Neuropsychiatric manifestations in patient with normal pressure hydrocephalus improved with therapeutic lumbar tapping

Normal pressure hydrocephalus is a communicating hydrocephalus without evident obstruction of the normal pathway of CSF flow. Normal-pressure hydrocephalus is a common cause of reversible dementia and it can also present with various psychiatric symptoms. A 76-year old man was brought to psychiatry OPD with history suggestive of decreased need for sleep for 8 days, disinhibited behaviour, increased libido, increased activity and increased talk for 4 days. On examination patient was noticed to be having increased psychomotor activity with increased talk, mood reported to be happy with elated affect, no content or perceptual disturbances were elicited. Cognitive functions were within normal limits. Personal and social judgement was impaired with grade 0 insight. General physical and systematic examinations were within normal limits. MRI reports showed ventricular enlargement suggestive of normal pressure hydrocephalus. Patient underwent diagnostic and therapeutic lumbar tapping. There was significant improvement in patient’s behavioural symptoms following therapeutic lumbar tapping. Therapeutic lumbar tapping in this case of normal pressure hydrocephalus was effective in the management of manic symptoms. Early identification of organic cause in late onset psychiatric disorders is necessary. Prompt intervention of the organic cause was effective in the management of manic symptoms

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

The United States COVID-19 Forecast Hub dataset

Academic researchers, government agencies, industry groups, and individuals have produced forecasts at an unprecedented scale during the COVID-19 pandemic. To leverage these forecasts, the United States Centers for Disease Control and Prevention (CDC) partnered with an academic research lab at the University of Massachusetts Amherst to create the US COVID-19 Forecast Hub. Launched in April 2020, the Forecast Hub is a dataset with point and probabilistic forecasts of incident cases, incident hospitalizations, incident deaths, and cumulative deaths due to COVID-19 at county, state, and national, levels in the United States. Included forecasts represent a variety of modeling approaches, data sources, and assumptions regarding the spread of COVID-19. The goal of this dataset is to establish a standardized and comparable set of short-term forecasts from modeling teams. These data can be used to develop ensemble models, communicate forecasts to the public, create visualizations, compare models, and inform policies regarding COVID-19 mitigation. These open-source data are available via download from GitHub, through an online API, and through R packages

Improving the Value of Standard Toxicity Test Data in REACH

Worldwide, environmental risk assessment strategies are based on the assumption that measuring direct effects of single substances, using a few single species tests, in combination with safety factors correcting for extrapolation inconsistencies, can be used to protect higher levels of biological organization, such as populations and even ecosystems. At the same time, we are currently facing a range of pollution problems (Millennium Ecosystem Assessment Series 2005), of which some could at least indirectly be linked to the fact that this assumption may not be fully valid. Consequently, there is an ongoing scientific debate on whether current chemical control protocols are sufficient for protection of ecosystems, and numerous suggestions for improvements have been presented by the scientific community, e.g. alternative tests and testing strategies. On the other hand, few of these suggestions actually reach the regulatory world (or become implemented), and risk assessment today basically follows the same paradigm as 30 years ago. While the new REACH regime is exceptionally ambitious, this chapter observes several problems and gaps in this regulatory framework. We suggest measures and approaches which imply increased ecological realism and understanding in future regulatory work

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Rhodium(I) and ruthenium(II) complexes with monothio-β-diketones and (mono-, di-scleno)bis(β-diketone)

885-888The treatment of the rhodium carbonylated species with monothio-β-diketonesleads to the formation of monomeric complexes of general formula [Rh(CO)2(tβdk)] (H-tβdk = mono-thio- β -diketone). The carbon monoxide group can be replaced in part by triphenylphosphine, triphenylphosphite and triphenylarsine to form complexes of the type [Rh(CO) (tβdt)L] (L = PPh3, OPPh3 and AsPh3). Further, bridged binuclear rhodium(I) and ruthenium(II) complexes of (mono- and di-seleno)bis(β-diketones) have also been prepared. All the complexes obtained have been characterised by means of analytical and spectroscopic data

Intrathecal Clonidine Versus Intrathecal Midazolam with Hyperbaric Bupivacaine for Post Operative Analgesia in Abdominal Hysterectomy: A Randomised Study

Objectives: This randomised study was conducted to compare the effects of intrathecal clonidine and midazolam with hyperbaric bupivacaine for post operative analgesia in patients undergoing abdominal hysterectomy. Materials and Methods: 60 patients of ages between 40 and 60 years of ASA grade I/II undergoing abdominal hysterectomy were randomly divided into two equal groups. Group C and group M received 0.5% hyperbaric bupivacaine 3ml with either clonidine 45µg with 0.2 ml saline or midazolam 2.5mg respectively intrathecally. Onset and duration of sensory blockade, haemodynamic changes, duration of post operative analgesia, number of rescue analgesics and side effects if any, were observed. Results: There was statistically significant difference in the onset and duration of sensory block (p<0.001) between the two groups. Duration of post operative analgesia was significantly longer in midazolam group (373.33±24.22 minutes) than in clonidine group (328.5±21.78 minutes). Conclusion: Spinal anaesthesia with 2.5 mg midazolam as an adjuvant to 3ml hyperbaric bupivacaine provides longer duration of post operative analgesia compared to 45µg clonidine with 3ml hyperbaric bupivacaine with better haemodynamic stability without any adverse effects

A REVIEW ON THE PHARMACOLOGICAL PROFILE OF TEPHROSIA CALOPHYLLA

Tephrosia calophylla is commonly known as Adavivempali and dumpavempali. This plant is usually grows in the form of shrubs. It is widely distributed in tropical, subtropical and arid regions of the world and it is specifically found in Andhra Pradesh. The different parts of the plant like leaves, seeds and root of this plant have been used in Ayurvedic medicine. The plant has been used in treatment of different disorders and it is having the various activities like hepatoprotective, antidiabetic, antioxidant, antibacterial, antifungal, antidiuretic, and hypolipidemic properties with a wide range of safety. It has various active compounds. The pharmacologically active compounds that have been identified are Calophione -A, B and C, Tephcalostan, Tephcalostan A, Tephcalostan C and Betulinic acid. The present objective of the study is to discuss about the various chemical constituents and their pharmacological activities of the plant against numerous disorders. Key words: Tephrosia calophylla, Betulinic acid, Tephcalostan A and Adavivempali