Age-stratified Assessment of Brain Volumetric Segmentation on the Indian Population Using Quantitative Magnetic Resonance Imaging.

BACKGROUND AND PURPOSE: Automated methods for quantifying brain tissue volumes have gained clinical interest for their objective assessment of neurological diseases. This study aimed to establish reference curves for brain volumes and fractions in the Indian population using Synthetic MRI (SyMRI), a quantitative imaging technique providing multiple contrast-weighted images through fast postprocessing. METHODS: The study included a cohort of 314 healthy individuals aged 15-65 years from multiple hospitals/centers across India. The SyMRI-quantified brain volumes and fractions, including brain parenchymal fraction (BPF), gray matter fraction (GMF), white matter fraction (WMF), and myelin. RESULTS: Normative age-stratified quantification curves were created based on the obtained data. The results showed significant differences in brain volumes between the sexes, but not after normalization by intracranial volume. CONCLUSION: The findings provide normative data for the Indian population and can be used for comparative analysis of brain structure values. Furthermore, our data indicate that the use of fractions rather than absolute volumes in normative curves, such as BPF, GMF, and WMF, can mitigate sex and population differences as they account for individual differences in head size or brain volume.

Redo-ALCAPA Repair With Left Subclavian Artery-to-Left Main Coronary Bypass for Left Coronary Atresia.

Different surgical techniques have been described for the primary repair of anomalous left coronary artery arising from the pulmonary artery (ALCAPA); however, very few techniques are described for management of coronary artery occlusion following ALCAPA repair. We present a case of a 7-year-old girl with left main coronary atresia status-post left coronary button transfer for ALCAPA in infancy. She underwent redo-sternotomy and left subclavian artery-to-left main coronary artery bypass plus mitral valve repair and had an uneventful postoperative course.

Imaging in Uterine Artery Pseudoaneurysm: A Rare, Potentially Fatal Cause of Secondary Post-partum Hemorrhage.

Secondary postpartum hemorrhage is one of the important cause of postpartum morbidity and mortality. Uterine artery pseudoaneurysm is a rare, potentially fatal but treatable cause of secondary post-partum hemorrhage. If not diagnosed timely, it can lead to life-threatening hemorrhage. We report the case of a 41-year-old woman who presented with profuse vaginal bleeding on 32nd day of cesarean section. On imaging a left uterine artery pseudoaneurysm was found in the uterine wall with blood clots in the uterine cavity. Patient was managed with aggressive fluid resuscitation and immediate interventional radiology procedure of selective embolization of pseudoaneurysm. High index of suspicion is needed to search for rare vascular causes like pseudoaneurysm.

Female mating experience and genetic background independently influence male mating success in fruit flies.

When the reproductive interests of males and females conflict, males can evolve traits that are harmful to females, and females can coevolve traits to resist this harm. In the fruit fly, Drosophila melanogaster, there is genetic variation in female resistance traits, which can affect the pre- and post-mating success of males that try to mate with them. However, it is not clear to what extent the expression of these phenotypes can be modified by environmental factors such as sociosexual experience. Here, we tested how the genetic background of a female and her previous mating experience interact to affect the mating success of focal males. In the experience phase, we placed females from 28 distinct genetic backgrounds individually either with a single male (low conflict) or with three males (high conflict) for 48 hr. In the subsequent test phase, we measured the mating and post-mating fertilization success of focal males paired individually with each female. We found that focal males paired with females from the high-conflict treatment were less successful at mating, took longer to mate when they were successful, and had a lower proportion of paternity share. Furthermore, we identified significant female genetic variation associated with male mating success. These results indicate that female experience, along with intrinsic genetic factors, can independently influence different fitness components of her subsequent mates and has implications for our understanding of plastic female mating strategies and the evolution of sexually antagonistic traits in males and females.

Plasticity in male mating behavior modulates female life history in fruit flies.

In many species, intense male-male competition for the opportunity to sire offspring has led to the evolution of selfish reproductive traits that are harmful to the females they mate with. In the fruit fly, Drosophila melanogaster, males modulate their reproductive behavior based on the perceived intensity of competition in their premating environment. Specifically, males housed with other males subsequently transfer a larger ejaculate during a longer mating compared to males housed alone. Although the potential fitness benefits to males from such plasticity are clear, its effects on females are mostly unknown. Hence, we tested the long-term consequences to females from mating with males with distinct social experiences. First, we verified that competitive experience influences male mating behavior and found that males housed with rivals subsequently have shorter mating latencies and longer mating durations. Then, we exposed females every other day for 20 days to males that were either housed alone or with rivals, and subsequently measured their fitness. We found that females mated to males housed with rivals produce more offspring early in life but fewer offspring later in life and have shorter lifespans but similar intrinsic population growth rates. These results indicate that plasticity in male mating behavior can influence female life histories by altering females' relative allocation to early versus late investment in reproduction and survival.

CT Imaging in Neurocritical Care.

CT imaging is the ideal technique for initial evaluation of neurocritical care patients. It is robust, reliable and relatively easy to interpret. Its ability to diagnose hemorrhage, bony fractures, brain edema and herniation in short scanning times makes it an ideal technique for neurological emergencies. The imaging equipment, normal anatomy and imaging findings in pathologies like infarct, hemorrhage, trauma and hydrocephalus are reviewed in the article. HOW TO CITE THIS ARTICLE: Bhargava R. CT Imaging in Neurocritical Care. Indian J Crit Care Med 2019;23(Suppl 2):S98-S103.

Restless leg syndrome a common undiagnosed comorbidity of clinical significance in cirrhosis.

AIM: Our aim was to study the prevalence and association of restless leg syndrome (RLS) in liver cirrhosis subjects. BACKGROUND: Sleep disturbances are common in cirrhosis. RLS is a chronic sensorimotor sleep disorder with an irresistible urge to move limbs. METHODS: Two hundred consecutive cirrhosis patients, presenting at Mahatma Gandhi Medical College & Hospital, Jaipur were evaluated. 157 subjects meeting the inclusion criteria were selected for further evaluation. Revised International Restless Legs Syndrome Study Group (IRLSSG) criteria 2012, was used for diagnosed of RLS. Severity of RLS was evaluated by a validated Hindi translation of International RLS severity (IRLS) scoring system. RESULTS: Of studied 157 cirrhotic, the mean age was 46.4 ± 10 years, 109 (69.43%) males and 48 (30.57%) females. 41 (26.11%) cirrhotic subjects had RLS. Child Turcotte Pugh (CTP) Class (A 9/55, B 15/68, C 17/34; p 0.043) and alcohol as etiology for liver dysfunction (p 0.03) were significantly associated with RLS. CONCLUSION: RLS is common comorbidity in cirrhosis, especially in alcohol related cirrhosis. RLS has a clinical correlation with prognosis & severity of cirrhosis.

Lumbar artery injury: A rare source of perirenal hematoma following percutaneous renal procedures.

Vascular complications are the most feared complication of percutaneous renal procedures. Hematuria and perirenal hematomas, if they occur, usually arise from injury to renal arteries or its branches. Lumbar artery injury after percutaneous renal procedures is a rare occurrence. We report two cases of lumbar artery injury: one after antegrade ureteric stenting and the other after percutaneous renal biopsy. Both were successfully treated by transcatheter embolization.

Effect of administration of a probiotic preparation on gut microbiota and immune response in healthy women in India: an open-label, single-arm pilot study.

BACKGROUND: Probiotics have been shown to be useful for the treatment of many disease conditions. These beneficial effects are believed to be mediated by change in the composition of gut microbiota and modulation of the host immune responses. However, the available data on the effect of probiotics on these parameters are quite limited. METHODS: We studied the composition of fecal microbiota, using 16S rRNA sequencing, and host immune responses in peripheral blood (plasma cytokine levels, T cell subsets and in vitro cytokine production after stimulation with anti-CD3/CD28 antibody or lipopolysaccharide) in a group of 14 healthy women at three time-points - before and after administration of a probiotic preparation (a capsule of VSL#3, each containing 112.5 billion freeze-dried bacterial cells belonging to 8 species, twice a day for 4 weeks), and 4-weeks after discontinuation of the probiotic administration. RESULTS: There was no change in the abundance of various bacterial taxa as well as in the alpha diversity of gut microbiota following administration of the probiotic, or following its discontinuation. Probiotic administration led to a reduction in the relative frequency of circulating Th17 cells, and in vitro production of cytokines in whole-blood cultures in response to lipopolysaccharide stimulation. However, it had no effect on the relative frequencies of Th1, Th2 and T regulatory cells among circulating peripheral blood mononuclear cells, on plasma cytokine levels and on in vitro production of cytokines by T cells. CONCLUSIONS: We found that VSL#3 administration did not lead to any changes in gut flora, but led to a reduction in the frequency of Th17 cells and in the production of pro-inflammatory cytokine on lipopolysaccharide stimulation. These findings suggest that the beneficial anti-inflammatory effect of this preparation in patients with autoimmune and allergic disorders may be related to reduced production of monocyte-derived cytokines rather than to changes in the composition of gut microbiota. TRIAL REGISTRATION: NCT03330678 , Date of registration 30th October 2017. Retrospectively registered.

Treatment of chronic genotype-3 hepatitis C virus infection using direct-acting antiviral agents: An Indian experience.

BACKGROUND: Direct-acting antiviral drugs (DAAs) are favored for the treatment of hepatitis C virus (HCV) infection. However, the experience with the DAAs currently available in India in the treatment of genotype-3 HCV is limited. We therefore reviewed our experience with these drugs in treating patients with chronic genotype-3 HCV infection, including those with cirrhosis. METHODS: We prospectively followed adult patients with genotype-3 HCV infection who had received treatment regimens containing sofosbuvir with/without daclatasvir. Patients were categorized as chronic hepatitis C (CHC), compensated cirrhosis (CC), and decompensated cirrhosis (DC). They received either (i) sofosbuvir and ribavirin, with or without pegylated interferon (Peg-IFN) for 12 or 24 weeks, or (ii) sofosbuvir and daclatasvir, with or without ribavirin for 12 or 24 weeks. Response was assessed using HCV RNA testing after 2 or 4 weeks of treatment (rapid virological response [RVR]), at treatment completion (end-of-treatment response [ETR]) or 12 weeks after treatment completion (sustained virological response [SVR12]). RESULTS: Of the 160 patients (90% treatment-naïve; CHC 49%, CC 32%, and DC 19%), 39 (24%) received Peg-IFN, sofosbuvir and ribavirin, 21 (13%) received sofosbuvir and ribavirin, and 100 (63%) received sofosbuvir and daclatasvir, with or without ribavirin. On intention-to-treat basis, RVR, ETR, and SVR12 in the entire cohort were 146/160 (91.3%), 151/160 (94.4%), and 147/160 (91.9%), respectively. Seven patients died (CC 2, DC 5) during treatment; four (2 CHC, 2 DC) patients discontinued treatment; and two patients with CC relapsed. CONCLUSIONS: Dual-DAA-based regimens were safe and highly effective in treating genotype-3 HCV infection in CHC and CC patients.

Multimodality management of primary diaphragmatic synovial sarcoma: First report.

Synovial cell sarcoma is an extremely rare tumor of mesenchymal origin. It commonly affects the soft tissues of the extremities but could possibly origin from the head and neck, heart, lung, pleura, mediastinum, esophagus, abdominal wall and the mesentery, and retroperitoneum. Primary synovial sarcoma of pleura, mediastinum, and lung have been reported. Primary synovial sarcoma of the diaphragm has not been reported to the best of our knowledge. We report a case of primary synovial cell sarcoma of the diaphragm presenting as a recurrent pleural effusion and pain in the left hypochondrium managed with multimodality approach.

Combined prednisolone and pirfenidone in bleomycin-induced lung disease.

Bleomycin is a cytostatic drug commonly employed in the treatment of Hodgkin's disease, seminomas, and choriocarcinoma. Bleomycin may induce a chronic pulmonary inflammation that may progress to fibrosis. So far, only corticosteroids have been used in the treatment of bleomycin-induced lung disease with variable results. Pirfenidone is an antifibrotic drug that has been approved for the treatment of idiopathic pulmonary fibrosis. We report two cases of bleomycin-induced lung disease treated successfully with pirfenidone and oral corticosteroids.

Carotid intima media thickness as a marker of atherosclerosis in ankylosing spondylitis.

Aim. Increased cardiovascular morbidity and mortality have been observed in ankylosing spondylitis because of accelerated atherosclerosis. We measured carotid intima media thickness (CIMT) as a surrogate marker of atherosclerosis in this study. Methods. In this study 37 cases of AS and the same number of matched individuals were recruited. CIMT measurements were done using B-mode ultrasound. Disease activity was assessed using Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) scores and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. Results. Mean age of the study groups was 29.43 ± 9.00 years. Average disease duration was 65.62 ± 54.92 months. Twenty-eight (75.68%) of cases were HLA B-27 positive. A significantly increased CIMT was observed in cases as compared to control group (0.62 ± 0.12 versus 0.54 ± 0.04; P < 0.001). CIMT in the cases group positively correlated with age (r = 0.357; P < 0.05), duration of disease (r = 0.549; P < 0.01), and BASMI (r = 0.337; P < 0.05) and negatively correlated with ESR (r = -0.295; P < 0.05). Conclusions. Patients of AS had a higher CIMT than those of the control group. CIMT correlated with disease chronicity.

Familial juvenile hyperuricemic nephropathy 1 (FJHN1).

Familial juvenile hyperuricemic nephropathy 1 (FJHN1) is an autosomal dominant disorder characterized by decreased urinary excretion of urate and hyperuricemia, followed by the development of chronic interstitial nephritis most often leading to progressive renal failure and death in middle age. We report a case of FJHN1 presenting as chronic tophaceous gout, hypertension, renal failure and a family history suggestive of autosomal dominant inheritance, for its rarity.