Letters to the Editor
Cerebrospinal fluid cytokines, matrix metalloproteinases, HIV, and tuberculous meningitis Sir, Raj et al. reported on “cerebrospinal fluid cytokines, matrix metalloproteinases, HIV and tuberculous meningitis.[1]” Raj et al. noted that “HIV infection did not affect a majority of the CSF cytokines and MMP levels in tuberculous meningitis (TBM) except for IL-1β level.[1]” In fact, many reports show that HIV infection results in alteration of CSFcytokine[2] and matrix metalloproteinases.[3] Juan et al. reported that “CSF INF-gamma levels (>6.4 IU/mL) are very valuable in TBM diagnosis.[4]” The question is why the observation by Raj et al. is different. First, the confounding medical disorders, including to the opportunistic infection, should be well considered. For example, the Cryptococcal meningitis can affect the CSF cytokine,[5,6] and cytokine therapy is also an alternative treatment for the Cryptococcal meningitis.[7] A further study with control of confounding medical disorder and treatment in HIV-infected cases is suggested. Sim Sai Tin, Viroj Wiwanitkit1,2,3,4,5 Medical Center, Shantou, China, 1Visiting Professor, Hainan Medical University, China, 2Visiting Professor, Faculty of Medicine, University of Nis, Serbia, 3 Adjunct Professor, Joseph Ayobabalola University, Nigeria, 4Senior Expert, Surin Rajabhat University, Thailand, 5Honorary Professor, Dr. Dnyandeo Yashwantrao Patil Medical University, Pune, Maharashtra, India
in human immunodeficiency seropositive and seronegative patients of tuberculous meningitis. Ann Indian Acad Neurol 2014;17:171-8. 2. Thea DM, Porat R, Nagimbi K, Baangi M, St Louis ME, Kaplan G, et al. Plasma cytokines, cytokine antagonists, and disease progression in African women infected with HIV-1. Ann Intern Med 1996;124:757-62. 3. Liuzzi GM, Mastroianni CM, Santacroce MP, Fanelli M, D’Agostino C, Vullo V, et al. Increased activity of matrix metalloproteinases in the cerebrospinal fluid of patients with HIV-associated neurological diseases. J Neurovirol 2000;6:156-63. 4. Juan RS, Sánchez-Suárez C, Rebollo MJ, Folgueira D, Palenque E, Ortuño B, et al. Interferon gamma quantification in cerebrospinal fluid compared with PCR for the diagnosis of tuberculous meningitis. J Neurol 2006;253:1323-30. 5. Naranbhai V, Chang CC, Durgiah R, Omarjee S, Lim A, Moosa MY, et al. Compartmentalization of innate immune responses in the central nervous system during cryptococcal meningitis/HIV coinfection. AIDS 2014;28:657-66. 6. Chang CC, Omarjee S, Lim A, Spelman T, Gosnell BI, Carr WH, et al. Chemokine levels and chemokine receptor expression in the blood and the cerebrospinal fluid of HIV-infected patients with cryptococcal meningitis and cryptococcosis-associated immune reconstitution inflammatory syndrome. J Infect Dis 2013;208:1604-12. 7. Jarvis JN, Meintjes G, Rebe K, Williams GN, Bicanic T, Williams A, et al. Adjunctive interferon-γ immunotherapy for the treatment of HIV-associated cryptococcal meningitis: A randomized controlled trial. AIDS 2012;26:1105-13.
Access this article online
For correspondence:
Quick Response Code:
Dr. Sim Sai Tin, Medical Center, Shantou, China.
E-mail: [email protected]
References
Website: www.annalsofian.org
DOI: 10.4103/0972-2327.144312
1. Rai D, Garg RK, Mahdi AA, Jain A, Verma R, Tripathi AK, et al. Cerebrospinal fluid cytokines and matrix metalloproteinases
Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia Sir, We n t t h r o u g h w i t h i n t e r e s t a n a r t i c l e e n t i t l e d “Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia” published in Ann Indian
Acad Neurol (2014;17:325-30). [1] Given the fact that neuropsychiatric symptoms are common both in patients with Alzheimer disease (AD) and those with vascular dementia (VaD),[1] the study has highlighted an important
Annals of Indian Academy of Neurology, January-March 2015, Vol 18, Issue 1
Letters to the Editor
issue and authors deserve credit for that. However, I have a few concerns with the methodology as described by the authors. The authors state that they used the mini-mental status exam (MMSE) for initial screening. They also used the Kolkata Cognitive Test Battery as also separately tested the language, praxis performance, executive functioning, as well as visuospatial and visuoperceptual functioning using standard methods. The authors claim that they based their diagnosis of dementia using Diagnostic and Statistical Manual of mental disorders. The authors further assessed behavioral and psychological symptoms on the basis of the NPI in the presence of a reliable caregiver. The authors translated the original NPI in to Bengali and used the same after following a standard technique. Now this takes me to my concerns with this study. I am unable to understand the role of MMSE in this study. MMSE or its modifications have in past been used as a screening tool in a two phase surveys for assessment of dementia.[2-4] As a screening tool it has been used to pick suspects of dementia and further evaluation has been carried on suspects to confirm cases of dementia. Further a random sample of screen negatives is selected for second phase assessment. This does not seem to have been done in this study. If this was done, then what was the need of using MMSE as a screening tool? The study seems to have been conducted as a one-phase cross-sectional study after applying dementia criteria from Diagnostic and Statistical Manual of mental disorders (DSM-IV). Further, even if the authors have used MMSE for screening (as they claim), they have been unable to report on how MMSE was made culturally and linguistically sensitive to the population under study. It may not be appropriate to use MMSE (English language) in the study population. The authors seem to be aware of this and that is why they have translated and validated their study tool for assessment of behavioral and psychological symptoms. Should not the same be done with the screening tool for assessment of dementia?
121
Sunil Kumar Raina Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India For correspondence: Dr. Sunil Kumar Raina, Department of
Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra - 176 001, Himachal Pradesh, India. E-mail: [email protected]
References 1.
2. 3. 4.
Bandyopadhyay TK, Biswas A, Roy A, Guin DS, Gangopadhyay G, Sarkhel S, et al. Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. Ann Indian Acad Neurol 2014;17:325-30. Raina S, Razdan S, Pandita KK, Raina S. Prevalence of dementia among Kashmiri migrants. Ann Indian Acad Neurol 2008;11:106-8. Chandra, Ganguli M, Pandav R, Johnston J, Belle S, DeKosky ST. Prevalence of Alzheimer’s disease and other dementias in rural India: The Indo-US study. Neurology 1998;51:1000-8. Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Is dementia differentially distributed — A study on the prevalence of dementia in migrant, urban, rural and tribal elderly population of himalayan region in northern India. N Am J Med Sci 2014;6:172-7. Access this article online Quick Response Code:
Website: www.annalsofian.org
DOI: 10.4103/0972-2327.144315
Cerebral venous sinus thrombosis: Role of extra cranial collateral circulation Sir, A 30-year-old lady, on regular oral contraceptive (OC) drugs since three years, presented with three weeks history of headache, which was dull aching, bilateral fronto-parieto-occipital region with recurrent episodes of vomiting. She also had history of transient visual obscurations and diplopia on looking at distant gaze for one week. There was no history of limb weakness, numbness, seizures or altered mental status. There was no past history of any major medical illness. On examination, pulse was 88/min and blood pressure was 124/ 80 mm Hg. Patient was conscious, oriented to time, place and person. Examination of cranial nerves showed bilateral papilledema and bilateral lateral rectus palsy. There was no
motor weakness, deep tendon reflexes were normal with bilateral plantar flexor. There were no meningeal signs.
Investigations Hemoglobin level was 13.5 gm%, TLC – 8000/mm3, platelet count – 3.15 lakh/mm3. Erythrocyte sedimentation rate (ESR) was 15 at end of 1st hour. Random blood sugar, renal function tests, liver function tests, thyroid function tests and serum electrolytes were normal. Anti-nuclear, anti-ds DNA and antiphospholipid antibodies were within normal limits and serum homocystiene level was normal. Magnetic resonance imaging (MRI) brain revealed normal brain parenchyma with thrombus visualized in superior sagittal sinus, bilateral transverse
Annals of Indian Academy of Neurology, January-March 2015, Vol 18, Issue 1
Copyright of Annals of Indian Academy of Neurology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Cerebrospinal fluid cytokines, matrix metalloproteinases, HIV, and tuberculous meningitis Sir, Raj et al. reported on “cerebrospinal fluid cytokines, matrix metalloproteinases, HIV and tuberculous meningitis.[1]” Raj et al. noted that “HIV infection did not affect a majority of the CSF cytokines and MMP levels in tuberculous meningitis (TBM) except for IL-1β level.[1]” In fact, many reports show that HIV infection results in alteration of CSFcytokine[2] and matrix metalloproteinases.[3] Juan et al. reported that “CSF INF-gamma levels (>6.4 IU/mL) are very valuable in TBM diagnosis.[4]” The question is why the observation by Raj et al. is different. First, the confounding medical disorders, including to the opportunistic infection, should be well considered. For example, the Cryptococcal meningitis can affect the CSF cytokine,[5,6] and cytokine therapy is also an alternative treatment for the Cryptococcal meningitis.[7] A further study with control of confounding medical disorder and treatment in HIV-infected cases is suggested. Sim Sai Tin, Viroj Wiwanitkit1,2,3,4,5 Medical Center, Shantou, China, 1Visiting Professor, Hainan Medical University, China, 2Visiting Professor, Faculty of Medicine, University of Nis, Serbia, 3 Adjunct Professor, Joseph Ayobabalola University, Nigeria, 4Senior Expert, Surin Rajabhat University, Thailand, 5Honorary Professor, Dr. Dnyandeo Yashwantrao Patil Medical University, Pune, Maharashtra, India
in human immunodeficiency seropositive and seronegative patients of tuberculous meningitis. Ann Indian Acad Neurol 2014;17:171-8. 2. Thea DM, Porat R, Nagimbi K, Baangi M, St Louis ME, Kaplan G, et al. Plasma cytokines, cytokine antagonists, and disease progression in African women infected with HIV-1. Ann Intern Med 1996;124:757-62. 3. Liuzzi GM, Mastroianni CM, Santacroce MP, Fanelli M, D’Agostino C, Vullo V, et al. Increased activity of matrix metalloproteinases in the cerebrospinal fluid of patients with HIV-associated neurological diseases. J Neurovirol 2000;6:156-63. 4. Juan RS, Sánchez-Suárez C, Rebollo MJ, Folgueira D, Palenque E, Ortuño B, et al. Interferon gamma quantification in cerebrospinal fluid compared with PCR for the diagnosis of tuberculous meningitis. J Neurol 2006;253:1323-30. 5. Naranbhai V, Chang CC, Durgiah R, Omarjee S, Lim A, Moosa MY, et al. Compartmentalization of innate immune responses in the central nervous system during cryptococcal meningitis/HIV coinfection. AIDS 2014;28:657-66. 6. Chang CC, Omarjee S, Lim A, Spelman T, Gosnell BI, Carr WH, et al. Chemokine levels and chemokine receptor expression in the blood and the cerebrospinal fluid of HIV-infected patients with cryptococcal meningitis and cryptococcosis-associated immune reconstitution inflammatory syndrome. J Infect Dis 2013;208:1604-12. 7. Jarvis JN, Meintjes G, Rebe K, Williams GN, Bicanic T, Williams A, et al. Adjunctive interferon-γ immunotherapy for the treatment of HIV-associated cryptococcal meningitis: A randomized controlled trial. AIDS 2012;26:1105-13.
Access this article online
For correspondence:
Quick Response Code:
Dr. Sim Sai Tin, Medical Center, Shantou, China.
E-mail: [email protected]
References
Website: www.annalsofian.org
DOI: 10.4103/0972-2327.144312
1. Rai D, Garg RK, Mahdi AA, Jain A, Verma R, Tripathi AK, et al. Cerebrospinal fluid cytokines and matrix metalloproteinases
Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia Sir, We n t t h r o u g h w i t h i n t e r e s t a n a r t i c l e e n t i t l e d “Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia” published in Ann Indian
Acad Neurol (2014;17:325-30). [1] Given the fact that neuropsychiatric symptoms are common both in patients with Alzheimer disease (AD) and those with vascular dementia (VaD),[1] the study has highlighted an important
Annals of Indian Academy of Neurology, January-March 2015, Vol 18, Issue 1
Letters to the Editor
issue and authors deserve credit for that. However, I have a few concerns with the methodology as described by the authors. The authors state that they used the mini-mental status exam (MMSE) for initial screening. They also used the Kolkata Cognitive Test Battery as also separately tested the language, praxis performance, executive functioning, as well as visuospatial and visuoperceptual functioning using standard methods. The authors claim that they based their diagnosis of dementia using Diagnostic and Statistical Manual of mental disorders. The authors further assessed behavioral and psychological symptoms on the basis of the NPI in the presence of a reliable caregiver. The authors translated the original NPI in to Bengali and used the same after following a standard technique. Now this takes me to my concerns with this study. I am unable to understand the role of MMSE in this study. MMSE or its modifications have in past been used as a screening tool in a two phase surveys for assessment of dementia.[2-4] As a screening tool it has been used to pick suspects of dementia and further evaluation has been carried on suspects to confirm cases of dementia. Further a random sample of screen negatives is selected for second phase assessment. This does not seem to have been done in this study. If this was done, then what was the need of using MMSE as a screening tool? The study seems to have been conducted as a one-phase cross-sectional study after applying dementia criteria from Diagnostic and Statistical Manual of mental disorders (DSM-IV). Further, even if the authors have used MMSE for screening (as they claim), they have been unable to report on how MMSE was made culturally and linguistically sensitive to the population under study. It may not be appropriate to use MMSE (English language) in the study population. The authors seem to be aware of this and that is why they have translated and validated their study tool for assessment of behavioral and psychological symptoms. Should not the same be done with the screening tool for assessment of dementia?
121
Sunil Kumar Raina Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India For correspondence: Dr. Sunil Kumar Raina, Department of
Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra - 176 001, Himachal Pradesh, India. E-mail: [email protected]
References 1.
2. 3. 4.
Bandyopadhyay TK, Biswas A, Roy A, Guin DS, Gangopadhyay G, Sarkhel S, et al. Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. Ann Indian Acad Neurol 2014;17:325-30. Raina S, Razdan S, Pandita KK, Raina S. Prevalence of dementia among Kashmiri migrants. Ann Indian Acad Neurol 2008;11:106-8. Chandra, Ganguli M, Pandav R, Johnston J, Belle S, DeKosky ST. Prevalence of Alzheimer’s disease and other dementias in rural India: The Indo-US study. Neurology 1998;51:1000-8. Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Is dementia differentially distributed — A study on the prevalence of dementia in migrant, urban, rural and tribal elderly population of himalayan region in northern India. N Am J Med Sci 2014;6:172-7. Access this article online Quick Response Code:
Website: www.annalsofian.org
DOI: 10.4103/0972-2327.144315
Cerebral venous sinus thrombosis: Role of extra cranial collateral circulation Sir, A 30-year-old lady, on regular oral contraceptive (OC) drugs since three years, presented with three weeks history of headache, which was dull aching, bilateral fronto-parieto-occipital region with recurrent episodes of vomiting. She also had history of transient visual obscurations and diplopia on looking at distant gaze for one week. There was no history of limb weakness, numbness, seizures or altered mental status. There was no past history of any major medical illness. On examination, pulse was 88/min and blood pressure was 124/ 80 mm Hg. Patient was conscious, oriented to time, place and person. Examination of cranial nerves showed bilateral papilledema and bilateral lateral rectus palsy. There was no
motor weakness, deep tendon reflexes were normal with bilateral plantar flexor. There were no meningeal signs.
Investigations Hemoglobin level was 13.5 gm%, TLC – 8000/mm3, platelet count – 3.15 lakh/mm3. Erythrocyte sedimentation rate (ESR) was 15 at end of 1st hour. Random blood sugar, renal function tests, liver function tests, thyroid function tests and serum electrolytes were normal. Anti-nuclear, anti-ds DNA and antiphospholipid antibodies were within normal limits and serum homocystiene level was normal. Magnetic resonance imaging (MRI) brain revealed normal brain parenchyma with thrombus visualized in superior sagittal sinus, bilateral transverse
Annals of Indian Academy of Neurology, January-March 2015, Vol 18, Issue 1
Copyright of Annals of Indian Academy of Neurology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
