The biochemical pathways of central nervous system neural degeneration in niacin deficiency

Neural degeneration is a very complicated process. In spite of all the advancements in the molecular chemistry, there are many unknown aspects of the phenomena of neurodegeneration which need to be put together. It is a common sequela of the conditions of niacin deficiency. Neural degeneration in Pellagra manifests as chromatolysis mainly in pyramidal followed by other neurons and glial cells. However, there is a gross lack of understanding of biochemi- cal mechanisms of neurodegeneration in niacin deficiency states. Because of the necessity of niacin or its amide derivative NAD in a number of biochemical pathways, it is understandable that several of these pathways may be involved in the common outcome of neural degener- ation. Here, we highlight five pathways that could be involved in the neuraldegeneration for which evidence has accumulated through several studies. These pathways are： 1） the trypto- phan-kyneurenic acid pathway, 2） the mitochondrial ATP generation related pathways, 3） the poly （ADP-ibose） polymerase （PARP） pathway, 4） the BDNF-TRKB Axis abnormalities, 5） the genetic influences of niacin deficiency.

A Case of Meningitis Caused by Mycobacterium abscessus in a Paediatric Patient

Mycobacterium abscessus, a rapidly growing and potentially pathogenic Mycobacterium, is an environmental contaminant and is commonly found in tap water supplies. We report a case of M. abscessus meningitis following VP shunt insertion. A 9-year-old male patient with previous history of aqueductal stenosis and hydrocephalus with VP shunt in situ, presented with pain abdomen of 10 days duration. Investigations revealed multiple mesenteric lymph nodes with impacted VP shunt tip within the omentum. Ascitic fluid and CSF tap showed Acid-Fast Bacilli, later confirmed to be M. abscessus. The patient was treated with Clarithromycin and Amikacin, leading to resolution of the infection. To the best of our knowledge, this is the first reported case of M. abscessus meningitis in an immunocompetent individual. We discuss the possible sources of infection and therapeutic challenges. It is of utmost importance to consider, with high index of suspicion, nontubercular Mycobacteria as the causative organism in patients, who do not respond to regular anti-tubercular regimen.

Isolation of <em>Mycobacterium celatum</em>from a Case of Koch’s Spine

Mycobacterium celatum is a newly discovered micro-organism causing disseminated infections in immuno compromised patients. Here we report a case of Mycobacterium celatum in an apparently immuno competent young patient with Koch’s spine, the organism was confirmed at tuberculosis research centre, Chennai. The patient was started with clarithromycin and ciprofloxin along with category-I ATT.

Correlation of Cognitive Performance and Thyroid Hormone Levels in Adolescents with Subclinical Hypothyroidism

Subclinical hypothyroidism (SCH) can negatively affect cognitive functioning. This study aimed at correlating serum T3, T4, TSH with adolescent’s performance on a learning disability scale. Methods: A cross-sectional study was conducted on 100 schoolchildren, (10 - 15 years). Thyroid hormones were estimated and classified into two groups: euthyroid and subclinical hypothyroid. NIMHANS index for Specific Learning Disabilities was used to assess the learning ability and cognitive functions. Results: Subclinical hypothyroid group made more mistakes than euthyroid group. In SCH male group, T3 correlated with language and T4 levels correlated in all areas except in language. In the females, there is no significant correlation between T3 and ability parameters except in partial correlation coeffeicient among euthyroid children in arithmetic, visual-motor skills and memory. T4 results did not correlate in language skills. There was a statistical significance between T4 and ability skills in girls except in language. TSH and language skills correlated in females. Conclusion: T3 and T4 levels have correlation with cognitive skills other than TSH. It is necessary to measure both T3 and T4 in addition to TSH in adolescents.

A study of the levels of urinary microalbumin in non-diabetic normotensive obese individuals

Diabetes mellitus, hypertension and obesity are associated with endothelial dysfunction. Microalbuminu-ria is an early sign of endothelial dysfunction. The occurrence of microalbuminuria in long standing diabetes mellitus and hypertension is well established. This study intends to find the occurrence of microal-buminuria in non-diabetic normotensive obese individuals. Objectives: To estimate urinary albumin creatinine ratio (UACR) in non-diabetic normotensive obese individuals. Design and Methods: 41 non- diabetic normotensive obese adults with Body Mass Index > 23 kg/m2 were taken as cases and 41 age and sex matched healthy non-obese adults with Body Mass Index < 23 kg/m2 were taken as controls. An-thropometric measurements (Body Mass Index and Waist circumference) and biochemical estimations (fasting blood glucose, lipid profile & spot urinary albumin creatinine ratio) were carried out. Results: urinary albumin creatinine ratio was lesser than the established microalbuminuric range of 30 - 300 mg/g, in both cases and controls irrespective of the values obtained for lipid profile and anthropometric indices. Conclusion: Microalbuminuria may not be present in obese patients without diabetes and/hypertension.

Fungal Keratitis and Ocular Surface Squamous Neoplasia in a HIV Positive Patient

Aim: We report a case of fungal keratitis and Ocular Surface Squalous Neoplasia (OSSN) occurring in a HIV positive patient. Method: A 32-year-old female patient presented with a non-healing ulcer, which was diagnosed as fungal keratitis. On examination her ocular surface also revealed OSSN on the nasal bulbar conjunctiva. Serological investigations revealed HIV positive status with CD 4 counts of 61 cells/μl. Patient was treated for fungal keratitis with topical antifungals and also underwent excision biopsy of OSSN which was reported as conjunctival intraepithelial neoplasia. The ulcer showed significant response to topical medication only after the commencement of Anti-Retroviral Therapy (ART). Conclusion: This case emphasizes on the importance of a thorough ocular examination to rule out associated ocular conditions and investigations to rule out immunosuppressive status in a non-healing ulcer.

Reverse latissimus dorsi muscle flap for complex back defects: our experience

Aim: The aim was to study the effectiveness of the reverse latissimus dorsi muscle flap in reconstruction of complex defects of the back. Methods: This is a retrospective study of patients who underwent reverse latissimus dorsi flap for reconstruction of the back, in a tertiary care hospital. The patient demographics, etiology, surgery indications and complications were studied. Results: The study had five patients between 2012 and 2016 who underwent reverse latissimus dorsi flap for reconstruction. The flaps survived in all the patients. Two patients had complications, unrelated to the latissimus dorsi muscle flap. Conclusion: The vascularity of the flap is reliable can be used to obliterate the dead space, can be used to control the infection, in complex cases of the back.