Apolipoprotein E polymorphism and the risk of aneurysmal subarachnoid hemorrhage in a South Indian population.

BACKGROUND: The rupture of a brain aneurysm causes bleeding in the subarachnoid space. This is known as aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the association of apolipoprotein E (APOE) polymorphism and the risk of aSAH in a South Indian population. METHODS: The study was performed on 200 subjects with aSAH and 253 healthy control subjects. Blood samples (5 ml) were used to isolate DNA and genotyping was performed for rs7412 and rs429358 using a Taqman allelic discrimination assay. Statistical software R.3.0.11 was used to statistically analyze the data and a p value < 0.05 was considered as statistically significant. RESULTS: We found a significant association with the risk of aSAH in ε3/ ε4 genetic model (OR = 1.91, 95% CI = 1.16-3.14, p = 0.01). However, in the other genetic models and allele frequency, there was no significant association with the risk of aSAH. In subtyping, we found a significant association of ε2 allele frequency with posterior communicating artery (PCOM) aneurysm (OR = 3.59, 95% CI = 1.11-11.64, p = 0.03). CONCLUSION: Our results suggest that APOE polymorphism has an influence on the risk of aSAH in this South Indian population, specifically in the PCOM subtype.

Design, synthesis, and analysis of antagonists of GPR55: Piperidine-substituted 1,3,4-oxadiazol-2-ones.

A series of 1,3,4-oxadiazol-2-ones was synthesized and tested for activity as antagonists at GPR55 in cellular beta-arrestin redistribution assays. The synthesis was designed to be modular in nature so that a sufficient number of analogues could be rapidly accessed to explore initial structure-activity relationships. The design of analogues was guided by the docking of potential compounds into a model of the inactive form of GPR55. The results of the assays were used to learn more about the binding pocket of GPR55. With this oxadiazolone scaffold, it was determined that modification of the aryl group adjacent to the oxadiazolone ring was often detrimental and that the distal cyclopropane was beneficial for activity. These results will guide further exploration of this receptor.

Surgical management of petroclival meningiomas: Factors affecting early post-operative outcome.

INTRODUCTION: Petroclival meningiomas pose a major challenge to the treating neurosurgeon. The philosophy of treatment has changed over the decades from a nihilistic attitude to that of aggressive total excision to now a more tempered, maximal safe excision preventing morbidity followed by adjuvant treatment. Despite the advances in neurosurgery, surgical management of these tumours is still associated with sizable morbidity and mortality. MATERIAL AND METHODS: This is a retrospective study of surgically managed petroclival meningiomas at our institute. Clinical status, radiological features and surgical outcome were analysed. RESULTS: Between January 2003 and August 2013, we have operated on 30 patients. The most common presenting complaints were varying degrees of cranial nerve involvement and cerebellar dysfunction. Surgery was done using one of the skull base approaches with the retrosigmoid approach being used maximally (22 cases). Total or near-total excision was possible in 11 cases. There was a post-operative deterioration in cranial nerve functions in all patients and deterioration in Karnofsky Performance Score in seven patients at discharge. Three improved to independent status on follow-up. There was mortality in two cases. Overall 23 of the 30 patients (76.6%) had favourable outcomes. CONCLUSIONS: These are challenging tumours to treat and are associated with sizable morbidity and mortality. On statistical analysis, we found that if the tumour has a size of 3-5 cm and petroclival in location with no sphenoid extension and the lesion is homogenous on T2-weighted images, then there was a trend towards gross total resection and favourable outcome.

Delayed Vasospasm in Endoscopic Transsphenoidal Pituitary Surgery: Two Case Reports and Reviews.

Background: Cerebral vasospasm (CVS) due to injuries to arteries of the circle of willies has been reported in transsphenoidal pituitary surgeries. However, the incidence of delayed vasospasm following endoscopic transsphenoidal surgery is rare. Materials and Methods: Total 569 pituitary adenomas were operated on by endoscopic transsphenoidal approach from January 2016 to February 2020. We retrospectively described two cases of vasospasm following pituitary surgery from our institution. Objective: To describe two cases of delayed cerebral vasospasm following endoscopic transsphenoidal surgery and review previous literature. Results: Out of two patients, the Glasgow outcome score (GOS) of one patient was favorable and the other was unfavorable. Conclusion: CVS is rare after transsphenoidal pituitary surgery, which makes its predictability difficult. The clinician should maintain a high index of suspicion in patients with suprasellar extension of the tumor and postoperative hematoma in the tumor bed. Similarly, care should be taken in patients with a subarachnoid hemorrhage in basal cistern, intraoperative arachnoid breach, and postoperative meningitis.

In search of the 'self': Holistic rehabilitation in restoring cognition and recovering the 'self' following traumatic brain injury: A case report.

BACKGROUND: Following mild-moderate traumatic brain injury (TBI), an individual experiences a range of emotional changes. It is often difficult for the patient to reconcile with their post-injury persona, and the memory of pre-injury personhood is particularly painful. Insight into one's cognitive deficits subsequent to injury can lead to an existential crisis and a sense of loss, including loss of self. OBJECTIVE: Restoration of cognitive functions and reconciliation with loss of pre-traumatic personhood employing a holistic method of neuropsychological rehabilitation in a patient suffering from TBI. METHODS: Ms. K.S, a 25-year-old female, presented with emotional disturbances following TBI. She reported both retrograde and anterograde amnesia. A multidimensional holistic rehabilitation was planned. Treatment addressed cognitive deficits through the basic functions approach. Cognitive behavioural methods for emotional regulation like diary writing helped reduce irritability and anger outbursts. Use of social media created new modes of memory activation and interactions. Compensatory strategies were used to recover lost skills, music-based attention training helped foster an individualised approach to the sense of one's body and self. RESULTS: As a result of these differing strategies, changes were reflected in neuro-psychological tests, depression score and the patient's self-evaluation. This helped generate a coherent self-narrative. CONCLUSION: Treatment challenges in such cases are increased due to patient's actual deficits caused by neuronal/biochemical changes. Innovative and multi-pronged rehabilitation strategies which involve everyday activities provided an answer to some of these problems. This method of rehabilitation may provide an optimistic context for future research.

Polymer leachates emulate naturally derived fluorescent dissolved organic matter: Understanding and managing sample container interferences.

Fluorescence spectroscopy has become a fundamental tool for the qualitative and quantitative fingerprinting of dissolved organic matter. Due to the inherent sensitivity of the technique, a strict sampling protocol should be followed to ensure sample integrity. A literature survey conducted as part of this research determined that 27% of fluorescence sampling has been conducted in polymeric containers, while 52% did not report. Given the potential for fluorescence leachates to arise from plastics commonly used in sampling bottles, a systematic laboratory investigation was undertaken to assess the likelihood of leachate contamination and consequent interferences. It was observed that characteristic fluorescent dissolved organic matter (FDOM) leachates from standard polypropylene sampling containers were produced at environmentally relevant peaks, Peak T (λEx/λEm: 250/349 nm) and B (λEx/λEm: 250/306 nm), commonly attributed to tryptophan-like and tyrosine-like molecular origins. Leachate fluorescence and concentration generally increased with elevated storage temperatures (>4 °C), sample acidification, container steam sterilisation and in new containers, with variability across different manufactured batches. For example, at ambient storage temperatures, the highest observed leachate intensity could contribute an error equivalent to as much as 98% (Peak T) and 2062% (Peak B) for highly treated water or 28% (Peak T) and 398% (Peak B) for surface water. For leachates formed under typical conditions, i.e., 3-day fridge storage, this reduced to 9% (Peak T) and 15% (Peak B) or 3% (Peak T/B) for the same water samples. In addition, PP was found to be typically unsuitable for DOC measurements, except under strict conditions (well-aged containers in short term cold storage). Consequently, we demonstrate the need for container material reporting, refrigerated storage, steam sterilisation avoidance, and the importance of glass usage for low FDOM samples. Future research should investigate the potential for polymer-based pollution as a potential origin of environmentally sampled FDOM.

The role of algal organic matter in the separation of algae and cyanobacteria using the novel "Posi" - Dissolved air flotation process.

Algae and cyanobacteria frequently require separation from liquid media in both water treatment and algae culturing for biotechnology applications. The effectiveness of cell separation using a novel dissolved air flotation process that incorporates positively charged bubbles (PosiDAF) has recently been of interest but has been shown to be dependent on the algae or cyanobacteria species tested. Previously, it was hypothesised that algal organic matter (AOM) could be impacting the separation efficiency. Hence, this study investigates the influence of AOM on cell separation using PosiDAF, in which bubbles are modified using a commercially available cationic polyelectrolyte poly(N, N-diallyl-N,N-dimethylammonium chloride) (PDADMAC). The separation of Chlorella vulgaris CS-42/7, Mychonastes homosphaera CS-556/01 and two strains of Microcystis aeruginosa (CS-564/01 and CS-555/1), all of which have similar cell morphology but different AOM character, was investigated. By testing the cell separation in the presence and absence of AOM, it was determined that AOM enhanced cell separation for all the strains but to different extents depending on the quantity and composition of carbohydrates and proteins in the AOM. By extracting AOM from the strain for which optimal separation was observed and adding it to the others, cell separation improved from <55% to >90%. This was attributed to elevated levels of acidic carbohydrates as well as glycoprotein-carbohydrate conjugations, which in turn were related to the nature and quantity of proteins and carbohydrates present in the AOM. Therefore, it was concluded that process optimisation requires an in-depth understanding of the AOM and its components. If culturing algae for biotechnology applications, this indicates that strain selection is not only important with respect to high value product content, but also for cell separation.

CD133 and BMI1 expressions and its prognostic role in primary glioblastoma.

Glioblastoma is the most common malignant brain tumour, generated by bulk of malignant cancer stem cells, which express various stem cell factors like CD133, BMI1 and nestin. There are several studies which show the importance of CD133 in cancer, but the function and interaction with other major oncogenes and tumour suppressor genes is still not understood. This study aimed to analyse the expression of CD133 mRNA and its correlations with BMI1 protein expression and TP53 mutations in newly diagnosed glioblastoma patients and its role in prognosis. Overexpression of CD133 mRNA and BMI1 protein was found in 47.6 and 76.2% patients respectively and TP53 mutations was seen in 57.1% of patients in our study.There was no correlation among TP53 mutations and expressions of CD133 and BMI1. We found that high level of BMI1 expression was favourable for the patient survival (P=0.0075) and high CD133 mRNA expression was unfavourable for the patient survival (P=0.0226).CD133 mRNA and BMI1 protein expression could independently predict the glioblastoma patient survival in multivariate analysis. In conclusion, the overexpression of these stem cell markers is a common event in glioblastoma progression and could be used as potential prognostic markers.

A review on prescribing patterns of antihypertensive drugs.

Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians' adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries.