers. A total of 97 bands were produced from 10 random amplified polymorphic DNA primers (49 bands) and 8 inter simple sequence repeat primers (48 bands). No polymorphic bands were obtained in any accessions using the two methods, which strongly suggested that M. tinctoria of this region appear as identical clones. Monomorphic pattern revealed the clonal plantation of M. tinctoria in this historical garden. This is the first report on use of molecular markers to infer the ancient plantation history. Consequences of genetically monomorphic population under global climate changes are discussed and conservation strategy is proposed.     

Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain

ObjectiveThe objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome.MethodsInformed consent was obtained from consecutive ED patients who presented with chest pain and were evaluated with coronary computed tomography angiography (cCTA). Cardiac risk factors, clinical presentation, electrocardiogram, and laboratory studies were recorded; the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were tabulated. Coronary computed tomography angiography findings were rated on a 6-level plaque burden scale and classified for significant CAD (stenosis ≥ 50%). Adverse cardiovascular outcomes were recorded at 30 days.ResultsAmong 250 patients evaluated by cCTA, 143 (57%) had no CAD, 64 (26%) demonstrated minimal plaque (< 30% stenosis), 26 (10%) demonstrated mild plaque (< 50% stenosis), 9 (4%) demonstrated moderate single vessel disease (50%-70% stenosis), 2 (1%) demonstrated moderate multivessel disease, and 6 (2%) demonstrated severe disease (> 70% stenosis). Six patients developed adverse cardiovascular outcomes. Among traditional cardiac risk factors, only age (older) and sex (male) were significant independent predictors of CAD. Correlation with CAD was poor for the TIMI (r = 0.12) and GRACE (r = 0.09-0.23) scores. The TIMI and GRACE scores were not useful to predict adverse outcomes. Coronary computed tomography angiography identified severe CAD in all subjects with adverse outcomes.ConclusionAmong ED patients who present with chest pain judged to be at low to intermediate risk for acute coronary syndrome, traditional risk factors are not useful to stratify risk for CAD and adverse outcomes. Coronary computed tomography angiography is an excellent predictor of CAD and outcome.     

Liposomal formulation of curcumin attenuates seizures in different experimental models of epilepsy in mice

Contemporary research indicates promising anticonvulsant effect of curcumin. However, its poor oral bioavailability is a major hindrance toward its pharmacological action. Thus, this study was carried out to evaluate the acute effect of liposome‐entrapped curcumin on increasing current electroshock seizures (ICES) test, pentylenetetrazole (PTZ)‐induced seizures, and status epilepticus in mice. Liposome‐entrapped curcumin in doses 25 and 50 mg/kg demonstrated significant increase in seizure threshold current and latency to myoclonic and generalized seizures in ICES test and PTZ‐induced seizures, respectively. Similarly, liposomal‐entrapped curcumin also increased the latency to the onset and decreased the duration of seizures during status epilepticus in mice. To conclude, liposomal‐entrapped curcumin possesses anticonvulsant activity against status epilepticus in mice.     

Conservative,open or percutaneous repair for acute rupture of the Achilles tendon

Purpose. To review the complications and recovery of patients with Achilles tendon rupture managed by percutaneous repair, open repair, and non-operative means in a tertiary referral centre between 2001 and 2003.

Methods. The operating theatre register and logbooks of the Consultants were used to identify surgically managed patients, while plaster room records were used for conservatively managed patients. We collated demographic and management details.

Results. The number of plaster changes (p < 0.001), median length of time in cast (p < 0.001), and number of outpatient visits (p < 0.05) was greater in conservatively managed patients. We performed no formal statistical analysis given the small numbers. Conservative management was the least expensive and open surgery the most costly modality of management. Percutaneous surgery was approximately a third of the cost of open surgery when performed under local anaesthetic.

Conclusion. In our setting, percutaneous repair and conservative management are viable alternatives to open surgery, which carries higher complications rates and was the most costly of the three. Individual patients will have different needs due to their age, occupation, or level of sporting activity.     

Pro/con debate: Should PaCO2 be tightly controlled in all patients with acute brain injuries?

You are the attending intensivist in a neurointensive care unit caring for a woman five days post-rupture of a cerebral aneurysm (World Federation of Neurological Surgeons Grade 4 and Fisher Grade 3). She is intubated for airway protection and mild hypoxemia related to an aspiration event at the time of aneurysm rupture, but is breathing spontaneously on the ventilator. Your patient is spontaneously hyperventilating with high tidal volumes despite minimal support and has developed significant hypocapnia. She has not yet developed the acute respiratory distress syndrome. You debate whether to tightly control her partial pressure of arterial carbon dioxide, weighing the known risks of acute hypocapnia in other forms of brain injury against the potential loss of clinical neuromonitoring associated with deep sedation and neuromuscular blockade in this patient who is at high risk of delayed ischemia from vasospasm. You are also aware of the potential implications of tidal volume control if this patient were to develop the acute respiratory distress syndrome and the effect of permissive hypercapnia on her intracranial pressure. In this paper we provide a detailed and balanced examination of the issues pertaining to this clinical scenario, including suggestions for clinical management of ventilation, sedation and neuromonitoring. Until more definitive clinical trial evidence is available to guide practice, clinicians are forced to carefully weigh the potential benefits of tight carbon dioxide control against the potential risks in each individual patient based on the clinical issues at hand.     

Norovirus Genogroup II Gastroenteritis in Hospitalized Children in South India

The distribution of norovirus (NoV) genogroup II in children < 5 years of age admitted to a south Indian hospital with diarrhea was investigated. Viral RNA extracted from 282 stool samples were screened for NoV GII and positive amplicons sequenced. Twenty-eight (9.9%) had NoV GII infection with a median age of 6 months, with more severe episodes of diarrhea among infected (median Vesikari score 13, interquartile range [IQR] 10–15) than children without infection (median score 10, IQR 8–13, P = 0.002). The study documents NoV GII infections as an important cause of gastroenteritis and the genetic diversity of circulating strains.