Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence.

OBJECTIVES: Dolutegravir (DTG) is widely recommended within three-drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two-drug regimens in clinical trials. This study evaluated the real-world effectiveness and discontinuations in people living with HIV-1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV). METHODS: This was a one-arm meta-analysis utilizing data from a systematic literature review. Data from real-world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations. RESULTS: Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4-1.3] and 0.6% (95% CI: 0.0-1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3-87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0-97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1-16.2) and 7.2% (95% CI: 2.1-14.4) of patients, respectively, at W48. Similar results were observed at W96. CONCLUSIONS: Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.

Development, validation, and application of an RP-HPLC method for concurrent quantification of Minoxidil and Finasteride in a topical solution for hair regrowth.

A topical solution comprising of Minoxidil (MXL) and Finasteride (FNS) for alopecia is formulated in the present work, which essentially contains a lipid-Lauroglycol FCC as a penetration enhancer. The objective of the proposed work was to develop a rapid, simple, and robust reverse phase high performance liquid chromatographic (RP-HPLC) method to determine MXL and FNS in the said formulation. Herein, the chromatographic conditions were optimized based on the theoretical principles of separation and physicochemical properties such as pKa and log P of both the Active Pharmaceutical Ingredients (APIs). The separation was accomplished on an Inertsil® ODS-3 C18 column (150mm×4.6mm; 5µm of particle size) at 25°C by using a mobile phase composed of 70:30 v/v ratio of Methanol and Milli-Q water along with 0.5% Triethylamine at pH 6.4 adjusted with Ortho Phosphoric Acid. Drug peaks showed a good resolution at 210nm. The retention times for MXL and FNS were found to be 2.40min and 6.39min, respectively. The developed method was found to be linear (R2≥0.998) in a concentration range of 5-100µg/mL for both the drugs. The method was validated according to the ICH guidelines Q2 (R1). The ability of the method to differentiate between the types formulations was demonstrated by the in vitro diffusion data performed using a highly sophisticated Strat-M® membrane. The cumulative amount of drug released (MXL and FNS) at the end of 24hours was maximum for the topical formulation containing lipids prepared using isopropyl alcohol and propylene glycol as the base.

Structure elucidation and biological activity of antibacterial compound from Micromonospora auratinigra, a soil Actinomycetes.

AIMS: The aim of this study was to isolate and characterize the bioactive compound of Micromonospora auratinigra, HK-10 and its antibacterial inhibitory mechanism. METHODS AND RESULTS: An oily bioactive compound was extracted from HK-10 (GenBank accession no. JN381554) and found to have promising antibacterial activity. The compound was characterized as 2-methylheptylisonicotinate (1) by (1) H, (13) C NMR and mass spectroscopy. Minimum inhibitory concentration (MIC) of this molecule was tested by micro broth dilution method and was found to be 70, 40, 80, 60, 60 and 50 µg for Staphylococcus aureus, Bacillus subtilis, Proteus vulgaris, Echerichia coli, Pseudomonas aeruginosa and Mycobacterium abscessus respectively. The effects of compound 1 were studied on bacterial membrane structure using scanning electron microscopy. The results indicated a membrane-disrupting mechanism, resulting in the dysfunction of the cytoplasmic membrane structure and cell death of the pathogenic bacterial strains. Kinetics of growth of the test organisms was also analysed and indicated 2-methylheptylisonicotinate 1 as a bactericidal agent. Furthermore, we have studied the binding affinity of 1 towards different membrane proteins of pathogenic bacteria by in silico analysis. CONCLUSIONS: 2-methylheptylisonicotinate was isolated from M. auratinigra, a rare actinobacterial strain possessing antibacterial activity through a membrane-disrupting mechanism, and has MICs similar to standard antibiotic neomycin sulphate. It is the first report about a strain of M. auratinigra, isolated from Indo-Burma biodiversity hotspot of North-east India with new antimicrobial activities. In silico studies have also supported these results performed on various membrane targets of pathogenic bacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: The antibacterial potential of M. auratinigra is reported for the first time. The results indicate the possible use of 2-methylheptylisonicotinate as a source of antibacterial agent against dreaded human pathogens.

Gallbladder Volume in Sikkimese Population.

Background Gall bladder volume can have clinical and therapeutic implications and possibly affect certain pathophysiological mechanisms of many diseases affecting the gallbladder including gall stones. Objective The objective of the study was to establish baseline indices of gallbladder volume for the Sikkimese population and determine its correlation with age, sex and Body Mass Index. Method A prospective epidemiologic study on selected 100 patients (equal male to female ratio) over the age of 36 years, undergoing ultrasound scan of abdomen, was undertaken. Age, Sex, Body Mass Index and gall bladder volume for each subject were collected and analysed statistically. Spearman's correlation test was performed to look for significant variables. Result The overall mean gallbladder volume in the present study was 15.47±7.9 ml with 17.2±8.9 ml and 13.74±6.4 ml being average volumes in males and females respectively, which gives the baseline indices for the Sikkimese population. Gall bladder volume was strikingly increased in obese subjects. There was a positive correlation between gall bladder volume and age (r=0.114), gender (r=0.182) and BMI (r= 0.175) but the strength of correlation was weak and not statistically significant (p <0.001). Conclusion Ultrasonography is an easy and effective method for evaluation of gall bladder volume. Sikkimese males have a larger fasting gall bladder volume which is directly correlated with higher body mass index. Fasting gall bladder volume has a weak correlation with advancing age.

Culture-independent metagenomic approach to characterize the surface and subsurface soil bacterial community in the Brahmaputra valley, Assam, North-East India, an Indo-Burma mega-biodiversity hotspot.

Soil bacterial communities, which contain the highest level of prokaryotic diversity of any natural environment, are important for ecosystem functioning. A culture-independent metagenomic approach was employed in the present investigation to characterize the diversity of soil bacterial community composition in five geochemically and hydrologically different surface and subsurface soil habitats of Brahmaputra valley, Assam, North-East India, an Indo-Burma mega-biodiversity hotspot. The diversity of soil bacterial community was determined through sequence analysis of 16S-23S intergenic spacer regions (ISR). Polymerase chain reaction (PCR) universal primers, 1406F (5'-TGYACACACCGCCCGT-3') and 155r (5'-GGGTTBCATTCRG-3') were used for amplification of 16S-23S ribosomal DNA intergenic spacers of bacteria. Amplification resulted in an intense array of PCR products approximately ranging in size from 200 to 900 bp. Clear banding patterns were observed in analysed samples using the primer set in combination. A clear change in microbial ISR profile was observed on visual analysis of gel electrophoresis profiles. Fast alignment database searches of PCR amplicons of 16S-23S ISR sequence data revealed that the isolated sequences resembled five major phylogenetic groups of bacteria, namely α-, ß- and γ-subdivisions of Proteobacteria, Acidobacterium and Comamonadaceae.

Isolation and evaluation of native cellulose degrading microorganisms for efficient bioconversion of weed biomass and rice straw.

Cellulose decomposing microorganisms (CDMs) are important for efficient bioconversion of plant biomasses. To this end, we isolated seven fungal isolates (Aspergillus wentii, Fusarium solani, Mucor sp., Penicillum sp., Trichoderma harzaianum, Trichoderma sp.1 and Trichoderma sp.2) and three bacterial isolates (bacterial isolate I, II and III) from partially decomposed farm yard manure, rice straw and vermicompost, and evaluated them for decomposition of rice straw (Oryza sativa), Ipomoea camea and Eichhornia crassipes biomass. CDMs inoculation, in general, reduced the composting period by 14-28 days in rice straw, 14-34 days in Eichhornia and 10-28 days in Ipomoea biomass over control. Of the 10 CDMs tested, Mucor sp. was found to be the most effective as Mucor-inoculated biomass required minimum time, i.e. 84, 68 and 80 days respectively for composting of rice straw, Eichhornia and Ipomoea biomass as against 112, 102 and 108 days required under their respective control. CDMs inoculation also narrowed down the C:N ratio of the composts which ranged from 19.1-22.7, 12.9-14.7 and 10.5-13.1 in rice straw, Eichhornia and Ipomoea biomass respectively as against 24.1, 17.1 and 16.2 in the corresponding control treatments. Aspergillus wentii, Fusarium solani, Mucor sp., and Penicillum sp. were found most effective (statistically at par) in reducing C:N ratio and causing maximum loss of carbon and dry matter in composted materials. These benefits of CDMs inoculation were also accompanied by significant increase in NPK contents in the composted materials.

Biomolecular characterization of 3500-year-old ancient Egyptian mummification balms from the Valley of the Kings.

Ancient Egyptian mummification was practiced for nearly 4000 years as a key feature of some of the most complex mortuary practices documented in the archaeological record. Embalming, the preservation of the body and organs of the deceased for the afterlife, was a central component of the Egyptian mummification process. Here, we combine GC-MS, HT-GC-MS, and LC-MS/MS analyses to examine mummification balms excavated more than a century ago by Howard Carter from Tomb KV42 in the Valley of the Kings. Balm residues were scraped from now empty canopic jars that once contained the mummified organs of the noble lady Senetnay, dating to the 18th dynasty, ca. 1450 BCE. Our analysis revealed balms consisting of beeswax, plant oil, fats, bitumen, Pinaceae resins, a balsamic substance, and dammar or Pistacia tree resin. These are the richest, most complex balms yet identified for this early time period and they shed light on balm ingredients for which there is limited information in Egyptian textual sources. They highlight both the exceptional status of Senetnay and the myriad trade connections of the Egyptians in the 2nd millennium BCE. They further illustrate the excellent preservation possible even for organic remains long removed from their original archaeological context.

Plant growth-promoting rhizobacteria (PGPR): emergence in agriculture.

Plant growth-promoting rhizobacteria (PGPR) are the rhizosphere bacteria that can enhance plant growth by a wide variety of mechanisms like phosphate solubilization, siderophore production, biological nitrogen fixation, rhizosphere engineering, production of 1-Aminocyclopropane-1-carboxylate deaminase (ACC), quorum sensing (QS) signal interference and inhibition of biofilm formation, phytohormone production, exhibiting antifungal activity, production of volatile organic compounds (VOCs), induction of systemic resistance, promoting beneficial plant-microbe symbioses, interference with pathogen toxin production etc. The potentiality of PGPR in agriculture is steadily increased as it offers an attractive way to replace the use of chemical fertilizers, pesticides and other supplements. Growth promoting substances are likely to be produced in large quantities by these rhizosphere microorganisms that influence indirectly on the overall morphology of the plants. Recent progress in our understanding on the diversity of PGPR in the rhizosphere along with their colonization ability and mechanism of action should facilitate their application as a reliable component in the management of sustainable agricultural system. The progress to date in using the rhizosphere bacteria in a variety of applications related to agricultural improvement along with their mechanism of action with special reference to plant growth-promoting traits are summarized and discussed in this review.

Isolation and Characterization of Antidermatophytic Bioactive Molecules from Piper longum L. Leaves.

Piper longum L. (Piperaceae) commonly known as "long pepper" is a well known medicinal plant in ayurveda. Different parts of this plant, such as root, seed, fruit, whole plant etc. are used traditionally in various ailments. Here we have investigated the antidermatophytic activity of sequentially extracted petroleum ether, chloroform, methanol and water extracts from P. longum leaf against Trichophyton mentagrophytes, T. rubrum, T. tonsurans, Microsporum fulvum and M. gypseum. Better activity of chloroform and methanol extracts was observed. The chloroform extract was selected for further study and the MIC value was recorded as 5.0 mg ml(-1) against the test organisms. In the chloroform extract, tannins and phenolic compounds were detected. Further activity-guided fractionation of chloroform extract by silica gel column chromatography yielded nine major fractions. Among these, fraction-1, 4, 5 and 7 showed higher antidermatophytic activity. Fraction-4 on further purification by repeated column chromatography yielded a potential antidermatophytic fraction showing MIC value of 0.625 mg ml(-1) against T. mentagrophytes and T. rubrum as determined by broth microdilution method. The major compounds were identified as 1,2-benzenedicarboxylic acid, bis(2-ethylhexyl) ester (C24H38O4] (41.45 %), 2,2-dimethoxybutane (C6H14O2] (13.6 %) and ß-myrcene (C10H16) (6.75 %) based on GC-MS data.

Variation in salinity tolerance and shoot sodium accumulation in Arabidopsis ecotypes linked to differences in the natural expression levels of transporters involved in sodium transport.

Salinity tolerance can be attributed to three different mechanisms: Na+ exclusion from the shoot, Na+ tissue tolerance and osmotic tolerance. Although several key ion channels and transporters involved in these processes are known, the variation in expression profiles and the effects of these proteins on Na+ transport in different accessions of the same species are unknown. Here, expression profiles of the genes AtHKT1;1, AtSOS1, AtNHX1 and AtAVP1 are determined in four ecotypes of Arabidopsis thaliana. Not only are these genes differentially regulated between ecotypes, the expression levels of the genes can be linked to the concentration of Na+ in the plant. An inverse relationship was found between AtSOS1 expression in the root and total plant Na+ accumulation, supporting a role for AtSOS1 in Na+ efflux from the plant. Similarly, ecotypes with high expression levels of AtHKT1;1 in the root had lower shoot Na+ concentrations, due to the hypothesized role of AtHKT1;1 in retrieval of Na+ from the transpiration stream. The inverse relationship between shoot Na+ concentration and salinity tolerance typical of most cereal crop plants was not demonstrated, but a positive relationship was found between salt tolerance and levels of AtAVP1 expression, which may be related to tissue tolerance.

A pharmacokinetic and bioequivalence study of Contiflo ICON 400 µg tablets in healthy Indian subjects.

INTRODUCTION: Tamsulosin, an alpha1 adrenoceptor blocking agent, exhibits selectivity for alpha1 receptors in human prostate. Blockade of these adrenoceptors can cause smooth muscles in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and a reduction in symptoms of benign prostatic hypertrophy. A new formulation Contiflo ICON 400 µg has been developed by Ranbaxy Laboratories Limited, India similar to Flomaxtra XL 400 µg of Astellas Pharma Limited, United Kingdom. This product is specifically designed to achieve a more consistent plasma concentration over a period of 24-h, a lower maximum plasma concentration (Cmax) and an independence of pharmacokinetics (PKs) on food intake. METHODS: The objective of the present study was to evaluate the pharmacokinetics and bioequivalence of the new formulation Contiflo ICON 400 µg of Ranbaxy Laboratories Limited, India and Flomaxtra XL 400 µg prolonged release tablets (containing tamsulosin hydrochloride prolonged release 400 µg) of Astellas Pharma Limited, United Kingdom. Study was conducted as an open label, balanced, randomized, two-treatment, two-period, two-sequence, cross over, single-dose bioequivalence study in 32 adult male human subjects under fed conditions. The mean (range) age, weight and height of the study subjects were 27.03 years (19 - 40 years), 57.19 kg (48 - 72 kg) and 166.81 cm (154 - 181 cm) respectively. Blood samples were collected at pre-dose and at 0.5, 1, 2, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 8, 9, 10, 12, 16, 20, 24, 36, 48, 72, and 96 h post dose in each period. Plasma samples were analyzed for tamsulosin by using validated liquid chromatographic mass spectrometry (LC-MS/MS) method. RESULTS: The Mean ± SD of pharmacokinetic parameters tmax, Cmax, AUC24, AUClast and AUCinf for Tamsulosin were 11.741 ± 4.7201 and 12.155 ± 6.3077 h, 10.7614 ± 4.76709 and 10.4954 ± 5.08979 ng/ml, 171.4674 ± 77.39695 and 160.6738 ± 77.98628 ng.h/ml, 262.7771 ± 150.21432 and 250.6854 ± 156.75581 ng.h/ml, 280.0702 ± 152.14253 and 273.5078 ± 156.85910 ng.h/ml for test and reference formulations respectively. The ratios of least square means and the 90% confidence interval of log transformed pharmacokinetic parameter Cmax, AUC24, AUClast and AUCinf were within 80 - 125% acceptance range. CONCLUSION: In conclusion, Contiflo ICON 400 µg tablets developed by Ranbaxy Laboratories Limited is bioequivalent to the reference formulation in healthy adult male volunteers under fed condition.

Comparative attitude and plans of the medical students and young Nepalese doctors.

INTRODUCTION: Many doctors are leaving Nepal to work abroad. To understand this problem better, we decided to study the attitude and plans of young doctors and medical students. MATERIALS AND METHODS: This cross-sectional study was conducted at Kathmandu Medical College involving 65 first year medical students, 100 interns and 100 house officers. The data collected was entered in Microsoft excel and analysed by SPSS (Statistical Package for Social Sciences) programme. Chi-square test was used to compare two proportions. Significance level was set at 5%. RESULTS: Only 2% house officers said that their job prospects were excellent as compared to 22.4% of students, whereas 20% house officers as compared to 9% students thought job prospects in Nepal were poor (p= 0.003). Eighty two percent of students thought that a doctor's service to his country was very important as compared to 51% of interns (p= 0.001) and 58% of house officers. Forty percent of students, 58% of interns and 48% of house officers (no statistical significance between the three groups) planned to migrate to a developed country after graduation. Eighty eight percent of students, 89% interns and 74% of house officers (no statistical significant differences between the three groups) were of the opinion that improving career opportunities or working environment of the doctor could make the profession more attractive. CONCLUSION: Although majority of students, interns and house officers were of the opinion that a doctor's service to his community/country was very important, almost half of them still planned to migrate to a developed country after graduation. Improving the chances of professional advancement and professional working environment can make the profession more attractive, and therefore, may decrease this tendency for brain drain from our country.

Numerical simulations of NMR relaxation in chalk using local Robin boundary conditions.

The interpretation of nuclear magnetic resonance (NMR) data is of interest in a number of fields. In Ögren (2014) local boundary conditions for random walk simulations of NMR relaxation in digital domains were presented. Here, we have applied those boundary conditions to large, three-dimensional (3D) porous media samples. We compared the random walk results with known solutions and then applied them to highly structured 3D domains, from images derived using synchrotron radiation CT scanning of North Sea chalk samples. As expected, there were systematic errors caused by digitalization of the pore surfaces so we quantified those errors, and by using linear local boundary conditions, we were able to significantly improve the output. We also present a technique for treating numerical data prior to input into the ESPRIT algorithm for retrieving Laplace components of time series from NMR data (commonly called T-inversion).

Bifunctionally engineered polyethylenimines as efficient DNA carriers and antibacterials against resistant pathogens.

In this study, we have designed and developed two series of bifunctional conjugates by tethering polyethylenimine with streptomycin. By varying the amount of streptomycin, conjugates, polyethylenimine-streptomycin, have been synthesized and characterized spectroscopically. Gel electrophoresis assay revealed a slight decrease in the cationic charge density on the conjugates as these retarded the mobility of pDNA at higher w/w ratios. Further, transfection studies showed that both the series of conjugates transfected the mammalian cells efficiently with low-molecular weight polyethylenimine-streptomycin conjugates were more competent (∼9-fold enhancement with respect to native bPEI) exhibiting high cell viability too. Besides, both the series of conjugates displayed excellent antibacterial activity on pathogenic bacteria, even better than native streptomycin on resistant strains. Altogether, these results ensure the promising potential of the projected bifunctional conjugates as safe and efficient gene delivery vectors as well as antibacterials for future biomedical applications.

Isolation and identification of antimicrobial agent-producing bacterium from Taxus baccata rhizosphere antagonistic against clinically significant microbes.

A bacterium identified as Pseudomonas fluorescence was isolated from Taxus baccata rhizosphere. Ethyl acetate extract from its culture filtrate yielded an active antimicrobial compound that was purified by TLC. The active metabolites were resolved by column chromatography on silica gel (60-120 mesh). The compound was further characterized on the basis of spectral data (UV, IR and (1)HNMR), which indicated the presence of an aromatic ring and phenolic functionality. The compound showed significant antimicrobial activity against two-gram positive bacteria (B. subtilis and S. aureus), four-gram negative bacteria (E. coli, K. pneumoniae, S. flexneri and P. aeruginosa), and one pathogenic fungus (Candida albicans). The minimum inhibitory concentration (MIC) of the compound ranged between 75µg to 250 µg/ml.

Clinico-laboratory profile of haemolytic uremic syndrome.

OBJECTIVE: To study the clinical profile, the spectrum of functional abnormalities, prognostic factors and outcome of children with haemolytic uremic syndrome (HUS). MATERIALS AND METHODS: This is a prospective, descriptive, single centre, cohort study, conducted on 42 children during the period of January 2004 to January 2005. RESULTS: The maximum numbers of cases were below 24 months of age with mean age of 26.6 months and male: female ratio of 2.8:1. Most of the cases (79%) occurred in the warmer months (April-September). The common clinical presentations were bloody diarrhoea, pallor, oliguria & anuria, fever, vomiting, abdominal distension and pain, involvement of central nervous system, chest and cardiovascular system and bleeding manifestations. The common haematological abnormalities were leucocytosis, thrombocytopenia, anaemia and features of haemolysis in the peripheral blood. Electrolyte abnormalities observed were in the form of hyponatremia, hypokalemia and hyperkalemia. Arterial blood gas analysis showed metabolic acidosis in 64% cases, where the estimations were done. The mean blood urea and serum creatinine levels were 113.7 mg/dL and 2.5 mg/dL, respectively. Stool examination showed blood in all cases. Urine examination showed microscopic haematuria and significant proteinuria in 74% and 38% cases, respectively. E. coli and Shigella were isolated in stool in three cases each and one case showed mixed growth of E. coli and Salmonella. The mortality rate was 21%. Significantly higher mortality was observed in females, patients presenting with complete anuria, leucocytosis, hyperkalemia and systemic involvement like central nervous system, cardio vascular system and chest. CONCLUSIONS: Female sex, complete anuria, leucocytosis, extra renal involvement and hyperkalemia were associated with poor outcome.

Inability of laser and rotary instrumentation to eliminate root canal infection.

BACKGROUND: The authors evaluated the antibacterial effectiveness of laser instrumentation and rotary instrumentation of anterior, single-rooted teeth infected with Enterococcus faecalis. METHODS: The authors divided 35 infected samples into five groups: Group A: inoculation, laser, 17 percent ethylene-diamine-tetra-acetate (EDTA), 2.5 percent sodium hypochlorite (NaOCl) (n=10); Group B: inoculation, laser, 17 percent EDTA, sterile saline (n = 10); Group C: inoculation, rotary, 17 percent EDTA, 2.5 percent NaOCl (n=10); Group D: inoculation, no instrumentation (positive control) (n=5); Group E: no inoculation, no instrumentation (negative control) (n=5). They sampled and incubated dentin shavings from each canal for bacterial growth. RESULTS: In Group A, eight tubes were positive for bacterial growth. In Group B, 10 tubes were positive for bacterial growth. In Group C, six tube were positive for bacterial growth. In Group D, all of the tubes were positive for bacterial growth. In Group E, no tubes showed bacterial growth. The Fisher exact test showed no significant differences among groups A, E and C. CONCLUSION: Neither the laser nor the rotary instrumentation was able to eliminate endodontic infection. CLINICAL IMPLICATIONS: Although lasers have been presented as high-tech tools for disinfecting root canals, the laser was ineffective in this study.

Analysis of CAG and CCG repeats in Huntingtin gene among HD patients and normal populations of India.

We have analysed the distribution of CAG and adjacent polymorphic CCG repeats in the Huntingtin gene in 28 clinically diagnosed unrelated Huntington's disease (HD) patients and in normal individuals belonging to different ethnic groups of India. The range of expanded CAG repeats in HD patients varied from 41 to 56 repeats, whereas in normal individuals this number varied between 11 and 31 repeats. We identified six CCG alleles from a total of 380 normal chromosomes that were pooled across different ethnic populations of India. There were two predominant alleles: (CCG)7 (72.6%) and (CCG)10 (20%). We report here for the first time one four-repeat CCG allele which has not been found in any population so far. We found 30 haplotypes (two loci CAG-CCG) for 380 normal chromosomes. In the present study, no statistically significant preponderance of expanded HD alleles was found on either (CCG)7 or (CCG)10 backgrounds. Our studies suggest that the overall prevalence of HD in Indian populations may not be as high as in Western populations. Further studies are necessary to identify the origin of HD mutation in these populations.

Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MR spectroscopy and magnetization transfer MR imaging.

BACKGROUND AND PURPOSE: MR imaging features are nonspecific with respect to the causative organism for patients with brain abscesses. On the basis of the hypothesis that the biochemical environment depends on the infecting organism and might be different in tuberculous compared with pyogenic brain abscesses, this study attempted to determine whether pyogenic brain abscesses can be differentiated from tuberculous brain abscesses by use of magnetization transfer (MT) MR imaging and in vivo proton MR spectroscopy. METHODS: Twenty-seven patients with a total of 33 pyogenic brain abscesses and three patients with a total of 12 tuberculous abscesses were evaluated with in vivo MR spectroscopy and MT MR imaging. The diagnosis in all cases was based on the culture of the causative organisms and histopathology whenever done as a part of clinical management. RESULTS: All 27 patients with pyogenic brain abscesses had lipid and lactate levels of 1.3 ppm and amino acid levels of 0.9 ppm with or without the presence of succinate, acetate, alanine, and glycine, while the three patients with tuberculous abscesses showed only such lipid and lactate levels. The MT ratio from the wall of the pyogenic abscesses was significantly higher (P <.001) than that from the tuberculous abscess wall. CONCLUSION: It might be possible to differentiate tuberculous abscesses from pyogenic abscesses by using MT MR imaging and in vivo MR spectroscopy, which could be of value in influencing the management of such cases.

Laryngeal myxoma.

Myxoma is an uncommon neoplasm in the head and neck region. Laryngeal myxomas are rarer still. We report a case of a large myxoma in the supraglottis, that was excised endoscopically.