Parkinsonian syndromes presenting with circadian rhythm sleep disorder–advanced sleep-phase type.

Background. Circadian rhythm sleep disorder–advanced sleep-phase type is a relatively uncommon disorder, mostly seen among the elderly population. Impaired circadian rhythms have been reported in neurodegenerative conditions; however, there are no reports of any circadian rhythm sleep disorder among patients with Parkinsonian syndromes. We report two patients who presented with this circadian rhythm disorder, and were then diagnosed with a Parkinsonian syndrome. The cases. A 65-year-old retired man presented with history of abrupt change in sleep schedules, sleeping around 6.30–7 p.m. and waking up around 3–4 a.m. for the last 2 months. On detailed examination, the patient was observed to have symmetrical bradykinesia and cogwheel rigidity of limbs. A diagnosis of multiple system atrophy was made, supported by MRI findings and evidence of autonomic dysfunction. Symptoms of change in sleep–wake cycles resolved over the next 1 year, while the patient was treated with dopaminergic therapy. A 47-year-old man, who was being evaluated for presurgical investigation for refractory temporal lobe epilepsy, presented with complaints suggestive of dysarthria, bradykinesia of limbs and frequent falls for 5 months. Simultaneously, he began to sleep around 7 p.m. and wake up at about 2–3 a.m. Examination revealed severe axial rigidity, restricted vertical gaze and bradykinesia of limbs. A diagnosis of progressive supranuclear palsy was made. Conclusion. This is the first report of Parkinson’s plus syndromes presenting with a circadian rhythm sleep disorder– advanced sleep-phase type. More prospective assessment for circadian sleep disorders may introduce useful insights into similar associations. Natl Med J India 2015;28:233–5

Effect of chronic exposure to biomass fuel smoke on pulmonary function test parameters.

Background: Life in a typical Indian household revolves around the cooking area, and Indian women spend much of their time there. Cooking stoves in most households are nothing more than a pit, a chulha (a U-shaped construction made from mud), or three pieces of brick. Cooking under these conditions entails high levels of exposure to cooking smoke. Aim of this study was to evaluate the effect of Chronic Exposure to Biomass Fuel Smoke on Pulmonary Function Test Parameters. Methods: 60 non-smoking women without any history of any major chronic illness in the past were selected for this study. The study group comprised of 30 rural female subjects who were chronically exposed to biomass fuel smoke combustion and 30 age matched urban female subjects exposed chronically to clean fuel combustion (Liquified Petroleum Gas–LPG) in Haryana (India). All the subjects were evaluated for pulmonary function tests by RMS Medspiror. Results: Biomass exposure index came out to be 85.68±3.69 for women cooking on biomass and LPG index was 64.17±6.97 for women cooking on LPG. This implies significant chronic exposure of women to biomass fuel smoke. The lung function parameters were significantly lesser in biomass exposed rural women [FEV1 (p<0.01), FVC (p<0.01), FEF25-75 (p<0.01), FEV1/FVC ratio (p<0.01), PEFR (p<0.01), MVV (p<0.01)] than the LPG exposed urban women. The evaluation of PFT suggested obstructive type of pulmonary disease. Conclusion: The derangement in pulmonary function parameters in women exposed to biomass smoke pollutants could be due to chronic significant exposure as suggested by high Biomass exposure Index. Inadequate ventilation in cooking area without chimney/vent also contributed to pulmonary function derangement and COPD.

Characterization of Bacteriocin like inhibitory substance produced by a new Strain Brevibacillus borstelensis AG1 Isolated from 'Marcha'

In the present study, a bacterium isolated from Marcha- a herbal cake used as traditional starter culture to ferment local wine in North East India, was evaluated for bacteriocin like inhibitory substance production and was tested against six food borne/spoilage causing pathogens viz. Listeria monocytogenes MTCC 839, Bacillus subtilis MTCC 121, Clostridium perfringens MTCC 450, Staphylococcus aureus, Lactobacillus plantarum and Leuconostoc mesenteroides MTCC 107 by using bit/disc method followed by well diffusion method. The bacterial isolate was identified as Brevibacillus borstelensis on the basis of phenotypic, biochemical and molecular characteristics using 16Sr RNA gene technique. Bacteriocin like inhibitory substance produced by Brevibacillus borstelensis AG1 was purified by gel exclusion chromatography. The molecular mass of the Brevibacillus borstelensis AG1 was found to be 12 kDa. Purified bacteriocin like inhibitory substance of Brevibacillus borstelensis was further characterized by studying the effect of temperature, pH, proteolytic enzyme and stability. Bacteriocin like inhibitory substance was found to be thermostable upto 100 °C, active at neutral pH, sensitive to trypsin, and partially stable till third week of storage thus showing a bright prospective to be used as a potential food biopreservative.

Hemophagocytic syndrome: a cause for fatal outcome in tuberculosis.

Hemophagocytic syndrome is rare syndrome characterized by unregulated proliferation and activation of macrophages and phagocytosis of the platelet, erythrocytes, lymphocytes and their hematopoietic precursors in the bone marrow, resulting in cytopenias. It is associated with stimuli-like infections, malignancies and immunocompromised states. We present here a case of generalized lymphadenopathy, hepatosplenomegaly and progressive cytopenias in a 17-year-old male.

Obstructing mass lesion of epiglottis: it can be tubercular.

We report a case of 60-year old male who had difficulty in breathing as well as in swallowing. On examination, he was found to be having proliferative growth of epiglottis and right aryepiglottic fold mimicking neoplasm. So emergency tracheostomy was performed and biopsy taken. He was found to be having asymptomatic miliary mottling on routine x-ray chest PA view. Further on HRCT, it turned out to be lesion suggesting tubercular etiology. Histopathology (epiglottic biopsy) report confirmed the whole process as tubercular. The patient recovered promptly in due course with anti-tubercular treatment. Point remains to be seen that if we can avoid tracheostomy and its complications in such cases.