Search

Plasma gamma-glutamyltransferase (GGT) was suggested to reflect the level of systemic oxidative stress. Oxidative stress induces changes in arterial structure and function and contributes to the development of hypertension. Therefore, GGT may be associated with arterial remodeling and blood pressure (BP) increment, even in absence of disease. To test this hypothesis, we evaluated, in 825 healthy subjects at low cardiometabolic risk, the associations of plasma GGT with carotid artery intima-media thickness (IMT), luminal diameter and prehypertension; in 154 subjects was evaluated also the association with aortic stiffness (cfPWV). Associations were controlled for insulin sensitivity, C-reactive protein, and life-style habits. In the main population, BP was remeasured after 3 years. Carotid diameter and cfPWV, but not IMT, were directly and independently related to plasma GGT. Subjects with prehypertension (N = 330) had higher GGT as compared with subjects with normal BP (22 [14] vs 17 [11] IU/L; adjusted P = 0.001), and within prehypertensive subjects, those who developed hypertension during 3 years had higher GGT than those without incident hypertension (27 [16] vs 21 [14] IU/L; adjusted P < 0.05). Within subjects with arterial stiffness measurement, those with prehypertension (N = 79) had higher both GGT and arterial stiffness (25 [14] vs 16 [20] IU/L and 9.11 ± 1.24 vs 7.90 ± 0.94 m/s; adjusted P < 0.01 and

This foundational chapter presents Mitchell’s writing as a barometer of the times that he inhabited. It sets out the book’s biographical and critical aims to examine the precise nature of the author’s literary achievement against the dramatic geopolitical background of the early decades of the twentieth century. Drawing authoritatively upon original sources, Mitchell’s short life is summarised as a triumph of innate talent over the social hardship and cultural poverty of his upbringing, from his origins in peasant society to service in the army and the airforce, thereafter moving to city life in Scotland and London, before finally settling in Welwyn Garden City. Mitchell’s personal experience of many of the key developments of the modern world, in country and city, at home and abroad, in wartime and peacetime, is shown to have shaped his personal ideology – particularly his left-wing radicalisation. The two central planks of his greatest writing, his love of nature and his fierce social commitment, are traced to his peasant upbringing as son to a poor Aberdeenshire crofter. His literary corpus is presented as a knowing response to the zeitgeist of the inter-war years, as a renunciation of outmoded Victorian modes and an embracing of the new.

Mitchell’s abiding interest in history and prehistory was a concomitant of his overarching commitment to human rights. This chapter studies the impulse underlying his dedication to the Diffusionist school of history, which most importantly served as a moral prop for his belief in human goodness. The four full-length history books that he published span his writing career and testify to the continuity of his ideological preoccupations, expressly with the welfare of the ordinary people and with the responsibilities of mankind with regard to safeguarding the rights of ethnic peoples and respecting the natural environment. His anti-imperialist sensibility is evident in his promotion of the rights of the peasant. This runs right through his biography of Mungo Park, with whom the author keenly empathises as son to a smallscale Scottish farmer, and his study of the pre-Columbian theocracies in his most academic treatise The Conquest of the Maya right up to his study of Fridtjof Nansen, which closes his final volume Nine Against the Unknown, hailed as the champion and embodiment of the most inspiring ethical, environmental, political and philosophical values.

Mitchell’s early fiction writing is analysed as a modern take on Arabian Fantasy mixing realism and mysticism and forging a strong spirit of place from memories of his army service in the middle east, particularly his principal posting in post-war Cairo. Mitchell’s story-cycles appear stylistically dated, but his experimentation, particularly with first person narrative, anticipates several of the signature features of his mature fiction style. The social and political temper of this early work is also seen to be reflective of his mature humanitarianism, in the subtle denunciation of colonialism and in the socialist utopianism seen at play throughout the narrative.

Mitchell’s first two novels are examined as works deploying the medium of imaginative literature for introspection and analysis of his own past. In reverse chronological order they recreate the narrative of his childhood and early adulthood, in the course of which they present a state of the nation critique of early twentieth century Britain. The forthright verisimilitude of the social realism is in keeping with the philosophical nihilism prevailing in the inter-war years, with the political responses of mainstream parties and of radical splinter groups such as the Anarchocommunist Party appearing unable to change society for the better. Mitchell’s technical experimentation with metafiction and intertextuality indicates the scale of his literary ambition, while his proto-feminist sympathies are marked by his reliance on female protagonists.

A quarter of this monograph is devoted to Gibbon’s masterpiece, the trilogy A Scots Quair, approached as a strategically integrated volume. This chapter places the book within its contemporary context, using original research to focus authoritatively on the aims and ideals that shaped its social, political, cultural and philosophical achievement. Sunset Song garners greatest attention for its bespoke narrative techniques and for the eclectic deployment of literary influences from Scotland and elsewhere. The nostalgic power and moral impact of this first novel as a compelling bildungsroman and an elegy for the crofting society destroyed by the war feeds into the more overtly political character of the remaining parts of the trilogy. The revolutionary political perspective at the heart of the work is convincingly based on the author’s ready identification with the subaltern classes, marking it as the highest form of littérature engagée. The Gibbon contributions to Scottish Scene are considered in relation to the central achievement of the trilogy, with the Scottish stories replicating the author’s signature style and, in ‘Forsaken’, successfully carrying it to a more sophisticated level of stylistic experimentation. The polemical essays are welcomed for shedding light on the author’s ideas and beliefs, about literature, politics, history and religion.

Lewis Grassic Gibbon galvanized the Scottish literary scene in 1932 with Sunset Song, the first novel of the epic trilogy A Scots Quair, that drew vividly upon his deprived upbringing on a small croft in Aberdeenshire to capture the zeitgeist of the early twentieth century. Yet his literary legacy extends significantly beyond his breakout book. The seventeen volumes that he amassed in his short life, under his own name of James Leslie Mitchell as well as his Scots pseudonym, demonstrate his versatility, as historian, essayist, biographer and fiction writer. His corpus pays testimony to his core principles, rooted in his rural upbringing: his restless humanitarianism and his deep veneration for the natural world. Set against an informed conspectus of Mitchell’s life and times and incorporating substantive new source material, this study provides a comprehensive and searching analysis of the canon of a combative writer whose fame in recent years – as cultural nationalist, left-wing libertarian, proto-feminist, neo-romantic visionary and trailblazing modernist – has carried far beyond his native land. In tune with the intellectual climate of the inter-war years, Gibbon emerges as a passionate advocate of revolutionary political activism; in addition, as a profound believer in the overarching primacy of nature, he is represented as a supreme practitioner in the field of ecofiction. Coupled with his modernist experimentation with language and narrative, this firmly establishes him amongst the foremost fiction writers of the twentieth century – uniquely, a figure whose achievement has consistently won both critical and popular acclaim.

Context Many hospitals in the United States are exploring greater investment in community health activities that address upstream causes of poor health. Objective Develop and apply a measure to categorize and estimate the potential impact of hospitals' community health activities on population health and equity. Design, setting, and participants We propose a scale of potential impact on population health and equity, based on the cliff analogy developed by Jones and colleagues. The scale is applied to the 317 activities reported in the community health needs assessment implementation plan reports of 23 health care organizations in the Minneapolis-St Paul, Minnesota, metropolitan area in 2015. Main outcome measure Using a 5-point ordinal scale, we assigned a score of potential impact on population health and equity to each community health activity. Results A majority (50.2%) of health care organizations' community health activities are classified as addressing social determinants of health (level 4 on the 5-point scale), though very few (5.4%) address structural causes of health equity (level 5 on the 5-point scale). Activities that score highest on potential impact fall into the topic categories of "community health and connectedness" and "healthy lifestyles and wellness." Lower-scoring activities focus on sick or at-risk individuals, such as the topic category of "chronic disease prevention, management, and screening." Health care organizations in the Minneapolis-St Paul metropolitan area vary substantially in the potential impact of their aggregated community health activities. Conclusions Hospitals can be significant contributors to investment in upstream community health programs. This article provides a scale that can be used not only by hospitals but by other health care and public health organizations to better align their community health strategies, investments, and partnerships with programming and policies that address the foundational causes of population health and equity within the communities they serve.

Morvan's syndrome is an autoimmune disorder of peripheral and central nervous system mediated by VGKC antibody. Here we report a case of Morvans syndrome who presented 1 month after ayurvedic drug intake. She presented with symptoms of peripheral nerve hyperexcitablity and autoimmune testing revealed positive result for VGKC antibody. Heavy metals level was also significantly raised. She improved after a course of steroids. This case report tries to highlight the association of VGKC mediated Morvans syndrome with heavy metal poisoning and its incidental occurence after Ayurvedic drug intake.

Clinicians face many challenges when diagnosing and treating breast cancer. These challenges include interpreting and co-locating information between different medical imaging modalities that are used to identify tumours and predicting where these tumours move to during different treatment procedures. We have developed a novel automated breast image analysis workflow that integrates state-of-the-art image processing and machine learning techniques, personalized three-dimensional biomechanical modelling and population-based statistical analysis to assist clinicians during breast cancer detection and treatment procedures. This paper summarizes our recent research to address the various technical and implementation challenges associated with creating a fully automated system. The workflow is applied to predict the repositioning of tumours from the prone position, where diagnostic magnetic resonance imaging is performed, to the supine position where treatment procedures are performed. We discuss our recent advances towards addressing challenges in identifying the mechanical properties of the breast and evaluating the accuracy of the biomechanical models. We also describe our progress in implementing a prototype of this workflow in clinical practice. Clinical adoption of these state-of-the-art modelling techniques has significant potential for reducing the number of misdiagnosed breast cancers, while also helping to improve the treatment of patients.

Purposes To assess the impact of a government‐sponsored reimbursement policy for cholinesterase inhibitors (ChEIs) on trends in physician visits with a diagnosis of Alzheimer's disease (AD). Methods Longitudinal population‐based study using interrupted time series methods. British Columbia outpatient claims data for individuals aged 65 and older were used to compute monthly AD visit rates and examine the impact of the ChEI reimbursement policy on the coding of AD. We examined trends in the number of patients with AD visits, the number of AD visits per patient, and visits with “competing” diagnoses (mental, neurological, and cerebrovascular disorders and accidental falls). Finally, we described demographic and clinical features of diagnosed patients. Results We analyzed 1.9 million AD visits. Faster growth in recorded AD visits was observed after the policy was implemented, from monthly growth of 7.5 visits per 100 000 person‐months before the policy (95% confidence interval [CI], 6.1‐8.9) to monthly growth of 16.5 per 100 000 person‐months after the policy (95% CI, 14.8‐18.3). After the implementation of the policy, we observed increased growth in the number of patients with recorded AD visits and the number of AD visits per patient, as well as a shift in diagnoses away from mental diseases and accidental falls to AD (diagnosis substitution). Conclusions British Columbia's reimbursement policy for ChEIs was associated with a significant acceleration in Alzheimer's visits. Evaluations of health services utilization and clinical outcomes following drug policy changes need to consider policy‐induced influences on the reliability of the data used in the analysis.

How to cite this article: Jeyaraj KM. Revisiting Post-stroke Epilepsy. Bengal Physician Journal 2020;7(1):22.

We report about two young males who developed significant proximal weakness of all four limbs secondary to intracranial hypertension due to intracranial venous sinus thrombosis. Intracranial venous sinus thrombosis can manifest in a variety of ways which includes isolated intracranial hypertension, focal neurological symptoms or signs and acute or subacute encephalopathy. Various false localising signs have been reported to occur in patients with raised intracranial pressure including cranial nerve palsies and extensive radiculopathy. In a patient presenting with flaccid areflexic quadriparesis and papilledema, the possibility of a potentially reversible dysfunction of the cranial nerves and spinal nerve roots due to a marked rise in intracranial and intraspinal pressure must be recognised. Lumboperitoneal shunt to reduce the intraspinal pressure on the spinal nerve roots has been advocated to reverse the symptoms of extensive radiculopathy in such patients. Both of our patients showed remarkable improvement in symptoms and signs with medical treatment of CVT.

SummaryWhat is known and objective Sacubitril/valsartan (LCZ696) has been recently approved for the treatment of heart failure (HF) patients with reduced ejection fraction. Several HF patients receive statins as co-medication. Methods Because clearance of statins is meditated via OATP1B1/1B3, the inhibition potential of these transporters by LCZ696 analytes was evaluated in vitro. Furthermore, an open-label, fixed-sequence clinical study was conducted to determine the effect of LCZ696 on the exposure of simvastatin and its active metabolite simvastatin acid. In this clinical study, 26 healthy subjects received simvastatin 40 mg alone or in combination with LCZ696 or after 1 or 2 h of LCZ696 dosing. Results and discussion Although no significant inhibition by LBQ657 (an active metabolite of sacubitril) and valsartan was observed, sacubitril inhibited OATP1B1 and OATP1B3 in vitro, with IC50 of 1·91 and 3·81 μm, respectively. Upon co-administration of simvastatin with LCZ696, the Cmax of simvastatin and simvastatin acid decreased by 7% and 13%, respectively. When administered 1 h after LCZ696 dosing, the corresponding Cmax of simvastatin and simvastatin acid decreased by 16% and 4%, respectively. When administered 2 h after LCZ696 dosing, the Cmax of simvastatin decreased by 33% and that of simvastatin acid increased by 16%. However, no notable changes were observed in the AUCs of simvastatin or simvastatin acid upon co-administration or time-separated administration with LCZ696. No notable impact of simvastatin co-administration was observed on the pharmacokinetics of LCZ696 analytes. LCZ696 and simvastatin were generally well tolerated when administered alone or in combination. What is new and conclusions Overall, the results of this study suggest that although sacubitril inhibited OATP1B1 and OATP1B3 in vitro, it does not translate into any clinically relevant in vivo effect.