Evans’ Index In Healthy North Indian Population: A Computed Tomographic Study

Background: As the humans age, there is decrease in size of brain tissue, increase in cerebrospinal fluid volumeand enlargement of ventricles. Brain ventricles can be studied by taking linear, planimetric or volumetricmeasurements. Linear ratios of width of ventricles to the width of skull or brain are considered to be an easy andreproducible measurement for assessment of ventricles. Evans’ index is one such linear ratio; it is the ratio ofmaximum width of frontal horns and maximum transverse internal diameter of skull in the same plane.Purpose of study: The purpose of our study was to obtain a baseline data of reference values of Evans index, inhealthy north Indian population.Materials and Methods: This study was jointly conducted by Department of Anatomy and Department ofRadiodiagnosis, King George’s Medical University, U.P, Lucknow. Axial CT scans of head region reportedradiologically normal, belonging to 100 individuals of different age groups were retrospectively collected andthoroughly analyzed using Radiant DICOM Viewer Software. Study subjects were categorized into V groups as perage: 18-30years, 31-40years, 41-50years, 51-60years and above 60years. Evans’ index was calculated.Results: Among study subjects, Evans’index ranged from 0.167 to 0.29 with a mean value of 0.23±0.02. Nosignificant association was observed between age and mean Evans’ Index (p>0.05). Mean Evans’ index was equalfor male and female and was not found to change with age.Conclusion: Study provided values for normal range of Evans’ index and proposes age dependent values of thesame for healthy adult males and females. The data could be utilized in routine radiological practice and byothers where required

The Second Brain

The ability of the microbiota of the gut to communicate with the brain and influence behaviour is an emerging topic of research.The enteric microbiota interacts with the host to form a relationship that governs homeostasis. Despite the unique enteric bacterial fingerprintof each individual there appears to be a certain balance that confers health benefits. A decrease in desirable bacteria therefore leads to a disturbed gastrointestinal, neuroendocrinal and immune relationship leading to a diseased condition. Studies are focussing on the impact of the microbiota on the host specially its effect on the brain.There are many studies which have demonstrated germ free mice displaying altered stress response, neurochemistry and anxiety in comparison to normal mice. Data obtained from such experiments show that modulation of enteric microbiota may be a useful strategy in stress related disorders, gastrointestinal disorders such as Irritable Bowel Syndrome (IBS) and Inflammatory bowel disease

Slow progressor of human immunodeficiency virus: 20 years follow-up of a case from North India.

A case of human immunodefi ciency virus (HIV) infection from North India is described with a 20-year follow-up. Patient fi rst reported in 1993 when he was detected HIV positive, remained healthy without treatment, married in 1999 and did not transmit the disease to his children or his wife and was lost to follow-up. He was thought to be an elite controller. After 15 years of the initial visit, his CD4 cells, however, were found to be low, with a viral load of 10,000/copies/ml. He was negative for human leukocyte antigen B57 and B27 alleles with a normal expression of CCR5 and CXCR4 on CD4 cells. Lymphocytes showed a signifi cant production of tumour necrosis factor alpha and interferon , but not of interleukin (IL)-2, IL4 or IL10. It is possible that gut infection, common in India, could have triggered T cell activation in the ensuing years, resulting in activation of HIV. The case illustrates the signifi cance of long-term follow-up of these patients for timely institution of anti-retroviral therapy.

High rate of mutation K103N causing resistance to nevirapine in Indian children with acquired immunodeficiency syndrome.

In north India the number of paediatric cases with acquired immunodeficiency syndrome (AIDS) is on the rise. Most drug combinations used for treatment of AIDS incorporate nevirapine, resistance to which develops very fast if given singly or because of unplanned interruptions. This paper investigates presence of mutations at codon 103 and codon 215 of the HIV pol gene causing resistance to nevirapine and zidovudine (AZT) respectively in 25 children with AIDS. Mutations T215Y and K103N were detected by a nested cum amplification refractory mutation system polymerase chain reaction (ARMS PCR) and the results were confirmed by direct sequencing in five randomly selected cases. Nineteen patients had received nevirapine containing regimen and six were drug naive. Mutation K103N was observed in 56% (14/25) of the children while mutation T215Y was found in none. Two of the six drug naïve children also showed K103N mutation. Thus, Indian children drug naïve or treated with nevirapine containing regimens show a high rate of mutation conferring resistance to nevirapine which calls for a judicious use of nevirapine both in antenatal and postnatal setting.