Targetting the tuberculoma.
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Adolescent↗
Biomedical subjects
S Prabhakar
Publications and source records attributed to S Prabhakar.
Anti-epileptic drugs.
As a sizeable population is affected by epilepsy, so its effective management is a matter of concern. Newer anti-epileptic drugs are now in use, aimed at controls of seizure with fewer side-effects over and above the conventional anti-epileptic drugs. The anti-epileptic drugs can be divided in two groups--conventional anti-epileptic drugs and newer anti-epileptic drugs. The drugs which fall in the first group are--phenytoin, phenobaibitone, valproic acid, carbamazepine, ethosuximide and clonazepam. The second group of drugs are--lamotrigine, clobazam, oxcarbazepine, topiramate and gabapentin. The pharmacology of the drugs are described in a nutshell in this article.
Anticonvulsants↗
Tetanus.
Tetanus is a potentially life threatening disease affecting nearly 50,000 to 1 million people world wide every year. Four major clinical forms of tetanus are described i.e. generalized, cephalic, localized and neonatal. Neonatal tetanus is particularly common in developing countries, due to unhygienic child birth practices, social taboos and improper immunization of pregnant mothers. Management of this disorder involves a team approach and aims at eradicating focus of infection, neutralizing the toxin, controlling spasms and dysautonomia and providing adequate ventilatory and supportive care. Metronidazole may be the preferred antibiotic although penicillin is still used frequently. Adequate wound debridement is necessary to prevent spore germination. Spasms are usually managed by sedatives like diazepam and neuromuscular blocking agents. Magnesium sulphate is an attractive substitute and may be tried if ventilatory facilities are unavailable. Use of baclofen is potentially advantageous but cannot be routinely prescribed. Dysautonomia is difficult to manage and requires therapy with benzodiazepines, morphine, magnesium sulphate, adrenergic blockers and recently tried baclofen therapy. Supportive care including ventilatory assistance are highly essential for successful outcome of the patients. It is imperative that complications are diagnosed early and managed appropriately. Immunization is extremely effective and is the key to prevention. Adequate steps and measures should be taken to increase awareness of this potentially preventable disease.
Diagnosis, Differential↗
Naegleria meningitis: a rare survival.
Acute amebic meningoencephalitis caused by free-living amebae naegleria fowleri is extremely rare and uniformly fatal with only seven survivals reported till date. An interesting case of naegleria meningitis diagnosed by wet mount cytology of cerebrospinal fluid (CSF) and treated with amphoterecin B, rifampicin and ornidazole with complete recovery is presented. In cases of suspected pyogenic meningitis, if CSF staining, antigen detection or culture is negative for bacteria, a wet mount cytology of CSF for naegleria is suggested. Early treatment with amphoterecin B and rifampicin may improve survival.
Adult↗
Scleroderma, stroke, optic neuropathy: a rare association.
A known case of scleroderma presented with right hemiparesis, focal seizures, optic atrophy and gangrene of digits. There was no evidence of peripheral nerve or muscle involvement. MRI showed multifocal infarcts in both cerebral hemispheres. MR angiography revealed poor flow in bilateral carotid arteries with collateralization from posterior circulation. She improved with phenytoin, nifedipine, antibiotics and immunosuppressants. The rarity of central nervous system affliction in scleroderma and large vessel vasculitis is discussed along with review of literature.
Adult↗
Visual loss with papilledema in Guillain-Barre syndrome.
Papilledema and raised intracranial pressure have been reported in association with Guillain-Barre syndrome. Papilledema is usually asympotomatic or associated with mild visual field defects, without any visual loss. The cerebrospinal fluid protein is usually reported to be high. A case of a 35 year old lady is reported, who presented with headache, diplopia and progressive visual loss in both eyes and limb weakness with hyporeflexia. Optic fundus examination showed bilateral papilledema. She had features of pseudotumor cerebri. Nerve conduction studies were suggestive of polyradiculopathy. The unusual things in this case, were the profound visual loss normal cerebrospinal fluid profiles and the presentation of papilledema before the limb weakness.
Adult↗
Detection of 1583 bp gene transcript in lymphocytes of muscular dystrophy patients.
DMD and BMD are X-lined recessive disorders. RAP-PCR was utilized to investigate differentially expressed gene transcripts in lymphocytes from DMD, BMD and normal individuals as possible diagnostic parameter. A 1583 bp transcript was found to be expressed in both DMD and BMD patients which was unrelated to the known dystrophin gene. This may prove helpful in determining the carrier status of DMD/BMD.
Base Sequence↗
Curing coupled-bunch instabilities with uneven fills.
A new, unified theoretical description of coupled-bunch instabilities in unevenly filled storage rings is presented. Uneven-fill longitudinal dynamics are explained in terms of two physical phenomena: fill-induced tune-spread damping and modulation coupling of strong even-fill eigenmodes. The latter is also present in the transverse plane. The analysis yields simple criteria for optimizing fill shapes to reduce the growth rates of the most unstable modes. Experimental results from the ALS and PEP-II are shown to be in good agreement with the theory.
Journal Article↗
Estimation of proton affinity of proline and tryptophan under electrospray ionization conditions using the extended kinetic method.
The relative order of the proton affinity (PA) of 20 naturally occurring amino acids has been determined under electrospray ionization conditions and compared with earlier studies of different research workers. The order we obtained is similar to that reported by other groups except in three cases viz., valine--aspartic acid, asparagine--glutamic acid and tryptophan--proline. The PA values of proline and tryptophan are determined by the extended kinetic method using amino acids themselves as reference bases. The PA values we thus obtained for proline and tryptophan are 219.9 and 221.6 kcal/mol, respectively.
Proline↗
Electrospray ionisation tandem mass spectrometric study of hydrogen-bonding interactions of some disaccharides with lysine.
The efficiency of formation of protonated heterotrimers of lysine with underivatised sugars (mono-, di-, and trisaccharides) and N-acetylglucosamine (N-AcGlc) was studied under electrospray ionisation conditions. The collision induced dissociation spectra of [Lys + sugar + NAcGlc + H](+) resulted in [Lys + NAcGlc + H](+) and [Lys + sugar + H](+) as the major product ions. Relative abundances of these two fragments reflect the extent of adduct formation of protonated lysine plus sugar, with reference to the reference compound NAcGlc. This relative abundance ratio was found to be characteristic of the sugar structure. In this way it was observed that the ability of lysine to form a protonated heterodimer with neutral sugars increases with an increase in the number of acetal oxygens. Lactose showed an anomalously high affinity for protonated Lys, possibly reflecting the axial hydroxyl at C4. The postulated involvement of the epsilon-NH(2) group of lysine in the formation of protonated heterodimers with sugars was supported by similar results of similar experiments with NH(3) in place of lysine.
Disaccharides↗
Ictal deafness--a report of three cases.
Though negative phenomena like motor inhibition, blindness or aphasia are described as an ictal manifestation of seizures, ictal deafness has not been reported so far. We observed transient ictal deafness in three cases of partial seizures. One of them had seizure spread to the temporal lobe to produce a complex partial seizure. Two of them have CT-detected lesions in the left temporal/parietal area. The other one had left temporal focus on EEG with a normal imaging study. The mechanism of such ictal negative phenomena is unclear. An epileptic focus around the primary auditory cortex, dampening its receptive ability may manifest as cortical deafness.
Adolescent↗
Detection and monitoring of cracks using mechanical impedance of rotor-bearing system.
The dynamic behavior of structures, in particular, that of a rotor, containing cracks is a subject of considerable current interest. In the present study, the influence of a transverse surface crack, both open and breathing conditions, on the mechanical impedance of the rotor-bearing system, has been investigated by FEM analysis for flexural vibrations. The results show that the mechanical impedance changes substantially due to the presence of crack and follow definite trends with the crack parameters (depth and location) and force location. The normalized mechanical impedance of rotor system is more sensitive to the breathing crack when compared to the open crack. The sudden changes in mechanical impedance have been observed at the multiples of the running frequency for the breathing crack. The measurement of mechanical impedance has been suggested for crack detection and condition monitoring of rotor-bearing systems.
Journal Article↗
Differences in frequency of the deletion polymorphism of the angiotensin-converting enzyme gene in different ethnic groups.
A polymorphism characterized by the insertion or deletion of a 287-bp Alu repeat sequence in intron 16 of the angiotensin-converting enzyme gene determines about half the serum angiotensin-converting enzyme level variability among individuals. The deletion polymorphism is associated with higher levels of angiotensin-converting enzyme and perhaps with a greater risk of cardiovascular diseases. The relative frequency of this genetic polymorphism in different ethnic groups is not known. The objective of this study was to compare the frequency of angiotensin-converting enzyme gene insertion/deletion polymorphism in different ethnic groups. Angiotensin-converting enzyme genotype was determined in middle-aged healthy hospital workers of three different ethnic origins (African Americans, whites, and Indians). There were 142 African Americans, 136 Indians, and 82 whites. The distribution of the deletion-deletion, insertion-deletion, and insertion-insertion genotypes in African Americans (29%, 60%, and 11%, respectively), Indians (19%, 50%, and 31%, respectively) and whites (29%, 40%, and 31%, respectively) was significantly different (p = < 0.005). The frequency of the deletion allele among African Americans, Indians, and whites (0.59, 0.49, and 0.44, respectively) was also significantly different (p=0.05). African Americans had the highest frequency of deletion allele and the lowest frequency of the insertion-insertion genotype among the three groups. The frequency of the deletion polymorphism of the angiotensin-converting enzyme gene is different among African Americans, whites, and Indians. This may be important in relation to the high risk of cardiovascular morbidity and mortality in African Americans and may be relevant in explaining differences in cardiovascular diseases in different populations. This finding also emphasizes the importance of studying angiotensin-converting enzyme gene polymorphism in genetically homogenous populations. Because of the small size of this study, however, these findings need further confirmation.
Adult↗
Management of respiratory failure in severe neuroparalytic snake envenomation.
Fourteen patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to respiratory critical care unit for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of anti snake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated. All patients had severe manifestations such as ptosis, extraocular muscle paresis and limb weakness along with dyspnoea. Seven patients (50%) had additional complaints of dysphagia and dysphonia. ASV was administered to all, with a median requirement of 900 ml. Mechanical ventilation was required for a median duration of 17 hours and all except one patient, who had suffered irreversible hypoxic cerebral injury prior to resuscitation, survived with complete neurological recovery. We conclude, that the timely institution of ventilatory support and anti-venom therapy in such patients, is associated with an excellent outcome.
Adolescent↗
Intramedullary cysticercosis : MRI diagnosis.
Three cases of dorsal intramedullary cysticercosis presenting as spastic paraparesis or paraplegia are reported. A definite preoperative diagnosis, using MRI, was made in two cases while in the third it was strongly suspected. One paraplegic patient regained full function whereas in the other two the deficit persisted even after successful cyst excision. The pathogenesis and recovery are discussed in the light of the MRI findings.
Adult↗
Albendazole therapy for solitary persistent cysticercus granuloma.
Use of Albendazole therapy for the treatment of patients having persisting intracranial solitary cysticercus granuloma is controversial. Most of the times these patients are treated empirically with variety of drugs for variable period. Some authors advocate biopsy before definitive treatment. 25 patients having radiologicaly persistent solitary cysticercus granuloma (>6 months) were given 15 days course of oral albendazole (15 mg/kg body wt). Cranial CT scan was repeated one month after the completion of albendazole therapy. It was evaluated for complete resolution, partial response (> 50% decrease in size of lesion) or no change as compared to previous scan. 12 patients (48%) showed complete resolution, 4 patients (16%) showed a partial response, while 9 patients (36%) did not show any change on follow up. Albendazole therapy may be useful for patients having persistent cysticercus granuloma.
Adolescent↗
Diagnosis of Creutzfeldt - Jacob disease.
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Brain↗
Vertebral artery dissection due to indirect neck trauma : an underrecognised entity.
Vertebral artery dissection is an important cause of brain stem stroke, especially in the young. Dissections of carotid and vertebral arteries in neck account for about 20% of strokes in young compared with 2.5% in the elderly. Three patients of vertebral artery dissection related to indirect neck trauma are described. The first patient developed the symptoms while dancing, the second after a trivial fall and the third while he was on a dental chair. None of them had a direct severe neck trauma or concomitant risk factor like hypertension, connective tissue disease or migraine. Clinical symptomatology was similar in all the patients and included occipito-nuchal pain, headache and brain stem dysfunction chiefly in the posterior inferior cerebellar artery (PICA) territory. One of the patients also had associated ischaemic myelopathy. MRA and DSA confirmed dissection in all with a predominant steno-occlusive picture. Cases of so called trivial neck movement/torsion related dissection have been described previously but have not received any major importance. Usually classified as 'spontaneous' or 'traumatic', there is a possible ambiguity in literature about appropriate terminology. We emphasise that a history of such subtle precipitating events be taken while diagnosing young patients with brain stem strokes, to recognise this clinical entity. Although mechanisms are not absolutely clear, yet there seems to be an important relationship between arterial dissection and neck movements or minor trauma.
Adult↗