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Biomedical subjects

S Sinha

Publications and source records attributed to S Sinha.

At least 19 recordsLinked to original sources

Conditional mouse models to study developmental and pathophysiological gene function in muscle.

This chapter will review conditional mouse model systems that have been developed to study gene function in skeletal, cardiac, and vascular smooth muscle cells in vivo with an emphasis on the utility of these models for investigating developmental and pathophysiological gene function in muscle. In general, these systems have utilized muscle-specific/selective promoter-enhancers in conjunction with site-specific DNA recombinases, e.g., Cre-loxP, and fusion proteins with these recombinases that confer temporal control, such as tamoxifen-inducible CreER systems. A major focus of this chapter will be to discuss unique challenges of studying Cre-mediated mutagenesis/gene targeting in these muscle types during development and in the adult animal, some of which are inherent of the muscle cell type being studied. For example, unlike cardiac and skeletal muscle cells, the vascular SMC is extremely plastic and able to undergo rapid phenotypic modulation to various environmental cues in vivo. Thus, employing SMC marker gene promoter enhancers for conditional gene targeting in SMCs must take into account the possibility and/or certainty that the particular SMC promoter enhancers used may or may not be transcriptionally active in SMCs of a vessel wall under normal and some pathophysiological conditions. Moreover, individual floxed loci within the same muscle cell type and tissue have different degrees of sensitivity to Cre, most likely dependent on the chromatin state of that particular gene, i.e., closed/condensed state or open/active state. Thus, Cre recombination may be ineffective for specific floxed gene DNA. Lastly, rigorous efforts must be made to confirm the degree of recombination in a tissue, taking into full account the multicellularity of the tissue, to understand the extent of the physiological effect in that organ.

Animals↗

Progressive myoclonic epilepsy: A clinical, electrophysiological and pathological study from South India.

Progressive myoclonic epilepsy (PME) is a syndrome complex encompassing different diagnostic entities and often cause problems in diagnosis. We describe the clinical, electrophysiological and pathological features of 97 patients with the diagnosis of PME evaluated over 25 years. Case records of confirmed patients of Neuronal ceroid lipofuscinosis (NCL = 40), Lafora body disease (LBD = 38), Myoclonic epilepsy with ragged red fibers (MERRF = 10), and probable Unverricht-Lundberg disease (ULD = 9) were reviewed. The mean age at onset in patients with NCL (n = 40) was 5.9+/-9.1 years (M:F:: 28:12). Subtypes of NCL were: late infantile (n = 19), infantile (n = 8), juvenile (n = 11) and adult (n = 2) NCL. EEG (n = 37) showed varying degree of diffuse slowing of background activity in 94.6% and epileptiform discharges in 81.1% of patients. Slow frequency photic stimulation evoked photo-convulsive response in 5 patients only. Giant SSEP was demonstrated in 7 and VEP study revealed a prolonged P100 (2) and absent waveform (7). Electrophysiological features of neuropathy were present in 3 patients. Presence of PAS and Luxol Fast Blue (LFB) positive, auto fluorescent (AF) ceroid material in brain tissue (n = 12) and electron microscopy of brain (n = 5), skin (n = 28) and muscle (n = 1) samples showing curvilinear and lamellar bodies established the diagnosis. Patients of LBD (mean age of onset at 14.4+/-3.9 years, M:F:: 24:14) with triad of PME symptoms were evaluated. EEG (n = 37) showed variable slowing of background activity in 94.6% and epileptiform discharges in 97.4%. Photosensitivity with fast frequency was observed only in 5 patients. CT (n = 32) and MRI (n = 4) revealed diffuse cortical atrophy. Giant SSEP was demonstrated in 24 patients of LBD while VEP study revealed a prolonged P100 (4) and absent waveform (8). Electrophysiological features of neuropathy were present in one patient. Diagnosis was established by the presence of PAS positive diastase resistant, Lugol's Iodine labeled inclusions in sweat glands of axillary skin (n = 35), brain (n = 2) and liver (n = 1). Ten patients with MERRF (mean age at onset: 14.6+/-5.8 years; M: F:: 3:2) had triad of PME symptoms. Muscle biopsy revealed oxidative reaction product and classical ragged red fibers. In nine patients of PME without cognitive decline, probable diagnosis of ULD (mean age at onset: 13.8+/-9.5 years) was considered after biopsy of skin and/or muscle excluded other forms of PMEs. Neuronal ceroid lipofuscinosis and Lafora body diseases were the common causes of PME in the series from south India. This is one of the largest series from the Indian subcontinent to the best of our knowledge. Photosensitivity is notably less common in LBD/NCL in this series distinctly different from those reported in the literature. Further exploration is required to determine whether different genotype is responsible. Morphological changes were helpful in diagnosis and could be confirmed by biopsy of peripheral tissues like skin and muscle in majority (60%). Electron microscopy was helpful in the diagnosis NCL and MERRF.

Adolescent↗

20 W single-mode Yb3+ -doped phosphate fiber laser.

We report the demonstration of the first, to our knowledge, cladding-pumped continuous-wave Yb(3+)-doped phosphate-glass fiber laser. Phosphate hosts are of interest because they can be much more heavily doped than silica, and because of the possibility that they may have a higher photodarkening threshold. In an 84.6 cm double-clad fiber doped with 12 wt. % of Yb(2)O(3) and laser-diode pumped at 940 nm, nearly 20 W of single-mode 1.07 microm output power was generated with 60.2 W of absorbed pump power. The measured dependence of the output power on pump power is in excellent agreement with simulations.

Journal Article↗

Synthesis and antitubercular activity of substituted phenylmethyl- and pyridylmethyl amines.

A total of 42 benzyl- and pyridylmethyl amines were synthesized either by reductive amination of aromatic/heteroaromatic aldehydes with amines or by conjugate addition of amines to the cinnamates followed by reduction of the ester group with lithium aluminium hydride to the respective propanolamines. All the synthesized compounds were evaluated against both avirulent and virulent strains of Mycobacterium tuberculosis. Many of the compounds exhibited MIC as low as 1.56microg/mL. Few of potent compounds were also evaluated against clinical isolates of MDR TB and found to be active at one or other concentrations with MIC as low as 3.12microg/mL.

Amines↗

Cardiac autonomic dysfunctions in chronic refractory epilepsy.

BACKGROUND: Sudden unexplained death is an important cause of mortality in patients with epilepsy and cause for this is not fully understood. One of the explanations is autonomic dysfunction (AD). Studies of AD in chronic refractory epilepsy are very few in the literature. AIM: To evaluate cardiovascular autonomic functions in chronic refractory epilepsy patients. METHODS AND MATERIALS: Seventy-three patients (31.5+/-9.8 years, M:F::45:28) with chronic intractable epilepsy attending the "refractory epilepsy clinic" at a tertiary referral center (National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India) were enrolled. Age and gender matched healthy subjects were recruited as controls. Heart rate (HR) and blood pressure (BP) at rest and HR response after deep breathing, Valsalva maneuver, postural change and BP response to postural change and isometric work were recorded. AD was graded as early if one of HR or BP, definite if two or more HR and severe if two or more HR with BP based tests were detected to be abnormal. RESULTS: The mean age at onset and duration of epilepsy was 12.4+/-8.5 years and 19.02+/-9.07 years, respectively. Twenty-three (31.5%) patients of refractory epilepsy had early involvement while 25 patients (primary generalized: 8, partial: 17) had Definite AD, and 16 (primary generalized: 4, partial: 12) had severe autonomic dysfunction. ANCOVA results showed expiration-inspiration, standing maximum:minimum ratio, standing 2 min systolic and isometric diastolic BP of the dysfunction group significantly differ compared to the control group. Patients with longer duration of epilepsy (23.2 years) had more severe dysfunction (p < 0.05) than patients with relatively shorter duration (17.5 years) of epilepsy. Antiepileptic drugs (AED) used did not show any significant role on autonomic functions in this study. CONCLUSION: This is the first study from India to evaluate autonomic functions in refractory epilepsy patients. Autonomic dysfunction was noted in 56.3% of patients. Anticonvulsants used were not associated with AD. Longitudinal controlled studies with 'newly diagnosed' epilepsy patients will enhance further understanding about the role of autonomic system in epilepsy.

Adult↗

Search of antitubercular activities in tetrahydroacridines: synthesis and biological evaluation.

A series of 9-substituted tetrahydroacridines were synthesized by nucleophilic substitution of chloro group with different nucleophiles in 9-chlorotetrahydroacridine (2). The latter could be obtained by POCl(3) mediated cyclization of the intermediate enamine, which in turn, was prepared by acid catalyzed condensation of anthranilic acid and cyclohexanone. Most of the compounds on antitubercular evaluation against M. tuberculosis H37 Rv and H37 Ra strains exhibited potent activities with MIC 6.125-0.78 microg/mL comparable to the standard drugs.

Acridines↗

Wilson's disease: cranial MRI observations and clinical correlation.

INTRODUCTION: Study of MRI changes may be useful in diagnosis, prognosis and better understanding of the pathophysiology of Wilson's disease (WD). We aimed to describe and correlate the MRI abnormalities of the brain with clinical features in WD. METHODS: MRI evaluation was carried out in 100 patients (57 males, 43 females; mean age 19.3+/-8.9 years) using standard protocols. All but 18 patients were on de-coppering agents. Their history, clinical manifestations and scores for severity of disease were noted. RESULTS: The mean duration of illness and treatment were 8.3+/-10.8 years and 7.5+/-7.1 years respectively. MRI of the brain was abnormal in all the 93 symptomatic patients. The most conspicuous observations were atrophy of the cerebrum (70%), brainstem (66%) and cerebellum (52%). Signal abnormalities were also noted: putamen (72%), caudate (61%), thalami (58%), midbrain (49%), pons (20%), cerebral white matter (25%), cortex (9%), medulla (12%) and cerebellum (10%). The characteristic T2-W globus pallidal hypointensity (34%), "Face of giant panda" sign (12%), T1-W striatal hyperintensity (6%), central pontine myelinosis (7%), and bright claustral sign (4%) were also detected. MRI changes correlated with disease severity scores (P<0.001) but did not correlate with the duration of illness. CONCLUSION: MRI changes were universal but diverse and involved almost all the structures of the brain in symptomatic patients. A fair correlation between MRI observations and various clinical features provides an explanation for the protean manifestations of the disease.

Adolescent↗

Risk of conjunctival contamination in total joint arthroplasty.

This study arose from a concern about the transmission of infection through conjunctival contamination during total joint arthroplasty surgery. A prospective analysis of 110 sets of personal face and eye protective equipment (Sterishields) used for 29 total hip arthroplasties (THA) and 26 total knee arthroplasties (TKA) were examined for macroscopic contamination. In additition, a postal questionnaire regarding the perceived risk of eye contamination and current practice of eye protection used during TKA and THA surgery was sent to 1500 Fellows of the British Orthopaedic Association. All Sterishields demonstrated macroscopic contamination with an average of 203 blood and fat spots. The number of these was significantly higher in the lower half of the Sterishields. Of the 834 useable replies, 48% of respondents did not use adequate eye protection routinely. Twenty-eight percent felt that no eye protection was needed, while 45% felt that the eye protection available compromised their vision and so did not use it. One hundred and seven respondents (13%) reported being aware of eye contamination, while 21 (2.5%) respondents were aware of at least one case of conjunctival infection following contamination. This study demonstrates that there is a high risk of conjunctival contamination with fat and blood in major total joint arthroplasty. The reported use of appropriate eye and face protection in the UK has been shown to be low (52%).

Arthroplasty, Replacement, Hip↗

A prospective assessment of carpal tunnel surgery with respect to age.

Six hundred and thirty five carpal tunnel decompressions in 490 patients were studied prospectively in two hand surgery centres to assess the effect of increasing age on the outcome after surgery. The outcome was assessed using the Levine-Katz carpal tunnel questionnaire, Tinel's sign, Phalen's test, Semmes-Weinstein monofilaments and pinch and grip strengths. Assessments were made pre-operatively, at 2 weeks and 6 months postoperatively. Information was also sought concerning co-morbid conditions. Cases were divided into four groups (less than 40 years of age, 40 to 60, 61 to 80, and over 80 years of age). Patients improved significantly in all age groups after carpal tunnel surgery. Despite a relatively high number of co-morbidities, older patients had an acceptable complication rate and their improvement was comparable to all other age groups.

Adult↗

Y-duplication of the male urethra: use of anterior anorectal wall for posterior urethral lengthening.

We have approached two patients with Y-duplication of the male urethra by a new two-staged technique to provide better results. A strip of anterior anorectal wall in continuity with the posterior urethra was used for posterior urethral lengthening and a tubed pedicled prepucial flap was used to reconstruct the anterior urethra without using the native urethra. This was done under a covering colostomy. After a gap of 6 months to allow for healing of the anorectum and to ensure adequate functioning of the perineal neourethra, second stage reconstruction was done using buried scrotal tube for the mid urethra along with colostomy closure. On follow-up at 8 and 12 months, respectively, both children were well with no stricture or fistula. There was normal anal continence and no stenosis. This technique tackles the problem in Y-duplication of the male urethra of lengthening the posterior urethral channel, which is often difficult to bring to the anterior half of the perineum especially if the opening is high up in the anorectum (case 2).

Child↗

Chronic sternal osteomyelitis complicating primary manubriosternal septic arthritis.

We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity.

Adult↗

Long term survival in subacute sclerosing panencephalitis: an enigma.

BACKGROUND: Subacute sclerosing panencephalitis (SSPE) usually has a progressive stereotypic downhill course and results in premature death. Long-term stabilization or remission is exceptional. OBJECTIVE: To analyze the profile of patients with a relatively 'benign' course who survive beyond 3 years. DESIGN: Descriptive analysis of 19 (16 male, 3 females)/307 (6.2%) patients with benign course who were evaluated at NIMHANS between January 1995 and December 2004. Their diagnosis was based on characteristic myoclonic jerks, elevated antibody titers against measles virus in CSF and periodic complexes in EEG. RESULTS: The mean age at onset of symptoms was 11.7+/-3.9 years and mean duration of follow-up from first symptom was 5.9+/-3.1 years (3-13.8 years). Their initial symptoms were seizures (7), myoclonus (6), visual disturbances (4), behavioral changes (1) and cognitive impairment (1). These patients had varied clinical course: stabilization in different stages for 6 months to 5 years (13), remissions for 6 months to 9 years and reversal of staging with functional recovery from being bed bound to ambulant (8). Their diagnosis was often delayed. Small sample size did not permit to analyze the influence of possible disease modifying agents used in 10 patients (isoprenosine-3, amantidine-4, oral steroids-4, methylprednisolone-1, intravenous immunoglobulin-1). CONCLUSIONS: Our observations suggest that SSPE may have a highly variable clinical course and warrants cautious approach for counseling at initial evaluation and while interpreting beneficial effect of disease modifying agent(s). There is a need to explore prognostic marker(s).

Adolescent↗

Phytoextraction capacity of the Chenopodium album L. grown on soil amended with tannery sludge.

The metal accumulation potential of Chenopodium album L. grown on various amendments of tannery sludge (TS) was studied after 60 days of sapling planted. The analysis of the results showed that the levels of pH, cation exchange capacity, organic carbon, organic matter and DTPA extractable metals (except Mn) of amendments increased by the addition of tannery sludge ratio. Shoot length of the plant increased by the addition of sludge, whereas, no marked change was observed in root length, fresh and dry weight of the plant. Accumulation of the metals in the plants was found in the order; Fe > Mn > Zn > Cr > Cu > Pb > Ni > Cd. Translocation of toxic metals (Cr, Pb, Cd) in different parts of the tested plant was found in the order; leaves > stems > roots. An increase in the photosynthetic pigments, carotenoid and leaf protein contents of the plants were found to increase with increase in sludge amendments. Correlation analysis between metal accumulation in the plants with DTPA extractable metals emphasized that Mn, Ni, Cr, Pb and Cd showed positive correlation (p < 0.05), whereas, Fe, Zn and Cu showed negative correlation. Transfer factor analysis emphasized that 10% TS amendments were suitable for phytoextraction of Cr. Overall analysis of the data exhibited that the plants may be used for phytoextraction of Cr from tannery waste contaminated soil as most of the metal was accumulated in harvestable part which is a matter of serious concern, whenever used for edible purposes.

Chenopodium album↗

Distribution of metals in the edible plants grown at Jajmau, Kanpur (India) receiving treated tannery wastewater: relation with physico-chemical properties of the soil.

The implications of metal contamination of agricultural soils due to long term irrigation with treated industrial wastewater and their subsequent accumulation in the vegetables/crops growing on such soils has been assessed in an area of industrial complex, Jajmau, Kanpur (India). Physico-chemical properties of the soil were also studied. The soil and vegetables/crops were sampled from an area of 2100 acre agricultural land and analyzed for physico-chemical properties and metal accumulation in different parts of the plants. The comparison of the data of physico-chemical properties of control and contaminated soil showed that salinity, electrical conductivity, available phosphorous, sodium and potassium content (both water soluble and exchangeable) were found high in contaminated soil. The analysis of plant available metal content in the soil showed the highest level of Fe, which ranged from 529.02 to 2615 microg g(-1) dw and lowest level of Ni (3.12 to 10.51 microg g(-1) dw). The analysis of the results revealed that accumulation of toxic metal Cr in leafy vegetables was found more than fruit bearing vegetables/crops. Thus, it is recommended that the leafy vegetables are unsuitable to grow in such contaminated sites. It is important to note that toxic metal, Ni was not detected in all the plants. The edible part of the vegetables (under ground) such as, garlic (19.27 microg g(-1) dw), potato (11.81 microg g(-1) dw) and turmeric (20.86 microg g(-1) dw) has accumulated lowest level of toxic metal, Cr than leafy and fruit bearing vegetables. In some fruit part of vegetables such as, bitter gourd, egg plant, jack tree, maize and okra, the accumulation of Cr was not detected and may be grown in this area.

Environmental Monitoring↗

Adult onset subacute sclerosing panencephalitis: clinical profile of 39 patients from a tertiary care centre.

Clinical and laboratory characteristics of 39 patients with adult onset subacute sclerosing panencephalitis (SSPE) are described and compared to those of juvenile onset patients regarding preceding measles, age at onset, gender, interval between onset and diagnosis, clinical profile, and course during follow up. Diagnosis was based on clinical and electroencephalographic findings and raised anti-measles antibody titres in cerebrospinal fluid. Mean age at SSPE symptom onset was 20.9+/-4.9 years and mean interval from onset to diagnosis was 6.3+/-9.6 months. Referral diagnosis was accurate in only 12 patients. Presenting symptoms included myoclonus, behavioural changes, seizures, and cognitive, visual, and extrapyramidal disturbance. All patients received symptomatic therapy; 19 also received disease modifying agents. Five of seven pregnant women had successful deliveries. The follow-up period varied widely (maximum 60 months, median 9 months). The profile of adult onset SSPE did not differ from the rest of the cohort, except for a longer interval between measles infection and symptom onset (p<0.0001). SSPE in adults poses diagnostic challenges for clinicians. A high index of suspicion and appropriate investigations are necessary for early diagnosis and counselling.

Adolescent↗