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Purpose To compare epilepsy-related injuries in untreated or inadequately treated patients and patients on adequate treatment. Methods In a cross-sectional case-control study, seizure-related injuries in patients who were either on no treatment or inadequate treatment were compared with another group of patients receiving appropriate evidence-based epilepsy treatment. The inadequately treated patients or ‘cases’ were drawn from an outreach epilepsy clinic while the adequately treated patients or ‘controls’ were recruited from a tertiary care facility providing comprehensive epilepsy management. Results The odds of injury were eight times higher in inadequately treated patients or cases compared to the adequately treated patients or controls. After adjusting for gender, epilepsy duration, seizure frequency, current medication, and number of AEDs, the odds of injury were 15. 8 times higher in the cases. Major injuries such as burns, fractures, and tooth injuries were also higher in the cases. Conclusion Untreated or inadequately treated epilepsy patients have a significantly higher risk of injuries. With adequate treatment, some of the risks of injury can be mitigated.

Objective Prognostic scores help in predicting mortality and functional outcome post intracerebral hemorrhage (ICH). We aimed to validate the ICH and ICH-GS scores in a cohort of Indian patients with ICH and observe the impact of any surgical intervention on prognostication. Methods This was an ambispective observational study of primary ICH cases enrolled between January 2014 and April 2018. Observed mortality on ICH and ICH GS scores for the entire cohort and individually for the medically and surgically managed patients was compared to the published mortality in the original derivation cohorts. Results 617 patients, (464 retrospective and 153 prospective) of ICH were included. In hospital mortality and 30-day mortality was 28.7% and 28.5% respectively. There was a significant association of increasing mortality with increasing ICH and ICH-GS scores. Area under receiver operating characteristic curve for 30-day mortality was 75.9% and 74.1% for ICH and ICH-GS scores respectively. However, mortality observed at individual scores was significantly less than previously reported. Among the surgically intervened patients (n = 265), both the expected mortality at baseline and discriminative ability of ICH and ICH-GS scores for 30-day mortality was significantly reduced following surgical intervention (ROC in surgically intervened groups: 59.9 (52.6-67.2) and 63(56-70) for ICH and ICH-GS scores respectively). Conclusions Although ICH and ICH-GS scores are valid in Indian population, mortality at individual scores is lower than previously reported. Mortality prediction using ICH and ICH GS scores is significantly modified by surgical interventions. Thus, newer prognostic tools which incorporate surgical intervention need to be developed and validated in future.

Purpose To compare long-term treatment outcomes in epilepsy patients from a single-visit outreach clinic on the Lifeline Express (LLE) with a conventional hospital (AIIMS) based epilepsy clinic in India. Methods Using a cross-sectional observational study design, consecutive epilepsy patients from fifteen LLE clinics conducted from 2009 to 2014 were compared to epilepsy patients registered in the same duration at the AIIMS epilepsy clinic. The primary outcome was to determine if patients were still taking AEDs. To determine current AED status, patients from the LLE clinic were contacted telephonically. For the AIIMS patients, hospital records were reviewed and phone calls made to those patients who had not followed-up for more than a year. Results In the 5 years under review, 1923 and 1257 patients had consulted at the LLE and AIIMS clinics respectively. Long-term outcomes were available for analysis in 688 AIIMS and 531 LLE clinic patients. Of the AIIMS patients, 581(87%) were continuing AEDs, 49(7%) had discontinued AEDs after being seizure-free for at least 5 years, 39(6%) had discontinued AEDs without medical advice and 19(2.8%) were dead. Outcomes in 531 LLE patients revealed that 351(72%) continued to be on AEDs, 34(7%) had discontinued AEDs on advice, 106 (22%) had discontinued AEDs without any medical advice and 40 (7.5%) were dead. The treatment gap in the LLE patients was reduced from 49% at first contact to 22% at follow-up 2–8 years later. Conclusions Even single-visit epilepsy clinics may be an effective option for reducing treatment gap in limited-resource regions of the world.

Gamma-Aminobutyric Acid (GABA) inhibitory neurotransmitter departs an energetic role in brain signalling system. Levels of GABA in the brain influence human behaviour, diminishes in the degree of GABA can cause seizures, depression, Parkinson's. To put it plainly, it plays a basic part in the significant issues of mind. It is exceptionally important to cure the issues linked to GABA. Writing overview proposed that nipecotic acid is an intense GABA reuptake inhibitor. This scaffold is likewise present in one of the promoted anticonvulsant drugs 'Tiagabine'. Tiagabine is only drug in the market which works through this mechanism however the medication is regulated with one more prescription for the synergistic impact. Nipecotic acid has several disadvantages such as it can't cross the blood-brain barrier because of its hydrophilic and zwitterionic nature. To avoid this problem nipecotic acid scaffold hybrids with the different aromatic groups can enhance the physical (lipophilicity) as well as biological properties of the resultant compound. So, there is a dire requirement for compounds that work through this mechanism. Several medicinal chemists and researchers are already working in this field and developed outstanding newer molecules. This review article compiles these developed new hybrids along with design strategies, structure-activity relationship, and biological activity as well as in silico studies. This review also demonstrates the synthesis of nipecotic acid and the core mechanism through which nipecotic acid acts as a GABA reuptake inhibitor.

LETM is a common syndrome and the diagnosis of CNS lymphoma is not usually considered in the list of differentials. Primary CNS lymphoma can present as longitudinally extensive transverse myelopathy. Failure to suspect and evaluate leads to delay in diagnosis and treatment. PCNSL may be non contrast enhancing on gadolinium enhanced MRI. CSF analysis should be done preferably before starting corticosteroids as it is usual practice in treatment of transverse myelitis, as steroids may lead to transient improvement and mask the correct diagnosis. Repeated CSF examinations may be needed to clinch the diagnosis.

Recent research in Android device forensics has largely focused on evidence recovery from NAND flash memory. However, pervasive deployment of NAND flash encryption technologies and the increase in malware infections which reside only in main memory have motivated an urgent need for the forensic study of main memory. Existing Android main memory forensics techniques are hardly being adopted in practical forensic investigations because they often require solving several usability constraints, such as requiring root privilege escalation, custom kernel replacement, or screen lock bypass. Moreover, there are still no commercially available tools for acquiring the main memory data of smart devices. To address these problems, we have developed an automated tool, called AMD, which is capable of acquiring the entire content of main memory from a range of Android smartphones and smartwatches. In developing AMD, we analyzed the firmware update protocols of these devices by reverse engineering the Android bootloader. Based on this study, we have devised a method that allows access to main memory data through the firmware update protocols. Our experimental results show that AMD overcomes the usability constraints of previous main memory acquisition approaches and that the acquired main memory data of a smartphone or smartwatch can be accurately used in forensic investigations.

In the modern scenario, thiazolidinone scaffold has emerged as a very potent scaffold as per its clinical significance concerned. It has attracted the keen interest of the researchers due to its great diversity in biological activities. Thiazolidinones are the saturated form of thiazole, called thiazolidine with a carbonyl group. The 1,3-thiazolidin-4-ones possess wide range of pharmacological activities such as anti-cancer, anti-diabetic, anti-microbial, anti-viral, anti-inflammatory and anti-convulsant. In the past few years, various newer synthetic approaches have been designed to synthesize diverse scaffolds to explore the various types of biological activities. In this review, an attempt has been made by the authors to summarize various synthetic strategies for thiazolidinone derivatives as well as their biological significance.

Purpose Our objective was to assess how telephonic review of outpatients with stable epilepsy compared with conventional face-to-face clinic management. Methods We constructed a randomized parallel group study of suitable patients attending our Epilepsy Clinic and compared telephonic review with conventional clinic visit based management. Primary outcomes were the percentage of patients with breakthrough seizures and total number of breakthrough seizures. We also compared cost, patient satisfaction and numbers defaulting. Results A total of 465 patients were randomized and 429 were included in the final analysis. There was no significant difference in breakthrough seizures between the two groups. Mean time spent in the consultation was 10min in the telephone group (FT) and 22h in the face-to-face group (FC) and cost was INR 865 more expensive on an average in the FC group. Satisfaction was over 90% in the FT group. Significantly more people in the FC group were lost to follow-up. Conclusion This study provides Class I evidence that the number of stable epilepsy patients who have breakthrough seizures and the total number of breakthrough seizures remain the same irrespective of whether patients are reviewed telephonically or face-to-face in the clinic. Clinicians managing epilepsy patients should consider using telephonic review for selected patients. Telephonic reviews have the potential of effectively reducing the secondary treatment gap in millions of patients who do not have easy access to doctors.

We report the case of a pregnant female presenting with behavioral change and hallucinations followed by focal seizures with impaired awareness. EEG revealed generalized slowing interspersed with extreme delta-brush pattern and MRI brain was normal. Both Serum and CSF anti-N-methyl-d-aspartate receptor (NMDAR) antibodies were positive. Patient had a prolonged hospital stay with full recovery and delivered a healthy baby, highlighting the significance of early diagnosis and management in this disorder.

Objectives Stroke constitutes a significant public health problem in developing countries. Caregivers provide an important support system for patient care but usually lack knowledge and skill to attend their stroke patients. We assessed whether a caregiver-directed educational intervention would reduce hospital-acquired complications and improve stroke patients’ outcomes. Materials and methods We randomly assigned two Neurology inpatient wards to receive either standard care or an educational intervention. The coprimary outcomes included incidence of hospital-acquired complications and in-hospital mortality. Secondary outcomes included the modified Rankin Scale and mortality at three months. Results Among 164 patients recruited, 82 received intervention, and standard care each. The mean (Standard deviation) Glasgow coma scale of patients was 11.01 (3.4), and National Institute of Health Stroke Scale was 19.17 (8.54). The incidence of complications (72 in the intervention versus 81 in the control group; p=0.56) was not different. Ten patients (12.2%) in the intervention group and 16 (19.5%) in the control group (p=0.20) died in-hospital. Twenty patients (27.8%) in the intervention and twelve (18.2%) in the control group attained modified Rankin Scale 0-2 at three months (p=0.12). The mortality at three months (20 [24.4%] in the intervention versus 25 [30.5%] in the control group) was not different (p=0.38). The intervention group had fewer complications (42 versus 68 in the control group; p=0.01) during the initial ten days of hospital stay, but adjusted analysis revealed no difference. Conclusion A structured educational intervention did not reduce the incidence of hospital-acquired complications, mortality, or morbidity. However, there was a trend towards fewer complications in the initial days of hospital stay. Extended hospital stay, caregiver fatigue, and dilution of the intervention over time might be reasons for the apparent lack of effect. Clinical trial registration-URL http://www.ctri.nic.in . Unique identifier: CTRI/2018/11/016312.

Background Lyme disease is endemic to parts of the Americas, Europe and Asia. However, only a handful of sporadic cases have been reported from India. In this study, we systematically evaluated the clinical and epidemiological features of Lyme disease in North India. Method All samples were tested by using the standard two-tiered testing algorithm (STTA). Paired serum and cerebrospinal fluid (CSF) were used for demonstrating Borrelia burgdorferi specific intrathecal IgG antibody synthesis (AI). In addition, a commercial tick-borne bacterial flow chip (TBFC) system and a real-time PCR were also used to detect Borrelia species and Anaplasma phagocytophilum in patients who were positive by STTA. Results The diagnosis of Lyme disease was confirmed in 18 (7.14%) of the 252 clinically suspected cases by STTA. Neurological involvement was reported in 14 (77.78%) patients, whereas joint and heart involvement was reported in five (27.78%) and three (16.67%) patients, respectively. Lymphocytic pleocytosis (median 37.5 cells/mm3; range 12–175 cells/mm3) in the CSF was seen in 11 of 14 Lyme neuroborreliosis (LNB) patients. Intrathecal production of Borrelia specific IgG antibodies was demonstrated in 9 (64.28%, n = 14) patients, a highly specific finding for neuroborreliosis. Two patients (11.11%) were also found to be co-infected with human granulocytic anaplasmosis. Conclusions The results of this study show clinical and laboratory evidence of endemic Lyme disease in North India and thus, highlight the importance for travel medicine practitioners and physicians to evaluate for Lyme disease in patients with compatible symptoms and a history of travel to tick risk areas.

Objective Idiopathic intracranial hypertension (IIH) is a disease of young with threat to vision if not diagnosed timely. This study looked at the putative predictors of poor visual outcome in patients with IIH at six months after presentation via a cohort study. Patients and methods All patients diagnosed with IIH from January 2011 to May 2015 were enrolled. The study design was ambispective cohort study. The baseline clinical and radiological characteristics assessed were age, sex, body mass index (BMI), duration of symptoms, transient visual obscuration, cranial nerve palsy, diminution of vision, Cerebrospinal fluid (CSF) opening pressure, empty sella, optic nerve dilatation, global configuration and transverse sinus stenosis. Follow up of visual outcome at six months was done to know the predictors of poor visual outcome. Results Eighty nine (89) patients were enrolled and 56 patients had follow-up of six months at the time of analysis. Majority of the patients were females (73/89 (82%)). The mean age was 29.9 ± 11.0 years. Mean body mass index (BMI) was 27.1 ± 5.4 kg/m2. Diminution of vision at presentation was seen in 54 (62%) patients. 64 eyes (36%) had visual acuity less than 6/18. Poor visual outcome at six months was seen in 23(41%) patients. Diminution of vision at presentation was found to be a poor predictor. Conclusion We found female sex and obesity to be less prevalent in our setting. Diminution of vision at presentation was a predictor of poor visual outcome at six months.

Single wall carbon nanotubes (SWCNTs) have attracted great attentions in the fields of nanoscience and nanotechnology due to their unprecedented physical/chemical/mechanical stability and high dimensional aspect ratio resulting superior electrical properties. However, their poor solubility in both organic and aqueous solvents refrain their solution processability and hence practical applications. In the present work, we report one-pot functionalization of SWNCT based on the nitrene chemistry of two structurally different aromatic azides having ester functional groups (very low concentrations 10% w/w), by thermal activation which renders them soluble in organic solvents and water. The resulting functionalized SWCNTs (f-SWCNT I & f-SWCNT II) covalent linkage and the strong electronic interaction between the P3HT and f-SWCNTs are confirmed by various spectroscopic measurements and electrochemical analysis. The bulk heterojunction (BHJ) photovoltaic cell based on the solution cast P3HT:PCBM with doping concentrations of f-SWCNTs, demonstrate up to 30% increase in the power conversion efficiency with respect to the reference cell under AM 1.5 illumination (100 mW/cm2).

A mild and efficient catalytic method has been developed to synthesize 3,4-dihydropyrimidinones in high yield by one-pot three component Biginelli condensation in the presence of triethylammonium acetate (TEAA) which acts as catalyst/reaction medium. Further, we have studied the antioxidant and antibacterial activities of these synthesized 3,4-dihydropyrimidinones. All the synthesized compounds reveal the significant antioxidant properties, these properties have been studied using 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging and cupric reducing antioxidant capacity (CUPRAC) assays. In addition, to this, these compounds also show the good antibacterial activity against four human pathogenic bacteria. (C) 2014 King Saud University. Production and hosting by Elsevier B.V.

All-solid-state flexible supercapacitor is assembled using multi-walled carbon nanotubes (MWCNT) and ionic liquid 1-ethyl-3-methylimidazolium tetrafluoroborate [EMIM][BF4] based gel polymer electrolyte. Flexible electrodes on polyethylene-terephthalate (PET) substrate were made by inkjet printed azide functionalized MWCNT (f-MWCNT), serving both as electrodes and charge collector. Fabricated supercapacitor f-MWCNT/gel polymer electrolyte/f-MWCNT (f-MWCNT SC) demonstrated high power and energy performance as a gel polymer electrolyte based all solid-state flexible supercapacitor. f-MWCNT SC demonstrates high specific capacitance 235 F/g at 5 mV/s in wide operating potential range of 3 V. Short relaxation time constant (Ͽo) (248 ms) with high apparent diffusion coefficient (Da) 2.25 y 10⿿8 cm2/s resulted in very high energy density 16.2 Wh/kg and power density 45 kW/kg at 1 A/g. f-MWCNT SC exhibits high flexibility and excellent cycling stability with capacity retention >90% after 5000 galvanostatic charge discharge cycles.

Epilepsy is one of the commonly prevailing neurological disorders. According to the reports, it is evident that about 80% of the epileptic cases have been observed in developing countries. Although there are many drugs with significant potency available in the market; still there is an issue of selectivity and toxicity. Therefore, continuous attempts have been made by the researchers to develop newer therapeutic agents against epilepsy. Many synthetic strategies have been available in the literature to synthesize various classes of anticonvulsants with promising activity. In the presented review, authors have summarized some newer synthetic routes being used for the synthesis of nitrogen-containing anticonvulsants taking a cue from the reported established anticonvulsant drugs viz. vigabatrin, sodium valproate, oxcarbazepine, felbamate, retigabine, and gabapentin. Various derivatives with the substitution for better anticonvulsant profile have been described in the figures for easy comparative study. The structure-activity relationship (SAR) of compounds with maximum potency has also been discussed. This article may serve as a boost for the researchers to modify the pre-existing synthetic routes as well as to improve potency and yield of the compounds.

A series of functionalized pyridazine derivatives (1–10) 4-phenyl-3,6-di(pyridine-4-yl)pyridazine (1), 3-(3,6-di(pyridin-4-yl)pyridazin-4-yl)aniline (2), 4-(pyridin-3-yl)-3,6-di(pyridin-4-yl)pyridazine (3), 3,6-di(pyridin-4-yl)-4-(thiophen-2-yl)pyridazine (4), 6-methyl-1,4-di(pyridin-4-yl)-5H-pyrrolo[3,4-d]pyridazine-5,7(6H)-dione (5), 4-phenyl-3,6-di(pyridine-3-yl)pyridazine (6), 3-(3,6-di(pyridin-4-yl)pyridazin-3-yl)aniline (7), 3,4,6-tri(pyridin-3-yl)pyridazine (8), 3,6-di(pyridin-3-yl)-4-(thiophen-2-yl)pyridazine (9), 6-methyl-1,4-di(pyridin-3-yl)-5H-pyrrolo[3,4-d]pyridazine-5,7(6H)-dione (10) were synthesized by one-step methodologies which also include Inverse Electron Demand Diels-Alder reaction. The compounds were isolated in high yields without any tedious purification procedures and characterized by NMR, Mass spectrometry, Elemental Analysis and X-ray diffraction techniques. The crystal structures of five compounds were studied. The pyridazines were subjected to anti-microbial evaluations where few of the compounds showed moderate to high activity against most of the bacteria and fungi presented in this study.

Although chronic risk factors for stroke are reasonably well understood, the acute precipitants, or triggers, of stroke relatively remain understudied. Identification of particular time periods during which stroke risk is elevated could prove a valuable strategy to reduce stroke incidence through the introduction of appropriate prevention strategies during a period of vulnerability. The aim of this study was to determine the prevalence of trigger factors in acute stroke patients and to investigate the association of the presence of trigger factors with initial stroke severity at presentation (National Institutes of Health Stroke Scale (NIHSS) score in ischemic stroke patients and volume of hematoma in hemorrhagic stroke patients).This was a hospital-based observational cross-sectional study. All consecutive patients of recent stroke (reporting within 1 week of stroke onset) were included in the study. This study examined the prevalence of 11 predefined triggers (including both well-established and potential triggers) in predefined hazard periods.In total, 290 patients participated in the study. Presence of any trigger factor out of 11 trigger factors studied was seen in 128 (44.2%) of 290 patients, 104 (46.4%) of 224 ischemic stroke patients and 24 (36.4%) of 66 hemorrhagic stroke patients. Psychological stress was present in 51 (17.6%) patients, among psychological stress: stressful life event in 34 (11.7%), negative affect in 17 (5.9%), acute alcohol abuse in 31 (10.7%), clinical infections in 24 (8.3%), and anger and coffee intake in 12 (4.1%) each. Sexual activity, trauma, and surgery were present in 5 (1.7%), 4 (1.4%), and 5 (1.7%) patients, respectively. None of the patients reported exposure to recreational drug abuse, startling event, and unusual vigorous physical exertion in hazard periods. Two or more trigger factors were present in 16 (5.5%) patients. Clinical variables independently associated with the presence of trigger factors in acute stroke after multivariate analysis were younger age (60 years) and stroke severity at initial presentation (ie, higher NIHSS score and higher hematoma volume).Trigger factors were present in 44.2% of acute stroke patients. Psychological stress (17.6%), acute alcohol abuse (10.7%), and clinical infections (8.3%) were the most common triggers. Younger age (60 years) and stroke severity at initial presentation were independently associated with the presence of trigger factors in acute stroke patients. However, these associations need to be further explored in community-based studies.

India is a subtropical country with clear seasonal variations in weather conditions. Seasonal and circadian variation in occurrence of subtypes of cerebrovascular disease has been of interest in several studies from different countries and climate zones, but discrepant results have made the conclusions unclear. The aim of the present study was to observe the seasonal and circadian variation in the occurrence of stroke and its subtypes among our population.This was a cross-sectional observational study based on new cases and past cases of stroke on follow-up, conducted between January 2011 and December 2012 in the Department of Neurology, at the All India Institute of Medical Sciences, New Delhi, India. The date and time of onset of the stroke was recorded. The categorization of months into season was in accordance with the Indian Meteorological Department guidelines. The time of onset was distributed into 6 hourly intervals. Statistical calculations were performed using Stata version 12.1 and SPSS version 20.A total of 583 patients were included for the study. The rate of occurrence of stroke was highest in the late morning 0600-1159 hours (P value.001) compared with other times of the day, regardless of gender or age for both ischemic and hemorrhagic strokes. It was lowest in late evening (1800-2359 hours) quadrant compared with other quadrants. Although there was no significant difference found by dichotomizing the groups into two 6-month periods, there was an increasing trend in number of patients with stroke during the months November-February. There was no difference in stroke occurrence between the types of stroke or within each type among different seasons with different temperatures. Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification of ischemic strokes also did not show any association with season or circadian rhythm.There is a significant increase in occurrence of strokes between 0600 and 1159 hours and lowest between 1800-2359 hours. No significant variation in stroke occurrence or subtype for any of the seasons was observed.

Background Young stroke patients constitute 15%-30% of all stroke patients in India as against 3.0%-8.5% reported from the West. The mechanisms for stroke in the young may include unconventional risk factors such as infections. We aimed to investigate the role (if any) of Chlamydia pneumoniae antibodies in young patients with acute ischemic stroke (AIS). Several proinflammatory cytokines and biomarkers are released early after the onset of brain ischemia. We assessed the role of heat shock protein (hsp) 65, neopterin, and myeloperoxidase upregulation after AIS in predicting stroke severity. We also assessed relationship of upregulated inflammatory biomarkers with C pneumoniae antibody titres (IgG, IgA, and IgM). Methods Eighty acute stroke patients and healthy age- and sex-matched controls were recruited. Blood samples were drawn within 1 week from the onset of stroke. Detection of IgA, IgG, and IgM antibodies to C pneumoniae was done with a validated microimmunofluorescence technique from 5 mL of serum in all subjects. Inflammatory biomarkers such as neopterin, myeloperoxidase and hsp 65 were estimated with sandwich enzyme linked immunosorbent assay (ELISA) method. Results hsp 65 and neopterin were significantly elevated in all stroke patients with respect to healthy controls (odds ratio [OR], 4.9; 95% confidence interval [CI], 23.5-67.8; P = .001 and OR, 4.4; 95% CI, 2.08-9.4; P = .04, respectively). Eighty-one percent of cases were seropositive for IgA versus 32% of controls ( P = .003), and IgG was positive in 52.7% versus 17.3% of controls ( P = .05). Myeloperoxidase levels were similar in patients and controls. Correlation and multiple regression indicated a high level of predictability and sensitivity of hsp 65 to IgA. C. pneumoniae antibody titres when all other variables were constant (F [4,90] = −6.8, P = .001). Patients with high NIHSS scores (>15) had elevated levels of hsp 65 (mean, 13.2 ng/mL) suggesting correlation with stroke severity. Conclusions The study demonstrated high levels of hsp 65 and neopterin levels in AIS correlated to significantly elevated IgA titres of C pneumoniae . Elevated levels of hsp 65 were associated with stroke severity.

A new catalytic method has been developed for the synthesis of aza/thia-Michael addition reactions of amines/thiols, which provide higher product yields. This catalyst is a combination of multi-walled carbon nanotubes (MWCNT) with triethylammonium hydrogen phosphate (TEAP) ionic liquid (IL), commonly referred to as bucky gel. In order to gain insight into the interactions involved between IL and MWCNT, we utilised Raman spectroscopy for our analysis. The interactions between MWCNT with TEAP were clearly evidenced by the increasing intensity ratios and spectral shift in the wavelength for the Raman D and G bands of MWCNT. The morphological studies of the resulting composite materials of TEAP and MWCNT (bucky gel) were carried out using scanning electron microscopy (SEM). The key advantage of using bucky gel as a catalyst is that higher product yield is obtained in reduced reaction time for Michael reactions.

A series of thirteen novel 2,4-thiazolidinedione derivatives were synthesized through three step reaction procedure. The title compounds were synthesized by Knoevenagel condensation at the 5th position of the 2,4-thiazolidinedione ring. Various physicochemical and spectral studies were conducted to characterize the synthesized derivatives including- IR, Mass, 1H NMR, 13C NMR and elemental analysis. The derivatives were screened for in vivo anti diabetic, in vivo anti-inflammatory and in vitro free radical scavenging activities by carrageenan induced rat paw edema method, alloxan induced diabetes in wistar rats method and FRAP (ferric reducing antioxidant power) method respectively. Some of the derivatives emerged out as potent antidiabetic, anti inflammatory and free radical scavenging agents. Molecular docking was carried out to investigate some possible structural insights into the potential binding patterns of the most potent anti-diabetic molecules NB7,NB12 and NB13 with the active sites of target PPARγ (PDB ID: 2PRG) using MOE software. Dichloro derivative compound NB-7 has shown great potential in the present study as it not only has maximum antidiabetic activity but also possess excellent anti-inflammatory and antioxidant potential.

Background Discrimination between tuberculous and acute bacterial meningitis is difficult by clinical features alone and laboratory methods may only supplement the clinical suspicion. We aimed to validate the diagnostic criteria by Thwaites et al. [1] and construct our own diagnostic predictors based on the clinical and laboratory features. Methods 380 patients of acute bacterial meningitis (ABM) and 210 patients of tuberculous meningitis (TBM) were enrolled retrospectively from June 2004 to June 2007 and prospectively from July 2007 to September 2008. HIV positive patients were excluded. Detailed history, clinical examination CSF analysis, haematological, biochemical investigations and imaging was performed in all patients. Results Factors associated with the diagnosis of TBM in the present study included rural area of residence, longer duration of disease, presence of clear CSF, lower percentage of CSF neutrophils, presence of diplopia and hemiparesis. On validation, age did not appear as a significant factor in our population. The diagnostic algorithm from our study group had a sensitivity of 95.71% and specificity of 97.63%. Conclusions The diagnostic criterion has a fair validation in our population when the age factor is excluded. The rule is useful in HIV negative patients with low CSF sugar and negative organism yield in the CSF.

In patients with intracerebral haemorrhage (ICH), early haemorrhage expansion affects clinical outcome. Haemostatic treatment reduces haematoma expansion, but fails to improve clinical outcomes in many patients. Proper selection of patients at high risk for haematoma expansion seems crucial to improve outcomes. In this study, we aimed to prospectively validate the CT-angiography (CTA) spot sign for prediction of haematoma expansion.PREDICT (predicting haematoma growth and outcome in intracerebral haemorrhage using contrast bolus CT) was a multicentre prospective observational cohort study. We recruited patients aged 18 years or older, with ICH smaller than 100 mL, and presenting at less than 6 h from symptom onset. Using two independent core laboratories, one neuroradiologist determined CTA spot-sign status, whereas another neurologist masked for clinical outcomes and imaging measured haematoma volumes by computerised planimetry. The primary outcome was haematoma expansion defined as absolute growth greater than 6 mL or a relative growth of more than 33% from initial CT to follow-up CT. We reported data using standard descriptive statistics stratified by the CTA spot sign. Mortality was assessed with Kaplan-Meier survival analysis.We enrolled 268 patients. Median time from symptom onset to baseline CT was 135 min (range 22-470), and time from onset to CTA was 159 min (32-475). 81 (30%) patients were spot-sign positive. The primary analysis included 228 patients, who had a follow-up CT before surgery or death. Median baseline ICH volume was 19·9 mL (1·5-80·9) in spot-sign-positive patients versus 10·0 mL (0·1-102·7) in spot-sign negative patients (p0·001). Median ICH expansion was 8·6 mL (-9·3 to 121·7) for spot-sign positive patients and 0·4 mL (-11·7 to 98·3) for spot-negative patients (p0·001). In those with haematoma expansion, the positive predictive value for the spot sign was61% (95% CI 47–73) for the positive predictive value and 78% (71–84) for the negative predictive value, with 51% (39–63) sensitivity and 85% (78–90) specificity[corrected]. Median 3-month modified Rankin Scale (mRS) was 5 in CTA spot-sign-positive patients, and 3 in spot-sign-negative patients (p0·001). Mortality at 3 months was 43·4% (23 of 53) in CTA spot-sign positive versus 19·6% (31 of 158) in CTA spot-sign-negative patients (HR 2·4, 95% CI 1·4-4·0, p=0·002).These findings confirm previous single-centre studies showing that the CTA spot sign is a predictor of haematoma expansion. The spot sign is recommended as an entry criterion for future trials of haemostatic therapy in patients with acute ICH.Canadian Stroke Consortium and NovoNordisk Canada.

The study was done to identify the predictors of refractory epilepsy in the North Indian population attending a tertiary care centre. This case–control study from August 2006 to December 2008 enrolled 200 consecutive patients of intractable epilepsy and 200 age matched controls with well controlled epilepsy. The factors which were significant in univariate analysis were age of onset before fourteen years (OR 7.92), partial seizures (OR 6.27), presence of neurological deficits (OR 19.68), perinatal insult (OR 11.00), delayed milestones (OR 13.93), history of CNS infection (OR 7.45), febrile seizures (4.33), high initial seizure frequency of more than one per month (OR 14.26), non response to first Anti Epileptic Drug (AED) (OR 6.71) and abnormal brain imaging (OR 20.47). On multivariate analysis significant predictors were radiological evidence of structural cerebral abnormality (OR 20.47), non response to first AED (OR 19.21), delayed mile stones (OR 9.09), high initial seizure frequency of more than one per month (OR 6.71), partial seizure type (OR 6.27), febrile seizures (OR 5.66) and age of onset before fourteen years (OR 3.09). It is thus possible to identify a certain profile of patients with epilepsy who are likely to be refractory to medical therapy. These observations would be useful in selecting patients early for evaluation in Northern India where a high surgical treatment gap exists.

Studies on genetic aberrations among Indian amyotrophic lateral sclerosis (ALS) patients are limited to C9orf72 and ATXN2 repeat expansions and mutations in the SOD1 gene. In this study, we used targeted next-generation sequencing to analyze 25 ALS-associated genes in a cohort of 154 Indian ALS patients. We identified known pathogenic mutations in SOD1 (G148D; H44R), TARDBP (M337V; N267S), DAO (R199Q), and ANG (K41I). In addition, we also identified 7 potentially pathogenic missense variants that have not been previously reported in ALS patients; this includes 3 novel variants (OPTN: K489E, DAO: E121K, and SETX: L2163V) that are not reported in large population databases and 4 rare variants (CHMP2B: E45K, SQSTM1: G262R and P438L, ERBB4: R103H) with a minor allele frequency of0.01 in large population databases. All known pathogenic, novel, and rare variants were detected in only 1 ALS patient each with the exception of the OPTN (K489E) variant that was detected in 2 patients in our cohort. In sum, we identified known and potentially pathogenic novel and rare mutations in 14 (9.1%) ALS patients in our cohort. This study represents the first comprehensive genetic analysis in the ethnically diverse population and thus provides a new insight into the genetics of Indian ALS patients.

microRNAs (miRNA) are a class of non-protein coding functional RNAs that are thought to regulate expression of target genes by direct interaction with mRNAs. miRNAs have been identified through both experimental and computational methods in a variety of eukaryotic organisms. Though these approaches have been partially successful, there is a need to develop more tools for detection of these RNAs as they are also thought to be present in abundance in many genomes. In this report we describe a tool and a web server, named CID-miRNA, for identification of miRNA precursors in a given DNA sequence, utilising secondary structure-based filtering systems and an algorithm based on stochastic context free grammar trained on human miRNAs. CID-miRNA analyses a given sequence using a web interface, for presence of putative miRNA precursors and the generated output lists all the potential regions that can form miRNA-like structures. It can also scan large genomic sequences for the presence of potential miRNA precursors in its stand-alone form. The web server can be accessed at http://mirna.jnu.ac.in/cidmirna/.

Catastrophic crude oil spills excite media interest but operators usually manage greater losses from daily shipping operations single-handed. This paper invites energy policy makers to re-embrace daily oil losses. It categorises them, discusses physical and accounting measures and reports empirically crude oil loss patterns and factors influencing them on some recent North Sea voyages. Losses varied with crude-type, measured by its vapour pressure, API gravity and viscosity, but evaporative loss in transit was low on these short voyages. Where sediment and water content influenced losses or error rates are exceptional, measurement techniques should be revised. Varying losses across load and discharge ports infer revisions to tank and terminal designs. Empirical evidence revealed reduced losses in double hull vessels, supporting clingage theories, although insufficient pre-1985 or segregated ballast tank vessels were in employment to permit meaningful comparisons with newer ships. Calculating and applying vessel experience factors assists comparison and loss prediction. To minimise losses requires closer involvement of policy makers with operators.