Objective: To evaluate the fasting serum glucose (FSG) lowering potential of different fractions (C & D) and subfraction (D1 & D2) from aqueous extract of Aloe vera leaf on normal and alloxan induced type 2 diabetic rats. Methods: Two fractions (C & D) obtained by common chemical treatment of the aqueous extract of Aleo vera leaf and subfraction (D1 & D2) from fraction D were administered to the alloxan induced (150mg/kg i.p.) diabetic rats. The FSG lowering capacity, of different fractions and subfractions, was then evaluated in terms of percentage reduction in blood glucose level. Results: Oral administration of fractions C & D and subfraction D1 & D2 for 15 days led significant (P<0.05) reduction to the elevated FSG level of alloxan induced diabetic rats. Percentage reduction in blood glucose level and comparison with standard drug glibenclamide suggest the superiority of fraction D and subfraction D1 in hypoglycaemic potential. Conclusions:The results suggest that fraction D and subfraction D1 from aqueous extracts of Aloe vera leaf possesses the maximum FSG lowering capacity and further investigation is required for determination of anti-diabetic principal(s) and exact mechanism of their hypoglycaemic action.

Ophthalmoplegic migraine is a rare disorder characterized by childhood onset recurrent attacks of migraineous headaches with paresis of ocular cranial nerves. The third cranial nerve is commonly involved. Involvement of fourth and sixth cranial nerve is uncommon. We present a child with opthalmoplegic migraine with recurrent sixth cranial nerve palsy on two occasions.

Intracranial hypotension syndrome is an uncommon manifestation of shunt overdrainage; characterized by a triad of postural headache, diffuse pachymeningeal gadolinium enhancement and low cerebrospinal fluid opening pressure. We describe a young female with recurrent episodes of postural headaches and reversible dorsal midbrain syndrome due to intracranial hypotension as a complication of shunt overdrainage, and a subsequent improvement following shunt ligation.

Phenytoin is one of the commonly used antiepileptic drugs. The common dose dependent and reversible neurological side effects of phenytoin are nystagmus, diplopia, dysarthria, ataxia, incoordination, chorioathetosis, orofacial dyskinesias and drowsiness. Persistent cerebellar dysfunction with cerebellar atrophy is a well known complication of long term phenytoin use. There are several mechanisms proposed including hypoxia due to frequent seizures or toxic effects of phenytoin on cerebellar Purkinje cells. However, irreversible cerebellar dysfunction following acute phenytoin intoxication is rare. We report a 20 year old female who presented with nystagmus, dysarthria, limb and truncal ataxia with orofacial dyskinesias and chorea. She also had cognitive and affective symptoms in the form of reduced attention, slow responses, lalling speech, blunting of affect, inappropriate laughter, reduced self care and executive dysfunction. The symptoms started 2 weeks following the initiation of phenytoin 300mg/ day, given prophylactically following left basal ganglia bleed. Her serum phenytoin was in toxic range, hence phenytoin was stopped. Her PET scan revealed bilateral cerebellar hypometabolism. At 6 months follow up, she had persistent ataxia with cognitive and affective dysfunction and follow up MRI showed diffuse cerebellar atrophy. The clinical and radiological fi ndings suggest that acute phenytoin intoxication is responsible for persistent ataxia and cerebellar cognitive affective syndrome.

Progressive multifocal leukoencephalopathy (PML) is a progressive lethal demyelinating disease of the brain, caused by JC virus. Reactivation of JC virus due to reduction of cellular immunity especially in setting of AIDS, is the commonest underlying cause. PML has classically been described in individuals with profound cellular immunosuppression such as patients with AIDS, haematological malignancies, organ transplant recipients or those treated with immunosuppressive or immunomodulatory medications for autoimmune diseases. Rarely it has also been diagnosed in cases with no or minimal immunosuppression. Here, we report a 50 year-old man who presented with sudden onset multiple neurologic defi cits. Neuroimaging, histopathology, and virology studies confi rmed the diagnosis of PML. We could not however demonstrate any underlying immunodefi ciency state. Our case suggests that absence of immunodefi ciency does not exclude the possibility of PML and should be considered in immunocompetent patients with a typical clinical course and neuroimaging fi ndings.

BACKGROUND: Human embryonic stem cells (hESCs) have the potential to treat various human disorders currently labeled as incurable and/or terminal illness. However, the fear that the patients' immune system would recognize them as non self and lead to an immune rejection has hampered their use. The main cause for immune rejection is usually the incompatibility of both donor and recipient's major histocompatibility complex (MHC). METHODS: We describe a hESC line developed through a patented technology that does not lead to immune reaction upon transplantation. We have transplanted these cells in >1,400 patients with chronic/terminal conditions and did not observe any immune reaction. No immunosuppressant were administered to these patients. We analyzed the expression levels of MHC-I and MHC-II on the surface of these hESCs using microarray technology. The gene targets for miRNA were analyzed using Gene ontology and DAVID database and pathways for these genes were determined using Reactome and Panther databases. RESULTS: Our results showed that the levels of expression of MHC-I and MHC-II on hESCs is almost negligible and thus the hESCs are less susceptible to an immune rejection. CONCLUSIONS: The hESCs cultured at our facility expresses low levels of MHC-I and do not produce an immune reaction. These can be administered universally and need no cross matching before transplantation.
Cell Line ; Gene Ontology ; Human Embryonic Stem Cells ; Humans ; Immune System ; Major Histocompatibility Complex ; MicroRNAs ; Neurons ; Tissue Donors ; Zygote

Population norms for Health Related Quality of Life using SF-36 are described. A national sample was canvassed in 2000 using a self-administered SF-36 in Bahasa Malaysia and English. Response rate was 30.6%, with 3072 usable data. Male: Female ratio was 1.04 and mean age was 39.8 years. Quality of life was affected by age and sex. Older population and women had a poorer quality of life. Population norms for Malaysia differed from those of US, Canada and Australia. The malaysian general population norm described is useful as reference point for studies in Malaysia. Variability in scores by age and sex emphasize the need to use appropriate age- or sex-specific normative data.
Data Collection ; Malaysia ; Postal Service ; *Quality of Life

Purpose: Trauma is a common cause of death worldwide and head injury is the most common form of trauma presented at the Emergency Department. Physiological scores are better for predicting outcome than anatomical scores. To reduce mortality rates, this study compared the capacity of the revised trauma scores (RTS) and the Glasgow coma scale- age- pressure (GAP) scores to predict the survival of patients and effectively channel resources. Methods: An observational study of head trauma patients aged 12 to 80 years was performed at a tertiary care center (N = 500). We noted demographic information, RTS and GAP trauma scores, and outcomes in terms of mortality or survival at 24 hours, 48 hours, and 7 days. Results: Of the 500 patients who were enrolled, 414 (82.8%) survived 24 hours, 373 (74.6%) survived 48 hours, and 265 (53%) survived after 7 days. Using the Receiver Operating Characteristic curve, the RTS score was a significantly better predictor of survival in patients with head trauma than the GAP score at 24 hours (p = 0.044) and 48 hours (p = 0.049) of admission. The results were not significantly different at 7 days (p = 0.240). Mortality or survival outcomes were not significantly different between the RTS and GAP scores (p = 0.373). Conclusion RTS appears to be a better early predictor for mortality (within 48 hours of admission) than the GAP score. The RTS was more effective in directing the triage of patients which improved survival rates in head trauma patients.

Purpose: To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease. Methods: A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score. Results: A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04). Conclusions Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.

BACKGROUND: We investigated whether the intraoperative administration of dexmedetomidine would attenuate the profound sympathoadrenal response associated with cleft palate (CP) surgery. METHODS: Sixty children aged 6 months to 12 years undergoing CP surgery under general anesthesia were randomly assigned to the control (C) or dexmedetomidine (D) groups. Group C received benzodiazepine (0.05 mg/kg midazolam followed by infusion of normal saline) fentanyl isoflurane anesthesia, and Group D received dexmedetomidine (loading 1 µg/kg followed by infusion of 0.5 µg/kg/h) fentanyl isoflurane anesthesia. Heart rate (HR), mean blood pressure (MBP), intraoperative fentanyl and isoflurane requirements, recovery scores, emergence agitation, pain scores, time and requirement of rescue analgesic, and surgeon satisfaction were noted. RESULTS: Intraoperative HR and MBP in Group D were significantly lower than the corresponding values in Group C (P < 0.001). HR decreased up to 16% in Group D. By contrast, HR increased up to 20% in Group C. Group D had comparable MBP to its baseline, whereas Group C had higher MBP until extubation (P = 0.015). Two children in Group D developed bradycardia and hypotension, which was successfully treated. The fentanyl and isoflurane requirements decreased by 43% and 30%, respectively, in Group D patients compared to those in Group C (P < 0.001). Group D had lower pain scores and less emergence agitation (P < 0.001). Time until requirement of first rescue analgesic was longer in Group D than that in Group C (P < 0.001). Surgeon satisfaction was higher in Group D than that in Group C. CONCLUSIONS: Intravenous dexmedetomidine during CP surgery attenuated hemodynamic responses with excellent surgeon satisfaction. Close monitoring of hemodynamics is recommended.
Anesthesia ; Anesthesia, General ; Benzodiazepines ; Blood Pressure ; Bradycardia ; Child ; Cleft Palate* ; Dexmedetomidine* ; Dihydroergotamine ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Isoflurane ; Midazolam ; Prospective Studies*