Trauma-induced extracranial internal carotid artery dissection leading to multiple infarcts in a young girl

Carotid artery dissections (CADs) represent an uncommon clinical condition that should be considered in the differential diagnosis of young individuals presenting with symptoms of stroke. The basic pathological changes in CAD include a disruption in the media or intima of arterial wall, through which the affected vasculature is predisposed to aneurysm or stenosis, and subsequent stroke. Carotid artery dissection may occur spontaneously or result from trauma, an underlying arteriopathic condition, or predisposing risk factors. The heterogeneous clinical presentations of CAD represent significant diagnostic difficulties, which often lead to delays in diagnosis and treatment. Further complicating the clinical picture is the lack of consensus regarding effective treatment modalities. Because of the often-subtle findings present in CAD, the treating physician must have a high index of suspicion to accurately diagnose and manage the condition. We report extracranial internal CAD in a 17-year-old girl leading to multiple infarcts that was successfully managed with initial antiplatelet therapy and subsequent anticoagulation.     

Sleep disturbance in Parkinson disease

Sleep disturbance is common in patients with Parkinson disease (PD), but it is often undetected due to inadequate history taking and poor self-reporting. Impaired sleep can have a severe impact on health, general well being, and quality of life. Sleep problems in PD have many potential causes, including the direct effect of PD itself, adverse events of anti-Parkinsonian medications, daytime sleep disturbance, age related causes, and other comorbidities. Patients with PD and their sleep partners should be asked about sleep disturbances and other night-time symptoms. Treatment strategies rely on identifying causal factors and need to be tailored to the individual and reviewed regularly.     

Hemimasticatory Spasm: A Case Report with a New Management Strategy

Hemimasticatory spasm is a rare neuromuscular disorder where the patient experiences involuntary, painful spasm of muscles of mastication. Only 15 cases have been reported in literature. We present a case which was treated unconventionally with satisfactory outcome.     

Kappa statistics in the screening of malignancy of prostate

The optimal upper limit of the normal range for prostate specific antigen (PSA) is suggested, but review of literature reveals that, malignancy of prostate can occur below that range and some benign prostatic diseases are occasionally associated with higher levels. The aim of the study is for early detection of prostatic malignancy. We tried to evaluate digital rectal examination (DRE), estimation of PSA and transrectal ultrasound (TRUS) guided core needle biopsy and histopathological examination in the patients. Seventy-two consecutive patients with lower urinary tract symptoms were taken in this retrospective study from January 2005 to February 2006. PSA level was measured by automated chemilumininescence system. Prostatic biopsies were taken for histopathological examination and stained with haematoxylin and eosin. Gleason grading was applied in case of adenocarcinoma of prostate. For detection of malignancy, sensitivity, specificity, predictive value for positive test and of negative test, percentage of false negatives and false positives, p-values, confidence interval and kappa statistical calculations were done. It was found 19 cases with PSA level > 4 ng/ml had benign diseases of prostate and one person having PSA level < 4 ng/ml had adenocarcinoma of prostate. Seven DRE positive cases had benign disease of the prostate and 5 DRE negative patients had adenocarcinoma of prostate. When compared, serum total PSA value alone and combined PSA and DRE, the later combined approach was found to be more useful. We recommend the study of DRE, PSA and TRUS guided core needle biopsy for detection of prostatic cancer at localised and potentially curable stage.     

Clearance of acanthosis nigricans associated with insulinoma following surgical resection

Acanthosis nigricans is said to be a marker of insulin resistance. It is known to occur in patients with insulinoma where there is marked hyperinsulinaemia. We report a case wherein the acanthosis disappeared following surgical resection of insulinoma and this strengthens the hypothesis that hyperinsulinaemia is responsible for acanthosis.     

Antibody response against neem leaf preparation recognizes carcinoembryonic antigen

An immune serum generated in Swiss mice against an aqueous preparation from neem leaf was reactive with carcinoembryonic antigen (CEA) and a peptide sequence derived from it. Using ELISA, we have demonstrated that CEA reactive antibody titer (chiefly IgG2a) was significantly decreased after absorption of the immune sera with CEA. Neem leaf preparation (NLP) generated immune sera was also reactive with CEA in immunoblotting and CEA reactive component in the NLP sera can be immunoprecipitated. Identical recognition of CEA expressed on human colorectal cancer specimens, by anti-CEA monoclonal antibody and NLP sera was documented by immunohistochemistry. NLP generated sera could also react with NLP in ELISA and this reactivity was decreased after absorption of the NLP with anti-CEA antibody. Estimation of protein in NLP revealed the presence of it, at least 10% of the total dry weight. In addition, existence of flavone and quercetin was also evidenced from LC-MS analysis. Further studies are needed to identify the antigenic component may have some homology with CEA molecule. This unique property of neem may be utilized for the immunotherapy of CEA positive tumors.     

Dual strategies for peptidoglycan discrimination by peptidoglycan recognition proteins (PGRPs)

The innate immune system constitutes the first line of defense against microorganisms in both vertebrates and invertebrates. Although much progress has been made toward identifying key receptors and understanding their role in host defense, far less is known about how these receptors recognize microbial ligands. Such studies have been severely hampered by the need to purify ligands from microbial sources and a reliance on biological assays, rather than direct binding, to monitor recognition. We used synthetic peptidoglycan (PGN) derivatives, combined with microcalorimetry, to define the binding specificities of human and insect peptidoglycan recognition proteins (PGRPs). We demonstrate that these innate immune receptors use dual strategies to distinguish between PGNs from different bacteria: one based on the composition of the PGN peptide stem and another that senses the peptide bridge crosslinking the stems. To pinpoint the site of PGRPs that mediates discrimination, we engineered structure-based variants having altered PGN-binding properties. The plasticity of the PGRP-binding site revealed by these mutants suggests an intrinsic capacity of the innate immune system to rapidly evolve specificities to meet new microbial challenges.