Neurophysiological studies in acute transverse myelitis

A systematic evaluation of anterior horn cell, motor and sensory pathways is possible by electromyography (EMG), motor (MEPs) and somatosensory (SEPs) evoked potentials, respectively, which may provide valuable information on acute transverse myelitis (ATM). In a prospective hospital-based study, EMG, MEP and SEP studies were carried out on admission and after 3 months in 39 patients with ATM. All the patients also underwent detailed clinical evaluation, and spinal magnetic resonance imaging (MRI) was performed in 28. Outcome was defined at the end of 3 months as poor, partial or complete recovery on the basis of functional status. Spinal MRI revealed hyperintense signal changes in T2 extending for two segments to the entire spinal cord. Central motor conduction time to tibialis anterior (CMCT-TA) was more frequently abnormal (90%), followed by tibial SEP (77%). CMCT to abductor digiti minimi (ADM) was abnormal in 30% and median SEP in 15% of patients. Evidence of denervation on EMG was present in 51% of patients. The CMCT-TA improved in 48% patients and tibial SEP in 32%. Median SEP improved in all patients, and CMCT-ADM remained prolonged in two. At 3 months 2 patients had died, and 18 had poor, 10 partial and 9 complete recovery. CMCT was correlated with miscle power, tone, reflec and MRI changes. Patients' outcome of was correlated with CMCT, SEP and EMG. These results are consistent with pronounced involvement of dorsal region of spinal cord in ATM. MEP is more frequently abnormal than SEP

Movement disorders in Japanese encephalitis

Movement disorders in Japanese encephalitis (JE), although reported, have not been analyzed systematically. In this study, we report an analysis of movement disorders in 14 out of 17 JE patients, correlated with the radiological findings. All patients had at least a four fold rise of IgG antibodies against JE in a haemagglutination inhibition test. The patients' ages ranged between 2 and 54 years and 4 of them were women. Extrapyramidal signs, such as hypokinesia, hypophonia and masking of the face, were present in all patients by the first month as the patients came out of the coma - except for 1 patient. Eight patients had axial and 3 tongue dyskinesia; rigidity was present in 6 and tremor in 2 patients. At 3 months, these symptoms improved considerably in 6 patients. Cranial CT scan revealed thalamic involvement in 10, which was bilateral in 9 patients. Two patients had brain stem and one had cerebellar involvement. Cranial MRI was carried out in 9 patients and revealed additional findings in lentiform nucleus, midbrain and pons in 3 each and cerebellum in 4 patients. Bilateral thalamic involvement on MRI was seen in all the patients, including two patients whose CT scans were normal. SPECT studies using 99mTc-ECD revealed bilateral thalamic hypoperfusion in all (n = 7) and frontal hypoperfusion in 3 patients. In JE, movement disorders are common and may be due to thalamic involvement in isolation or in combination with basal ganglia or midbrain or both

Vitamin B12 deficiency neurological syndromes: correlation of clinical, MRI and cognitive evoked potential

Objective: To evaluate cognitive function in B12 deficiency neurological syndromes and response to B12 therapy. Methods: Patients were diagnosed on the basis of low serum B12 or megaloblastic bone marrow or both. Detailed neurological examination was performed and mental status was evaluated by the Mini Mental State Examination (MMSE).Hemo-globin, RBC indices, blood counts, serum chemistry, HIV, thyroid profile, antiparietal cell antibody and craniospinal MRI were done. Cognitive evoked potential was carried out using the odd ball auditory paradigm and recording was achieved from Fz, Cz and Pz referred to mastoid. P3 latency and amplitude were measured and compared with 33 age and sex matched controls. Three months following B12 therapy, clinical and P3 values were reevaluated and compared with the baseline values. Results: 36 patients, aged 16-80 years were included; 32 patients were above 40 years of age. Their median education level was 14 years. The presenting syndrome was myeloneurocognitive in 9, myeloneuropathy in 10,myelocognitive in 8,myelopathy in 8 and only cognitive in 1 patient.MMSE was abnormal in 17; between 28-19 in 14 and 18-11 in 3 patients. Cranial MRI carried out in 14 patients revealed multiple white matter hyperintensity in T2 in 3 and cortical atrophy in 1. P3 was unrecordable in 7 and latency was prolonged in 8 out of 33 patients. P3 latency was significantly prolonged in patients compared to controls and both MMSE and P3 latency improved significantly at the 3-month followup. Conclusion: MMSE was abnormal in 47 % and P3 in 45.5% of patients with B12 deficiency neurological syndromes which improved following treatment. Significance: There is high incidence of reversible cognitive impairment and P3 abnormalities in B12 deficiency neurological syndromes

Central motor conduction studies in internal capsule and corona radiata infarction

Clinical and evoked-potential studies in internal capsule and corona radiata infarction are lacking. We report the results of a clinical and central motor conduction time (CMCT) study in 16 patients with internal capsule and 17 with computed tomography (CT)-proven corona radiata infarction. Patient's outcome was defined at the end of 3 months on the basis of the Barthel Index score. Four patients with type A capsular infarction (middle third of posterior limb of internal capsule) all had severe weakness, while 2 also had persistently unrecordable CMCT and poor outcome. Twelve patients with type B internal capsular infarction (genu, anterior limb, anterior or posterior third of posterior limb) had a milder degree of weakness, and CMCT was recordable in 9. At 3 months' follow-up, however, CMCT was recordable in all 12 patients. All of these patients had a partial (n = 4) or complete (n = 5) recovery. Thirteen patients with type A corona radiata infarction (middle third of corona radiata) had more pronounced weakness, and CMCT was unrecordable in all of these patients except 1 on initial examination. Follow-up after 3 months was possible in 8 patients, and CMCT became recordable in 3. One of these patients had complete, 3 partial, and 4 poor recovery. In type B corona radiata infarction (anterior or posterior third of corona radiata), the clinical signs and CMCT did not follow a regular pattern. Clinical and CMCT abnormalities in internal capsular infarction followed a more predictable pattern compared with those in corona radiata infarction. A less predictable pattern of weakness and CMCT change in corona radiata infarction may be attributed to a less definite organisation of motor pathways compared with the internal capsule

MINERAL CONTENT OF SOME EDIBLE MEDICINALLY IMPORTANT LEAFY VEGETABLES OF KAMRUP DISTRICT OF ASSAM, INDIA

Objective: The aim of the present study was to determine the mineral components of Amaranthus spinosus, Oxalis corniculata, Bacopa monnieri, Paedaria foetida and Centella asiatica.Methods: Mineral compositions of the five selected edible medicinally important leafy vegetables were evaluated following standard methods including AAS.Results: All the examined vegetables were found to be the rich source of macroelements as well as trace minerals. Potassium was the most abundant macroelement ranging from 4570.0-16030.0 mg/kg, followed by sodium, calcium and magnesium. Among the trace elements iron was highest (184.1- 518.2 mg/kg), followed by zinc, manganese and copper.Conclusion: From the present study it can be concluded that the plants under investigation are potential source of both macro and micronutrients and proper consumption prove to be beneficial as they cure several deficiency as well as other deadly diseases.Â

Can electromyography predict the prognosis of transverse myelitis?

The role of clinical and magnetic resonance imaging (MRI) features on the prognosis of acute transverse myelitis has been studied, but the role of electromyography (EMG) changes, although reported, has not been investigated. Seventeen patients with acute transverse myelitis were subjected to clinical evaluation, MRI scanning and concentric needle EMG. The outcome was defined on the basis of a 3-month Barthel Index (BI) score as good or poor. The EMG changes in these groups were compared. All of the patients had complete paraplegia (power grade 0), except 1 who had grade III power. Mild upper limb weakness was present in 6 patients. Joint position and vibration sense were impaired in the lower limbs, and a horizontal limit to sensory loss to pinprick was present in all of the patients. Spinal MRI was abnormal in 12 of 14 patients. EMG of the lower limb muscles in the acute stage (within 15-30 days of onset) revealed fibrillations or sharp waves or both in 11 patients. At 3-month follow-up, the lower limb power had improved in 8 and upper limbs in all 6 patients. The EMG changes also improved in 6 patients; fibrillations either disappeared or were markedly reduced. The motor unit potentials (MUPs) were of long duration, polyphasic with reduced recruitment. In 5 patients, however, no MUPs could be recorded and fibrillations persisted. Lower limb hypotonia and fibrillations on EMG were significantly related to the 3-month outcome. EMG evidence of denervation in the lower limb muscles in acute transverse myelitis suggests a poor outcome as assessed by 3-month Barthel index score

Origin of X-rays in the low state of the FSRQ 3C 273: Evidence of inverse Compton emission

We analyze the 2.5--10 keV X-ray spectra of the luminous quasar 3C 273 and simultaneous observations in UV wavelengths from XMM--Newton between 2000 and 2015. The lowest flux level ever was observed in 2015. The continuum emission from 3C 273 is generally best described by an absorbed power-law but during extremely low states the addition of fluorescence from the K-shell iron line improves the fit. We study the spectral evolution of the source during its extended quiescent state and also examine connections between the X-ray and ultraviolet emissions, which have been seen in some, but not all, previous work. We detect a possible anti-correlation between these two bands during the low state that characterized 3C 273 for most of this period; however, this was not present during a flaring state. A harder-when-brighter trend for the X-ray spectrum was observed in these long-term observations of 3C 273 for the first time. We suggest that the X-ray emission in 3C 273 is the result of inverse Compton scattering of soft UV seed photons (emitted from the local environment of the AGN), most likely in a thermal corona. We can explain the significant temporal variation of the spectral continuum as an outcome of changing optical depth of the comptonizing medium, along the lines of the wind-shock model proposed by Courvoisier and Camenzind (1989).Comment: 17 pages, 8 figures, 3 tables; Accepted for publication in MNRA

Serial changes in motor and somatosensory evoked potentials in putaminal haemorrhage

Little is known about evoked potential changes in putaminal haemorrhage. In this study, somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) have been serially evaluated and their role in the prognosis of putaminal haemorrhage is now reported. Nineteen patients with CT- or MRI-proven putaminal haemorrhage were examined after a mean duration of 13 days (range 2-30); there were 4 females and 9 males, ranging in age between 25 and 70 years. The haematomas were of medium size in 13 and large or small in 3 patients each. The changes in the clinical picture and the SEPs and MEPs were evaluated on admission, and after 30 and 90 days. Central motor conduction time (CMCT) could not be recorded in 13, but was prolonged in 2 and normal in 4 patients. Median SEPs revealed the absence of near field potentials in 11 and prolongation of N9-N20 conduction time in 1 patient. In the follow-up period MEP and SEP abnormalities only changed in 5 patients; MEPs changed in 4 and SEPs in 2. The period of normalisation of MEPs ranged between 1 and 6 months. CMCT correlated with motor and N9-N20 conduction time with sensory impairment. Eight patients had poor, 6 partial and 5 complete recovery. Power, sensation, CMCT, and size and location of haematoma made positive contributions to recovery

Small intestinal mucosal cells in piglets fed with probiotic and zinc: a qualitative and quantitative microanatomical study

Background: Probiotics and zinc are commonly used and beneficial in pig production. This work aimed to assess the effects of probiotic and zinc on the mucosal cells of the small intestine in respect to digestive capacity and immunity in pre- and post-weaned piglets.Materials and methods: Eighteen Large White Yorkshire piglets were divided equally into control and treatment groups. The piglets were maintained in standard management conditions and were weaned at 28 days of age. The treatment group of piglets fed a mixture of probiotics orally at 1.25 × 109 CFU/day and zinc at 2000 ppm/day from birth to 10 days of age. At three different age-groups viz. day 20 (pre-weaning) and, day 30 and day 60 (post-weaning), the animals were sacrificed. For histomorphology, the tissue samples were processed and stained with Mayer’s haematoxylin and eosin for routine study, combined periodic acid-Schiff-Alcian blue for mucopolysaccharides and Masson-Hamperl argentaffin technique for argentaffin cells. The stained slides were observed under the microscope. The samples were processed as per the standard procedure for scanning and transmission electron microscopy. The statistical analysis of the data using the appropriate statistical tests was also conducted.Results: The mucosal epithelium of villi and crypts were lined by enterocytes, goblet cells, argentaffin cells, microfold (M-cell) cells, tuft cells and intraepithelial lymphocytes. The multipotent stem cells were located at the crypt base. The length of the enterocyte microvilli was significantly longer (p < 0.05) in the treatment group of piglets. The number of different types of goblet cells and argentaffin cells was more in treated piglets irrespective of segments of intestine and age. The intraepithelial lymphocytes were located in apical, nuclear and basal positions in the lining epithelium of both villus tip and base with their significant increase in the treatment group of piglets. The transmission electron microscopy revealed the frequent occurrence of tuft cells in the lining mucosa of the small intestine in treated piglets.Conclusions: Dietary supplementation of probiotic and zinc induced the number of different mucosal cells of villi and crypts in the small intestine that might suggest the greater absorptive capacity of nutrients and effective immunity in critical pre and post-weaned piglets