Genotypic characterization of Listeria monocytogenes isolated from humans in India.

Listeria monocytogenes is a foodborne pathogen associated with severe diseases in humans and animals. The genotypic analysis of 17 L. monocytogenes isolates recovered from humans in India during 2006-2009 using multiplex serotyping PCR allowing serovar predictions, conventional serology and by pulsed field gel electrophoresis (PFGE) is presented. The isolates were recovered from patients exhibiting various clinical conditions. A multiplex-PCR based serotyping assay revealed 88·24% (15/17) of the strains belonging to the serovar group 4b, 4d, 4e and 11·76% (2/17) to the serovar group 1/2b, 3b. Conventional serology indicated that 13 (76·47%) L. monocytogenes isolates to be of serotype 4b, 2 (11·76%) serotype 4d, and 2 (11·76%) serotype 1/2b. Ten ApaI and nine AscI pulsotypes were recognized among the 17 human isolates. PFGE analysis allowed discrimination among isolates of the same serotype and among isolates from the same sampling areas or those isolated from different areas. Thus, PFGE together with multiplex-PCR serotyping allows rapid discrimination of L. monocytogenes strains. In addition, the predominance of L. monocytogenes serotype 4b is of concern, as this serotype has been most frequently associated with human listeriosis outbreaks.

Expression and inducibility of alpha, pi, and Mu glutathione S-transferase protein and mRNA in murine lung.

This investigation sought to establish the cellular expression and distribution of the alpha, pi, and mu classes of glutathione S-transferase (GST) enzymes in murine lung under control conditions and after treatment with tert-butyl-4-hydroxyanisole (BHA). Immunohistochemical and in situ hybridization studies were used to identify lung cells that were labeled for the GST subunits Yp, Ya, and Yb1. Immunoblotting of cytosolic proteins produced single bands of 28, 29, and 31 kD for Ya, Yp, and Yb1, respectively, in samples from untreated and BHA-treated mice. Treatment with BHA increased Ya and Yp reactivity, but this was not as marked for Yb1. Immunohistochemical staining for the Yp, Ya, and Yb1 subunits was localized in bronchioles and parenchyma of untreated and BHA-treated mice. Bronchiolar Clara and alveolar type II cells were stained to the greatest extent for all of the GST subunits. BHA treatment produced increased staining that was most pronounced in the bronchiolar epithelium. Ya and Yp were localized in the cytoplasm and nucleus, whereas Yb1 was found mainly in the cytoplasm. Immunoblots of extracted nuclear proteins revealed a band of 29 kD for Ya, with increased immunoreactivity in BHA-treated mice. In situ hybridization done with oligonucleotide probes showed abundant silver grains representing Ya, Yp, and Yb1 messenger RNA (mRNA) transcripts in the bronchioles. Grains were also localized in alveolar septa, and were most numerous in type II cells. Quantitative image analysis confirmed good agreement between relative levels of protein and mRNA transcripts. Quantities of mRNA transcripts for all subunits were increased in the parenchyma by BHA treatment, but the magnitudes of induction were most striking for Ya and Yp in the bronchioles. These results demonstrated that Ya, Yp, and Yb1 reside in specific lung areas and cells, and that in induced states, their increased expression is accompanied by increased mRNA.

The levodopa test in Parkinson's disease.

The clinical diagnosis of Parkinson's disease may be difficult. In elderly patients there may be other causes of the triad of rigidity, bradykinesia and tremor. This study was designed to assess whether a single levodopa challenge could predict dopa responsiveness in patients with Parkinson's disease. Twenty-two of 27 newly diagnosed patients completed the study. Of the 22, 17 (77%) responded positively to the initial test and five (23%) showed no response. At 1 month, 18 (82%) were improved on treatment and four (18%) were not. Thus the initial test predicted 17 (94%) of the 18 who responded at 1 month and correctly identified the response of 21 (95%) of the 22 patients. There was only one false negative result. Patients with negative results turned out to have other parkinsonian syndromes. A positive levodopa test helps to confirm the diagnosis of Parkinson's disease and a negative test should alert one to alternative diagnoses.

Cholangiocarcinoma associated with hypercalcaemia and ascites presenting as sclerosing cholangitis.

This report tells of a patient presenting with apparent primary sclerosing cholangitis which turned out to be a cholangiocarcinoma. The patient also had ascites and hypercalcaemia, both of which have not been described before in association with cholangiocarcinoma.

Covert hypothyroidism with weight loss and atrial fibrillation.

Hypothyroidism may present with weight gain and/or cardiovascular manifestations such as bradycardia or cardiac failure, but has not previously been documented as presenting with atrial fibrillation and weight loss. Our case highlights the importance of thyroid function tests in heart failure and emphasises the importance of regular follow-up after irradiation to the thyroid.

Diabetic neuropathic cachexia associated with malabsorption.

Diabetic neuropathic cachexia is characterized by neuropathic pain and severe weight loss of unknown aetiology. We describe four patients with diabetic neuropathic cachexia who were found to have malabsorption. Four diabetic patients presented with neuropathic pain, anorexia, depression and weight loss of 16 (range 10-21) kg. None complained of diarrhoea. There were three males and one female, median age 54 (46-67) years. A butterfat test showed a serum turbidity difference of 9 (6-10) light scattering units (normal greater than 60 units). The median serum xylose was low and there was delayed urinary xylose excretion. Urinary indicans, small bowel histology, liver function tests, and thyroid and renal function were normal. Ultrasound scans of liver, gall bladder and pancreas, and endoscopic retrograde cholangiopancreatogram were normal. The patients were treated with pancreatic supplements and a high calorie diet. Three have completely recovered and the other patient is improving. Thus these cases of diabetic neuropathic cachexia appeared to be associated with malabsorption which may be due to pancreatic dysfunction. It is suggested that the management of diabetic neuropathic cachexia should include the investigation and treatment of malabsorption.

Low dose botulinum toxin in spasmodic torticollis.

Botulinum toxin has been successfully used to treat spasmodic torticollis. The optimum dosage is not clear and the recommended doses in the United Kingdom are 20-25 ng. We have used much lower doses (average 13 ng) without loss of efficacy and accompanied by a reduction in side effects. We treated 12 patients (eight women and four men) with a mean duration of torticollis of 4 years. Eleven of the 12 patients (91%) showed an improvement in total scores for pain and degree of head movement. The benefits appeared a week after treatment and lasted for 3 months. Side effects were minimal and transient. Our experience suggests low doses of the toxin may be equally efficacious.

The apomorphine test in parkinsonian syndromes.

The dopamine receptor agonist apomorphine has been used successfully to treat on-off swings in Parkinson's disease. Its value as a predictor of dopa responsiveness in idiopathic Parkinson's disease (IPD) was assessed and its potential role in differentiating IPD from the Parkinsonian plus syndromes (PPS) of multisystem atrophy, progressive supranuclear palsy and olivopontocerebellar atrophy was investigated. The response to an injection of apomorphine was observed in 20 patients with IPD and eight with PPS after being off levodopa for 12 hours. Patients were reassessed after taking levodopa for one month. Nineteen of the 20 patients (95%) with IPD showed a positive response to apomorphine and 18 (90%) to oral levodopa. In the PPS group, two patients (25%) responded to the apomorphine injection but not to oral levodopa. Apomorphine produced severe drowsiness in the PPS patients. It is suggested that the test can predict dopa responsiveness in IPD and may be of help in confirming a doubtful diagnosis. It has potential value in differentiating IPD from PPS.

Bilateral subdural haematomas and normal CT brain scans.

We describe the case of a 59-year-old man who presented with headaches suggestive of raised intracranial pressure. He had a normal computerised tomographic (CT) scan on two occasions over a period of two months during which time he continued to deteriorate. Eventually, a magnetic resonance imaging (MRI) scan showed the presence of bilateral subdural haematomas. This case thus illustrates that normal CT scans may not exclude an intracranial pathology--and, if in doubt, an MRI scan should be sought.

Coarctation of the aorta associated with a sinus venosus atrial septal defect presenting with endocarditis in middle age.

We report the case of a 44 year old man who presented with an infective endocarditis and was found to have a coarctation of the aorta associated with a sinus venosus atrial septal defect and a small ventricular septal defect. The association of coarctation with a sinus venous atrial septal defect presenting with endocarditis in an adult is extremely rare.

Multiple sclerosis associated with trismus.

This report describes the case history of a middle-aged lady who presented with symptoms and signs over one year leading to a diagnosis of multiple sclerosis. During one of her relapses, she developed trismus--an association that has not been described before in multiple sclerosis.