Involvement of dual serotypes during a severe dengue outbreak in Wadi area, Nagpur district, Maharashtra 2017.

BACKGROUND & OBJECTIVES: An outbreak of dengue-like illness was reported from Wadi area within the Nagpur Municipal Corporation during September-October 2017 with five deaths. Major symptoms reported were high fever (103-106 oF), acute joint pains, myalgia, drowsiness, breathlessness, etc. An investigation was conducted to confirm the etiological agent, its characterization and the vectors involved in the outbreak. METHODS: Serological analysis was conducted to detect dengue (DEN)/chikungunya IgM antibodies in 158 sera samples. Nested-PCR was carried out to serotype eight ELISA positive samples. Adult and larval mosquito collections were conducted in the affected areas to determine species composition and mosquito density. RESULTS: Dengue IgM antibodies were detected in 44 sera samples. Molecular typing revealed involvement of DEN-2 and DEN-3 serotypes. Dengue hemorrhagic fever symptoms were observed in two patients. Aedes aegypti breeding was found rampant with Breteu index and house index ranging from 23 to 70 and 17 to 56, respectively. Major breeding habitats encountered were, used tyres, cement tanks and refrigerator trays. INTERPRETATION & CONCLUSION: Clinical symptoms, detection of anti-DEN IgM antibodies in high number of samples and heavy breeding of Ae. aegypti confirmed it was a dengue outbreak.

Production and characterization of polyhydroxybutyrate from Vibrio harveyi MCCB 284 utilizing glycerol as carbon source.

AIMS: Production and characterization of polyhydroxybutyrate (PHB) from moderately halophilic bacterium Vibrio harveyi MCCB 284 isolated from tunicate Phallusia nigra. METHODS AND RESULTS: Twenty-five bacterial isolates were obtained from tunicate samples and three among them exhibited an orange fluorescence in Nile red staining indicating the presence of PHB. One of the isolates, MCCB 284, which showed rapid growth and good polymer yield, was identified as V. harveyi. The optimum conditions of the isolate for the PHB production were pH 8·0, sodium chloride concentration 20 g l-1 , inoculum size 0·5% (v/v), glycerol 20 g l-1 and 72 h of incubation at 30°C. Cell dry weight (CDW) of 3·2 g l-1 , PHB content of 2·3 g l-1 and final PHB yield of 1·2 g l-1 were achieved. The extracted PHB was characterized by FTIR, NMR and DSC-TGA techniques. CONCLUSIONS: An isolate of V. harveyi that could effectively utilize glycerol for growth and PHB accumulation was obtained from tunicate P. nigra. PHB produced was up to 72% based on CDW. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report of an isolate of V. harveyi which utilizes glycerol as the sole carbon source for PHB production with high biomass yield. This isolate could be of use as candidate species for commercial PHB production using glycerol as the feed stock or as source of genes for recombinant PHB production or for synthetic biology.

Characterization of anthocyanin from red sorghum (Sorghum bicolor) bran by liquid chromatography-electron spray ionization mass spectrometry analysis.

In the present study, anthocyanin pigments from red sorghum (Sorghum bicolor) bran were identified and characterized by Liquid Chromatography-Electron Spray Ionization Mass Spectrometry. The individual anthocyanins were identified by comparing their mass spectrometric data and retention times, published data. 3-deoxyanthocyanidins and methyl 3-deoxyanthocyanidins were identified in red sorghum bran. This paper presents complete LCMS profile and MS spectrometric data of red sorghum bran.

Tobacco use and exposure to second-hand smoke among high school students in Ernakulum district, Kerala: A cross-sectional study.

Objectives: Tobacco use and exposure to second-hand smoke (SHS) in the home setting are major health hazards for adolescents. The objectives of this study were to estimate tobacco use and exposure to SHS among high school students in Ernakulam district of Kerala, India, and to investigate associated factors. Study design: Cross-sectional study. Methods: A school-based cross-sectional study was carried out in 25 randomly selected high schools from 210 schools in the Ernakulam educational district of Kerala, India. The minimum calculated sample size for ever-use of tobacco and SHS exposure was determined to be 2500, with 95% confidence interval (CI) and 10% relative precision. Data were collected using a semi-structured, pre-tested questionnaire from 2585 high school students. Data analyses were performed using SPSS version 20. Results: The ever-use of tobacco was reported to be 3.9% (95% CI 3.16 to 4.54) and the mean age of the participants was 13.97 ± 0.77 years. One-fifth of participants had tried a tobacco product before the age of 10 years. SHS exposure at home was reported by one in every 5 respondents (20.3%). Male gender (adjusted odds ratio [aOR] 8.79; 95% CI 3.16, 24.53), presence of a family member who smokes within the home (aOR 4.28; 95% CI 2.58, 7.12), lack of awareness about the harmful effects of SHS exposure (aOR 2.47; 95% CI 1.41, 5.18) and having seen an advertisement or promotion at point of sale (aOR 2.16; 95% CI 1.29, 3.60) were found to be independent predictors for tobacco use.Participants with respiratory infections were three times more likely to have experienced SHS exposure at home (aOR 2.87; 95% CI 2.21, 3.74), there was an 86% protective effect of SHS exposure for participants with a father in a professional occupation compared with unskilled profession (aOR 0.14; 95% CI 0.02, 0.67; p < 0.15) and participants with ever-use of tobacco were two times more likely to have experienced SHS exposure at home (aOR 1.63; 95% CI 3.13, 8.98). Conclusions: SHS exposure in the home environment continues to be high. Urgent innovative measures are necessary for the implementation of tobacco smoke-free homes and to reduce tobacco use in this vulnerable population. Further studies are necessary to determine ways to reduce smoking within homes and to increase population awareness.

Predictors of mortality in rhinocerebral mycosis.

INTRODUCTION: Rhinocerebral mycosis is a rapidly progressive fatal opportunistic infection, predominantly affecting people in an immunocompromised state. Aggressive surgical therapy, with repeated debridement in combination with intravenous amphotericin B can lead to a high rate of cure. AIM: To determine the predictors of mortality in rhinocerebral mycosis. MATERIALS AND METHODS: The demographic data, clinical features, radiological (MRI/CT) findings, treatment details of patients with a diagnosis of rhinocerebral mycosis confirmed on histopathology were analyzed retrospectively. The outcome was assessed as alive and dead. Univariate analysis with odds ratio (OR) was employed in data analysis. Chi-square test was used for P value. RESULTS: There were 38 patients. The age range was 7-82 (mean 48.68) years; 30 (79%) were males. Craniofacial pain was the most common initial presenting symptom, noted in 29 (76.3%). Rhino-orbital involvement was noted in 24 (63.2%) and 12 (31.6%) had associated focal neurological deficits. Immunocompromised state was noted in 24 (63.2%). Eighteen (47.4%) patients died. The predictors for mortality: odds ratio (95% CI) were 2.45 (1.01-3.89) for elderly age, 5.67 (4.13-7.21) for intracranial extension, 2.6 (1.26-3.94) for immunocompromised state, 2.62 (1.25-3.99) for infection with zygomycosis and 2.33 (1.01-3.65) for anemia. CONCLUSION: Rhinocerebral mycosis is associated with high mortality in spite of aggressive therapy. Intracranial extension with focal neurological deficits is a major predictor of mortality in rhinocerebral mycosis.

Clinical and electroencephalographic study of first-degree relatives and probands with juvenile myoclonic epilepsy.

PURPOSE: Juvenile myoclonic epilepsy (JME) is a common, well-defined epileptic syndrome. This study aims to examine the clinical and EEG features of probands with JME and to identify the incidence of different types of idiopathic generalized epilepsies (IGEs) and IGE trait in first-degree relatives. METHODS: Clinical and EEG data were collected from 132 first-degree relatives and 31 probands with JME. The data were analyzed using descriptive statistics, chi-square test, t-test and ANOVA. RESULTS: All probands had a history of generalized tonic clonic seizures (GTCS) and myoclonic jerks; 25.8% had a history of absence seizures. Family history of epilepsy was noted in 42% and epilepsy in first-degree relatives was reported in 38.7%. We found JME in 44% of the symptomatic first-degree relatives. The incidence of epilepsy was higher in siblings (19%) than in offspring (8%) or parents (4%), the difference between the groups being significant (p < 0.05). IGE trait was noted in 6% of the asymptomatic first-degree relatives. Finally, IGE features were found in 61%. Subjects with IGE features were younger (mean age 19.6 years) than those without IGE features (mean age 32.4 years) and the difference between the groups was significant. CONCLUSION: The incidence of different kinds of IGEs and typical EEG trait is high in first-degree relatives of JME probands. IGE features were noted in 61% of the families. JME is the most common type of IGE and IGE features were found to be more frequent among siblings than parents. These findings confirm familial susceptibility to IGE.

Hemiballismus due to an ipsilateral striatal haemorrhage: an unusual localization.

Hemiballismus has been correlated clinico-anatomically with lesions of the contralateral side, most commonly of the subthalamic nucleus. Hemiballismus due to an ipsilateral lesion is extremely rare. We report the case of a 55 year old female who developed a right sided hemiballismus due to a right striatal haemorrhage, which simultaneously caused a left hemiplegia. The hemiballismus subsided on treatment with dopamine-blockers over the next two weeks.

Aspergillosis of the central nervous system.

Aspergillosis of the central nervous system is rare. The spread to the CNS is usually from the lungs and uncommonly from paranasal sinuses. Four cases of CNS aspergillosis with spread of infection from the paranasal sinuses are described. Two patients had meningitis, one intracranial granuloma and one presented with subarachnoid haemorrhage resulting from a fungal mycotic aneurysm. Difficulties in establishing the diagnosis are discussed.

Quantitative ELISA for platelet m-calpain: a phenotypic index for detection of carriers of Duchenne muscular dystrophy.

In order to measure the amount of m-calpain in platelets from Duchenne muscular dystrophy (DMD) patients, carriers and controls, an enzyme linked immunosorbent assay (ELISA) has been developed using polyclonal antibodies raised against m-calpain (Calcium dependent neutral protease), purified from human placenta. Compared to controls a nine-fold increase in the level of m-calpain was observed in all 25 DMD patients and eight obligate carrier mothers studied. Serum creatine kinase (SCK) values of four of these obligate carriers were found to be overlapping with that of normal values, limiting its usefulness. Since calpain levels were found to be raised in all DMD patients and obligate carriers, the estimation of calpain in all female relatives of the ones affected with DMD (with or without raised serum CK) would prove a facile index. Population screening for carrier females using this cost and labour effective index may help in assessing the carrier status and counselling the at risk families.

A rare presentation of posterior communicating artery aneurysm.

This is a report of a successfully treated case of a 55-year-old woman with posterior communicating artery aneurysm who had a partial 3rd nerve palsy with pupillary sparing, temporal lobe intracerebral hematoma and a subdural hematoma. Such an association has not been reported earlier.

Delayed onset generalised dystonia after cyanide poisoning.

A 27 year old female developed delayed onset of persistent generalized dystonia following a suicidal attempt with potassium cyanide. Cranial CT scan showed bilateral putaminal hypodensities which were also seen on MRI scans to be hypointense on T1 and hyperintense on T2 weighted images. Multimodality evoked potentials were normal. An improvement was noted with levodopa.

Subacute encephalopathy with seizures in alcoholism.

Generalised seizures are a common manifestation of acute alcohol intoxication. Alcohol is known to precipitate generalised seizures in patients with focal brain pathology. A rare case of secondarily generalised seizures precipitated by alcohol in a patient without an underlying focal brain lesion is reported. Electroencephalopgraphy (EEG) showed periodic lateralised epileptiform discharges (PLEDs) on the side contralateral to the focal motor fits.

Recurrent Miller fisher syndrome: a case report.

Miller fisher syndrome (MFS) is a variant of Guillain-Barre syndrome characterized by the triad of ophthalmoplegia, ataxia and areflexia. Recurrences are exceptional with MFS. A case with two episodes of MFS within four years is reported. He presented with findings of ophthalmoplegia, ataxia, areflexia, and oropharyngeal weakness and mild distal sensory impairment during both episodes. Electrophysiological findings showed reduced compound muscle action potentials and sensory nerve action potentials with no evidence of conduction blocks. Nerve biopsy showed segmental demyelination. MRI of brain was normal. He responded well to immunoglobulins during both episodes suggesting that immunomodulating drugs have a role in the treatment of MFS.

Streptokinase induced primary intraventricular haemorrhage.

Primary intraventricular haemorrhage secondary to thrombolytic therapy has not been reported. A 55 years male who received i.v. streptokinase (STK) followed by heparinization for an acute myocardial infraction developed an extensive primary intraventricular haemorrhage from which he made an uneventful recovery over the next three months.

The antiproliferative activity of 3-deoxyanthocyanins extracted from red sorghum (Sorghum bicolor) bran through P(53)-dependent and Bcl-2 gene expression in breast cancer cell line.

AIMS: The aim of this study was to investigate the anti proliferative activity of 3-deoxyanthocyanin extracted from red sorghum bran on human breast cancer cell line MCF 7. The confirmatory tests were carried out in vitro through the expression studies of p(53) and (bcl) 2 genes in MCF 7 cells. METHOD: The 3-deoxyanthocyanins were isolated from red sorghum bran and cytotoxic studies were performed in MCF 7 cell line by MTT assay. The mRNA expression levels of p(53) and (bcl) 2 genes were performed using semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis in MCF 7 cells. KEY FINDINGS: On cytotoxic studies, the present data indicates sorghum anthocyanins, which showed 84.09% of inhibition in the proliferation of MCF 7 cells, and the CTC(50) value was 300 µg/ml. The sorghum 3-deoxyanthocyanins induced apoptosis in MCF 7 was mediated by stimulation of the p(53) gene and down regulation of the (bcl) 2 gene. SIGNIFICANCE: The significance of our work was the anthocyanin isolated from red sorghum bran inhibits the proliferation of human breast cancer cell line.

Postcholecystectomy syndrome (PCS).

The term postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. Although rare, these patients may present with abdominal pain, jaundice or dyspeptic symptoms. Many of these complaints can be attributed to complications including bile duct injury, biliary leak, biliary fistula and retained bile duct stones. Late sequelae include recurrent bile duct stones and bile duct strictures. With the number of cholecystectomies being performed increasing in the laparoscopic era the number of patients presenting with PCS is also likely to increase. We briefly explore the syndrome and its main aetiological theories.