hsa-miR-320a mediated exosome release under PD stress conditions rescue mitochondrial ROS and cell death in the recipient neuronal and glial cells.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by dopaminergic neuronal cell death. Emerging evidence suggest exosomes as a crucial player in the progression and pathogenesis of PD via intercellular communication between different cell types in brain. Exosome release is enhanced from dysfunctional neurons/glia (source cells) under PD stress and mediates the transfer of biomolecules between different cell types (recipient) in brain leading to unique functional outcomes. Exosome release is modulated by alterations in the autophagy and lysosomal pathways; however, the molecular factors regulating these pathways remain elusive. Micro-RNAs (miRNAs) are class of non-coding RNAs that regulate gene expression post-transcriptionally by binding target mRNA and modulate its turnover and translation; however their role in modulating exosome release is not understood. Here, we analyzed the miRNAs-mRNAs network which target cellular processes regulating exosome release. hsa-miR-320a showed the maximum mRNA targets of autophagy, lysosome, mitochondria and exosome release pathways. hsa-miR-320a regulate ATG5 levels and modulate exosome release under PD stress conditions in neuronal SH-SY5Y and glial U-87 MG cells. hsa-miR-320a modulates autophagic flux, lysosomal functions, and mitochondrial ROS in neuronal SH-SY5Y and glial U-87 MG cells. Exosomes derived from hsa-miR-320a expressing source cells under PD stress conditions were actively internalized in the recipient cells and rescued cell death and mitochondrial ROS. These results suggest that hsa-miR-320a regulates autophagy and lysosomal pathways and modulates exosome release in the source cells and derived exosomes under PD stress conditions rescue cell death and mitochondrial ROS in the recipient neuronal and glial cells.

Biochemical findings in sudden unexpected death in epilepsy: Hospital based case-control study.

PURPOSE: A review study on the biochemistry of epilepsy showed that in epileptic patients, serum glucose and cholesterol concentrations are low, sodium is unaffected, potassium increases, glucose is high and mild hypocalcemia. We have conducted a biochemical study on sudden unexpected death in epilepsy (SUDEP) cases in an attempt to establish the characteristic biochemical values to diagnose these deaths. METHODS: This was a hospital based case-control study done at All India Institute of Medical Sciences, New Delhi for one year. Twenty SUDEP cases and 20 age- and sex-matched controls were included in the study. Femoral blood, cerebrospinal fluid, vitreous humor, and pericardial fluid were biochemically analyzed for sodium, potassium, calcium, glucose, N-acetyl- cysteine activated creatine kinase (CK-NAC) and isoenzyme CK-MB. RESULT: Serum sodium, CK-MB and CK-NAC level was found significantly increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. Likewise, in CSF, sodium and CK-NAC was found increased and potassium level was found decreased in SUDEP cases. In vitreous humor, sodium and CK-MB level was found increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. In pericardial fluid, sodium, CK-NAC and CK-MB level was found increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. CONCLUSION: It concludes that high sodium level and low potassium level could be associated with SUDEP. However, this is a small size study, a larger study is needed to verify the findings. Furthermore, it is difficult to conclude whether these findings are exclusive to SUDEP.

Suicidal asphyxiation by carbon monoxide within a polythene bag.

Suicide by inhalation of carbon monoxide is not uncommon and usually involves car exhausts or burning charcoal or defective boilers. We report a case of a 25-year-old man, who committed suicide by inhaling carbon monoxide gas inside a polythene bag in a bathroom. The open carbon monoxide cylinder found inside the polythene bag was purchased online by the deceased a few days earlier. He had stated that the gas would be used for his experiment on the environment. A suicide note recovered from his trouser pocket revealed his intention for a painless death.

Categories of foot at risk in patients of diabetes at a tertiary care center: Insights into need for foot care.

OBJECTIVE: Diabetic foot ulcers and amputations are preventable. Aim of this study was to determine the distribution of categories of foot at risk in patients with diabetes, attending a tertiary care hospital and factors that affect it. MATERIALS AND METHODS: Detail history and examination including neurological and vascular assessment were performed in 100 patients with diabetes attending a Tertiary Care Hospital. Foot at risk was classified according to the task force of foot care interest Group of American Diabetes Association. Category of foot at risk was correlated with demographic and clinical features. RESULTS: Fifty-two percent patients had foot at risk-category 1 and 2. Loss of protective sensation (LOPS) was present in 33% (category 1). Peripheral arterial disease (PAD) was present in 19% (category 2). Both LOPS and PAD were present in 10% patients. 95% had never received foot care advice by health professionals, let alone prescriptive footwear or vascular consultation. CONCLUSIONS: This study brings forth that foot at risk of ulcer is rampant in patients with diabetes. There are lacunae in diabetic foot care at all levels of care. With the increase in diabetes, cost effective steps are required to improve foot care among diabetes in India. Considering the demographic profile of patients in our study, growing number of patients with diabetes, lack of time and staff allocated for foot care in our setup, audiovisual aids seems a good option to spread foot care awareness among diabetes.

Anesthetic management of emergent laparoscopic bilateral adrenalectomy in a patient with a life-threatening cortisol crisis.

Cushing syndrome may rarely present with life-threatening hypercortisolism, manifested by hypertension, hypokalemia, hyperglycemia, and edema. If medical treatment proves ineffective in ameliorating the symptoms, emergent rescue adrenalectomy may be the only way to relieve the crisis. We describe the anesthetic management of a patient with an ectopic adrenocorticotropic hormone-secreting tumor, whose condition was rapidly deteriorating due to severe cortisol excess, and emergent adrenalectomy was the only available therapeutic modality. Despite severe metabolic derangement, edema, and incipient respiratory failure, emergent bilateral laparoscopic adrenalectomy was performed and the patient improved sufficiently to undergo surgery for the ectopic lesion without incident.

Awareness of foot care among patients with diabetes attending a tertiary care hospital.

BACKGROUND: The prevalence of diabetes in India is rising. It is also occurring at a younger age. Ulcers on the foot in patients with diabetes are a common cause of amputations and are largely preventable. We assessed the awareness of foot care among patients with diabetes attending a tertiary care hospital in northern India and whether this varied with the level of healthcare availed, i.e. primary, secondary or tertiary. METHODS: A scored questionnaire was designed based on foot care practices advised by the American Diabetes Association as part of the national diabetes education programme. It was administered to 400 patients and a total foot care score was calculated and correlated with various variables. RESULTS: Only 50 of 400 patients (12.5%) had received previous foot care advice from healthcare professionals, and 193 (48.2%), 28 (7%) and 179 (44.8 %) patients were being taken care of by primary, secondary and tertiary healthcare systems, respectively. Almost one-quarter of patients were uneducated. The mean foot care score in all three groups was 5 of a maximum of 14, which was poor. CONCLUSION: The awareness of foot care among people with diabetes is low among those attending all levels of healthcare: primary, secondary and tertiary. It is necessary to educate people about foot care, lack of which will lead to a huge financial and health burden due to preventable complications of diabetes.

Central pontinemyelinosis, hyperparathyroidism, hypokalemia.

Central pontinemyelinolysis (CPM) is one of the rare non-inflammatory demyelinating diseases of the pons and very rarely it can involve extrapontine structure as well. The exact etiopathogenesis of this condition is still unclear. Rapid correction of hyponatremia has been attributed as a most common factor, but alcoholism, malnutrition, prolonged use of diuretics, psychogenic polydipsia, post liver transplant and hypokalemia have also been attributed as a causative factor. We describe a case of hyperparathyroidism with concomitant hypercalcemia accompanied by central pontine myelinosis without hyponatremia/hyperosmolality or associated rapid corrections of sodium, which developed as a consequence of severe hypokalaemia.

An obese young man with uncontrolled diabetes and insatiable hunger: Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is a rare cause of obesity. With the rising incidence of obesity, clinicians need to be aware of genetic causes of obesity and when to suspect them. A case of PWS, which was diagnosed in adulthood, has been discussed. This case is special because of lack of history of floppiness in infancy and predominance behavioral problems.