Mycophenolate mofetil as induction and maintenance immunosuppressive therapy in adult primary central nervous system vasculitis: A prospective observational study.

To observe the clinical and angiographic effectiveness of mycophenolate mofetil (MMF) as induction and maintenance immunosuppressive therapy in primary central nervous system vasculitis (PCNSV). In this open-label prospective study done at a tertiary care neurology centre, adult patients with PCNSV, diagnosed by Calabrese's criteria, were recruited from 2017 to 2021 and treated with glucocorticoids, MMF and standard of care. Patients were followed-up and clinical and angiographic changes were recorded. Total 26 patients were recruited with median age 39 years (34-49) with a slight female predilection (61.5%). Angiographic diagnoses were: small vessels disease 11.5%; large vessels disease 42.3% and both in 46.2%. Median duration of follow-up was 24.5 months (14.25-38). Proportion of patients with severe disability (modified Rankin Score (mRS) 4-6) at baseline was 73.08% (19/26) which reduced to 7.69% (2/26) (p < 0.001). At the last follow-up mRS = 0 was achieved in 38.5% (10/26) and mRS of ≤ 1 was achieved in 69.2% (18/26). Median time to achieve a mRS ≤ 1 was 12 months (95% CI: 6.8-17.2). Angiography was repeated in 16 patients after a median duration of 13 months (10.5-19.7), out of which 10 (62.5%) showed improvement and 5 (31.2%) showed non-progression of lesions. MMF may be an effective immunosuppressive therapy in adult PCNSV as both induction and maintenance. Serial DSA of brain may be useful to monitor the effect of treatment. Key Points • Mycophenolate mofetil is effective as induction and maintenance immunosuppressive therapy in PCNSV. • Repeat angiogram may be useful to monitor treatment response in PCNSV.

CNS Melioidosis: A Diagnostic Challenge.

Melioidosis is an emerging tropical disease. Central nervous system (CNS) melioidosis may present as a brain abscess or encephalomyelitis mimics tuberculosis. Early diagnosis and management decreases mortality as well as morbidity. This case of brain abscess and encephalomyelitis in a young man with no known comorbidities was a diagnostic challenge. The surgery helped in debulking as well as isolating the causative organism. Appropriate antibiotic therapy for melioidosis was lifesaving and prevented further complications.

Efficacy of leflunomide as a steroid-sparing agent in treatment of Indian giant cell arteritis patients: A 2-year follow-up study.

OBJECTIVES: To evaluate the effectiveness of leflunomide as a steroid-sparing agent among Indian patients with giant cell arteritis (GCA) and to assess the changes of "halo sign" within affected arteries, detected ultrasonographically, after remission. METHODS: In this prospective observational study, patients fulfilling American College of Rheumatology criteria for GCA and having halo sign in temporal artery ultrasound were treated with leflunomide and predefined tapering dose of prednisolone. Ultrasounds of temporal and axillary arteries were done at baseline and after remission were achieved. RESULTS: Twenty-two GCA patients were followed up for a median duration of 24 months (interquartile range, IQR: 18-33). All patients showed clinical improvement and steroids could be stopped in 17 out of 22 patients. Median time to achieve remission (symptom-free with normal inflammatory markers) was 3 (95% confidence interval [CI]: 2.4-3.6) months. Median time to achieve reduction to prednisolone dose <5 mg/d was 9 months (95% CI: 7-11). Prednisolone dose could be reduced in all patients while on leflunomide, suggesting steroid-sparing effect and a steroid-free remission could be achieved after a median of 14 months (95% CI: 9.4-18.6). Ultrasonographically, all patients showed improvement of halo signs, after 8 weeks (IQR 7.25-12). Seven patients experienced a clinical relapse after 12 months (IQR: 5-21) of initial remission. The predictors of relapse were duration of symptoms before initiation of immunosuppression therapy and delayed achievement remission by strict criteria. CONCLUSION: This study showed efficacy and safety of leflunomide as a steroid-sparing agent in Indian GCA patients.

Bruns Syndrome - An Unusual Presentation.

Bruns syndrome is characterized by attacks of sudden severe headache, vomiting, and vertigo precipitated due to abrupt movements of the head due to presence of mobile deformable intraventricular lesion causing episodic obstructive hydrocephalus. Proposed underlying mechanism is intermittent or positional CSF obstruction resulting from ball-valve mechanism. Most common etiologies are NCC and intraventricular tumors. Here we present an unusual case of Bruns syndrome that was initially MRI negative.

Optimization study for refractance window drying process of Langra variety mango.

Refractance window (RW) drying of mango pulp has shown good quality retention compared to conventional drying methods. Different pulp thickness (2, 3 and 4 mm) and drying temperature (85, 90 and 95 °C) were optimized for RW drying of mango pulp for responses as drying time, ascorbic acid, total phenolics content (TPC) and hardness of mango leather. Face-centered central composite design was performed for optimization using Design-Expert software. RW drying of 2 mm thick mango pulp took the shortest drying time, however lower ascorbic acid and TPC were determined as compared to 3 mm and 4 mm thick pulp mango leather. Hardness of RW dried mango leather was determined to be in the chewable range as 3.62-5.33 N. The optimum solution generated for RW drying temperature and pulp thickness was 95 °C and 2.49 mm, respectively. The drying time was 22.5 min with high quality retention in terms of ascorbic acid, TPC and hardness as 62.33 mg/100 g DW, 7.72 mg GAE/g DW and 4.60 N respectively of dried product with desirability function obtained was 0.969. More nutrients were preserved in mango leather as well as microstructure of mango powder was observed as smooth and flaky with uniform thickness of powder particles with RW drying process when compared with tray and oven drying at 95 °C drying temperature and 2.50 mm mango pulp thickness.

Development of super-atmospheric oxidation chamber for orthodox tea processing and its validation through neural network approach.

BACKGROUND: Orthodox tea is known for its distinct aroma and superior quality. However, the oxidation step that is most crucial for developing these attributes needs precise control and is also time consuming. In the present study, a super-atmospheric oxidation chamber (SOC) was designed to address this issue. Oxidation of hand-rolled tea leaves was performed at an elevated oxygen concentration inside the SOC. Both pressure and processing time were varied over the ranges 101-303 kPa and 0-150 min, respectively. Theaflavin (TF), thearubigin (TR) and total color (TC) were determined experimentally and then predicted through artificial neuron network (ANN) modeling. RESULTS: An increasing oxygen concentration and attainment of 100% relative humidity in the compressed air was recognized at elevated air pressure. The observed rate of formation or depletion in TF, TR and TC values was faster with compression of the ambient air. The experimental data points were predicted based on an ANN network containing 18, 10 and 16 neurons in the hidden layer since lowest mean square error and mean absolute error values were observed for the given experimental TF, TR and TC values respectively. CONCLUSION: Considering the significant decrease in oxidation duration and minimal mechanized complexity of the design, the set-up developed in the present study can be upscaled for industrial application in orthodox tea processing. © 2019 Society of Chemical Industry.

Refractance window drying of fruits and vegetables: a review.

Fruit and vegetable drying to make leather, pestil or powder products is a challenging task. Traditional drying adversely affects the taste, colour, nutritional qualities and preservation of bioactive compounds due to high-temperature exposure of the product. The substitute for traditional drying processes is consequently necessary to impart superior quality and preserve greater nutritional value in processed foods. Refractance window (RW) drying is a thin film drying system having high heat and mass transfer rates that speeds up the rate of drying. Polyester (Mylar), an infrared transparent plastic sheet transmits radiative heat to food during the RW drying process with higher drying rate, more retention of nutrients and low aroma and flavour loss. RW drying is reported to be affected by the thickness of puree or slices and temperature of drying, as thick samples need longer drying time, generate higher water activity, bring changes in colour parameters, experience higher effective diffusion coefficient (Deff ) and result in lower solubility of powder. RW drying was compared with different drying processes and was observed to have more retention of nutrients and be more economical. RW dried samples were better in terms of colour and textural quality when compared with other traditional drying methods. © 2018 Society of Chemical Industry.

A randomized, open labeled study comparing the serum levels of cobalamin after three doses of 500 mcg vs. a single dose methylcobalamin of 1500 mcg in patients with peripheral neuropathy.

BACKGROUND: Vitamin B12 deficiency has been associated with peripheral neuropathy, loss of sensation in the peripheral nerves, and weakness in the lower extremities. Methylcobalamin is the most effective analogue of vitamin B12 used to treat or prevent the complications associated with vitamin B12 deficiency. The current study aimed to compare the serum cobalamin levels after administration of two different regimes of methylcobalamin in peripheral neuropathy patients. METHODS: The present study was a prospective, randomized, comparative study. The study consisted of two parallel groups, group A (methylcobalamin 500 µg injection intramuscularly three times a week) and group B (methylcobalamin 1500 µg injection intramuscularly once a week). A control group of healthy volunteers was also included. RESULTS: A total of 24 patients (12 in each group) were included in the study. Five healthy volunteers were also included as a control in each group. At the end of treatment, serum cobalamin levels were significantly (P = 0.028) higher in group A (1892.08 ± 234.50) as compared with group B (1438.5 ± 460.32). The serum cobalamin levels in Group A healthy volunteers were also two times higher than that of group B (P = 0.056). Both the LANSS scale and DN4 questionnaire reported similar results at end of treatment. CONCLUSIONS: The 500 µg methylcobalamin thrice weekly regime is more effective in increasing the serum cobalamin levels as compared to the 1500 µg methylcobalamin once weekly regime.

Genesis of Influenza A(H5N8) Viruses.

Highly pathogenic avian influenza A(H5N8) clade 2.3.4.4 virus emerged in 2016 and spread to Russia, Europe, and Africa. Our analysis of viruses from domestic ducks at Tanguar haor, Bangladesh, showed genetic similarities with other viruses from wild birds in central Asia, suggesting their potential role in the genesis of A(H5N8).

Quantitative Analysis of Major Phytochemicals in Orthodox tea (Camellia sinensis), Oxidized under Compressed Air Environment.

This study describes major changes in phytochemical composition of orthodox tea (Camellia sinensis var. Assamica) oxidized under compressed air (CA). The experiments for oxidation were conducted under air pressure (101, 202, and 303 kPa) for 150 min. Relative change in the concentrations of caffeine, catechins, theaflavins (TF), and thearubigins (TR) were analyzed. Effect of CA pressure was found to be nonsignificant in regulating caffeine concentration during oxidation. But degradation in different catechins as well as formation of different TF was significantly affected by CA pressure. At high CA pressure, TF showed highest peak value. TR was found to have slower rate of formation during initial phase of oxidation than TF. Even though the rate of TR formation was significantly influenced by CA, a portion of catechins remained unoxidized at end of oxidation. Except caffeine, the percent change in rate of formation or degradation were more prominent at 202 kPa.