Creutzfeldt-Jakob disease.

Cruetzfeldt-Jakob disease is a prion protein disease causing a transmissible, subacute, fatal neurodegenerative disease characterized by a spongiform encephalopathy. Though rare, ever since Pruisner described the pathogenesis in 1982, this disease kept the clinicians as well as biologists spellbound, because of its distinct clinical picture and the novel mechanism of transmission. There was a further quantum leap in the interest in the disease with the establishment of its new clinical variant, the so called 'mad cow disease' in the late 1990s and had led to more stringent measures to ensure the quality of cattle-feeds and cattle-derived food products. The sporadic genetic variants, the commonest form of the disease, continue to challenge the genetic scientists. Advances in neuroimaging, cerebrospinal fluid marker proteins and genetic linkage studies now offer excellent diagnostic methods, while advances in therapeutic medicine which use products from cadaveric extracts such as growth hormone for treatment of hypopituitarism, dural grafts for neurosurgical procedures and cornea for transplantation etc. have thrown new challenges in controlling this serious disease.

Dot-ELISA for the diagnosis of neurocysticercosis

O objetivo do presente estudo foi estandardizar e avaliar o Dot-ELISA, um teste simples e rápido para detectar anticorpos de cisticercos no soro para diagnóstico da neurocisticercose (NCC). O antígeno usado no estudo foi um homogenizado completo de cistos de Cysticercus cellulosae obtidos de porcos infectados e marcados sobre a membrana de nitrocelulose. Os soros testados foram coletados de pacientes com NCC e os soros controle de pacientes com outras doenças e estudantes saudáveis e doadores e sangue do "Jawaharlal Institute of Postgraduate Medical Education and Research Hospital", em Pondicherry, durante o período de estudo de 2001 a 2003. Dot-Elisa detectou anticorpos em 14 de 25 (56%) casos suspeitos de NCC, em 13 de 23 (56,5%) em CT/MRI casos provados de NCC e em 2 de 25 (8%) cada em controles de infecções do sistema nervoso não devidas à cisticercose e controles saudáveis. O teste mostrou sensibilidade de 56,25%, especificidade de 92%, valor preditivo positivo de 87,09% e valor preditivo negativo de 70,76%. Resultados do presente estudo mostram que o Dot-ELISA como teste simples pode ser usado em trabalhos de campo ou em laboratórios pobremente equipados para o diagnóstico da NCC.

Feasibility of acute thrombolytic therapy for stroke.

BACKGROUND: Thrombolysis is an expensive medical intervention for ischemic stroke and hence there is a need to study the feasibility of thrombolysis in rural India. Aims: To asses the feasibility and limitations of providing thrombolytic therapy to acute ischemic stroke patients in a rural Indian set-up. MATERIAL AND METHODS: The first 64 consecutive patients registered under the Acute Stroke Registry in a university referral hospital with a rural catchment area were studied as per a detailed protocol and questionnaire. RESULTS: Of the 64 patients 44 were ischemic strokes, and 20 were hemorrhagic. Thirteen (29.55%) patients with ischemic stroke reached a center with CT scan facility within 3 hours, of whom only 7 (15.91%) were eligible to receive thrombolytic therapy as per the existing clinical and radiological criteria, but none received the therapy. Of the remaining 31 (70.45%) who arrived late, 11 (25%) had no clinical and radiological contraindications for thrombolysis, except the time factor. All the patients belonged to a low socioeconomic status and a rural background. CONCLUSION: Though a large proportion of ischemic stroke patients were eligible to receive thrombolytic therapy, the majority could not reach a center with adequate facilities within the recommended time window. More alarmingly, even for those patients who reached within the time window, no significant attempt was made to initiate thrombolysis. These data call not only for attention to improve existing patient transport facilities, but also for improving the awareness of efficacy and therapeutic window of thrombolysis in stroke, among the public as well as primary care doctors.

Acanthameba meningoencephalitis: a case report.

A 45 year old lady presented with history of recent surgery for uterovaginal prolapse and retained vaginal tampons following which she developed chronic meningitis due to acanthameba infection. Patient responded to a regimen containing albendazole. She was left with hydrocephalus as a sequelae.