Simultaneous sulfidation of Mo and Co oxides supported on Au(111).

Here we present the results of a study carried out to investigate the simultaneous sulfidation of Co and Mo oxide nanoparticles on Au(111) as a synthesis strategy to prepare a model catalyst for hydrodesulfurization (HDS). We make use of scanning tunneling microscopy and X-ray photoelectron spectroscopy to track the changes in morphology and chemistry during the synthesis of a mixed Mo and Co oxide precursor and the sulfidation thereafter, to the respective sulfides. We investigated the effects of temperature and the duration of sulfidation on the completeness of the sulfidation process. Our study shows that the formation of MoS2 with the CoMoS edge (the desired model catalyst) is not affected by the time or the temperature of sulfidation. However, the yield of the Co-promoted MoS2 slabs is limited by the formation of large clusters due to the spreading of Mo and Co oxide phases upon sulfidation. Complete sulfidation of the mixed oxide precursor to Co-promoted MoS2 can be accelerated by increasing the sulfidation temperature to 730 K due to the thermally activated nature of Mo oxide sulfidation. Thus, we demonstrate that using a mixed Mo and Co oxide precursor as a starting point for the Co-promoted MoS2 phase for fundamental catalytic studies is a viable strategy.

Changes in stroke volume variation and cardiac index during open major bowel surgery.

BACKGROUND: Stroke volume variation (SVV) is a dynamic indicator of preload, which is a determinant of cardiac output. Aims: Aim of this study was to evaluate the relationship between changes in SVV and cardiac index (CI) in patients with normal left ventricular function undergoing major open abdominal surgery. PATIENTS AND METHODS: Patients undergoing major open abdominal surgery were monitored continuously with FloTrac® to measure SVV and CI along with standard monitoring. Both SVV and CI were noted at baseline and every 10 min thereafter till the end of surgery and were observed for concurrence between the measurements. RESULTS: 1800 pairs of measurement of SVV and CI were obtained from 60 patients. Mean SVV and CI (of all patients) measured at different time points of measurement showed that as SVV increased with time, the CI dropped correspondingly. When individual readings of CI and SVV were plotted against each other, the scatter was found to be wide, reiterating the lack of agreement between the two parameters (R2 = 0.035). SVV >13% suggesting hypovolemia was found at 207 time points. Of these, 175 had a CI >2.5 L/min/m2 and only 32 patients had a CI <2.5 L/min/m2. CONCLUSION: SVV, a dynamic index of fluid responsiveness can be used to monitor patients expected to have large fluid shifts during major abdominal surgery. It is very specific and has a high negative predictive value. When SVV increases, CI is usually maintained. Since many factors affect SVV and CI, any increase in SVV >13%, must be correlated with other parameters before administration of the fluid challenge.

Protonated state and synergistic role of Nd3+ doped barium cerate perovskite for the enhancement of ionic pathways in novel sulfonated polyethersulfone for H2/O2 fuel cells.

In recent decades, there has been a need for novel advancement of sustainable non-fluorinated polymer electrolyte membranes for proton exchange membrane fuel cell (PEMFC) applications. The set forth strategy aims to ameliorate proton conduction of sulfonated polyethersulfone (SPES) polymer membranes with a distinct mixture of barium cerate (BCO) and neodymium-doped barium cerate (BCNO) perovskites developing cationic composite membranes (CCMs) prepared through a technique of solvent casting. The CCMs were subjected to analysis of their mechanical, structural, chemical compositional, thermal, morphological, oxidative, physicochemical, electrochemical and fuel cell polarization performance respectively. Acceptor doping of the trivalent neodymium group at the B site of BCO increases the number of oxygen vacancies and improves ionic conduction. The CCM of neodymium-doped barium cerate demonstrates a higher proton conductivity of 42.2 mS cm-1 with a lower activation energy of 6.80 kJ mol-1 at 80 °C. The maximum current density and power density with the OCV of 0.93 V for the neodymium-doped barium cerate membrane are 397 mA cm-2 and 117 mW cm-2, which is 1.8 times greater than that of the pure SPES membrane. On the basis of polarization performance, the SPES membrane with neodymium-doped barium cerate has great potential in highly-efficient PEMFC applications.

Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: a prospective cohort study.

OBJECTIVE: To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). DESIGN: Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. SETTING: Three New York City hospitals. POPULATION: Pregnant women >20 weeks of gestation admitted for delivery. METHODS: Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. MAIN OUTCOME MEASURES: Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. RESULTS: Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). CONCLUSION: Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery. TWEETABLE ABSTRACT: COVID-19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.

A sensitive refining of in vitro and in vivo toxicological behavior of green synthesized ZnO nanoparticles from the shells of Jatropha curcas for multifunctional biomaterials development.

ZnO nanoparticles (NPs) possess a wide range of biological functions in pharmaceutical and cosmetic applications due to their excellent antimicrobial, optical and UV protective properties. This study first reports the toxicological assessment of ZnO NPs green synthesized from Jatropha curcas shells for multifunctional biomedical applications. The hot water extract of J.curcas shells is utilized as a chelating agent for the reduction of zinc acetate and then, the prepared ZnO NPs are broadly characterized using X-ray spectroscopic and electron microscopic observations. The prepared ZnO NPs acquire high purity (100%) wurtzite crystal with hexagonal structure with the average particle size of 53 nm. In vitro and in vivo toxicity evaluation against human tumor cell lines and zebrafish embryos have ascertained the purpose of ZnO NPs in clinical research. Toxic effects of ZnO NPs were observed by a dose-dependent reduction of bacterial growth at ≥1   µg ml-1, by teratogenicity and genotoxicity in zebrafish embryos (from 3 to 90 µg ml-1) and by a significant nanoparticle uptake (0.5 ng µl-1) by a fish serum. In contrast, ZnO NPs fail to reduce the proliferation of human bladder tumor cells (UC6) and cell viability of A549 cells in vitro up to 500 µg ml-1. All these observations limit the unobstructed application of ZnO NPs at higher concentrations. Thus, abundantly used metal oxide nanoparticles like ZnO NPs examined in our present study in different animal models under in vitro and in vivo conditions will be the significant screening strategy to determine the nanotoxicity.

Weil syndrome causing autoimmune haemolytic anaemia.

Weil syndrome is a fulminant form of leptospirosis, usually caused by spirochetal organism Leptospira interrogans. It is characterized by icterus, petechial rashes over the body, signs of renal failure and hepatic failure. Anaemia is a usual manifes- tation of Leptospira infection, but autoimmune haemolytic anaemia is rare. We report a patient with autoimmune haemolytic anaemia following Leptospira infection, which was responsive to high-dose steroid therapy.

A Comparative Evaluation of Apical Leakage using Three Root Canal Sealants: An in vitro Study.

AIM: Apical leakage is one of the drawbacks leading to endodontic failure. Various root canal sealants have been tried in endodontics. The present study was conducted to compare root canal sealants such as Endorez, Realseal, and Metaseal in preventing apical leakage. MATERIALS AND METHODS: Sixty mandibular single-canal premolars were divided into three groups of 20 each. Group I teeth were sealed with Endorez, group II teeth with Realseal, and group III teeth with Metaseal. After completing endodontic treatment in all teeth and sealing with above sealants, glucose leakage value was assessed at 1st, 8th, and 15th day. RESULTS: At day 1 [mean ± standard deviation (SD)], leakage was 0.416 ± 0.011 in group I, 0.234 ± 0.09 in group II, and 0.328 ± 0.19 in group III. On 8th day, it was 2.124 ± 0.108 in group I, 0.624 ± 0.102 in group II, and 1.31 ± 0.24 in group III. On 15th day, it was 5.178 ± 0.125 in group I, 3.122 ± 0.150 in group II, and 4.25 ± 0.28 in group III. The mean apical leakage in all groups in different days was statistically significant (p < 0.05). CONCLUSION: Endorez sealant showed highest apical leakage, whereas Realseal had minimum leakage. There was significant increase in leakage in all groups with the progression of time. CLINICAL SIGNIFICANCE: With the advent of different root canal sealants, the success rate of the root canal-treated teeth can be confirmed.

Comparative efficacy of chemical stabilizers on the thermostabilization of a novel live attenuated buffalopox vaccine.

In the present investigation, the thermostability of a live attenuated buffalopox vaccine prepared with an indigenous baffalopox virus isolate (BPXV Vij/96) and freeze-dried under conventional lyophilizing conditions is described. Three different stabilizer combinations like LS (lactalbumin hydralysate + sucrose), LHT (lactalbumin hydralysate + Trehalose dihydrate) and TAA (Trehalose dihydrate + l- Alanine + l-Histidine) were used to prepare the vaccine. The study indicated that the LS stabilizer was found to be the stabilizer of choice followed by LHT and TAA for buffalopox vaccine at all temperatures studied. The presence of stabilizers has beneficial influence in preserving the keeping quality of the vaccine. Further, among the diluents used to reconstitute the freeze-dried buffalopox vaccine, double distilled water, 0.85% normal saline solution and phosphate buffer saline were the choice of diluents in that order. However, 1M MgSO4 did not perform well at higher temperatures. Investigation suggests for using LS as a stabilizer for freeze-drying and any of the three diluents except 1MgSO4 for reconstitution of buffalopox vaccine.

CHARACTERIZATION OF CLOSTRIDIUM DIFFICILE ISOLATED FROM DIARRHEAL PATIENTS IN A TERTIARY-CARE HOSPITAL, KARNATAKA, SOUTH INDIA.

Increase in Clostridium difficile infection in tertiary-care hospitals in Karnataka, South India with a paucity of data on antibiotic susceptibility and genetic characteristics of the pathogen from this region of the country necessitated this study. From April 2012 to December 2014, 480 hospitalized antibiotic-associated diarrhea cases with a history of antibiotic treatment in the previous three weeks were enrolled. Sixteen percent of the samples were positive for C. difficile toxins A and B by rapid enzyme immunoassay, anaerobic culture and multiplex PCR. In 40 representative strains, minimum inhibitory concentrations (MICs) determined by E-test revealed that 39 strains were resistant to imipenem and moxifloxacin (MIC > 32 µg/ml), 38 to clindamycin (MIC > 256 µg/ml) and 19 to tetracycline (MIC > 4 µg/ml), while all 40 strains were susceptible to ampicillin (MIC < 2 µg/ml), ampicillin sulbactam (MIC < 8 µg/ml), metronidazole (MIC < 8 µg/ml) and vancomycin group (MIC < 2 µg/ml). Pulsed field gel-electrophoresis (PFGE) of 13 representative strains grouped them into three clusters: cluster A consisting of two strains having > 65% similarity, cluster B of 6 strains with 100% similarity (considered clonal) and 3 strains with > 85% similarity, and cluster C of 2 strains with 50% similarity. Clusters A and C contained unrelated strains having different antibiograms. Periodic monitoring of resistance profiles with epidemiological typing by PFGE should aid in interpretation of emerging drug resistant C. difficile clones.

Mg-Doped Hydroxyapatite/Chitosan Composite Coated 316L Stainless Steel Implants for Biomedical Applications.

In this investigation, ultrasonication process was used for the synthesis of magnesium doped nano-hydroxyapatite (MH) (0, 1, 2, and 3 mol% of Mg concentration) particles with controlled size and surface morphology. The size of the prepared MH particles was in the range of 20-100 nm with narrow distribution. Increase in the concentration of Mg reduced the particle size distribution from 60 to 40 nm. On incorporation of Mg in HAp lattice, an increase of 20-66 nm in specific surface area was observed in microporous HAp particles. XRF and XRD patterns reveal that the particles possess stoichiometric composition with reduced crystallinity with respect to the Mg concentration. Surface morphology of MH/chitosan (CTS) coated implant was found to be uniform without any defects. The corrosion rate of the implant decreased with increase in Mg concentration. The in vitro formation of bonelike apatite layer on the surface of the MH/CTS coated implant was observed from simulated body fluid studies. The antimicrobial activity of the MH/CTS composites against gram-positive and gram-negative bacterial strains indicated that increasing Mg concentration enhanced antimicrobial properties. Nanoindentation analysis of apatite coated implant surface reveals that the mechanical property depends on the concentration of magnesium in HAp. From the cytotoxicity analysis against NIH 3T3 fibroblast, it was observed that the Mg incorporated HAp/CTS composite was less toxic than the MHO/CTS composite. From this result, it was concluded that the MH/CTS nanocomposites coated implant is the excellent material for implants.

Epidemiology, Clinico-Haematological Profile and Management of Aplastic Anaemia: AIIMS Experience.

BACKGROUND: The incidence of aplastic anaemia (AA) is higher in Asia than in the West. The precise incidence of AA in India is not known due to lack of epidemiological study. 20-40% of pancytopenic patients in referral centres are of aplastic anaemia. PATIENTS AND METHODS: This was an analysis of 1501 patients diagnosed with aplastic anaemia over a period of seven and half years (January 2007- June 2014) attending the Aplastic clinic of department of haematology of All India Institute of Medical Sciences, New Delhi. The details regarding medical history, physical examination, complete blood count, bone marrow aspirate and biopsy, treatment received, were retrieved. Inherited bone marrow failure was screened in patients below 35 years. Treatment response was analysed for various treatment modalities. RESULTS: 1501 patients of AA from 20 different states of India were analysed. The bulk of patients were from Uttar Pradesh (28.7%), Bihar (23.6%), Delhi/NCR (20%) and Haryana (7%).The average number of new aplastic anaemia patients enrolled per year 214 (range: 101 -263). The median age at presentation was 25 years (range 2-83),with M;F - 2.3:1. Severity of AA revealed: severe (SAA): 75%, very severe (VSAA): 15%, non-severe (NSAA): 10%. Inherited bone marrow failure syndromes constituted 5% (75 patients) of all aplastic anaemia patients. The most common clinical presentations were pallor (97%), bleeding manifestations (69.6%) and fever (54%). The haematological parameters showed: median level of haemoglobin level: 5.9 gm/dL, WBC: 2700/mm3, ANC: 380/mm3, platelet: 1 0000/mm3. PNH clone was present in 13.5% of patients. 107 patients (7%) were lost to follow up or expired before any treatment was initiated. Only 69 patients (4.5%) received treatment with HLA-matched sibling stem cell transplantation and another 232 (15.5%) patients received ATG plus cyclosporine as immunosuppressive therapy. Seven hundred thirteenpatients (47.5%) received cyclosporine. The overall response to various treatment modalities was: HLA matched sibling haematopoietic stem cell transplant: 75.3%, Anti-thymocyte globulin plus cyclosporine: 58.7%, cyclosporine plus androgen: 45.6%, cyclosporine alone: 32.2%. CONCLUSION: Management of AA is a real challenge in developing countries.This is one of the largest case series from a single centre from India. It is our endeavour to reduce the detrimental outcome by increasing awareness among patients and referring physicians to reduce the delay between diagnosis and treatment.

Marginal accuracy of nickel chromium copings fabricated by conventional and accelerated casting procedures, produced with ringless and metal ring investment procedures: A comparative in vitro study.

BACKGROUND: Conventional investing and casting techniques are time-consuming and usually requires 2-4 h for completion. Accelerated nonstandard, casting techniques have been reported to achieve similar quality results in significantly less time, namely, in 30-40 min. During casting, it is essential to achieve compensation for the shrinkage of solidifying alloy by investment expansion. The metal casting ring restricts the thermal expansion of investment because the thermal expansion of the ring is lesser than that of the investment. The use of casting ring was challenged with the introduction of the ringless technique. MATERIALS AND METHODS: A total of 40 test samples of nickel chromium (Ni-Cr) cast copings were obtained from the patterns fabricated using inlay casting wax. The 20 wax patterns were invested using metal ring and 20 wax patterns were invested using the ringless investment system. Of both the groups, 10 samples underwent conventional casting, and the other 10 underwent accelerated casting. The patterns were casted using the induction casting technique. All the test samples of cast copings were evaluated for vertical marginal gaps at four points on the die employing a stereo optical microscope. RESULTS: The vertical marginal discrepancy data obtained were tabulated. Mean and standard deviations were obtained. Vertical discrepancies were analyzed using analysis of variance and Tukey honestly significantly different. The data obtained were found to be very highly significant (P < 0.001). Mean vertical gap was the maximum for Group II (53.64 µm) followed by Group IV (47.62 µm), Group I (44.83 µm) and Group III (35.35 µm). CONCLUSION: The Ni-Cr cast copings fabricated with the conventional casting using ringless investment system showed significantly better marginal fit than that of cast copings fabricated from conventional and accelerated casting with metal ring investment and accelerated casting using ringless investment since those copings had shown the least vertical marginal discrepancies among the four methods evaluated in this study.

Evaluation of stability of live attenuated camelpox vaccine stabilized with different stabilizers and reconstituted with various diluents.

In this study, thermostability of a Vero cell attenuated live camelpox vaccine under conventional lyophilization conditions has been evaluated. Three stabilizers were used separately for freeze-drying the vaccine and the stability of the vaccine, both in freeze-dried and reconstituted forms at different temperatures was assessed. The study revealed that the camelpox vaccine lyophilized with TAA stabilizer found superior with a shelf life of 44 months, 227 days, 22 days and 20 days at 4, 25, 37 and 45 °C, respectively followed by LS stabilizer. In terms of half-life, TAA stabilizer proved better followed by LS and BUGS stabilizers at all temperatures except at 25 °C in which LS found relatively superior. Among the four diluents viz. 1x PBS (phosphate buffered saline, pH 7.4), 0.85% NaCl, distilled water and 1 M MgSO4, PBS was a better diluent followed by 0.85% NaCl. Both the diluents maintained the infectivity titer more than the minimum effective dose (3 log10TCID50 with a maximum titre of 6.53 log10TCID50 in both the diluents) for 60 h at 37 and 45 °C. However, 1 M MgSO4 found less suitable for camelpox vaccine dilution. The study indicates that the TAA and 1× PBS are the choice of stabilizer and diluent, respectively for camelpox vaccine.

Carboxylic Group Functionalized Carbon Quantum Dots inhibit Hen Egg White Lysozyme Amyloidogenesis, leading to the Formation of Spherical Aggregates with Reduced Toxicity and ROS Generation.

INTRODUCTION: Proteinopathies are a group of diseases where the protein structure has been altered. These alterations are linked to the production of amyloids, which are persistent, organized clumps of protein molecules through inter-molecular interactions. Several disorders, including Alzheimer's and Parkinson's, have been related to the presence of amyloids. Highly ordered beta sheets or beta folds are characteristic of amyloids; these structures can further self- -assemble into stable fibrils. METHOD: Protein aggregation is caused by a wide variety of environmental and experimental factors, including mutations, high pH, high temperature, and chemical modification. Despite several efforts, a cure for amyloidosis has yet to be found. Due to its advantageous semi-conducting characteristics, unique optical features, high surface area-to-volume ratio, biocompatibility, etc., carbon quantum dots (CQDs) have lately emerged as key instruments for a wide range of biomedical applications. To this end, we have investigated the effect of CQDs with a carboxyl group on their surface (CQD-CA) on the in vitro amyloidogenesis of hen egg white lysozyme (HEWL). RESULT: By generating a stable compound that is resistant to fibrillation, our findings show that CQD-CA can suppress amyloid and disaggregate HEWL. In addition, CQD-CA caused the creation of non-toxic spherical aggregates, which generated much less reactive oxygen species (ROS). CONCLUSION: Overall, our results show that more research into amyloidosis treatments, including surface functionalized CQDs, is warranted.

Effectiveness of interventions to prevent abuse in people living with dementia in community settings: A systematic review.

OBJECTIVES: This review examined the evidence for interventions to prevent the abuse of people living with dementia in the community. METHODS: The articles were retrieved from 2000 to 2023 from six databases, including MEDLINE via PubMed, CINAHL Plus via EBSCO, EMBASE, ProQuest Medical Library, Web of Science, and Scopus. The research articles that focused on finding the effectiveness of interventions for preventing abuse of people living with dementia in community settings were included in this review. The review included randomized controlled trials and pre-test post-test trials only. The quality appraisal of the eligible studies was done using ROB 2 and ROBINS II. The findings were tabulated and narratively synthesised. RESULTS: Out of 1831 articles, only three were included in this review. Only two RCTs were included in this efficacy review. Both the studies showed that the interventions were not effective in reducing abuse. The studies utilised family caregiver interventions like psychological interventions and online supportive education. The review identified psychological interventions with some evidence. Another study was a quasi-experimental study that used dialectical behaviour therapy as an intervention to reduce abuse occurrence. The study showed low evidence and focused only on reporting of elder abuse as an outcome. CONCLUSION: This review found very few studies and was not able to draw a conclusion on the effectiveness of interventions for abuse in people living with dementia. Given the paucity of research, there is a clear need to identify how to overcome the challenges faced in elder abuse research and further refine the development of approaches to reduce elder abuse among people living with dementia in community settings.

Delving into Matrix Metalloproteinase-1 (MMP-1) and its Significance in Periodontal Diseases.

Matrix metalloproteinase-1 (MMP-1) plays a pivotal role in the pathogenesis of periodontal diseases, particularly periodontitis, by virtue of its collagenolytic activity targeting collagen type I, the primary component of periodontal tissues. This review abstract elucidates the intricate involvement of MMP-1 in periodontal tissue homeostasis and its dysregulation in disease states. Elevated MMP-1 levels, observed in gingival tissues and crevicular fluid of individuals with periodontitis, correlate with the degradation of collagen fibers within the periodontium. This degradation contributes to the detachment of teeth from surrounding tissues and exacerbates alveolar bone resorption, hallmark features of periodontal breakdown. Therapeutically, targeting MMP-1 activity emerges as a promising strategy, prompting ongoing research into MMP inhibitors and host modulation therapies. Understanding MMP-1's nuanced role in periodontal diseases paves the way for personalized treatment approaches and holds promise in reshaping periodontal disease management for improved patient outcomes and periodontal health.

Enzymes in Peri-implant Sulcular Fluid: A Window into Periodontal Health - A Comprehensive Review.

Enzymes in peri-implant sulcular fluid (PISF) have emerged as essential biomarkers in the field of periodontics, providing critical insights into the health and stability of dental implants. This essay explores the significance of various enzymes in PISF, including matrix metalloproteinases (MMPs), elastase, alkaline phosphatase, acid phosphatase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT), in assessing the local inflammatory environment and diagnosing peri-implant diseases. The analysis of these enzymes facilitates early detection of complications, personalized treatment planning, and long-term monitoring, emphasizing the need for a multidisciplinary approach to patient care. Collaboration among dental professionals and patient education is crucial in ensuring the successful management and maintenance of dental implants. Understanding the role of enzymes in PISF and their implications in periodontal health underscores their significance in contemporary periodontics and emphasizes the need for ongoing research and technological advancements.

Rapidly Progressive Dementia in an Elderly Male: Perseverance Becomes the Key to a Rare Diagnosis.

Cognitive impairment in a patient with rapidly progressive dementia (RPD) develops faster than expected for a known dementia syndrome. It poses as a diagnostic challenge for the physician who must identify the diagnosis among a broad spectrum of differentials. Here, we discuss the case of a 60-year-old male who presented with a four-month history of progressive gait disturbance, incoherent talking, dysarthria, hand tremors, and new-onset bladder incontinence. Neurological examination revealed fast saccades, cerebellar dysarthria, hypertonia, and normal power in all four limbs, brisk reflexes, past pointing, intentional tremors, resting myoclonic jerks, and ataxic gait. Initial differentials of progressive paraneoplastic encephalitis, infectious encephalitis, and toxic encephalopathy were considered. However, the results of lumbar puncture and blood investigations-voltage-gated potassium channel (VGKC) antibody and N-methyl-D-aspartate (NMDA) receptor antibody, tumor markers, viral markers being negative and ammonia and lactate levels being normal led us to think of another possibility. With such rapidly progressive dementia, myoclonic jerks, extrapyramidal signs, and cerebellar signs, a diagnosis of Creutzfeldt-Jakob disease (CJD) was taken into consideration. A cerebrospinal fluid (CSF) sample was sent for CSF protein 14-3-3 quantification by enzyme-linked immunosorbent assay (ELISA) and came out positive. During his stay in the hospital, our patient developed multiple complications, and his clinical state progressively worsened. With no signs of improvement and the known fatal nature of the disease, the goals of care were discussed with the family and we all agreed on providing palliative care. The patient passed away on day 15 of hospital admission.

Acute Cryptococcal Meningitis in a Patient With Idiopathic CD4 Lymphocytopenia: A Rare Clinical Entity.

Cryptococcal meningitis is a known cause of opportunistic infection in immunocompromised patients, especially those with AIDS. Very few cases exist in literature where cryptococcal meningitis is seen in patients without evidence of HIV infection. Here, we describe a case of an elderly woman presenting with clinical features of meningitis. Our patient tested positive for cryptococcal antigen (CRAg) in the CSF and growth of Cryptococcus neoformans was obtained in CSF culture. Further laboratory investigations revealed CD4 lymphocytopenia (233 cells/µl) in the absence of HIV infection. When we checked the CD4 count, beyond a period of six weeks, it was reported to be low, which confirmed our diagnosis of idiopathic CD4 lymphocytopenia (ICL). She was successfully treated with amphotericin B along with flucytosine for two weeks and discharged on maintenance antifungal therapy for eight weeks. This case emphasizes the need to maintain a high index of suspicion and consider the possibility of opportunistic infections even in the absence of HIV infection for timely diagnosis and treatment.