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Background The purpose of study was to compare the changes in blood pressure in patients undergoing phacoemulsification cataract surgery under topical and peribulbar anaesthesia during preoperative, intraoperative and postoperative period. Methods In this prospective cohort study, 240 patients undergoing phacoemulsification were divided into topical (Group 1) and peribulbar (Group 2) equally. Proparacaine 0.5% drops were used for topical anaesthesia, and Inj lignocaine with Inj bupivacaine were used to give peribulbar anaesthesia. Preoperative blood pressure was taken 30 min before surgery with automated sphygmomanometer. Intraoperative blood pressure was taken during phacoemulsification, and postoperative blood pressure was taken 1 h after surgery. Outcomes assessed were systolic, diastolic and mean blood pressure. Results Systolic blood pressure in Group 1 was significantly increased in the intraoperative phase, whereas it was significantly decreased in Group 2 in the intraoperative phase. Diastolic and mean blood pressure in Group 1 showed no significant change, whereas in Group 2, both showed significant reduction in intraoperative and postoperative phases. Conclusion The increase in intraoperative systolic blood pressure in topical group could be due to discomfort from microscope light, iris manipulation, irrigation and aspiration during surgery. The decrease in intraoperative systolic and diastolic blood pressure in peribulbar group could be due to systemic absorption of local anaesthetic. The mean preoperative systolic blood pressure was also higher in the topical group, which could be due to anxiety or stress under topical anaesthesia. The changes in blood pressure need to be observed so that timely intervention can be made to achieve favourable postoperative outcome.

Neuromyelitis optica spectrum disorders (NMOSDs) are rare autoimmune-mediated chronic inflammatory disorders involving the central nervous system. The concept of NMOSDs has widened up recently. Its diagnostic criteria have broadened the knowledge of this particular disease including the atypical cases where antiaquaporin-4 antibody is negative and anti-myelin oligodendrocyte glycoprotein (MOG) antibody is positive. Myelin oligodendrocyte glycoprotein is a protein expressed on the outer surface of myelin sheath and oligodendrocytes of the central nervous system. The detection of anti-MOG-Ab is emerging evidence, and thus, research on the role of this antibody in such seronegative cases is still underway. Early diagnosis and adequate therapy is essential in such cases. Here, we report an eight-year-old girl who was diagnosed with NMOSDs and found to have anti-MOG antibodies in place of AQP-4 antibodies.

Shulman's disease (eosinophilic fasciitis) is a very rare autoimmune disorder with an unknown etiopathogenesis. During the initial period of disease, it usually causes limb and trunk edema followed by collagenous thickening of the subcutaneous fascia. Eosinophilia is a predominant laboratory finding during the initial phase of the disease and less prominent in the later phases. Patients may also present with arthritis, myositis, peripheral neuropathy, and rarely pleuropericarditis. Here, we are reporting a case of eosinophilic fasciitis presenting with vague constitutional symptoms, fever, and peripheral blood eosinophilia followed by rapidly evolving skin tightening with joint contractures and muscle stiffness, which misled the treating team toward Scleroderma and its overlap syndromes. The diagnosis was finally clinched by a full-thickness skin biopsy along with underlying fascia and muscle tissue from an effected area, with a gratifying treatment response to standard immune suppression.

Purtscher-like retinopathy is a rare phenomenon reported in disorders including acute pancreatitis, collagen vascular diseases, fat embolism, chronic renal failure, amniotic fluid embolism, battered baby syndrome and several autoimmune diseases. We report an atypical initial feature of rheumatoid arthritis in a middle-aged male. This case will raise awareness among generalists to recognize this disease early.

PURPOSE: To estimate concurrent changes in Central Corneal Thickness (CCT) and Intraocular pressure (IOP) during normal pregnancy. METHODS DESIGN: Prospective cohort study of changes in Central Corneal thickness and Intraocular pressure in 45 pregnant women during third trimester and six weeks postpartum in a tertiary care hospital in Western Maharashtra, India. The change in Central Corneal thickness was measured by ASOCT in third trimester of pregnancy and six weeks postpartum. The change in Intraocular pressure was measured by Noncontact tonometer in units of mm of Hg in third trimester of pregnancy and six weeks postpartum. Correlation analysis was performed between the change in CCT and IOP. RESULTS: Results of our study suggest a signicant increase in CCT accompanied by a decrease in IOP in the same eyes during the third trimesters of normal pregnancy compared to six weeks postpartum. CONCLUSION: Due consideration should be given while diagnosing glaucoma during pregnancy and initiating treatment in view of physiological variance in IOP. Novel spectacle prescription and refractive surgeries must be circumvented during pregnancy owing to erroneous results due to these physiological changes in pregnancy.

BACKGROUND: Pseudoexfoliative material is being implicated in causing tear film abnormalities, and the aim of the present study was to prove it and to compare with the normal healthy participants. METHODS: A total of 398 eyes of 200 participants were studied, and two groups were formed. The first, pseudoexfoliation syndrome (PEXS) group, included 198 eyes of 100 patients, and the second, age-matched control group, included 200 eyes of 100 participants. Tear film abnormalities were compared in the two groups by tear meniscus height (TMH), Schirmer test I, Schirmer test II and tear film break-up time (TBUT). RESULTS: On comparing the two groups using independent t-test, a significant difference was found in Schirmer test I, Schirmer test II, and TBUT between the PEXS group (Schirmer test I: 23.98 ± 10.68 mm, Schirmer test II: 17.11 ± 8.78 mm, and TBUT: 9.778 ± 5.54 s) and the age-matched control group (Schirmer test I: 27.08 ± 9.58 mm, Schirmer test II: 19.98 ± 8.48 mm, and TBUT: 13.495 ± 5.65 s) (p = 0.003 [Schirmer test I]; p = 0.001 [Schirmer test II]; and p

Background Association of keratoconus with vernal keratoconjunctivitis is well known, but there are few topographic studies describing actual prevalence especially in India where it is a common condition. There is also scarce literature on the topographic patterns and subclinical topographic anomalies in cases of vernal catarrh and their relationship with various subtypes. This study was conducted to estimate the prevalence of subclinical keratoconus among Indian subjects with vernal keratoconjunctivitis and describe the various topographic abnormalities which can help in screening for these cases. Methods In the cross-sectional study conducted at a tertiary care center, 76 established cases of vernal keratoconjunctivitis were evaluated with placido disc–based videokeratography for topographic abnormalities and early keratoconus based on modified Rabinowitz–McDonnell criteria. Results Seventeen (11.2%) eyes satisfied both the modified Rabinowitz–McDonnell criteria of keratoconus. Corneal topographic pattern analysis showed asymmetric bowtie with inferior steepening in 17.11% of the patients. None of these patients had clinical evidence of keratoconus. Conclusions The study showed 11.2% prevalence of keratoconus in patients suffering from vernal keratoconjunctivitis. The findings highlight the importance of using a simple placido disc–based corneal topography system for screening the patients with vernal keratoconjunctivitis for keratoconus. This can help in early detection and preventive intervention.

Anomalous coronary artery origins are not common in routine clinical practice. The incidence of coronary anomalies in patients undergoing coronary angiography is less than 1%. The greatest challenges faced in the management are delays in identification and difficulty engaging the anomalous coronary artery. Operator experience in promptly identifying the anomaly and selection of the appropriate catheter is critical for successful intervention. We are presenting a case of acute inferior and posterior wall myocardial infarction (MI) with an anomalous origin of the left circumflex artery from the right coronary sinus. Learning objective is that percutaneous coronary intervention (PCI) in an anomalous left circumflex can be technically difficult because selective cannulation of the vessel may not be easy. An anomalous left circumflex artery has a rare presentation of ST-elevation myocardial infarction (STEMI). Complicated STEMI with cardiogenic shock is not commonly seen in anomalous coronary artery origin from the right sinus. Percutaneous intervention in patients with STEMI with an anomalous left circumflex artery has a high risk and is technically challenging. J Med Cases. 2020;11(2):41-43 doi: https://doi.org/10.14740/jmc3429

Background: TB has been found to coexist with malnutrition among patients at diagnosis in both developed and developing countries. Malnutrition is considered as an important risk factor for tuberculosis and it is also a common consequence of tuberculosis. Aims: To estimate the proportion of malnutrition among tuberculosis (TB) patients at diagnosis and to determine factors associated with malnutrition.Materials and methods: It's a Cross sectional study conducted in a slum under one of the Tuberculosis Units, of Malvani, Mumbai for the duration of 9 months in total 200 diagnosed tuberculosis patients fulfilling inclusion criteria. An interviewer administered schedule consisting of questions regarding their socio-demographic status, economic status, body mass index (BMI) and type of tuberculosis at diagnosis.All responses tabulated in Microsoft-Excel 2010 Software. Data is analysed using Epi data analysis Version 2.2.2 build 177.Results: The mean body mass index was 16.8 Kg/m2. Malnourished patients were 79%, including 35% having severe thinness (

Background/aimsTo evaluate the corneal endothelial changes in patients with alcohol dependence syndrome (ADS).MethodsA total of 322 corneas of 322 subjects were studied, and two groups were formed. The first, the ADS group, included 161 corneas of 161 patients and the second, the age-matched control group, was composed of 161 corneas of 161 healthy subjects. Both the groups were examined by specular microscope and the endothelial parameters were compared. The endothelial parameters were also compared before and after the abstinence of alcohol in the former group. The ADS group was further analysed to assess the influence of life time alcohol consumption, years/pattern of drinking, levels of Liver enzymes, levels of mean corpuscular volume, screening questionnaires and stages of fatty liver on corneal endothelium.ResultsOn comparing the two groups using Mann-Whitney U test, a significant difference was found in central corneal thickness (CCT) and endothelial cell density (CD) between the ADS (CCT: 529±29 µm, CD: 2571±236 cells/mm2) and control groups (CCT: 510±32 µm, CD: 2752±291 cells/mm2) (PConclusionsCorneal endothelial alteration is present in patients with ADS, more marked in patients with an increase in stage of fatty liver.

Thirty-two years old male patient presented with four day history of mild redness, pain and blurring of vision of the left eye. He gave history of similar episode 4-5 months back and it subsided with treatment. Visual acuity on presentation was 6/6 RE and 5/60 → 6/12 with -1.5 DSph/-2.75 D Cyl at 110o (left eye). Anterior segment was normal in the right eye. In the left eye, fine keratic precipitates on cornea and trace anterior chamber cells and flare were noted. Pigments were seen on anterior capsule of lens. Dilated fundus examination revealed a normal appearing disc with no cup in right eye and pale disc with C:D ratio 0.8 with a thin neuro-retinal rim in the left eye. Colour vision was normal. Intraocular pressure (IOP) was 14 and 35 mm Hg by applanation in the right and left eyes, respectively. On gonioscopy ciliary body band was visible for 360 degree without any peripheral anterior synechiae or inflammatory deposits. Automated perimetry revealed full visual field in the right eye and a dense scotoma with central island of field in the left eye. He was treated with oral and topical antiglaucoma medications along with topical steroids. On follow up, his vision was 6/6 (right eye) and 6/12 (left eye) with IOP of 12 and 16 mm Hg.

This study investigated the effect of dietary supplemented synthetic, and shrimp shell meal (SSM) derived natural astaxanthin combination on growth, digestive and metabolic enzyme activities, antioxidative status, physio-metabolic responses, and skin colouration of high valued discus (Symphysodon aequifasciatus) advanced juveniles reared in captive condition. Four isonitrogenous (50 % crude protein), isolipidic (9% ether extract), and isocaloric (around 400 kcal digestible energy/100 g) experimental diets viz. Control (only synthetic astaxanthin, without SSM), T1 (15 % SSM + synthetic astaxanthin), T2 (20 % SSM + synthetic astaxanthin), T3 (25 % SSM + synthetic astaxanthin) were prepared and fed to satiation level twice daily for 90 days. Results indicated significantly (P

Carotenoprotein, a complex of carotenoids and protein, extracted from shrimp shell waste can be an effective source of carotenoid as well as antioxidant in fish diets. In the present study, the nutritional potential of carotenoprotein extracted from shell wastes of Parapeneopsis stylifera on growth, physiometabolic changes and coloration in high-value ornamental fish, oscar (Astronotus ocellatus) was assessed in a 120 days feeding trial. Four iso‑nitrogenous (30–31% CP) and isolipidic (11.34–11.55% CL) diets were formulated with graded levels of carotenoprotein inclusion like 0%, 5%, 10% and 15% and designated as Control, T1, T2 and T3 respectively. At the end of the feeding trial, growth indices such as final body weight, weight gain, and specific growth rate indicated that fish fed with 10 and 15% levels of carotenoprotein incorporated diet showed higher growth compared to control and T1. Oxidative stress enzymes like SOD and Catalase were lower in 15% and 10% carotenoprotein incorporated diets respectively in both gills and liver. Stress indicators like serum glucose and cortisol activity were found to be higher in control than in diets with 10% (T2) as well as 15% (T3), suggesting the stress-reducing ability of the carotenoprotein in fish feed. Relatively higher respiratory burst activity in fishes of T3 group indicated higher immunity status of the fish. Quantitative colour values in terms of redness, chroma in the fin region as well as carotenoid content in scale, skin and muscle of fish were higher in T2 (10% carotenoprotein incorporated diet) as compared to T3 (15% carotenoprotein incorporated diet). Overall, this study clearly showed that dietary incorporation of as little as 10% carotenoprotein is advisable to ornamental fish farmers for enhanced growth, colouration, as well as antioxidant activity in this popular high value ornamental fish for maximizing their profit.

PURPOSE To evaluate the corneal endothelial changes in patients with chronic renal failure. METHODS A total of 128 corneas of 128 subjects were studied, and 3 groups were formed. The first, the dialyzed group, composed of 32 corneas of 32 patients; the second, the nondialyzed group, composed of 34 corneas of 34 patients; and the third, the age-matched control group, composed of 64 corneas of 64 healthy subjects were examined by a specular microscope and the endothelial parameters were compared. The dialyzed group (enhanced level of toxins in the blood) was further analyzed to assess the influence of blood urea, serum creatinine, serum calcium, and serum phosphorus including the duration of dialysis on corneal endothelium. RESULTS On comparing the 3 groups using analysis of variance and posthoc tests, a significant difference was found in the central corneal thickness (CCT) and endothelial cell density (CD) between the control (CCT: 506 ± 29 μm, CD: 2760 ± 304 cells/mm) and dialyzed groups (CCT: 549 ± 30 μm, CD: 2337 ± 324 cells/mm) [P < 0.001 (CCT); P < 0.001 (CD)]; control and nondialyzed groups (CCT: 524 ± 27 μm, CD: 2574 ± 260 cells/mm) [P = 0.023 (CCT); P = 0.016 (CD)]; and dialyzed and nondialyzed groups [P = 0.002 (CCT); P = 0.007 (CD)]. Using the linear generalized model, a significant correlation was found between the endothelial parameters and blood urea only [P = 0.006 (CCT), 0.002 (coefficient of variation), 0.022 (CD), and 0.026 (percentage of hexagonality)], although the correlation was poorly positive for CCT but poorly negative for the remaining endothelial parameters. CONCLUSIONS Corneal endothelial alteration is present in patients with chronic renal failure, more marked in patients undergoing hemodialysis and with raised blood urea level.

Background Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness. Without treatment, over 45% of eyes can develop permanent visual loss. Hyperglycaemia has recently been described as a risk factor for the development of retinopathy of prematurity (ROP), a proliferative vascular disease of the retina that primarily affects premature infants. The characteristic neoproliferative growth of blood vessels in the retina is very well under stood with the clinical and experimental experiences with Diabetic retinopathy. The purpose of this study was to evaluate a possible relation between glucose levels in VLBW (Very Low Birth Weight) infants and development of ROP. Method All at risk infants of a Neonatal Intensive Care Unit (NICU) of a tertiary care centre in western India were included in the study. The blood sugar values of the neonates were recorded at multiple times during their first week of life. On completion of 31 weeks of gestational age or 04 weeks of birth age, the neonates were subjected to ROP screening as per standard protocols. Result A total of 103 neonates were included in the study and were subjected to ROP screening. A total of 32 neonates developed ROP at the end of the study. It was found with statistical significance that the neonates with higher average blood glucose values in the initial period of life had higher incidence of ROP at the time of screening with a Relative Risk of 2.506 (CI = 1.287, 4.882). Conclusion A high average blood glucose level in neonates during the first week of life is an indicator for developing ROP at a later date. These neonates should be kept under close follow up in order to facilitate timely detection and prompt intervention.

Risk taking is the foundation of business activity. Quantifying it in an accurate manner such that the magnitude, impact, and point in time effect is recognized financially is critical for efficiency in business. Both unhedged and mispriced risk, while opposites in terms of the cost of doing business, have similar effects of loss of capital for the entire community an entity operates with. In this paper, we examine the list of known risks which need to firewalled against for a business to survive as well as thrive. Costing risks and derivatives in a similar manner allows for representing the health of a business in relation to its impact in the reassuringly standardized form of a balance sheet.

Sudden onset myopia is seen in several local or systemic conditions.1 Local conditions include blunt ocular trauma and ocular inflammation. Systemic conditions include diabetes, pregnancy and certain drugs like hydrochlorothiazide and topiramate.1 However Systemic Lupus Erythematosus (SLE) as a cause of transient myopia is so rare that it has not been reported in these articles. Neither has sudden onset transient myopia been included in the ocular manifestations of SLE.2, 3 A case of SLE which presented with acute myopia is presented herewith.

Purpose: To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes. Methods: A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size 7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30. Results: The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C. Conclusion: PKE done in eyes with maximal pupillary dilatation of 5 mm at the end of one month.

Background The donor lenticule insertion techniques play a crucial role in outcomes following descemet stripping endothelial keratoplasty (DSEK) and the current study is aimed to compare two of the commonly performed donor lenticule insertion techniques in DSEK. Method Descemet stripping endothelial keratoplasty was performed in 48 eyes of 48 patients at two tertiary eye care centers from January 2014 to December 2016. At one center (Group 1), 26 patients had Sheets glide-assisted lenticule insertion whereas at other center (Group 2), 22 patients had Busin glide-assisted insertion of donor lenticule. Best corrected visual acuity (BCVA), manifest spherical equivalent, manifest cylinder, endothelial cell density (ECD) and percentage of endothelial cell loss (ECL) were compared between the two groups at 6 months after DSEK. In addition, intraopertaive and postoperative complications were also compared. Results At 6 months after DSEK, an insignificant difference was observed in BCVA [Group 1: 0.48 logarithm of the minimum angle of resolution (log MAR); Group 2: 0.50 log MAR (p = 0.74)], mean manifest spherical equivalent [Group 1: 0.64 diopter (D); Group 2: 0.59 D (p = 0.74)], mean manifest cylinder [Group 1: 1.35 D; Group 2: 1.32 D (p = 0.92)] and mean ECL [Group 1: 26.75%; Group 2: 28.76 (p = 0.44)] between the two groups. In addition, the rate of complications is similar between the two groups. Conclusions Both Sheets glide-assisted and Busin glide-assisted donor lenticule insertion techniques are associated with similar surgical outcomes after DSEK.

Introduction: India is presently facing an epidemic of diabetes mellitus and the risks of chronic complications from the disease are associated with the duration of the disease as well as the degree of hyperglycaemia. Diabetic retinopathy is a known microvascular complication of diabetes mellitus and is the most common cause of blindness in the western countries. Apolipoproteins are the protein component of lipoproteins. Apart from acting as structural proteins, they also act as cofactors to various enzymes. Aim: To measure the levels of serum apolipoproteins and glycated haemoglobin in cases of diabetic retinopathy and to assess their association with the stages of diabetic retinopathy. Material and Methods: The 135 diabetic cases [with (110) and without (125) retinopathy] attending the Ophthalmology OPD of this tertiary care hospital were included in the present study. Following retinoscopy, the patients were classified as Non-Proliferative Diabetic Retinopathy (NPDR) (n=75) and Proliferative Diabetic Retinopathy (PDR) (n=35). The controls (n=100) were age and sex matched patients who did not have diabetes. The cases and controls were assessed for HbA1c, total cholesterol, triglycerides, HDL cholesterol, Apo A-I and Apo B-100. Results: The HbA1c was found to be higher in diabetics without retinopathy (7.02%) as compared to controls (5.58%) (p

Carotenoproteins from four different shrimp shell wastes Penaeus monodon, Parapenaeopsis stylifera, Metapenaeus affinis and Nematopalemon tenuipes were extracted with the aid of papain enzyme and characterized by their protein, amino acid and carotenoid content of the shell wastes and the antioxidant activities like DPPH, FRAP, ABTS radical scavenging activity and reducing power assay of the carotenoprotein. Higher protein content of 9.8 g 100 g−1 and 9.2 g 100 g−1 was recovered from shell waste of Penaeus monodon and Parapenaeopsis stylifera respectively along with highest carotenoid content of 114 ± 0.02 μg g−1 in Parapenaeopsis stylifera followed by 100.6 ± 0.02 μg g−1 from the shell waste of Metapenaeus affinis. Highest antioxidant activity was found in the carotenoprotein extracted from the shell waste of P. stylifera which suggest that the antioxidant activity of carotenoids followed a concentration dependent pattern. The amino acid profile showed that carotenoprotein is a rich source of essential amino acids such as glutamic acid, aspartic acid, lysine and leucine. Among shell wastes, P.stylifera shell waste was calculated to be superior as it contained higher amount of essential amino acids and exhibited higher antioxidant activity in terms of protein, carotenoid as well as radical scavenging and reducing power and it could serve as a supplementary nutritive feed ingredient in animal diets. This would help in utilization of crustacean (shrimp) shell waste for formulating low cost feed for ornamental fish and also encourage shrimp processing industries to utilize of the same in order to control pollution of land and water.

Our aim primarily was to compare the recurrence rate with three techniques of conjunctival fixation (suture versus fibrin glue versus autologous in situ blood coagulum) over bare sclera following pterygium excision. Ninety eyes of 90 patients with primary pterygium were randomly divided into three groups: group I (30 eyes) underwent autografting and fixation with 8-0 vicryl sutures, group II (30 eyes) with fibrin glue and group III (30 eyes) with autologous in situ blood coagulum. The patients were reviewed on 2nd day, weeks 1 and 4, and at every 3 months till 12 months after surgery. Rate of recurrence was similar (p = 0.585) across the three groups. Time taken for surgery for Group 1 was more as compared to group 2 (p < 0.001) and group 3 (p < 0.001). Also, group 2 cases took significantly more time as compared to group 3 (p < 0.001). Postoperative patient discomfort (foreign body sensation, epiphora, pain and irritation) was more in suture-assisted autografting as compared to the other two groups. However, at some points along the time line, patient discomfort was significantly more in group III as compared to group II. Complications like graft retraction, graft displacement and cyst formation were seen in a few patients but were not statistically significant across the three groups. All three techniques were found to be useful methods and were associated with similar rate of recurrence.

The prevalence of obesity (body mass index >30) is increasing in both the developed and developing countries. In India, the prevalence of overweight individuals is reported from 20-40% in various studies with over 5-10% being obese [1, 2]. Obesity is associated with increased mortality and morbidity. Direct association between obesity and several diseases, including diabetes mellitus, hypertension, coronary artery disease, obstructive sleep apnoea, gastroesophageal reflux disease, osteoarthritis and various malignancies is well recognized. In addition to increased risk of coronary artery disease, obesity is associated with heart failure, sharing a complex relationship [3]. In the Framingham Study, almost 6000 individuals without a history of heart failure (mean age 55 years) were followed for a mean of 14 years. The risk of developing heart failure was two-fold higher in obese individuals, as compared to the subjects with a normal body mass index (BMI). Individuals with obesity have a form of cardiomyopathy attributed to chronic volume overload, characterized by left ventricular dilatation, increased left ventricular wall stress and compensatory left ventricular hypertrophy. Most studies have reported abnormal diastolic function without abnormal systolic function. Does presence of left ventricular (LV) dysfunction translate into a bad prognosis? Reports involving stable outpatients suggest that obesity is associated with improved survival after the development of heart failure. This finding is paradoxical because obesity increases the risk and worsens the prognosis of other cardiovascular diseases. This is called the obesity paradox [4]. In this issue, Chadha et al have analysed the impact of BMI on LV function [5]. In this cross sectional study of 51 overweight/obese and 25 normal individuals, various echocardiographic parameters of systolic and diastolic dysfunction were studied. Subclinical LV diastolic dysfunction was found in all grades of obesity that correlated with the BMI. The authors have defined obesity on the basis of BMI alone. However the Asian Indian phenotype implies higher percentage body fat and abdominal adiposity at lower or similar BMI levels as compared to white Caucasians. Even “non obese” Indians have higher abdominal obesity and use of various anthropometric parameters like waist hip ratio and waist circumference might have been better predictors [6]. The definition of overweight and obesity in the present study is based on western recommendations while more stringent cut off points of anthropometric parameters are emerging for Indian population [7]. The duration of obesity is also an important factor and has not been looked into. Limitations notwithstanding, the study highlights the presence of LV dysfunction amongst overweight and obese individuals. Most importantly, to the long list of illnesses that are predisposed to by obesity, we have an addition in the form of heart failure. We have one additional reason to shed weight by a judicious combination of diet and exercises.

Endovascular procedures aim to reduce the morbidity and mortality. Repair is indicated for aneurysms that are the source of pain and tenderness, which may indicate an impending rupture. The options for repair include traditional open aortic surgery or endovascular repair. Endograft has been used in patients with aortic dissection, noting the extremely complex nature of open surgical repair in these patients, while the results have been excellent. Aneurysm formation is a significant complication after therapy for Coarctation of aorta (CoA). Aneurysms develop after surgical as well as transcatheter repair procedures of CoA. We report a rare case of coarctation of the aorta with dissecting aortic aneurysm who presented with sudden onset of chest pain radiating to back and dyspnea for 3 days. He successfully underwent balloon dilatation of coarctation segment followed by aortic stent-graft implantation. Uneventful during procedure prompts recovery on follow-up.

Background: Optical coherence tomography is a non-invasive imaging technique routinely used in ophthalmology to visualize and quantify the layers of the retina. It also provides information on optic nerve head topography, peripapillary retinal nerve fibre layer thickness and macular volume which correlate with axonal loss. These measurements are of interest in optic neuropathies and in multiple sclerosis. The OCT parameters are now used as endpoints in neurologic clinical trials.Methods: A prospective study involving 30 patients of multiple sclerosis and equal number of age and sex matched controls were subjected to evaluation of retinal changes (peripapillary retinal nerve fiber layer and central macular thickness) using Zeiss Cirrus HD-OCT machine. The results collected were then subjected to statistical analysis.Results: Significant RNFL thinning was seen in patients of multiple sclerosis compared to the age and sex matched controls. Marked thinning was seen in superior and temporal quadrants of right eye (p value of 0.002 and 0.008 respectively) and all quadrants in left eye with a p value of < 0.001. Patients with multiple sclerosis for more than 5 yrs showed statistically significant RNFL thinning in the superior quadrant of right eye (p

This paper describes the hardware and software components used in a Supervisory Control And Data Acquisition (SCADA) system, developed by the Centre for Development of Advanced Computing (CDAC), Thiruvananthapuram, for Advanced Steam Temperature Control of a 210 MW thermal power plant boiler. Details of how this SCADA system implements desirable property like fault tolerance and high availability is outlined. Additionally, the paper also discusses the Extended Kalman Filter (EKF) based predictive steam temperature control algorithm running in the Remote Terminal Unit (RTU) of this SCADA system. This algorithm is compared against the cascaded PID scheme used in conventional steam temperature control. Establishing the effectiveness of this SCADA system in increasing the availability of the system and reducing the process lag associated with conventional steam temperature control is the main objective of this paper.

The elongation factor Tu (EF-Tu) from Pseudomonas aeruginosa was purified as a 45-kDa polypeptide that forms a complex with both the 12- and 16-kDa forms of nucleoside-diphosphate kinase (Ndk) and predominantly synthesizes GTP. 70 S ribosomes of P. aeruginosa predominantly synthesize GTP, which is inhibited in presence of anti-Ndk antibodies. Anti-EF-Tu antibodies change the specificity of ribosomal GTP synthesis to all nucleoside triphosphate synthesis. Ndk has been shown to be a part of 30 S ribosomes, whereas EF-Tu is found to be associated with the 50 S ribosomal subunit. These data indicate that GTP synthesis in the ribosome is modulated both by Ndk and by EF-Tu. Peptide chain elongation as measured by polymerization of Phe-tRNA on a poly(U) template in presence of GDP can be inhibited by anti-Ndk antibodies and restored by the addition of GTP. Anti-EF-Tu antibodies similarly inhibit peptide chain elongation by P. aeruginosa ribosomes in the in vitro translation assay; however, this inhibition cannot be overcome by adding back GTP. Because the purified EF-Tu.16-kDa Ndk complex predominantly synthesizes GTP, it seems likely that this complex is a significant source of GTP for translational elongation in protein biosynthesis.

We report the purification and characterization of a protein from the membrane fraction of Pseudomonas aeruginosa showing intrinsic guanosine triphosphatase (GTPase) activity. The protein was purified as a 48-kDa polypeptide capable of binding and hydrolyzing GTP. The N-terminal sequence of the purified protein revealed its similarity to the Escherichia coli Ras-like protein (Era), and the protein cross-reacted with anti-Era antibodies. This protein was named Pseudomonas Ras-like protein (Pra). Anti-Pra antibodies also cross-reacted with E. coli Era protein. Pra is autophosphorylated in vitro, with phosphotransfer of the terminal phosphate from [gamma-32P]GTP but not [gamma-32P]ATP. Pra is capable of complex formation with the truncated 12-kDa form of nucleoside diphosphate kinase (Ndk) but not with the 16-kDa form. Purified Pra was also shown to physically interact with pyruvate kinase (Pk); Pk and Pra can form a complex, but when the 12-kDa Ndk, Pk, and Pra are all present, Pk has a higher affinity than Pra for forming a complex with the 12-kDa Ndk. The 12-kDa Ndk-Pra complex catalyzed increased synthesis of GTP and dGTP and diminished synthesis of CTP and UTP or dCTP and dTTP relative to their synthesis by uncomplexed Ndk. Moreover, the complex of Pra with Pk resulted in the specific synthesis of GTP as well when Pra was present in concentrations in excess of that of Pk. Membrane fractions from cells harvested in the mid-log phase demonstrated very little nucleoside triphosphate (NTP)-synthesizing activity and no detectable Ndk. Membranes from cells harvested at late exponential phase showed NTP-synthesizing activity and the physical presence of Ndk but not of Pk or Pra. In contrast, membrane fractions of cells harvested at early to late stationary phase showed predominant GTP synthesis and the presence of increasing amounts of Pk and Pra. It is likely that the association of Pra with Ndk and/or Pk restricts its intrinsic GTPase activity, which may modulate stationary-phase gene expression and the survival of P. aeruginosa by modulating the level of GTP.

We report the utilization of site-directed and random mutagenesis procedures in the gene encoding nucleoside diphosphate kinase (ndk) from Pseudomonas aeruginosa in order to examine the role of Ndk in the production of alginate by this organism. Cellular levels of the 16-kDa form of the Ndk enzyme are greatly reduced in P. aeruginosa 8830 with a knockout mutation in the algR2 gene (8830R2::Cm); this strain is also defective in the production of the exopolysaccharide alginate. In this study, we isolated four mutations in ndk (Ala-14-->Pro [Ala14Pro], Gly21Val, His117Gln, and Ala125Arg) which resulted in the loss of Ndk biochemical activity; hyperexpression of any of these four mutant genes did not restore alginate production to 8830R2::Cm. We identified six additional amino acid residues (Ser-43, Ala-56, Ser-69, Glu-80, Gly-91, and Asp-135) whose alteration resulted in the inability of Ndk to complement alginate production. After hyperproduction in 8830R2::Cm, it was determined that each of these six mutant Ndks was biochemically active. However, in four cases, the in vivo levels of Ndk were reduced, which consequently affected the growth of 8830R2::Cm in the presence of Tween 20. Two mutant Ndk proteins which could not complement the alginate synthesis defect in 8830R2::Cm were not affected in any characteristic examined in the present study. All of the mutant Ndks characterized which were still biochemically active formed membrane complexes with Pk, resulting in GTP synthesis. Two of the four Ndk activity mutants (His117Gln and Ala125Arg) identified were capable of being truncated to 12 kDa and formed a membrane complex with Pk; however, the complexes formed were inactive for GTP synthesis. The other two Ndk activity mutants could be truncated to 12 kDa but were not detected in membrane fractions. These results further our understanding of the role of Ndk in alginate synthesis and identify amino acid residues in Ndk which have not previously been studied as critical to this process.

Nucleoside diphosphate kinase (EC 2.7.4.6) (Ndk) is a ubiquitous enzyme functioning in the intracellular distribution of terminal phosphate bond energy among the various nucleotides used in synthetic and regulatory functions in cells. We have previously reported that in Pseudomonas aeruginosa, this important enzyme is transcriptionally regulated by the gene algR2 and posttranslationally regulated by a phosphoprotein phosphatase for the phosphorylated form of Ndk. We report here that an intracellular protease cleaves the 16-kDa form of Ndk to a 12-kDa form that undergoes autophosphorylation with an efficiency almost identical to that of the 16-kDa form. The 12-kDa form was found to be predominantly associated with the P. aeruginosa cell membrane fraction, whereas the 16-kDa form was predominantly cytoplasmic. In the membrane-associated state, the 12-kDa form of Ndk was found to synthesize GTP in preference to other nucleoside triphosphates. The specificity toward GTP synthesis could be abolished by the addition of Tween 20 or Triton X-100. The activity itself could be abolished by the addition of anti-Ndk antibody to the assay mixture. The formation of the 12-kDa form of Ndk and its association with the cell membrane were found to be related to the growth stage of P. aeruginosa, with less than 1% of the 12-kDa Ndk detectable in the membrane fraction at early log phase in comparison with the levels present at late stationary phase.

Burkholderia cepacia AC1100 uses the chlorinated aromatic compound 2,4,5-trichlorophenoxyacetic acid as a sole source of carbon and energy. The genes encoding the proteins involved in the first step (tftA and tftB [previously designated tftA1 and tftA2, respectively]) have been cloned and sequenced. The oxygenase, TftAB, is capable of converting not only 2,4,5-trichlorophenoxyacetic acid to 2,4,5-trichlorophenol but also a wide range of chlorinated aromatic phenoxyacetates to their corresponding phenolic derivatives, as shown by whole-cell and cell-free assays. The rate of substrate utilization by TftAB depends upon the extent of chlorination of the substrate, the positions of the chlorines, and the phenoxy group. These results indicate a mechanistic similarity between TftAB and the 2,4-dichlorophenoxyacetic acid/alpha-ketoglutarate-dependent dioxygenase, TfdA, from Alcaligenes eutrophus JMP134. The promoter of the oxygenase genes was localized by promoter-probe analysis, and the transcriptional start site was identified by primer extension. The beta-galactosidase activity of the construct containing the promoter region cloned upstream of the beta-galactosidase gene in the promoter-probe vector pKRZ-1 showed that this construct is constitutively expressed in Escherichia coli and in AC1100. The -35 and -10 regions of the oxygenase genes show significant sequence identity to typical Escherichia coli sigma 70 promoters.

Nucleoside-diphosphate kinase (ATP:nucleoside-diphosphate phosphotransferase, EC 2.7.4.6; NDP kinase) is an important enzyme for the maintenance of the correct cellular levels of nucleoside triphosphates (NTPs) and their deoxy derivatives (dNTPs) and is involved in the regulation of cellular development. The enzyme is under the dual control of algR2 and algH in Pseudomonas aeruginosa. We report here the purification and characterization of a protein that dephosphorylates the phosphorylated intermediate form of the P. aeruginosa NDP kinase (Ndk). Dephosphorylation of Ndk phosphate leads to loss of its enzymatic activity. The 10.1-kDa polypeptide shows 77% homology at the N terminus with the Spo0E phosphatase, identified as a negative regulator of sporulation in Bacillus subtilis and 66% with the human Bax protein, identified as an effector of programmed cell death. The phosphatase termed Npp showed varied specificity toward phosphorylated Ndks from different sources including human erythrocyte Ndk phosphate. Its activity toward other histidine phosphates such as CheA or the alpha-subunit of succinyl-CoA synthetase or phosphoesters such as p-nitrophenyl phosphate was quite limited. Npp was stable at room temperature up to 2 h and required Mg2+ for activity. The presence of a phosphatase capable of dephosphorylating the phosphorylated form of P. aeruginosa Ndk represents an interesting and efficient mode of post-translational modification of an enzyme crucial to cellular development.

We have previously reported that two genes cloned from a cosmid library of Escherichia coli can restore mucoidy to an algR2 mutant of Pseudomonas aeruginosa. AlgR2 is a protein involved in the regulation of nucleoside diphosphate kinase (Ndk) as well as alginate synthesis in P. aeruginosa. One of the E. coli genes, rnk, encodes a 14.9 kDa protein with no homology to any other proteins. The other gene, sspA, encodes the stringent starvation protein, a regulatory protein involved in stationary-phase regulation and the stringent response of E. coli. While both rnk and sspA restored alginate production to the P. aeruginosa algR2 mutant, only rnk restored Ndk activity to the mutant. In this report, we have examined the effect of mutations in rnk and sspA on the levels of Ndk in E. coli. We find that a mutation in rnk drastically reduces the level of Ndk in E. coli. A mutation in sspA, however, affects the level of another nucleoside diphosphate kinase distinct from Ndk. The proteins can be easily distinguished from each other by their different affinities for nucleoside diphosphates (NDPs) and also by the differential effect of anti-Ndk antibodies on the reactions they catalyse. The ability of either of these two proteins to restore alginate synthesis in the algR2 mutant of P. aeruginosa demonstrates the importance of nucleoside triphosphate synthesis and energy metabolism for alginate synthesis. Additionally, a role for the stringent starvation protein (SspA) in the modulation of nucleoside triphosphate (NTP) levels in E. coli is also suggested from these experiments.

Alginate is an important virulence factor for Pseudomonas aeruginosa during infection of the lungs of cystic fibrosis patients. The genes encoding enzymes for alginate production by P. aeruginosa are normally silent. They are activated in response to several environmental conditions, including high osmolarity, exposure to ethanol, or long-term growth under conditions of nutrient deprivation. Several genes which participate in the activation of alginate gene promoters have been identified; among these is the algR2 (algQ) gene. AlgR2 is an 18-kDa protein which has been shown to regulate the critical algD gene encoding GDP-mannose dehydrogenase as well as to regulate the levels of a tricarboxylic acid cycle enzyme, i.e., succinyl coenzyme A synthetase, and nucleoside diphosphate kinase (Ndk), an enzyme involved in nucleoside triphosphate synthesis. Succinyl coenzyme A synthetase and Ndk form a complex in P. aeruginosa. While algR2 is required for alginate synthesis at 37 degrees C, an algR2 insertion mutant was still able to make alginate slowly at 37 or at 30 degrees C. We used this observation to identify and clone a gene, termed algH. A strain with mutations in both algR2 and algH is unable to produce alginate at either 37 or 30 degrees C, and it is fully defective in Ndk production.

The algR2 (also known as algQ) gene of Pseudomonas aeruginosa has previously been identified as being necessary for alginate production at 37 degrees C. We have cloned two genes, from a cosmid library of Escherichia coli, which can restore mucoidy to an algR2 mutant of P. aeruginosa. The complementing regions of both cosmids were localized by subcloning restriction fragments. One of the E. coli genes identified here has not previously been described; we have named this gene rnk (regulator of nucleoside diphosphate kinase). It encodes a 14.9 kDa protein with no homology to any other protein. The other gene, sspA, is a regulator involved in stationary-phase regulation in E. coli. Either gene will restore mucoidy to an algR2-deficient strain of P. aeruginosa. AlgR2 has been shown to regulate at least two enzymes, succinyl-CoA synthetase (Scs) and nucleoside diphosphate kinase (Ndk), which form a complex in P. aeruginosa. When we examined the ability of the E. coli analogues to regulate Ndk, we found that rnk but not sspA was able to restore Ndk activity to the P. aeruginosa algR2 mutant. Furthermore, rnk was able to restore growth of the algR2 mutant in the presence of Tween 20, which inhibits other Ndk-like activities.

Infection with mucoid, alginate-producing strains of Pseudomonas aeruginosa is the leading cause of mortality among patients with cystic fibrosis. Alginate production by P. aeruginosa is not constitutive but is triggered by stresses such as starvation. The algR2 (also termed algQ) gene has been previously identified as being necessary for mucoidy; an algR2 mutant strain is unable to produce alginate when grown at 37 degrees C. We show here that the levels of phosphorylated succinyl coenzyme A synthetase (Scs) and nucleoside diphosphate kinase (Ndk), which form a complex in P. aeruginosa, are reduced in the algR2 mutant. We were able to correlate the lower level of phosphorylated Scs with a decrease in Scs activity. Western blots (immunoblots) also showed a decreased level of Ndk in the algR2 mutant, but the presence of another kinase activity sensitive to Tween 20 provides the missing Ndk function. The effect of AlgR2 on tricarboxylic acid (TCA) cycle enzymes appears to be specific for Scs, since none of the other TCA cycle enzymes measured showed a significant decrease in activity. Furthermore, the ability of the algR2 mutant to grow on TCA cycle intermediates, but not glucose, is impaired. These data indicate that AlgR2 is responsible for maintaining proper operation of the TCA cycle and energy metabolism.

Endogenous intraocular infection of fungal etiology is extremely rare in an immunocompetent individual. Usually, an antecedent history of trauma, surgery, intravenous drug abuse or an immunocompromized state can be elicited. Scedosporium apiospermum is a known cause of keratomycosis after traumatic implantation and can cause fatal disseminated infection in immunocompromized patients. However, cases of S. apiospermum intraocular infection in immunocompetent individuals have been very rarely reported in literature. We report here a case of an anterior chamber exudative mass due to S. apiospermum in an immunocompetent individual which was managed successfully with anterior chamber wash and intravitreal injection of voriconazole.

The history of disease contributes to a better understanding of the growth of ideas in medicine. The colonial period was marked by a rapid increase in the variety of diseases that were known to European practitioners. We have studied the diary of Dr Charles Smith who worked in Bangalore in the nineteenth century. We feel that some of his descriptions tally with later accounts of cysticercosis. He also comments on a wide range of behavioural symptoms, and attempts to correlate neuropathological observations to these. This neuropsychiatric perspective was prominent in the nineteenth century. Infective causes of psychiatric disorders are once again considered important; this account highlights the fact that similar ideas were prevalent in British India, even 150 years ago. In addition, Dr Smith's comments describe the social mileu of 'western' medicine in India in the early colonial period.