Exploring the Serum Level of RE1 Silencing Transcription Factor in Alzheimer's Disease

Objectives:The aim of this study was to evaluate the serum RE1 silencing transcription factor (REST) level in Alzheimer's disease (AD), mild cognitive impairment (MCI), and elderly controls by using surface plasmon resonance (SPR) technology. Materials and Methods?In this case–control study of 133 subjects, 49 patients with AD, 49 patients with MCI, and 35 elderly controls were recruited. The REST protein concentrations were evaluated by SPR. The resonance unit for each sample was recorded and the concentration of serum REST of study group was derived from the standard curve. All the experiments were done in triplicates. Statistical analysis was done and p-value of < 0.05 was considered as statistically significant. Results?A significant difference was observed in the Montreal Cognitive Assessment score, Hindi Mental State Examination scale (HMSE) score education, disease duration, and gender among the groups. A significant (p>0.0001) difference in the duration of disease between AD and MCI was observed. It was observed that the mean concentration of serum REST was not significantly (p?=?0.266) different among the groups. Conclusion?This study first time evaluated the serum levels of REST in AD, MCI and age-matched elderly controls. The rest levels were similar in all groups; however, it can provide a new direction to future blood-based biomarker studies of REST.

Application of real‑time quantitative polymerase chain reaction assay to detect Legionella pneumophila in patients of community‑acquired pneumonia in a tertiary care hospital.

Legionella pneumophila is one of the important pathogen responsible for community –acquired pneumonia attributing for 1-5% of cases. Since early and accurate therapy reduces mortality, rapid and reliable diagnostic methods are needed. A total of 134 samples of blood, urine and respiratory tract fluids were collected. Blood was tested for IgG, IgM and IgA antibodies using commercially available kits. A total of 8 (6%) samples were found to be positive for L. pneumophila by quantitative reverse transcription polymerase chain reaction (qRT‑PCR), compared to conventional PCR where 6 (4.4%) samples were positive. Serology was positive in a total of 32 (23%) cases though only 3 (2.2%) of the PCR‑positive cases were positive by serology as well. These results suggest that real‑time PCR can detect Legionella infection early in the course of the disease before serological response develops.

Tricky typhus ticks two: A report of two sisters from North India presenting with acute respiratory distress syndrome due to scrub typhus.

Scrub typhus is emerging as an important cause of acute febrile illness in Northern India. This is a report of two sisters presenting concurrently with acute respiratory distress syndrome. A diagnosis of scrub typhus was made in both the patients, and they were successfully treated with doxycycline.

Legionella pneumophila infection associated with renal failure causing fatality in a known case of sarcoidosis.

Legionella pneumophila infection may become fatal in immunocompromised state. We report here the first known fatal case from India due to Legionella pneumophila infection complicated by renal failure in a patient undergoing treatment for Sarcoidosis. Sarcoidosis is an idiopathic systemic inflammatory disease involving multiple organs. Urine antigen detection and polymerase chain reaction targeting 16S rRNA gene could help in rapid diagnosis of the infection and thereby start specific therapy. Clinical awareness along with availability of rapid diagnostic tests and institution of specific therapy may reduce morbidity and mortality associated with this infection especially in immunocompromised state.

Molecular detection of Mycoplasma pneumoniae by quantitative real-time PCR in patients with community acquired pneumonia.

Background & objectives: Mycoplasma pneumoniae is the most important and common cause of community-acquired pneumonia (CAP). The conventional detection methods (culture and serology) lack sensitivity. PCR offers a better approach for rapid detection but is prone to carry over contamination during manipulation of amplification products. Quantitative real-time PCR (qRT-PCR) method offers an attractive alternative detection method. In the present study, qRT-PCR, PCR and serology methods were used to detect M. pneumoniae infection in cases of pneumonias and findings compared. Methods: A total of 134 samples consisting of blood (for serology) and respiratory secretions (for PCR and qRT-PCR) from 134 patients were collected. The blood samples were tested for IgG, IgM and IgA using commercially available kits. For standardization of PCR of M. pneumoniae P1 gene was cloned in pGEMTEasy vector. Specific primers and reporter sequence were designed and procured for this fragment. The qRT-PCR assay was performed to prepare the standard curve for M. pneumoniae positive control DNA template and detection in patient samples. Results: Of the 134 patients, 26 (19%) were positive for antibodies against M. pneumoniae. IgG was positive in 14.92 per cent (20) cases, IgM in 4.47 per cent (6) and IgA was positive in 5.22 per cent (7) cases. In the qRT-PCR assay 19 per cent (26) samples were positive. Of the 26 qRT-PCR positive samples, nine could be detected by serology. PCR was positive for 25 samples. An extra sample negative by PCR was detected by qRT-PCR. Thus, real-time PCR assay, PCR and serology in combination could detect M. pneumoniae infection in 43 patients. Interpretation & conclusions: The study shows that 17 patients were detected by serology alone, 17 were detected by qRT-PCR only and nine patients were positive by both serology and real-time PCR. Of the 134 samples tested, 25 were positive by conventional PCR, but qRT-PCR could detect one more sample that was negative by PCR and serology. These results suggest that a combination of two or three methods may be required for reliable identification of CAP due to M. pneumoniae.

Serological & molecular approaches for diagnosis of leptospirosis in a tertiary care hospital in north India: A 10-year study.

Background & objectives: Leptospirosis, a spirochetal zoonosis, is underreported from the northern States of India. This study reports results of a 10-year retrospective sero-epidemiological survey of leptospirosis conducted in a tertiary care hospital in New Delhi, India. Method: A total of 1453 patients clinically suspected for leptospirosis were included and investigated initially by IgM ELISA. A proportion of these were subjected to culture, microscopic agglutination test (MAT) and polymerase chain reaction (PCR). Results: Of the 1453 patients, 391 (26.90%) were positive serologically by IgM ELISA. Seropositive and seronegative patients revealed no significant difference in clinical features and laboratory parameters. Amongst the IgM seropositive cases, culture for leptospires was positive in 5 of 192 (2.6%), MAT in 50 of 138 (36.23%), PCR from blood and urine in 10 of 115 (8.7%) and 10 of 38 (26.31%) cases, respectively. In Leptospira spp. positive patients co-infections with viral hepatitis E, malaria and dengue fever were diagnosed in 27 cases. Interpretation & conclusions: The overall seropositivity for leptospirosis was 26.9 per cent in our study. A decreasing trend in seropositivity was observed in recent years. Co-infections with malaria, dengue, hepatitis A and E were also seen. Since leptospirosis is a treatable disease, correct and rapid diagnosis may help in effective management of patients.

Sero diagnosis of Legionella infection in community acquired pneumonia.

Background & objectives: Legionella pneumophila has been increasingly recognized as an emerging pathogen responsible for community acquired pneumonia (CAP) worldwide. In India, the actual burden is not known. The present study was thus undertaken to see the presence of Legionella infection in patients with community acquired pneumonia admitted in a tertiary care centre in north India. Methods: Both children and adults (n=113) with symptoms of pneumonia were included in the study. Clinical samples (blood, urine, nasopharyngeal aspirates, bronchoalveolar lavage, sputum, etc.) were collected and subjected to culture and other tests. Enzyme linked immunosorbent assay (ELISA) was done by commercial kits for all the three classes of immunoglobulins (IgG, IgM & IgA). Urinary antigen was also detected using commercial kits. Culture was performed on 51 respiratory tract fluid samples. Serum samples of 44 healthy controls were also screened for the presence of anti-legionella antibodies (IgG, IgM & IgA). Results: Thirty one of the 113 cases (27.43%) were serologically positive. Anti-legionella IgG, IgM and IgA antibodies were positive in 7.96, 15.92 and 11.50 per cent patients respectively. In controls, seropositivity was 9.09 (4/44). IgA was positive in 3 and IgM, IgG combined in one. Antigenuria detection by Microwell ELISA kit showed 17.69 per cent positivity. Four antigenuria positive patients were also serologically positive; of these two patients were positive for IgM, hence considered as confirmed cases of Legionella infection. None of the sample was culture positive. Interpretation & conclusions: Combination of serology and antigenuria detection may be a valuable tool for the diagnosis of Legionella infection in absence of culture positivity. In order to evaluate the actual burden of Legionella in community acquired pneumonia, further studies with larger samples need to be done.

Acute disseminated encephalomyelitis--another cause of post malaria cerebellar ataxia.

The aetio-pathogenesis of delayed onset cerebellar ataxia following Plasmodium falciparum malaria is uncertain. An autoimmune demyelinating pathology has been suspected though not yet definitively substantiated. In the present communication we report a case of delayed onset cerebellar ataxia following acute falciparum malaria, where magnetic resonance imaging revealed demyelinating lesions in the pons and cerebellar peduncles which disappeared after resolution of symptoms.

Well-differentiated inflammatory liposarcoma presenting as pyrexia of unknown origin.

Liposarcomas have diverse histological appearance and clinical manifestations. Well-differentiated inflammatory liposarcoma is an uncommon sub-type, which often causes diagnostic difficulty. We report here a young female patient who presented with prolonged pyrexia and sub-diaphragmatic mass and was detected to have this uncommon soft tissue sarcoma on laparotomy.

Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme.

BACKGROUND: An estimated 68 million Indians are above the age of 60 years; however, information on their health status and needs is limited. Experience in developed countries shows that multiple chronic illnesses, nutritional deficiency and functional disability are common features of old age. For the development of any health programme, reliable situational information is essential. We therefore assessed the health and functional status of older Indians seeking health services. METHODS: We carried out a prospective cross-sectional observational study on 1586 subjects > or = 60 years of age (1035 men and 551 women), who attended the Geriatric Clinic of the All India Institute of Medical Sciences, New Delhi. A clinical and laboratory evaluation was carried out through a pre-designed protocol evolved after reviewing the relevant literature. The protocol included a questionnaire on demographic details, personal habits, socio-economic variables, family structure, past and present medical history, use of medications and aids, presence of certain common symptoms and perceived functional disability. Evaluation included a detailed physical examination, functional assessment, psychiatric assessment and a set of laboratory tests. RESULTS: Ninety-five per cent of the subjects were < 80 years of age and 87% of them sought medical attention for an acute illness that had occurred in the month prior to their coming to our clinic. One or more chronic illnesses were present in 96% and each subject had a mean of 2.5 diagnoses. However, they suffered from a limited number of illnesses of which the 10 most common accounted for 80% of the diagnoses. Hypertension, cataract and osteoarthritis were the 3 most common illnesses. About one-third of a subset of 209 subjects had a psychiatric illness; depression accounted for 50% of all psychiatric illnesses. A detailed functional assessment was carried out in 1268 subjects which showed that deficits of vision and hearing were the most frequent disabilities. Impairment of daily activities and cognition accounted for 6.9% and 5.1% of the diagnoses, respectively. A majority of them considered their home free from the hazard of accidents and were sure of support from their families at times of need. CONCLUSION: Multiple chronic illnesses, frequent acute illnesses and deficits of vision and hearing are the major health and functional problems of the health-seeking older population in India. It is difficult to assess the total service needs of the population from this study because of its unrepresentative character, though it provides a fair picture of the expectations of care of older people in India.

Mycoplasma pneumoniae and community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia is an important cause of mortality and hospitalization in all age groups. In temperate climates, Mycoplasma pneumoniae is a common respiratory pathogen causing pneumonia. Information on human Mycoplasma infection in India is scarce. METHODS: We aimed to determine the frequency of Mycoplasma pneumoniae infection among patients with community-acquired pneumonia in a prospective cross-sectional study. The assessment included clinical and radiological evaluation followed by microbiological evaluation for the specific pathogen. Microbiological investigations included aerobic and anaerobic blood culture, anti-Mycoplasma IgM antibody detection by gelatin particle agglutination test and ELISA, culture of respiratory tract secretions for Mycoplasma pneumoniae and other organisms, and detection of specific Mycoplasma pneumoniae antigen by indirect immunofluorescence. RESULTS: Sixty-two patients (42 men and 20 women; mean age 41.7 years) with community-acquired pneumonia were investigated prospectively. They included 42 immunocompetent and 20 immunocompromised patients. Six patients had definitive evidence of Mycoplasma pneumoniae infection and an additional 16 patients had a probable diagnosis. In all, 22 (35.5%) patients with pneumonia had Mycoplasma pneumoniae infection. Of these, 12 patients belonged to the immunocompromised group and 10 to the immunocompetent group. Patients with Mycoplasma pneumoniae infection also had secondary bacterial infection as evidenced by organisms isolated from blood in 50% and from respiratory tract secretions in 68%. CONCLUSION: Community-acquired pneumonia has a polymicrobial aetiology, of which the prevalence of Mycoplasma pneumoniae is 35%. The study has two implications: (i) Mycoplasma pneumoniae infection is frequently associated with secondary bacterial infection; and (ii) initial empirical antibiotic therapy for community-acquired pneumonia in India must include antibiotics with activity against Mycoplasma pneumoniae.

Tuberculosis: a rare cause of splenic abscess.

Splenic abscess is a rare condition associated with septicemic conditions. Splenic abscess due to tuberculosis is still rarer, mostly diagnosed in immuno-compromised hosts. A case of tubercular splenic abscess without any underlying disease is reported.

Constipation.

Constipation is a common problem in day-to-day practice. As there are wide variations in normal bowel habits, there is no standard definition. Altered colonic transit and disorders of the anorectal mechanism are the essential abnormalities in patients who experience this symptom. While there are several organic causes, functional disorders are by far the commonest cause of constipation. Clinical assessment should include a careful history, eliciting information on lifestyle, diet and personality. Extensive investigations are seldom warranted. Reassurance and long term treatment with a wide range of laxatives provide symptomatic relief.