Regional differences in temporal incidence of Clostridium difficile infection: a systematic review and meta-analysis.

BACKGROUND: Previous decades have witnessed a change in the epidemiology of Clostridium difficile infections. This study aimed to determine temporal trends in the incidence of C difficile infection across geographic regions. METHODS: An initial search of the relevant literature was conducted from date inception to October 2018 without language restriction. We estimated the pooled incidences using logit transformation, weighted by inverse variance. The Joinpoint Regression Analysis Program was used to explore its temporal trend. RESULTS: Globally, the estimated incidence of C difficile infection increased from 6.60 per 10,000 patient-days in 1997 to 13.8 per 10,000 patient-days in 2004. Thereafter, a significant downward trend was observed, at -8.75% annually until 2015. From 2005 to 2015, the incidences in most European countries decreased at a rate between 1.97% and 4.11% per annum, except in France, where an increasing incidence was observed (ß = 0.16; P < .001). The incidences have stabilized in North America over the same period; however, in Asia, the incidence increased significantly from 2006 to 2014 (annualized percentage change = 14.4%; P < .001). The increase was greatest in Western Asian countries, including Turkey and Israel (ß > 0.10; P < .004). CONCLUSIONS: This study revealed rapid changes in the incidence of C difficile infection. This meta-analysis should inform the allocation of resources for controlling C difficile infection and future surveillance efforts in countries where epidemiologic information on C difficile infection remains sparse.

A quasi-ballistic drain current, charge and capacitance model with positional carrier scattering dependency valid for symmetric DG MOSFETs in nanoscale regime.

This paper presents a physically valid quasi-ballistic drain current model applicable for nanoscale symmetric Double Gate (SDG) MOSFETs. The proposed drain current model includes both diffusive and ballistic transport phenomena. The model considers the important positional carrier scattering dependency effect near the source region described in terms of transmission and reflection co-efficients related to the scattering theory. The significance of carrier transport near the bottleneck source region is illustrated where the carriers diffuse into the channel at a relatively lower velocity before accelerating ballistically. The results obtained demonstrate carrier scattering dependency at the critical layer defined near the low field source region on the drain current characteristics. The proposed model partly evolves from Natori's ballistic bulk MOSFET model that is modified accordingly to be valid for a symmetric Double Gate MOSFET in the nanoscale regime. Carrier degeneracy and Fermi-Dirac statistics are included in the work so as to justify the complete physicality of the model. The model is further extended and is shown to be continuous in terms of terminal charges and capacitances in all regions of operation. A comparative analysis is also done between the proposed quasi-ballistic model and a hypothetical complete ballistic device.

A rare case of hyaline cell-rich atypical chondroid syringoma with divergent differentiation.

Chondroid syringoma (CS) also known as mixed tumor of the skin, is a rare benign adnexal tumor accounting for < 0.098%. Epithelial cells arranged in cords and tubules set in myxoid or chondroid stroma. Differentiation such as osteoid, sebaceous or mature adipocytes can be seen rarely. Hyaline cell rich is a rare variant of CS composed of cells with eosinophilic hyaline cytoplasm and plasmacytoid features. CS can have benign, atypical and malignant variants. The term atypical mixed tumor is recommended for those tumors which have histological features of malignancy such as infiltrative margin, satellite tumor nodules and tumor necrosis but without proven metastasis. Very few case reports of hyaline cellrich benign CS have been reported in the past, but to the best of our knowledge, possibly it is the first case of atypical hyaline cellrich CS of the little finger in a 65 year-old female showing divergent differentiation.

A Rare Case of Primary Plasma Cell Leukaemia with Monosomy X.

Primary Plasma Cell Leukaemia (pPCL) is a very rare and aggressive subtype of plasma cell dyscrasias with a very poor outcome and characterized by presence of >2x109/l circulating plasma cells. Overall incidence being 1%-2% of all malignant plasma cell diseases and 0.9% of all acute leukaemias. Patients with primary and secondary PCL have similar clinical features but differences do exist. Here we report a rare and interesting case diagnosed as primary PCL in a 44-year-old female with unusual clinical presentation and complex karyotyping. Her serum electrophoresis showed a monoclonal IgG component and immunohistochemistry of bone marrow plasma cells showed CD 38 positive and CD 20 negative. The patient initially responded partially for combination chemotherapy, but succumbed after 20 days of diagnosis. We are presenting this case to highlight the importance of early diagnosis of such haematological malignancies in settings where treatment options like stem cell transplantation are limited.

Pseudoangiomatous variant of spindle cell lipoma: Report of a rare case.

Pseudoangiomatous spindle cell lipoma is a rare variant of spindle cell lipoma. It exhibits irregular and branching spaces with villiform connective tissue projections, leading to formation of a characteristic angiomatoid pattern in addition to benign spindle cells and mature adipocytes. Recent studies have shown that these branching spaces are lined by endothelial cells and express markers. Therefore, the term "angiomatous variant" instead of "pseudoangiomatous" has been proposed for these lesions. We describe one of such lesions in the thumb of a young female. To the best of our knowledge, this is the first reported case of pseudoangiomatous variant of spindle cell lipoma from India.

Antiarthritic activity of a polyherbal formulation against Freund's complete adjuvant induced arthritis in Female Wistar rats.

OBJECTIVES: To formulate a polyherbal formulation and evaluate its antiarthritic activity against Freund's complete adjuvant induced arthritis in Female Wistar rats. MATERIALS AND METHODS: Glycosmis pentaphylla, Tridax procumbens, and Mangifera indica are well-known plants available throughout India and they are commonly used for the treatment of various diseases including arthritis. The polyherbal formulation was formulated using the ethanol extracts of the stem bark of G. pentaphylla , whole plant of T. procumbens, and leaves of M. indica. The polyherbal formulation contains the ethanol extracts of G. pentaphylla, T. procumbens, and M. indica in the ratio of 2:2:1. The quality of the finished product was evaluated as per the World Health Organization's guidelines for the quality control of herbal materials. Arthritis was induced in female Wistar rats using Freund's complete adjuvant (FCA), and the antiarthritic effect of polyherbal formulation was studied at doses of 250 and 500 mg/kg. The effects were compared with those of indomethacin (10 mg/kg). At the end of the study, blood samples were collected for biochemical and hematological analysis. The radiological examination was carried out before terminating the study. RESULTS: Polyherbal formulation showed significant antiarthritic activity at 250 and 500 mg/kg, respectively, and this effect was comparable with that of indomethacin. The antiarthritic activity of polyherbal formulation is supported by biochemical and hematological analysis. CONCLUSION: The polyherbal formulation showed signinicant antiarthritic activity against FCA-induced arthritis in female Wistar rats.

Cystic fibroadenoma: report of a rare case with review of literature.

Fibroadenomas with a predominant cystic change are called cystic fibroadenomas. These are extremely rare forms of fibroadenomas and only one case has been reported so far. They are classified under the category of complex fibroadenomas. Complex fibroadenomas are a rare variant of fibroadenomas occurring in elderly females. They are characterized by presence of one of the complex features along with the usual patterns of fibroadenoma such as cysts more than 3 mm, papillary apocrine metaplasia, or sclerosing adenosis. Patients with these lesions have higher chances of developing carcinoma of breast. We present a case of 35 years old lady with a freely mobile mass in the left breast diagnosed as cystic fibroadenoma after thorough histopathological examination of the lesion.

Reduced vancomycin susceptibility in porcine ST9 MRSA isolates.

Porcine strains of livestock-associated methicillin resistant Staphylococcus aureus (LA-MRSA) have been recognized in many countries and have been shown to be able to cause human infection. Resistance to non-beta lactam antibiotics has been reported but non-susceptibility to vancomycin, which is known to occur in human MRSA, has so far not been observed in LA-MRSA. Such resistance is typically fairly low level involving changes in the cell wall thickness. The development of resistance is usually preceded by presence of a sub-population having an increased MIC, which is selected for by exposure to vancomycin. This study investigated vancomycin susceptibility of one hundred porcine MRSA isolates using three MIC methods including spiral gradient endpoint (SGE) technique which allows visualization of more resistant sub-populations. SGE revealed 16 strains with an MIC above 2.0 mg/L, of which 14 were determined to have MIC 4 mg/L by agar dilution (AD). SGE revealed a further two isolates with MIC < 2 mg/L had a sub-population >2 mg/L. In addition, trailing endpoints not reaching resistance were present in 26 isolates with MIC < 2 mg/L. Sequencing of the genes of the VraSR/GraSR two component systems of ten of the resistant strains for comparison with susceptible strains revealed changes, including the presence of stop codons, in vraS and graR, but these were not consistent in all isolates. Other genetic changes may contribute to vancomycin non-susceptibility and require investigation. As failure to respond to treatment has been reported in clinical isolates with MIC > 1.5 mg/L, the presence of vancomycin non-susceptibility in porcine isolates is of concern and further monitoring of LA-MRSA is essential.

Emphysematous pyelonephritis in a diabetic leading to renal destruction: pathological aspects of a rare case.

Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority of cases occur in diabetics with poor glycemic control, while a small percentage may be due to urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment, presenting with left flank pain and poor stream of urine since one week. Laboratory tests revealed that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal parenchymal destruction. The nephrectomy specimen was studied in detail to know the histopathological findings in a case of diabetic patient with emphysematous pyelonephritis. We present this case not only because of it being a rare complication of diabetes, but also to focus on the histopathological findings of the same, documentation of which is limited in literature.

Anti-arthritic activity of ethanolic extract of Tridax procumbens (Linn.) in Sprague Dawley rats.

OBJECTIVE: To determine the anti-arthritic effect of whole plant ethanolic extract of Tridax procumbens (Asteraceae) in female Sprague Dawley (SD) rats using the Freund's Complete Adjuvant (FCA) model. MATERIALS AND METHODS: The plant was collected from different regions of Madurai District, Tamil Nadu, and the phytoconstituents were identified through chemical tests. Ethanol (95%) was used to obtain the whole plant extraction through Soxhlet extractor. Female SD rats were used for anti-arthritic screening. Arthritis was induced using FCA, and the anti-arthritic effect of the ethanolic extract of T. procumbens was studied at doses of 250 and 500 mg/kg. The effects were compared with those of indomethacin (10 mg/kg). At the end of the study, the liver enzyme levels were determined and a radiological examination was carried out. RESULT: The preliminary phytochemical analysis of the ethanolic extract of T. procumbens indicated the presence of alkaloids, tannins, flavonoids and saponins. T. procumbens at 250 and 500 mg/kg significantly inhibited the FCA-induced arthritis in the rats. This was manifested by as a decrease in the paw volume. The arthritic control animals exhibited a significant decrease in body weight compared with control animals without arthritis. T. procumbens animals showed dose dependent reduction in decrees in body weight and arthritis. At the same time, T. procumbens significantly altered the biochemical and haematological changes induced by FCA (P < 0.05). The anti-arthritic effect of T. procumbens was comparable with that of indomethacin. CONCLUSION: The whole plant extract of T. procumbens showed significant anti-arthritic activity against FCA-induced arthritis in female SD rats.

Antidiabetic and antihyperlipidemic effects of an ethanolic extract of the whole plant of Tridax procumbens (Linn.) in streptozotocin-induced diabetic rats.

OBJECTIVE: To study the antidiabetic and antihyperlipidemic effects of an ethanolic extract of the whole plant of Tridax procumbens (Asteraceae) in streptozotocin-induced diabetic rats. MATERIALS AND METHODS: The whole plant of T. procumbens was collected in different regions of Madurai districts, Tamil Nadu. The air dried whole plant of T. procumbens was extracted with ethanol (95%) in a Soxhlet apparatus for 72 h. Diabetes was induced in male Wistar rats by streptozotocin (50 mg/jk, i.p.) and nicotinamide (120 mg/kg, i.p) injection. The dry mass of the extract was used for preliminary phytochemical and pharmacological analysis. Diabetic rats were treated with glibenclamide (0.25 mg/kg, p.o.) or T. procumbens extract (250 and 500 mg/k, p.o.) for 21 consecutive days. The blood samples were collected at regular intervals to access hypoglycemic effect of an ethanolic extract of the whole plant of T. procumbens. At the end of the experiment, serum lipid profile and liver enzymes levels were analyzed for all the experimental animals and compared with diabetic control. RESULTS: The preliminary phytochemical analysis of an ethanolic extract of the whole plant of T. procumbens indicated the presence of alkaloids, tannins, flavonoids, saponins, and phenolic compounds. The ethanolic extract of the whole plant of T. procumbens at 250 and 500 mg/kg has significant antidiabetic and antihyperlipidemic activities. The diabetic control animals exhibited a significant decrease in body weight compared with control animals. T. procumbens inhibited streptozotocin-induced weight loss and significantly alter the lipid levels. CONCLUSION: The ethanolic extract of the whole plant of T. procumbens showed significant antidiabetic and antihyperlipidemic activities against streptozotocin-induced diabetes in rats.

Emphysematous pyelonephritis in a diabetic leading to renaldestruction: pathological aspects of a rare case

Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority of cases occur in diabetics with poor glycemic control, while a small percentage may be due to urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment, presenting with left fl ank pain and poor stream of urine since one week. Laboratory tests revealed that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal parenchymal destruction. The nephrectomy specimen was studied in detail to know the histopathological fi ndings in a case of diabetic patient with emphysematous pyelonephritis. We present this case not only because of it being a rare complication of diabetes, but also to focus on the histopathological fi ndings of the same, documentation of which is limited in literature.

Days lost due to disability of diclofenac-induced adverse drug reactions / Días perdidos debido a discapacidad por reacciones adversas inducidas por diclofenaco

Disability Adjusted Life Years (DALY) is a widely used measure to quantify the burden of diseases or illness. DALYs for a disease is calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the equivalent healthy Years Lost due to Disability (YLD). The only difference from the YLD and Days Lost due to Disability (DLD) calculation is that instead of considering the duration of Adverse Drug Reaction (ADR) in years, it is calculated in days. Objective: DLD was measured for diclofenac tablets to prepare the ADR profile. Methods: The study was done on the patients (18-65 years old) attending the community pharmacy at Kasaragod district, South India, with prescription of diclofenac tablets. Patients reported ADRs on their next visit to the pharmacy or they had called to the provided phone number and reported it. Disability Weight (DW) was calculated in an analogue scale from 0-1. Zero represent complete health and 1 represent death or equivalent condition. DW was multiplied with occurrence and duration of ADRs in days. Results: About 943 patients received diclofenac tablets in 1000 prescriptions were successfully followed up for possible, probable and definite ADRs. A total of 561 reactions reported in 2010 for diclofenac tablet in the study population. There were 34 different types of ADRs under 12 physiological systems/organs. Most common reactions were on gastrointestinal (GI) system (48%), followed by skin (14%), Central Nervous System (10%), renal (7%), and cardiovascular (7%). Abdominal pain, cramps or flatulence was the highest occurring GI ADR (107), followed by 43 rashes, 42 nausea/vomiting, 37 indigestion, 34 peptic ulcers, 31 edema etc. DLD for peptic ulcer was considerably high (0.078) per 1000 of the study population on diclofenac. The most damaging ADR were peptic ulcer with or without perforation, followed by rash 0.036 DLD and edema 0.027 DLD. There was considerable DLD by acute renal failure (0.012) Steven-Johnson syndrom (0.013) even though few cases were reported. Conclusion: Diclofenac has a complex adverse drug profile. Around 34 types of reactions were reported. Diclofenac was widely prescribed because of the experiential belief of comparative safety with other NSAIDs. The study shows the importance of pharmacovigilance even on the most prescribed medicine. Most disabling ADR for the study population was peptic ulcer with or without perforation. YLD or DLD are useful measures of calculating disability caused by ADRs. Future studies could focus on improving the usefulness & precision of DLD (AU)

Los años de vida ajustados a la discapacidad (DALY) es una medida ampliamente usada para cuantificar el daño de la enfermedad. Los DALY para una enfermedad se calculan por la suma de los años de vida perdidos (YLL) debido a mortalidad prematura en la población y el equivalente años de vida saludable perdidos por la discapacidad (YDL). La única diferencia en el cálculo de los YLD y los días perdidos por discapacidad (DLD) es que en lugar de considerar la duración de la reacción adversa en años, se calcula en días. Objetivo: Se midió los DLD por el diclofenaco tabletas para preparar el perfil de RAM. Métodos: El estudio se realizó en pacientes (18-65 años) que visitaron la farmacia comunitaria del distrito de Kasaragod, Sur-India, con una receta de diclofenac en tabletas. Los pacientes comunicaron las RAM en su posterior visita a la farmacia o llamaron o se les llamó por teléfono y las comunicaron. El peso de la discapacidad (DW) se calculó en una escala de 0-1. Cero representaba la salud completa y 1 representaba la muerte o situación equivalente. El DW se multiplicaba por la aparición y duración en días de las RAM. Resultados: Unos 943 pacientes que recibieron diclofenac tabletas en 1000 recetas fueron seguidos con éxito para sus RAM posibles, probables y confirmadas. Durante 2010 se comunicó un total de 561 reacciones en la población en estudio. Hubo 34 tipos diferentes de RAM sobre 12 órganos o sistemas diferentes. Las reacciones más comunes fueron en el sistema gastrointestinal (48%), seguidas de piel (14%), sistema nervioso central (10%), renal (7%), y cardiovascular (7%). Dolor abdominal, calambres o flatulencia fueron las RAM GI más frecuentes, seguidas de 43 irritaciones, 42 nauseas/vómitos, 37 indigestiones, 34 úlceras pépticas, y 31 edemas. Los DLD para úlcera péptica fueron considerablemente elevados (0,078) por 1000 individuos en estudio con diclofenac. La RAM más dañina fue la úlcera péptica con o sin perforación, seguida de la irritación con 0,036 DLD y el edema con 0,027 DLD. Hubo considerables DLD por fallo renal agudo (0,012) e incluso se comunicaron algunos casos de síndrome de Steven-Johnson (0,013). Conclusión: El diclofenac tiene un perfil de reacciones adversas complejo. Se comunicaron 34 tipos de reacciones. El diclofenac era ampliamente prescrito por la creencia empírica de la seguridad comparativa contra otros AINE. El estudio demuestra la importancia de la farmacovigilancia, incluso en los fármacos más prescritos. La RAM más incapacitante para la población de estudio fue la úlcera péptica con o sin perforación. Los YLD o los DLD son medidas útiles para calcular la incapacidad causada por RAM. Futuros estudios podrían centrarse en mejorar la utilidad y precisión de los DLD (AU)

Neuropharmacological activity of Lippia nodiflora Linn.

INTRODUCTION: In the recent years, plants containing flavonoids have gained much more interest in research area, as they are found to be specific ligands for benzodiazepine receptors. MATERIAL AND METHODS: In our investigation, we evaluated the neuropharmacological profile of petroleum, chloroform and ethanolic extracts of aerial part of Lippia nodiflora Linn. With experimental models using test such as potentiation of diazepam-induced sleeping time, locomotor activity, motor coordination, exploratory behavior pattern, elevated plus maze and maximal electroshock convulsions. Diazepam at doses of 5, 4, and 1 mg/kg served as standard. RESULTS: Results showed that the ethanolic extract of L. nodifl ora at both doses (250 and 500 mg/kg p.o.) and its chloroform extract at a higher dose of 500 mg/kg produced central inhibitory (sedative) effects, anticonvulsant effect and anxiolytic effect in mice. Values were statistically significant (P < 0.05 and P < 0.01) when compared to the control group. The petroleum ether extract of plant at both dose levels (250 and 500 mg/kg p.o.) did not produce any central effects. CONCLUSION: In conclusion, we can say that the ethanolic and chloroform extracts showed the central inhibitory activity due to the presence of fl avonoids and this fact was also supported by the finding that the petroleum ether extract did not show any central effect and flavonoids were not found in it.

Ion-activated In Situ Gelling Ophthalmic Delivery Systems of Azithromycin.

Gelation of pectin caused by divalent cations especially calcium ions has been applied to develop an ophthalmic formulation of azithromycin in the present study. Rapid elimination of drug on instillation into cul de sac would be minimal with in situ gelling ophthalmic solution leading to increased precorneal contact time and prolonged drug delivery. In the formulation development studies pectin was used in different concentrations (1-5% w/v) and different proportions of the hydrocolloids hydroxypropyl methylcellulose and sodium carboxymethyl cellulose of different grades of viscosity were used. The primary criteria for formulation optimization were gelling capacity and rheological behaviour. In addition, formulations were evaluated for pH, and antimicrobial efficacy and drug release. The clarity, pH, gelation in simulated tear fluid and rheological properties of the optimized formulations were satisfactory. The formulations inhibited the growth of Staphylococcus aureus effectively in cup-plate method and were proved to be safe and non irritant on rabbit eyes. The results indicate that pectin based in situ gels can be successfully used to prolong the duration of action of azithromycin.

Transdermal delivery of venlafaxine hydrochloride: the effects of enhancers on permeation across pig ear skin.

Venlafaxine representing a new class of antidepressants is a potent serotonin/ norepinephrine reuptake inhibitor. Transdermal delivery of venlafaxine hydrochloride (VHCl) may result in proper patient compliance by reducing the incidence of the undesirable GI problems generally associated with its plural oral dosing. The present study is an attempt to investigate the improvement of the transdermal flux of the hydrophilic VHCl by certain permeation enhancers viz. glycerin, urea, propylene glycol and mixture of propylene glycol and ethanol across pig ear skin. The cumulative drug release was the highest from the formulation F5 consisting of the mixture of propylene glycol and ethanol in sodium alginate gel with a load of 25% w/w VHCl with 96% permeation enhancement. The steady state flux observed with F5 was 0.203 mg cm(-2) hr and an area of 15.27 cm(2) would suffice to arrive at a required therapeutic concentration of VHCl in the blood.

Scrape cytology in the early diagnosis of eyelid sebaceous carcinoma.

The low incidence and the non-specific clinical symptoms led us to conclude that the diagnosis of a sebaceous carcinoma of the eyelid often occurs very late. Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which can exhibit aggressive local behavior, can have pagetoid spread and can metastasize to regional lymph nodes and distant organs. The neoplasm is known to masquerade as other benign and less malignant lesions, and has relatively high morbidity and mortality. Scrape cytology was done in a 70-year-old female with a tumor in left upper lid. Cytological smears were suggestive of sebaceous carcinoma. Subsequently, histopathology confirmed the diagnosis of sebaceous gland carcinoma. The article highlights the role of scrape cytology in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma, to prevent recurrence and metastasis.

Rapid detection of vancomycin-non-susceptible Staphylococcus aureus using the spiral gradient endpoint technique.

OBJECTIVES: Several methods have been introduced for detection of vancomycin-non-susceptible Staphylococcus aureus [heterogeneous vancomycin-intermediate S. aureus (hVISA) and vancomycin-intermediate S. aureus (VISA)]. However, the limitations of these methods can delay appropriate therapy for the patient. This study evaluated the spiral gradient endpoint (SGE) technique for detection of hVISA/VISA. METHODS: The SGE method was evaluated for intra-batch, inter-batch and inter-observer reproducibility in comparison with MICs determined by agar dilution. Three media, Mueller-Hinton agar, brain heart infusion agar and brain heart infusion agar with 5% glucose, were evaluated. The SGE method was compared with agar dilution for correlation of MIC and susceptibility category using control strains, clinical isolates and induced vancomycin-non-susceptible strains. RESULTS: The SGE method had good reproducibility and there was excellent correlation of MICs generated by SGE using brain heart infusion agar with those by agar dilution (r(2) =0.950), with no difference in resistance categories generated by the two methods. All VISA isolates were correctly identified and the method allowed easy identification of hVISA by means of the trailing endpoint. CONCLUSIONS: SGE offers a simple, rapid and cost-effective alternative method for the detection of hVISA/VISA for the routine laboratory. Early recognition of vancomycin-non-susceptible strains can allow the change to appropriate antibiotics, resulting in potentially better patient outcomes.

Lipid lowering activity of ethanolic extract of leaves of Aegle marmelos (Linn.) in hyperlipidaemic models of Wistar albino rats.

Lipid lowering effect of 50% ethanolic extract of the leaves of A. marmelos (Linn.) was evaluated in triton and diet induced hyperlipidaemic models of Wistar albino rats. The extract at 125 and 250 mg/kg dose levels inhibited the elevation in serum cholesterol and triglycerides levels on Triton WR 1339 administration in rats. The extract at the same dose levels significantly attenuated the elevated serum total cholesterol and triglycerides with an increase in the high-density lipoprotein cholesterol in high-fat diet- induced hyperlipidaemic rats. The standard drugs atorvastatin in the former and gemfibrozil in the latter studies showed slightly better effects.

Use of functional MRI to guide decisions in a clinical stroke trial.

BACKGROUND AND PURPOSE: An investigational trial examined safety and efficacy of targeted subthreshold cortical stimulation in patients with chronic stroke. The anatomical location for the target, hand motor area, varies across subjects, and so was localized with functional MRI (fMRI). This report describes the experience of incorporating standardized fMRI into a multisite stroke trial. METHODS: At 3 enrollment centers, patients moved (0.25 Hz) the affected hand during fMRI. Hand motor function was localized at a fourth center guiding intervention for those randomized to stimulation. RESULTS: The fMRI results were available within 24 hours. Across 12 patients, activation site variability was substantial (12, 23, and 11 mm in x, y, and z directions), exceeding stimulating electrode dimensions. CONCLUSIONS: Use of fMRI to guide decision-making in a clinical stroke trial is feasible.