A Study of Dermatoglyphic Patterns in Epileptic Patients

The aim of study was to establish a relation of dermatoglyphic patterns of palm in epileptic and normal subjects so that it may be used as a diagnostic tool for identifying cases at risk. The dermatoglyphic study was carried out on 50 patients of epilepsy and 50 normal subjects. The dermatoglyphic traits, which presented a significant difference, were a-b ridge count, lateral deviation, c-line pattern, palmar pattern and finger tip pattern. Mean values of a-b ridge count were more in epileptic patients, especially in left hand, than controls. The ratio of ulnar and radial lateral deviation in control was 1:3 while in epileptic it was 1:5. C-line pattern presented less frequency of proximal and ulnar type patterns in cases. Radial type of C-line pattern was higher in cases. On the other hand this pattern was absent in 29% of controls than cases (8%). Arch type of palmar patterns were showing a very significant difference between controls (79%) and cases (2%). Frequency of loops were much more and vestiges were absolutely absent in cases. The frequency of Arch type of finger tip pattern was more in control. These findings suggest that antenatal factors may contribute to the etiology of epilepsy. A considerable progress in dermatoglyphics has been established as a useful diagnostic and research tool in medicine.     

Colestyramine slows gastric emptying of liquids and reduces appetite in healthy subjects

Background There is evidence to suggest that the particulate resin colestyramine, a bile acid sequestrant formerly used as a cholesterol‐lowering agent, enhances secretion of the gut hormone cholecystokinin (CCK). Established physiological actions of CCK include inhibition of gastric emptying and induction of satiation. This study evaluated the hypothesis that colestyramine, which is luminally retained, would slow gastric emptying of liquids and suppress appetite in humans. Methods Nine healthy volunteers consumed 500 mL liquid test meals containing 4 g colestyramine, 12 g colestyramine, or control (water alone), on three occasions, in a randomized order. The effect of colestyramine on gastric emptying was determined non‐invasively using the ¹³C‐acetate breath test, and appetite and other gut‐centered sensations were rated using visual analog scale questionnaires. Key Results Colestyramine dose dependently slowed liquid gastric emptying compared with control (water) (4 g vs control, ～20% reduction, P < 0.05; 12 g vs control, ～35% reduction, P < 0.01). Colestyramine also significantly reduced hunger (4 g vs control, ～20% reduction, P < 0.01), and the amount of food participants felt able to eat (12 g vs control, ～32% reduction, P < 0.001), but increased bloating (both doses, P < 0.05), with no effect on ratings of nausea. Conclusions & Inferences This study provides the first evidence that colestyramine significantly slows liquid gastric emptying and reduces appetite in healthy humans. Colestyramine therefore presents an attractive gut‐brain signaling research tool in that it is not absorbed and thus lacks potentially confounding postabsorptive effects. Furthermore, with clear effects on gastric emptying and appetite, colestyramine now merits consideration as a trial therapeutic strategy for appetite suppression and weight loss.     

Antimicrobial susceptibility pattern and prevalence of extended spectrum beta-lactamase (ESBLs) producing strains of Klebsiella pneumoniae from a major hospital in New Delhi

Extended spectrum beta-lactamases (ESBLs) are plasmid mediated enzymes capable of hydrolyzing penicillins, broad spectrum-cephalosporins and monobactams. The ESBL producing K. pneumoniae strains are being reported from around the world including India. The present study was taken up to evaluate the ESBL production and in-vitro susceptibility of K. pneumoniae isolates from a hospital. The bacterial isolates collected during 2003 included 51 K. pneumoniae biochemically confirmed isolates from 395 patients admitted in various wards of a major hospital in New Delhi. The isolates were from pus, wound, pleural fluid, urine and tracheal aspirate of patients attending respiratory, urology and burns wards. Antimicrobial susceptibility was carried out by Kirby Bauer's disc diffusion technique using NCCLS criteria. A screening of ESBL production was done by Double-disc synergy test (DDST) and using E-test ESBL strips. The frequency of resistance among K. pneumoniae for the cephalosporins (cefoxitin, cefuroxime, cefotaxime, ceftazidime, and cefepime) and non-cephalosporins (aztreonam, piperacillin, chloramphenicol and trimethoprim-sulfamethoxazole) were in the range of 39.2-88.0% and 51.0-90.2% respectively. 14 different antimicrobial resistance profiles were recognized ranging from resistance to only four (n=6, 11.7%) to as many as ten (n=9, 17.7%). Among the 51 isolates of K. pneumoniae strains, a total of 36 (70.6%) could be identified as ESBL producers, that correlates with the high frequency of multi-drug resistant K. pneumoniae The study shows alarming rise in ESBL production among K. pneumoniae strains and high rate of resistance to a wide range of cephalosporin and non-cephalosporin group of antimicrobials.     

Out-of-hospital automatic cardioversion of ventricular tachycardia

A 42 year old man who survived sudden cardiac death was treated with an automatic implantable cardioverter/defibrillator. After a 5 month symptom-free interval, the patient received two internal discharges in the conscious state while wearing an ambulatory electrocardiographic recorder. Analysis of the tape revealed that both discharges were activated by two bursts of polymorphous ventricular tachycardia, the first one occurring at the end and the second at the onset of episodes of slow, hemodynamically stable monomorphous ventricular tachycardia. This case illustrates the reliability of the automatic implantable cardioverter/defibrillator as an antiventricular tachycardia device and the problem posed by its exposure to nonsustained ventricular tachycardia.     

Carotid artery occlusive disease

Stroke is the third most common cause of death and the leading cause of disability in the United States. Management of identifiable risk factors and careful selection of patients for operative intervention constitute the current approach to reducing the morbidity and mortality associated with stroke. A carefully performed carotid endarterectomy (CEA), which has a low periprocedural complication rate, is the only form of mechanical cerebral revascularization for which definitive evidence of clinical effectiveness has been reported. Recently, retrospective case reports and case series have demonstrated the feasibility of carotid angioplasty and stenting as a possible alternative to CEA. In the tradition of the two previous National Institutes of Health (NIH)-sponsored trials--the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS)--the National Institutes of Health has sponsored a clinical trial (CREST: Carotid Revascularization-Endarterectomy vs Stent Trial) that is currently under way to determine the efficacy and risks of carotid angioplasty and stenting compared with CEA.