Botulinum toxin-A as a treatment option for refractory idiopathic trigeminal neuralgia of the ophthalmic branch: a case report and literature review.

Trigeminal neuralgia is one of the most common neurological pains affecting the head and neck and is associated with severe, lancinating, electrical pain episodes. The maxillary and mandibular branches are usually affected. The ophthalmic branch is rarely involved and, when present, it requires a comprehensive workup to rule out major conditions. Pharmacotherapy and surgery are the most common treatment options for this condition. Systemic medications may pose a wide range of side effects and effectiveness may decrease over time while surgery has inherent complications. Injectable onabotulinum toxins have been utilized for various applications in medicine and dentistry. There is, however, limited data on their use for the management of refractory trigeminal neuralgia of the ophthalmic branch. We present the case of a 58-year-old male diagnosed with refractory idiopathic trigeminal neuralgia affecting the ophthalmic branch, which was unresponsive to standard care and successfully managed with onabotulinum toxin type A. This treatment should be considered in cases of refractory trigeminal neuralgia prior to surgery. We reviewed the relevant literature concerning the application of Onabotulinum toxin A for managing trigeminal neuralgia of the ophthalmic branch. This case report and review aim to enlighten the application of Onabotulinum toxin A for managing refractory trigeminal neuralgia of the ophthalmic branch. Our case report and review show that Onabotulinum toxin A could be used for managing TN of the ophthalmic branch.

Assessment of Prescription Adherence to Secondary Prevention Guideline Recommendations and Patient Adherence to Pharmacotherapy and Lifestyle Modifications in Acute Coronary Syndrome and Chronic Coronary Syndrome Patients.

BACKGROUND: Coronary artery diseases (CADs) contribute to the majority of deaths and disabilities worldwide. People who have suffered an acute myocardial infarction (AMI) are at a higher risk of having a further attack. Hence, prolonged secondary prevention is necessary following index myocardial infarction (MI) for long-term cardiovascular protection as it reduces the morbidity and mortality associated with reinfarction, improves the quality of life, and is cost-effective. METHODS: An observational, ambidirectional study was carried out in a tertiary care hospital for 6 months. A total of 200 patients above 18 years of age with a confirmed diagnosis of acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) were included in the study. Prospective data were collected using a self-designed patient profile form and by interviewing patients in the cardiac outpatient department while retrospective data were collected from the medical records department of the hospital. RESULTS AND CONCLUSION: Sex-wise distribution showed that males and females constituted 79 and 21% of the study participants, respectively, while the age-wise distribution revealed that the majority of patients were in the age-group of 60 years and above (63.5%). Hypertension and diabetes mellitus were the most common comorbid conditions, while dyslipidemia was the least observed comorbidity. Prescription adherence to secondary prevention guideline recommendations was studied, which revealed that 26.5% of the prescriptions were adherent to all four guideline recommendations. On evaluating adherence to pharmacotherapy, the maximum proportion of patients demonstrated moderate adherence (45%).

Optimization of calcium gluconate and Bacopa monniera extract levels in calcium enriched herbal ice cream by response surface methodology.

Calcium enriched herbal ice cream was developed using calcium gluconate (CG) as calcium source, Bacopa monniera whole plant extract (BME) is an herb containing saponins. Ice cream was prepared by incorporating CG and BME together. Preliminarily the range of CG and BME levels were fixed as 50-250 mg/100 mL and 10-50 mg/100 mL of ice cream mix respectively. Response surface methodology (RSM) was used to optimize the levels of two ingredients (CG and BME). Central Composite Rotatable Design using two variables and five responses comprising of sensory attributes was used for computation of optimized solution. All the responses fitted well into quadratic equation with R2 > 0.60. The optimum levels of CG and BME are 217.34 mg/100 mL and 10 mg/100 mL for preparation of experimental ice cream. RSM recommended with 87% acceptability for the optimum levels of CG and BME. Product is prepared with optimized solution and subjected to sensory evaluation.

Physiological, Biochemical, Epigenetic and Molecular Analyses of Wheat (Triticum aestivum) Genotypes with Contrasting Salt Tolerance.

Abiotic stress exerts significant impact on plant's growth, development, and productivity. Productivity of crop plants under salt stress is lagging behind because of our limited knowledge about physiological, biochemical, epigenetic, and molecular mechanisms of salt tolerance in plants. This study aimed to investigate physio-biochemical, molecular indices and defense responses of selected wheat cultivars to identify the most contrasting salt-responsive genotypes and the mechanisms associated with their differential responses. Physio-biochemical traits specifically membrane stability index, antioxidant potential, osmoprotectants and chlorophyll contents, measured at vegetative stage, were used for multivariate analysis to identify the most contrasting genotypes. Genetic and epigenetic analyses indicated the possible mechanisms associated with differential response of the wheat genotypes under salt stress. Better antioxidant potential, membrane stability, increased accumulation of osmolytes/phytophenolics, and higher K+/Na+ ratio under 200 mM NaCl stress identified Kharchia-65 to be the most salt-tolerant cultivar. By contrast, increased MDA level, reduced soluble sugar, proline, total chlorophyll, total phenolics contents, and lower antioxidant potential in HD-2329 marked it to be sensitive to the stress. Genetic and bioinformatics analyses of HKT1;4 of contrasting genotypes (Kharchia-65 and HD-2329) revealed deletions, transitions, and transversions resulting into altered structure, loss of conserved motifs (Ser-Gly-Gly-Gly and Gly-Arg) and function in salt-sensitive (HD-2329) genotype. Expression analysis of HKTs rationalized the observed responses. Epigenetic variations in cytosine methylation explained tissue- and genotype-specific differential expression of HKT2;1 and HKT2;3.

Simplified staging laparotomy in FIGO stage 1 epithelial ovarian cancer: follow-up and outcomes in south Wales, U.K.

We have conducted a retrospective analysis of FIGO stage 1 ovarian cancer patients in south Wales, who underwent a simplified staging laparotomy without routine nodal sampling and peritoneal biopsies. Patient records from January 2004 to December 2010 were analysed. A total of 116 patients were included in the final analysis. Adjuvant chemotherapy was offered to patients with risk factors for relapse (grade > 1, clear cell histology, or stage > Ia); overall, 89 patients (76.7%) received adjuvant single agent carboplatin (n = 54, 46.5%) or combination chemotherapy (n = 35, 30.2%). After a median follow up of 41 months (range 12-95), 18 patients have relapsed (15.5%), of these 17 had risk factors and 16 had received adjuvant chemotherapy. Eighteen patients have died, of whom 6 of non-cancer related causes without prior relapse. 5-year overall and relapse free survival were 80%. In conclusion, in situations where there are limited resources and operating time constraints, our data suggest that a simplified staging laparotomy approach may be a reasonable compromise in apparently early stage ovarian cancer: this may result in a more aggressive use of chemotherapy, but survival outcomes seem comparable to other series.

Performance characteristics of urinalyses for the diagnosis of pediatric urinary tract infection.

PURPOSE: The purpose of this study is to determine whether point-of-care (POCT) urinalysis (UA) is as accurate as laboratory-performed UA in diagnosing urinary tract infections (UTIs) in the pediatric emergency department (PED). BASIC PROCEDURES: This was a retrospective series of children (0-18 years old) seen at a tertiary care PED from July 2008 to December 2012 in whom UA and urine culture were obtained. Urinalyses were considered positive if leukocyte esterase and/or nitrites were positive. Performance characteristics for the 2 types of UAs were calculated using urine culture as the reference standard. MAIN FINDINGS: A total of 43452 specimens were sent for laboratory-performed UA and culture, and 6492, for POCT UA and culture (in 2908 specimens, both UAs were performed). Sixty-four percent of specimens were from girls, 51% were catheterized, and 7.5% had UTIs. The sensitivity of POCT UAs and laboratory-performed UAs was 82.5% (confidence interval [CI], 79.4%-85.3%) and 89.1% (CI, 86.4%-88.8%), respectively. The superior performance of laboratory-performed UAs was driven by the sensitivity of microscopy. Laboratory-performed UAs were more sensitive than the POCT in girls (90.6% [CI, 89.4%-91.8%] vs 82.8% [79.4%-85.8%]). PRINCIPAL CONCLUSIONS: Although POCT UAs offer more rapid turnaround times, the sensitivity is greater for laboratory-performed UAs. Given the difficulty in following up PED patients after discharge as well as the potential morbidity from untreated UTIs, the rapidity of the POCT UA must be balanced against the lower sensitivity of this assay. The benefit of more accurate diagnosis may outweigh the potentially longer PED length of stay associated with a laboratory-performed UA.

Development of simple sequence repeat markers for the soybean rust fungus, Phakopsora pachyrhizi.

Twenty-four simple sequence repeat markers were developed for Phakopsora pachyrhizi, a fungal pathogen of soybean (Glycine max) and other legumes. All 24 of the loci were evaluated on 28 isolates of P. pachyrhizi. Twenty-one loci were polymorphic, with allelic diversity ranging from two to eight alleles, and null alleles were observed for eight of the 24 loci. A preliminary screen with the closely related species, P. meibomiae, indicated that these primer pairs are specific to P. pachyrhizi.

A homozygous single-base deletion in MLPH causes the dilute coat color phenotype in the domestic cat.

Three proteins have been described in humans and mice as being essential for even distribution, transport, and translocation of pigment granules, with defects in these molecules giving rise to lighter skin/coat color. The dilute phenotype in domestic cats affects both eumelanin and phaeomelanin pigment pathways; for example, black pigmentation combined with dilute appears gray and orange pigments appear cream. The dilute pigmentation segregates as a fully penetrant, autosomal recessive trait. We conducted classical linkage mapping with microsatellites in a large multigeneration pedigree of domestic cats and detected tight linkage for dilute on cat chromosome C1 (theta=0.08, LOD=10.81). Fine-mapping identified a genomic region exhibiting conserved synteny to human chromosome 2, which included one of the three dilute candidate genes, melanophilin (MLPH). Sequence analysis in dilute cats identified a single base pair deletion in exon 2 of MLPH transcripts that introduces a stop codon 11 amino acids downstream, resulting in the truncation of the bulk of the MLPH protein. The occurrence of this homozygous variant in 97 unrelated dilute cats representing 26 cat breeds and random-bred cats, along with 89 unrelated wild-type cats representing 29 breeds and random-bred cats, supports the finding that dilute is caused by this single mutation in MLPH (p<0.00001). Single-nucleotide polymorphism analyses in dilute individuals identified a single haplotype in dilute cats, suggesting that a single mutation event in MLPH gave rise to dilute in domestic cats.

Results of a physician and respiratory therapist collaborative effort to improve long-term metered-dose inhaler technique in a pediatric asthma clinic.

BACKGROUND: Despite advances in therapy, asthma continues to be the chronic condition most responsible for school absenteeism and pediatric hospitalizations. This is especially true for inner-city children. We operate an inner-city Pediatric Asthma Compliance and Technique (PACT) clinic in which physicians and respiratory therapists collaborate to improve metered-dose inhaler (MDI) technique and outcomes among asthmatic children. OBJECTIVE: To determine the efficacy of our strategy for improving MDI technique and asthma outcomes. METHODS: Children referred to the PACT clinic underwent standardized assessment based on the Expert Panel Guidelines of the National Heart, Lung, and Blood Institute (NHLBI). Clinicians demonstrated and reinforced correct MDI technique at each visit. Using a standardized format we prospectively collected, at the patient's first visit (T1) and most recent visit (T2), data on demographics, MDI-technique scores (MDI steps done correctly; scale of 0-8), pulmonary function, and asthma severity (NHLBI classification scale: 1 = mild intermittent to 4 = severe persistent). Statistical analyses were performed using parametric and non-parametric tests. RESULTS: Of the 60 patients who attended the PACT clinic between 1999 and 2002, 15 were excluded from the study because of incomplete data recording. Mean duration from T1 to T2 was 11.8 +/- 9.5 months. At T1 and T2, respectively, the mean MDI-technique scores were 53% and 81%, the mean overall asthma severity scores were 2.6 and 2.3, and the mean overall pulmonary function severity scores were 2.4 and 2.1. MDI-technique scores significantly improved between TI and T2 (p < 0.001). The black patients had the largest improvement in MDI technique (p < 0.001), but their pulmonary function test results, overall asthma severity, and pulmonary function severity did not improve significantly. The white patients significantly improved both their MDI technique (p = 0.004) and their overall asthma severity scores (p = 0.005). CONCLUSION: In our PACT clinic asthmatic children showed sustained improvement in MDI technique, and some of the patients improved in pulmonary function and overall asthma severity score.

Molecular determinants of intracellular pH modulation of human Kv1.4 N-type inactivation.

A-type K+ currents serve important functions in neural and cardiac physiology. The human A-type Kv1.4 channel (hKv1.4) shows fast N-type inactivation when expressed in Xenopus laevis oocytes. We found that intracellular pH (pH(i)) regulated the macroscopic inactivation time constant (tau) and current amplitude (I(peak)), producing a 2-fold change with each pH unit change in the physiologically relevant range of 8.0 to 6.0. These effects of pH(i) were completely abolished by a large deletion in the hKv1.4 N terminus. Site-directed mutagenesis identified a histidine (H16) in the inactivation ball domain as a critical H+ titratable site mediating the pH effects on N-type inactivation between pH 7.0 and 9.0. Substituting this histidine with arginine not only accelerated the time course of macroscopic channel inactivation but also eliminated the H+ effects on hKv1.4. In addition, a glutamic acid (E2) in the ball domain constitutes another H+ titratable site that mediates the pH effects in the more acidic pH range of 5.0 to 7.0. These results suggest that N-type inactivation in hKv1.4 is regulated by pH(i) in the physiologic range through ionization of specific amino acid residues in the ball domain. Such pH(i) effects may represent an important fundamental mechanism for physiological regulation of excitable tissue function.

Effect of yogurt and bifidus yogurt fortified with skim milk powder, condensed whey and lactose-hydrolysed condensed whey on serum cholesterol and triacylglycerol levels in rats.

The possible hypocholesterolaemic properties of milk and fermented milk products have been investigated in groups of albino rats given a basal diet, basal diet plus cholesterol, and basal diet plus cholesterol together with whole milk or standard or bifidus yogurt. The yogurts were fortified with skim milk powder, condensed whey or lactose-hydrolysed condensed whey. After 30 d, triacylglycerols, total cholesterol, HDL-cholesterol and LDL-cholesterol were measured in serum. Whole milk and ordinary yogurt had no hypocholesterolaemic effect, but standard yogurt containing lactose-hydrolysed condensed whey and all bifidus yogurts lowered serum cholesterol. In general, yogurts changed HDL-cholesterol little, but tended to raise triacylglycerols. There was marked lowering of LDL-cholesterol in rats given either type of yogurt fortified with whey proteins. This study has demonstrated in a rat model that bifidus yogurts and yogurts fortified with whey proteins can reduce total and LDL-cholesterol, and suggests that if they have the same effect in human subjects they have potential value in cholesterol-lowering diets.