Optimizing the management of neuromyelitis optica and spectrum disorders in resource poor settings: Experience from the Mangalore demyelinating disease registry

Background:

In resource-poor settings, the management of neuromyelitis optica (NMO) and NMO spectrum (NMOS) disorders is limited because of delayed diagnosis and financial constraints.

Aim:

To device a cost-effective strategy for the management of NMO and related disorders in India.

Materials and Methods:

A cost-effective and disease-specific protocol was used for evaluating the course and treatment outcome of 70 consecutive patients.

Results:

Forty-five patients (65%) had a relapse from the onset and included NMO (n = 20), recurrent transverse myelitis (RTM; n = 10), and recurrent optic neuritis (ROPN; n = 15). In 38 (84.4%) patients presenting after multiple attacks, the diagnosis was made clinically. Only 7 patients with a relapsing course were seen at the onset and included ROPN (n = 5), NMO (n = 1), and RTM (n = 1). They had a second attack after a median interval of 1 ± 0.9 years, which was captured through our dedicated review process. Twenty-five patients had isolated longitudinally extensive transverse myelitis (LETM), of which 20 (80%) remained ambulant at follow-up of 3 ± 1.9 years. Twelve patients (17%) with median expanded disability status scale (EDSS) of 8.5 at entry had a fatal outcome. Serum NMO-IgG testing was done in selected patients, and it was positive in 7 of 18 patients (39%). Irrespective of the NMO-IgG status, the treatment compliant patients (44.4%) showed significant improvement in EDSS (P ≤ 0.001).

Conclusions:

Early clinical diagnosis and treatment compliance were important for good outcome. Isolated LETM was most likely a post-infectious demyelinating disorder in our set-up. NMO and NMOS disorders contributed to 14.9% (45/303) of all demyelinating disorders in our registry.Key Words: Demyelinating disease registry, immunosuppression, India, neuromyelitis optica, neuromyleitis optica spectrum disorders     

Comparative Evaluation of Dimensional Accuracy and Tensile Strength of a Type IV Gypsum Using Microwave and Air Drying Methods

To evaluate dimensional accuracy and tensile strength of a type IV gypsum product, at different time intervals, dried in air or a microwave oven. Eighty specimens prepared from a cylindrical mould were used for measuring tensile strength (group A). Twenty specimens from a master die mould were used for determining dimensional accuracy (group B). In group A, 40 specimens were dried in open air at room temperature (A1). The other 40 were removed after 30 min and air dried for 20 min. These were subjected to microwave oven drying for 5 min (A2). Ten specimens each were tested under diametral compression at each of the following time periods: 1, 2, 4 and 24 h after drying. In group B, ten specimens were dried in open air at room temperature (B1). Ten specimens were removed from the mould after 30 min and air dried for 20 min. These were then dried in a microwave oven for 5 min (B2). The data was statistically analyzed using students unpaired “t” test. At all time intervals, diametral tensile strength (DTS) values for specimens dried in microwave oven were significantly higher than for those dried in open air. There were no significant differences between the dimensional accuracy of the two groups. In this study, microwave oven drying had a positive effect on the DTS of a type IV gypsum and the microwave oven dried specimens were as accurate as the air dried specimens over the same time period.     

A systems toxicology approach to the surface functionality control of graphene–cell interactions

The raised considerable concerns about the possible environmental health and safety impacts of graphene nanomaterials and their derivatives originated from their potential widespread applications. We performed a comprehensive study about biological interaction of grapheme nanomaterials, specifically in regard to its differential surface functionalization (oxidation status), by using OMICS in graphene oxide (GO) and reduced graphene oxide (rGO) treated HepG2 cells. Differential surface chemistry (particularly, oxidation – O/C ratio) modulates hydrophobicity/philicity of GO/rGO which in turn governs their biological interaction potentiality. Similar toxic responses (cytotoxicity, DNA damage, oxidative stress) with differential dose dependency were observed for both GO and rGO but they exhibited distinct mechanism, such as, hydrophilic GO showed cellular uptake, NADPH oxidase dependent ROS formation, high deregulation of antioxidant/DNA repair/apoptosis related genes, conversely, hydrophobic rGO was found to mostly adsorbed at cell surface without internalization, ROS generation by physical interaction, poor gene regulation etc. Global gene expression and pathway analysis displayed that TGFβ1 mediated signaling played the central role in GO induced biological/toxicological effect whereas rGO might elicited host-pathogen (viral) interaction and innate immune response through TLR4–NFkB pathway. In brief, the distinct biological and molecular mechanisms of GO/rGO were attributed to their differential surface oxidation status.     

Salivary sialic acid levels and dental health in children with congenital heart disease

Congenital cardiac disease is one of the most common developmental anomalies in children. Higher caries prevalence and gingivitis compared to healthy children have been shown in children with congenital heart disease which has a significant implication in the medical care of these patients associated with bacteraemia and endocarditis. Sialic acids being terminal sugar components and marker of chronic inflammatory response are found to be present at higher levels in children with poor oral health status. So the present study aimed to evaluate the oral health status and salivary sialic acid levels among the children with congenital heart disease and normal healthy siblings. A total of 71 children with heart diseases aged 6-10 years attending various heart institutes were examined for oral hygiene status, gingival status and dental caries status by using modified WHO oral assessment form. A case-matched control group of 50 children were also examined. Salivary flow rate, pH and sialic acid levels were measured after saliva collection. The results were subjected to Unpaired t test and Pearson's Correlation Coefficient Test. The salivary pH, salivary flow rate, dental caries status, oral hygiene and the gingival status were significantly compromised with a positive correlation with the sialic acid levels in saliva, leading to increased treatment needs in the study group. Therefore the amount of sialic acid in the saliva can be a useful index of the severity of oral disease.