Role of vascular endothelial growth factor in tuberculous meningitis: A prospective study from a tertiary care center in North India.

INTRODUCTION: The status of vascular endothelial-derived growth factor (VEGF) in the pathogenesis of tuberculous meningitis (TBM) remains far from clear. We prospectively evaluated the role of serum and cerebrospinal fluid (CSF) VEGF in TBM. PATIENTS AND METHODS: This prospective study was conducted at a tertiary care center in North India from January 2018 to June 2019. Consecutive drug-naive patients (n = 82) of TBM diagnosed on the basis of modified Ahuja's criteria were included in the study. The results were compared with 49 control subjects (n = 49). Serum and CSF VEGF were done in all the cases and controls. Follow-up serum VEGF levels were done in 34 patients after 3 months of completion of antitubercular therapy. The VEGF levels were estimated using the human VEGF enzyme-linked immunosorbent assay kit. RESULTS: The mean age was 29.9 ± 13.1 years. The study group consisted of 33 (40.2%) men and 49 (59.8%) women. BACTEC MGIT960 was positive in 15 (18%) patients while multiplex tuberculosis polymerase chain reaction was positive in 73 (89%) patients. Levels of VEGF in serum and CSF of TBM patients were not elevated when compared to controls. There was no association between final outcome in TBM and decrease in serum levels of VEGF at follow-up. CONCLUSION: VEGF may not be playing a significant role in the pathogenesis of TBM. Future studies with larger sample size may clarify the status of VEGF further in TBM.

Hemorrhage from Adrenal Vein Rupture during Adrenal Vein Sampling.

We describe a case of right adrenal hemorrhage from adrenal vein sampling treated conservatively with overnight admission and pain control. We review the existing literature on rates of this complication, typical clinical outcomes, and practical tips to avoid its occurrence.

Persistent Bleeding after Coil Embolization of a Pancreatic Transplant Pseudoaneurysm: Should Covered Stents Be the Primary Management?

Life-threatening arterial complications after pancreatic transplantation can be dire. Pseudoaneurysms can be challenging to treat. There are multiple strategies to treat such complications. We present a case of pancreatic pseudoaneurysm which was initially treated by coiling followed by subsequent covered stent placement for a more durable outcome. We advocate for a "stent first" approach to these lesions if feasible.

In Response to Author: Hiccups before a Pulmonary Embolism Speak against This as a Cause.

How to cite this article: Goyal A, Pallavi K, Awasthy AK. In Response to Author: Hiccups before a Pulmonary Embolism Speak against This as a Cause. Indian J Crit Care Med 2023;27(3):229.

Image Guided Bone Marrow Biopsy.

Bone marrow biopsy and aspiration are common diagnostic procedures used for the diagnosis and monitoring of multiple conditions including hematologic malignancies, non-hematologic malignancies, infection, and metabolic processes. While these procedures can be done on the inpatient floor or in clinic, imaging guidance has been utilized to improve patient safety. This article will review the patient work-up and considerations, as well as technique for performing both computed tomography and fluoroscopic guided bone marrow biopsies.

Kidney Tissue Biopsy.

Kidney tissue biopsy is a commonly performed procedure which is valuable in the work-up for patients with medical renal disease and renal transplant. This article will review indications, contraindications, technique and potential complications of kidney biopsy.

Direct transmesenteric venous interventions in the acute post liver transplant setting.

INTRODUCTION: Portal venous thrombosis and stenosis are uncommon but serious causes of liver transplant graft failure. While surgical thrombectomy can be utilized for the treatment of portal steno-occlusive disease, venous interventions with IR have been performed with encouraging results. CASE DESCRIPTION: 69-year-old female with non-alcoholic steatohepatitis cirrhosis who received a liver transplant complicated by portal vein thrombus. Efforts between transplant surgery and IR allowed for successful thrombus removal via direct SMV access. RESULTS: The advantages of direct SMV access with the surgery team include direct approach to accessing thrombus, sparing of liver parenchyma, and significant hemostatic control.

Amyloid Imaging: Poised for Integration into Medical Practice.

Amyloid imaging represents a significant advance as an adjunct in the diagnosis of Alzheimer's disease (AD) because it is the first imaging modality that identifies in vivo changes known to be associated with the pathogenesis. Initially, 11C-PIB was developed, which was the prototype for many 18F compounds, including florbetapir, florbetaben, and flutemetamol, among others. Despite the high sensitivity and specificity of amyloid imaging, it is not commonly used in clinical practice, mainly because it is not reimbursed under current Center for Medicare and Medicaid Services guidelines in the USA. To guide the field in who would be most appropriate for the utility of amyloid positron emission tomography, current studies are underway [Imaging Dementia Evidence for Amyloid Scanning (IDEAS) Study] that will inform the field on the utilization of amyloid positron emission tomography in clinical practice. With the advent of monoclonal antibodies that specifically target amyloid antibody, there is an interest, possibly a mandate, to screen potential treatment recipients to ensure that they are suitable for treatment. In this review, we summarize progress in the field to date.

Histopathology and Florbetaben PET in Patients Incorrectly Diagnosed with Alzheimer's Disease.

Of 57 individuals diagnosed with Alzheimer's disease (AD) in a phase III study, 13 (23%) had amyloid-ß (Aß) levels on postmortem histopathology that did not explain the dementia. Based on postmortem histopathology, a wide range of different non-AD conditions was identified, including frontotemporal dementia, hippocampal sclerosis, and dementia with Lewy bodies. Of the histopathologically Aß negative scored cases ante-mortem Florbetaben PET scans were classified as negative for Aß in 11 patients based on visual analysis and in all 12 quantifiable cases based on composite standardized uptake value ratios. Thus, florbetaben PET can assist physicians in the differential diagnosis of neurodegenerative disorders by reliably excluding Aß pathology.

Early investigational drugs targeting tau protein for the treatment of Alzheimer's disease.

INTRODUCTION: Alzheimer's disease (AD) is a progressive neurodegenerative disorder that is a significant burden to society. With continual expansion of our understanding of the disease, novel therapies are emerging as potential therapeutics to either halt or reverse progression of the disease. AREAS COVERED: This paper aims to provide an overview of current drug therapies aimed at targeting the tau protein. With this protein known to be a noted pathologic finding of the disease, trials of therapeutics aimed at this protein have been under investigation. This article is based on data obtained from PubMed searches, TauRx, ALZFORUM, and Clinicaltrials.gov with search terms including: anti-tau, tau therapeutic agents in AD, Phase 0, I, II, III trials in AD, monoclonal antibodies and vaccines. EXPERT OPINION: Broad-based treatments that target tau, including microtubule stabilization and tau aggregation inhibitors, appear to be of greatest promise. Immunotherapy appears to be relatively safe and efficacious but narrow whereas protein kinase inhibition has not demonstrated clinical benefit to date.

Absence of effect of chronic nicotine administration on amyloid beta peptide levels in transgenic mice overexpressing mutated human APP (Sw, Ind).

Studies have indicated that nicotine has disease-modifying and cognitive-enhancing properties in Alzheimer's disease (AD). Nicotine has been proposed to be neuroprotective through anti-amyloid beta (Abeta) effects, anti-excitotoxic effects, and anti-free radical effects. Previously, conflicting data from Abeta plaque developing transgenic mice have shown significant Abeta-lowering effects, or alternatively no effects, of nicotine administration. In this study, dosing of transgenic mice (J20 strain) with mutated human APP (Swedish mutations: K670N and M671L and Indiana mutation: V717F) transgene, with nicotine in drinking water for 20 weeks did not have a significant effect on total levels of Abeta 40 or 42 in hippocampus or cortex. This treatment strategy resulted in increased levels of nicotinic acetylcholine receptor activity, and reduced levels of cortical glial fibrillary acidic protein, but had no effect on cortical synaptophysin protein levels. The J20 mouse strain produces higher levels of Abeta 42, the more pathogenic form of Abeta, than Abeta 40 compared to other Abeta plaque developing mouse strains; this could account for differences in effectiveness of nicotine in transgenic mice models of AD.