Envelope specific T cell responses & cytokine profiles in chikungunya patients hospitalized with different clinical presentations.

BACKGROUND & OBJECTIVES: Since the 2006 massive outbreaks, chikungunya (CHIK) is a major public health concern in India. The aim of this study was to assess envelope specific immune responses in patients with chikungunya infection. METHODS: This study included 46 hospitalized patients with chikungunya virus infection (encephalitis, n=22, other systemic involvement, OSI, n=12, classical, n=12) and six controls from Ahmedabad city, Gujarat, India. T cell responses and the levels of Th1, pro/ anti-inflammatory cytokines against the CHIK virus envelope antigens were assessed by lymphocyte proliferation assay and by cytometric bead array in flow cytometry, respectively. RESULTS: Lymphoproliferative response was uniform among the patients. Comparisons of cytokines revealed significantly higher levels of interleukin (IL)-4 and IL-5 in encephalitis, OSI and classical patients versus controls. The levels of tumour necrosis factor (TNF)-α were higher in classical patients categories compared to the controls. Interferon (IFN)-γ levels were lower in encephalitis patients versus control. INTERPRETATION & CONCLUSIONS: Our findings showed recognition of T cell epitopes on the envelope region of chikungunya virus by all patient categories. Lower level of IFN-γ may be associated with the severity of disease in these patients.

A Rare Cause of Ortner's Syndrome and a Case-Based Review of Literature.

Ortner's syndrome refers to the compression of the recurrent laryngeal nerve by cardiovascular disorders of various etiologies. We describe a rare case of Ortner's syndrome caused by thoracic aorta aneurysm and a brief review of literature on this unusual cause of Ortner's syndrome. Hoarseness of voice due to the compression of recurrent laryngeal nerve by thoracic aorta aneurysm could be a harbinger of aneurysmal rupture.

A rare complication of Yellow Phosphorous poisoning.

Yellow phosphorous is one of the most common toxins reported to cause fulminant hepatic failure. Yellow phosphorous is a component of rodenticides and fireworks, and is freely available over the counter. The mortality rate as high as 27% from fulminant hepatic failure has been reported following ingestion of yellow phosphorous.1 Multisystem toxicity affecting gastrointestinal, cardiac, renal and central nervous systems occurs.2 There is a paucity of literature on its haematological toxicity. In this case report, we highlight the clinically significant myelosuppression observed in a patient resulting from yellow phosphorous; a small literature review has also been done on this rare complication.

Accessibility and quality of secondary care rheumatology services for people with inflammatory arthritis: a regional survey.

Secondary care rheumatology services for patients with inflammatory arthritis (IA) in the West Midlands were audited using Arthritis and Musculoskeletal Alliance (ARMA) standards of care. Questionnaires were analysed from 1,715 patients in 11 rheumatology departments. ARMA standards recommend full multidisciplinary team assessment; referral rates to nurse specialists (52.3%), physiotherapists (48.7%) and occupational therapists (36.5%) were, however, lower than expected. Attendance at existing hospital-led education groups was rare (8.9%), awareness of existing helplines was moderate (59.2%) but the proportion of patients reporting satisfaction with advice about their disease was high (80.5%). Significant variations were found between departments. For patients with IA < 2 years (n = 236), 84.5% were seen by a rheumatologist within the ARMA standard of 12 weeks of referral; diagnosis of a type of IA was made at the first rheumatology appointment in 66.4%; 82.8% of rheumatoid arthritis patients had commenced disease-modifying drugs, although time to commencement varied across departments. This study raises issues regarding provision of rheumatology services, prioritisation of patient referral and patient education.

Effect of bacopa monniera on cold stress induced neurodegeneration in hippocampus of wistar rats: a histomorphometric study.

INTRODUCTION: Bacopa monniera/ Brahmi,is used over centuries in Ayurvedic medicine for memory development, learning, concentration and other mental illnesses such as nervousness and poor cognition. The present study aims to evaluate the effect of Bacopa monniera (Brahmi, BM) on cold stress induced histological changes in hippocampus of Wistar rats. MATERIALS AND METHODS: Total 24 male rats divided into four groups were used (n=6) for this study. Group I was control in which rats were kept under ideal laboratory conditions, Group II was given 40 mg/kg of BM extract, Group III was cold water swim stress in which rats were forced to swim in the cold water maintained at 18±2(o)C till it started to sink for a period of one month and Group IV in which cold water swim stress given for a month followed by oral administration of BM extracts 40mg/kg treatment for a month. The whole study was carried out for a period of 60 d. The animals were sacrificed next day and their brains dissected out for histomorphometric analysis. The diameter, packing density and total number of neurons were calculated from stained histological section by using micrometry in the CA-1 region of the hippocampus. STATISTICAL ANALYSIS: The analysis and plotting of graphs were carried out using Sigma Plot 12 (Systat Software Inc., USA). Values are expressed as Mean ± SEM (n = 6). One way analysis of variance followed by Student-Newman-Keul's multiple comparisons test was used for the comparison of means. A probability of 0.05 and less was taken as statistically significant. RESULTS: The results showed that there is no significant difference in the diameter of the cells between the groups but total number of the cells in Group II was statistically significant when compared with the others groups. Student-Newman-Keuls method showed that Group II and Group IV are statistically significant when compared to Group III (p<0.05). CONCLUSION: RESULTS indicates that when BM extracts administered orally produce neuroprotective effect in cold stress induced hippocampal neurodegeneration of rats. Hence, the herb BM can possibly be used as an adjuvant to improve memory to combat stress in our day to day life.