Serum B12, Homocysteine Levels, and their Effect on Peripheral Neuropathy in Parkinson's Disease: Indian Cohort.

BACKGROUND: Cobalamin deficiency, either due to dietary inadequacy or increased consumption attributable to levodopa-mediated metabolic disturbance, and resultant hyperhomocysteinemia may contribute to peripheral neuropathy (PN) in Parkinson's disease (PD). AIM: The aim of the study is to assess the prevalence of Vitamin B12 deficiency, hyperhomocysteinemia in Indian PD patients, and their association with PN. MATERIALS AND METHODS: Clinical details were collected in 93 patients over a period of 2 years. Seventy controls were included in the study. Serum B12, homocysteine, folate, electroneurography, and autonomic function tests were done. The prevalence of B12 deficiency and hyperhomocysteinemia in PD patients and controls was assessed. The association of B12 and homocysteine levels with patients' age, disease duration, levodopa equivalent daily dose, cumulative levodopa dose, Unified Parkinson's Disease Rating Scale-III off score, modified Hoehn and Yahr score, and presence or absence of PN was studied. RESULTS: Serum B12, homocysteine levels, prevalence of B12 deficiency, and hyperhomocysteinemia were no different between cases and controls. Seven of 93 (9.68%) PD patients had PN. The median values of serum B12, folate, and homocysteine levels across patients with or without PN could not be compared as only seven of our patients had PN. CONCLUSION: The prevalence of B12 deficiency, hyperhomocysteinemia, and incidence of PN among our patients is very less when compared to the Western population. The conjecture that PN in PD patients may be secondary to B12 deficiency/hyperhomocysteinemia stands as a speculation.

Intrasinus thrombolysis in cerebral venous sinus thrombosis: Experience from a university hospital, India.

BACKGROUND: Intrasinus thrombolysis (IST) is believed to improve outcome in patients of cerebral venous sinus thrombosis (CVST) unresponsive to heparin. PURPOSE: The purpose of this article is to describe our experience with IST in patients of CVST unresponsive to heparin. MATERIALS AND METHODS: Hospital databases were searched, and patients with CVST who underwent IST from May 2011 to March 2014 were identified. Data on clinical presentation, duration of symptoms, and indications and dosage of IST were retrieved and outcomes analyzed. RESULTS: Twenty-four patients received IST. The presenting symptoms included headache (n = 19), seizures (n = 16), and altered sensorium (n = 14); signs included papilledema (n = 20) and hemiparesis (n = 15). Nineteen patients received unfractionated heparin (UFH), four received low-molecular-weight heparin (LMWH), and one received both. In one patient, microcatheter could not be passed, two patients bled intracranially, and three had nonintracranial bleeds. Among four deaths, none was due to iatrogenic bleeding. On discharge, 10 patients (43.5%) had good improvement with the modified Rankin Scale (score; mRS) ≤2 and eight (34.8%) had partial improvement with mRS = 3, 4. Seventeen patients (73.9%) had mRS ≤2 at 6 months follow-up. Bleeding complications of urokinase were less than those of alteplase. Recanalization of the involved sinuses was achieved in all. Early intervention led to successful recanalization. Functional recanalization decreased intracranial bleeding. CONCLUSION: Till date, our study is the largest series of IST in CVST reported from India. IST may be more effective than systemic heparin anticoagulation in moribund and unresponsive patients despite the potential for bleeding manifestations. Functional recanalization is adequate for good results. However, a randomized prospective study comparing heparin anticoagulation with IST is warranted.

Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India.

BACKGROUND: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. OBJECTIVE: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. MATERIALS AND METHODS: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. RESULTS: Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2). CONCLUSION: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.

Conscious sedation for awake fibreoptic intubation: a review of the literature.

PURPOSE: Awake fibreoptic intubation (AFOI) is the gold standard of management of the predicted difficult airway. Sedation is frequently used to make the process more tolerable to patients. It is not always easy to strike a balance between patient comfort and good intubating conditions on the one hand and maintaining ventilation and a patent airway on the other. In the last 30 years, many drugs and drug combinations have been described, but there is very little in the literature to help guide the practitioner to choose between them. The objective of this article is to discuss the evidence supporting the use of the agents described with regard to their efficacy, recommended doses and techniques, and limitations to their use for AFOI. SOURCE: Publication databases were searched for articles published from 1996 to 2012 relating to sedation for AFOI. PRINCIPLE FINDINGS: Benzodiazepines, propofol, opioids, alpha2-adrenoceptor agonists, and ketamine are the main classes of drugs that have been described to facilitate AFOI. Drugs that are most suitable have a combination of both anxiolytic and analgesic properties. The ideal choice of drug may vary depending on the patient and the indication for AFOI. CONCLUSION: There is good evidence to support the use of two drugs in particular, remifentanil and dexmedetomidine. Each has certain unique characteristics that make them an attractive choice for an AFOI.

Vertical distribution of polychaetes in brackishwater pond of Nethravathi estuary, India.

Vertical distribution of polychaetes in a semi-enclosed brackishwater pond of Nethravathi estuary was studied for one year from February 2004 to January 2005. The semienclosed brackishwater pond is a shallow water body with an average depth of 1-1.5 m with an area of 12 ha having direct connection with the estuary which opens into the Arabian sea. A total of nine species of polychaetes were identified. Among these, Dendronereis aestuarina and D. arborifera were most common and accounted for 65.62% of total abundance. The fauna were more abundant at 5-10 cm depth than at 0-5 cm depth and decreased beyond 10 cm depth. Species composition and the abundance of polychaetes were generally high during postmonsoon followed by premonsoon and monsoon season. Polychaete abundance showed positive significant correlation with organic carbon content at all depth layers of sediments in all the stations.

Water quality, biofilm production and growth of fringe-lipped carp (Labeo fimbriatus) in tanks provided with two solid substrates.

The effects of two substrates, sugarcane bagasse (T(1)) and paddy straw (T(2)) on water quality and growth of Labeo fimbriatus were studied in mud-bottomed, manured cement tanks, in triplicate; a set of three tanks without substrate served as control (T(3)). Addition of manure and substrate brought about a decrease in dissolved oxygen level, but it stabilized after 15 days, when the tanks were stocked with 30 fish each, fed at 3% body weight daily and reared for 90 days. Total ammonia content in substrate based treatments was relatively lower than in the control. Significantly higher nitrite-nitrogen was recorded in the control tanks. The total plate counts (TPC) of bacteria in water did not differ significantly between treatments and control. The overall mean value of TPC with substrate was higher in T(2) than in T(1). The mean phytoplankton density in water was the highest in T(1), followed by T(3) and T(2), whereas zooplankton density was the highest in T(1) followed by T(2) and T(3). The growth of fish was significantly (P<0.05) higher in substrate-based tanks, the percentage increases over control being 30.44 (T(1)) and 28.71 (T(2)) respectively. Higher RNA, DNA and RNA:DNA ratios were recorded under T(1), followed by T(2) and T(3). Higher enzyme activity was observed in fish from substrate treatments, which was attributable to the additional nutrients derived through the biofilm. The results demonstrated that production of L. fimbriatus can be significantly increased by the introduction of biodegradable substrates into culture systems where fertilization and feeding are employed.