Multiple sexually transmitted co-infections are associated with adverse reproductive outcomes in asymptomatic adolescent pregnant women; A Prospective cohort study

Background

A prospective cohort was conducted to assess the prevalence of seven RTIs/STIs in adolescent asymptomatic pregnant women to find a significant correlation between infection and pregnancy.

Methods

The study was restricted to 18–19 years of asymptomatic adolescent pregnant women attending Ante-Natal Care and the health status of the pregnant women were followed up to parturition. The health status of the infant was followed till 6 months post-delivery. The prevalence of the concerning pathogens and the significance of their association with adverse outcomes of pregnancy were determined.

Results

Among 279 subjects, the most significant co-infections were observed for M. hominis with U. parvum (9.31%; p-value–0.0071/OR−2.6421) and U. urealyticum (7.88%; p-value–0.0119/OR−2.6455). Statistically significant associations were found between C. trachomatis [(p-value-0.0439); OR−2.9902] and M. genitalium [(p-value−0.0284); OR−3.442] with PTB, N. gonorrhoeae with LBW <2.5 kg [(p-value−0.0052);OR−4.9017], U. urealyticum with VLBW <2 kg [(p-value-0.0262);OR−3.0207], M. genitalium [(p-value-0.0184); OR−11.7976] and T. vaginalis with PROM [(p-value 0.0063); OR−19.4275] while M. genitalium [(p-value 0.0190); OR–12.9230] and U. urealyticum [(p-value 0.0063); OR-14.5149] with PPROM with 95% CI respectively.

Conclusions

Asymptomatic adolescents are at high risk of adverse pregnancy outcomes if infected with the concerned pathogens.

Pericardial Effusion Secondary to Nilotinib in an Elderly Patient With Chronic Myelogenous Leukemia

Tyrosine kinase inhibitors (TKIs) are the first-line treatment for patients with chronic myelogenous leukemia (CML). Serositis, including pleural and pericardial effusions, is a frequent adverse event with some TKIs while less frequent with others. We present a case of a 76-year-old woman with CML on nilotinib who presented with progressive fatigue and was eventually found to have cardiac tamponade from a large pericardial effusion attributed to nilotinib. The patient required urgent therapeutic pericardiocentesis and switching of TKIs from nilotinib to bosutinib. 

Adverse events and Breakthrough infections associated with COVID-19 vaccination in the Indian population

Vaccines against COVID‐19 provide immunity to deter severe morbidities associated with the infection. However, it does not prevent infection altogether in all exposed individuals. Furthermore, emerging variants of SARS‐CoV‐2 impose a threat concerning the competency of the vaccines in combating the infection. This study aims to determine the variability in adverse events and the extent of breakthrough infections in the Indian population. A retrospective study was conducted using a pre‐validated questionnaire encompassing social, demographic, general health, the status of SARS‐CoV‐2 infection, vaccination, associated adverse events, and breakthrough infections in the Indian population. Informed consent and ethical approval were obtained as per Indian Council of Medical Research (ICMR) guidelines. Participants, who provided the complete information, were Indian citizens, above 18 years, and if vaccinated, administered with either Covishield or Covaxin, were considered for the study. Data have been compiled in Microsoft Excel and analyzed for statistical differences using STATA 11. The responses from 2051 individuals fulfilling the inclusion criteria were analyzed. Among 2051, 1119 respondents were vaccinated and 932 respondents were non‐vaccinated. Among 1119 vaccinated respondents, 7 were excluded because of missing data. Therefore, out of 1112 vaccinated, 413 experienced adverse events with a major fraction of younger individuals, age 18–40 years, getting affected (74.82%; 309/413). Furthermore, considerably more females than males encountered adverse consequences to vaccination (p < 0.05). Among vaccinated participants, breakthrough infections were observed in 7.91% (88/1112; 57.96% males and 42.04% females) with the older age group, 61 years and above (odds ratio, 3.25 [1.32–8.03]; p = 0.011), and males were found to be at higher risk. Further research is needed to find the age and sex‐related factors in determining vaccine effectiveness and adverse events.

Significant higher adverse events following COVID‐19 vaccination in females in comparison to males.

Breakthrough infections among Indian population was found to be 7.91%.

Older people and males were found to be at high risk for getting breakthrough infections.

Arrhythmia prevalence among patients with polymyositis-dermatomyositis in the United States: An observational study

BACKGROUND

Systemic inflammation has been associated with atherosclerotic cardiovascular diseases (ASCVD) and arrhythmia occurrence in rheumatologic conditions such as rheumatoid arthritis. Polymyositis and dermatomyositis (PD) are rare rheumatologic conditions characterized by symmetrical proximal muscle weakness and, in the case of dermatomyositis, cutaneous eruption. Although there is literature associating PD with ASCVD, no population-level studies have analyzed arrhythmia risk in PD.

OBJECTIVE

The purpose of this study was to assess the prevalence of arrhythmia and its subtypes by age and sex in patients with PD and to determine associations between arrhythmia and PD.

METHODS

This retrospective cohort study included adults for whom hospitalizations had been recorded in the National Inpatient Sample database in the United States between 2016 and 2018. Patients with PD were matched (1:10) by age to patients without PD. Prevalence of arrhythmia was calculated in the 2 groups and compared by sex and age groups. Associations between PD and arrhythmia were determined after adjustment for common arrhythmia risk factors.

RESULTS

From 107,001,355 hospitalizations, 32,085 adults with PD were matched to 320,850 controls. Patients with PD aged <70 years had a higher prevalence of arrhythmia and higher adjusted odds of arrhythmia compared with controls. This increased risk was only seen for supraventricular arrhythmias. Adults with PD had increased odds of in-hospital mortality if they had an arrhythmia diagnosis (odds ratio 3.3; 95% confidence interval 2.5-4.5; P <.001).

CONCLUSION

We found a higher prevalence and odds of arrhythmias, particularly supraventricular arrhythmias, in young and middle-aged patients with PD compared with matched controls. Arrhythmias were associated with significant mortality among patients with PD.

Impact of prolotherapy in temporomandibular joint disorder: a quality of life assessment

Chronic pain and functional impairment associated with temporomandibular joint (TMJ) disorders (TMD) considerably reduce oral health-related quality of life (OHRQoL). In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of QoL using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 - 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks) using the method suggested by Hemwall-Hackett. They were asked to answer the OHIP-14 questionnaire before and two years after prolotherapy. Seven domains of OHRQoL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domain scores and total OHIP-14 scores were compared using inferential statistics (chi squared and Wilcoxon signed rank tests). Prolotherapy was effective over time, as all the domains' mean scores decreased considerably after treatment. The total mean score before prolotherapy was 21.20, which was extensively reduced to 13.08 after prolotherapy (p=0.001). There was statistically significant improvement in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap (p≤0.005 in all cases). We concluded that prolotherapy has a promising role in the improvement of OHRQoL of patients with TMD, and its beneficial effects persist at least two years after treatment.

Anesthetic management of a patient with Sheehan's syndrome and twin pregnancy while undergoing a cesarean section

Sheehan's syndrome (SS) is caused by infarction of the pituitary gland usually precipitated by hypotension due to massive uterine hemorrhage during the peripartum period. Once SS develops, it becomes a major comorbidity for the young females and predisposes them to further medical, obstetric, and anesthetic complications. Herein, we report the perioperative anesthetic management of a 28-year-old female, already diagnosed with SS precipitated by urosepsis and septicemic shock in a previous pregnancy, now presenting with twin pregnancy for elective cesarean section. Her magnetic resonance imaging brain revealed pituitary apoplexy and she had hypothyroidism with gestational diabetes mellitus. The overall successful perioperative management of the patient is described along with an emphasis on aggressive management of hypotension due to any cause in the peripartum period to prevent infarction/necrosis of anterior pituitary gland.

Efficacy of buffered local anaesthetics in head and neck infections

Lignocaine is one of the most commonly-used agents to anaesthetise an area preoperatively. It can, however, cause undesirable effects such as burning on injection, relatively slow onset, and unreliable, or lack of, numbness when injected into infected tissues as a result of the acidic pH of commercial preparations (the pH is between 3.5 and 7.0 compared with the physiological pH, which is between 7.35 and 7.45). The aim of this comparative study was to evaluate the efficacy of buffered local anaesthetic on infected areas by altering the pH with 8.4% sodium bicarbonate, to measure the pain before and after the injection, and to record the time of onset of anaesthesia. All 60 patients were given 2% lignocaine hydrochloride with adrenaline 1:80,000 and 30 patients were randomly allocated to have 10:1 dilution of 8.4% sodium bicarbonate (study group). Pain was assessed on a visual analogue scale and a verbal rating scale. There was a significant difference in the amount of pain between control and study groups (p=0.025). The mean (SD) time (minutes) to onset of local anaesthesia in the study group was 1.06 (0.25) compared with 2.96 (0.81) in the control group (p<0.001). Our results confirm the efficacy of the buffered local anaesthetic solution in reducing pain on injection and resulting in quicker onset of anaesthesia. Increasing the pH of lignocaine solutions with bicarbonate immediately before use, therefore, should be considered when treating various acute infections of the head and neck.

Ponseti Technique for the Management of Congenital Talipes Equinovarus in a Rural Set-Up in India: Experience of 356 Patients

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person’s mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.

Galectin-3: an emerging biomarker in stroke and cerebrovascular diseases

The carbohydrate-binding molecule galectin-3 has garnered significant attention recently as a biomarker for various conditions ranging from cardiac disease to obesity. Although there have been several recent studies investigating its role in stroke and other cerebrovascular diseases, awareness of this emerging biomarker in the wider neurology community is limited. We performed a systematic search in PubMed, Embase, Scopus, CINAHL, Clinicaltrials.gov and the Cochrane library in November and December 2016 for articles related to galectin-3 and cerebrovascular disease. We included both human and pre-clinical studies in order to provide a comprehensive view of the state of the literature on this topic. The majority of the relevant literature focuses on stroke, cerebral ischemia and atherosclerosis, but some recent attention has also been devoted to intracranial and subarachnoid hemorrhage. Higher blood levels of galectin-3 correlate with worse outcomes in atherosclerotic disease as well as in intracranial and subarachnoid hemorrhage in human studies. However, experimental evidence supporting the role of galectin-3 in these phenotypes is not as robust. It is likely that the role of galectin-3 in the inflammatory cascade within the central nervous system following injury is responsible for many of its effects, but its varied physiological functions and multiple sites of expression mean that it may have different effects depending on the nature of the disease condition and the time since injury. In summary, experimental and human research raises the possibility that galectin-3, which is closely linked to the inflammatory cascade, could be of value as a prognostic marker and therapeutic target in cerebrovascular disease.

Prevalence of dental caries, periodontitis, and oral hygiene status among 12-year-old schoolchildren having normal occlusion and malocclusion in Mathura city: a comparative epidemiological study

OBJECTIVE

The aim was to find the prevalence of dental caries, periodontitis, and oral hygiene index-simplified (OHI-S) among 12-year schoolchildren having normal occlusion and malocclusion in Mathura city.

MATERIALS AND METHODS

The present study was a cross-sectional study done among the 100 subjects who have been selected from 5 schools in four different geographical locations. The data regarding their socio-demographic characteristics, dental caries status, periodontitis status and oral hygiene status was collected using structured proforma. Means, standard deviations and test of significant were used as statistics to describe the data.

RESULTS

The results showed that there was no significant difference between dental caries status, periodontitis status among subjects having normal occlusion and malocclusion (P = 0.06, 0.093) but significant relationship was found OHI-S and children who were having malocclusion (and P = 0.022). Significant difference was also found between periodontitis and oral hygiene status (P = 0.00).

CONCLUSION

It was observed from the present study that normal occlusion and malocclusion had no or weak significant effect on overall caries and periodontitis prevalence whereas oral hygiene status had a strong effect on overall periodontitis prevalence but not in relation to prevalence of dental caries in 12-year-old school children in Mathura city.

Occurrence of domestic violence among women and its impact on oral health in Jodhpur City

BACKGROUND

This study had a two objectives to determine the prevalence of domestic violence and to know the impact of the same on the oral health.

MATERIALS AND METHODS

An observational cross-sectional study was done in Jodhpur, Rajasthan; among 150 married women of 18 to 60 years of age using a predesigned pretested proforma from 18th January 2014 to 27th February 2014. Pretested semistructured open-ended questionnaire used for collecting the data from the study subjects. Pearson's Chi-square test and p-value were used to calculated the occurrence and impact of domestic violence on oral health among women.

RESULTS

The most common form of domestic violence found was physical abuse (54.7%) followed by emotional abuse (20.0%) and financial abuse (14.0%). The most important risk factor was alcoholism followed by literacy status and having a girl child. Study shows that physical abuse is more in graduate than lower level of educational females. Females living in urban area show highest frequency of physical abuse than those living in rural area. Injury to the face were highly reported (38.7%) followed by injury to lip (13.3%) and nose fracture/bleeding nose (9.3%).

CONCLUSION

Government has to take stringent action to prevent domestic violence by making women more self-reliant especially by making women more literate and more financially independent.

Evaluation of adult dental patterns on orthopantomograms and its implication for personal identification: A retrospective observational study

Background:

Establishing a person's identity is a very complex process and is one of the main objectives of the forensic science also. Dental radiographs are certainly one of the most desirable pieces of antemortem evidence because of their highly objective nature as compared with other records. The aim of the present study is to establish the utility of orthopantomography for human identification.

Materials and Methods:

A total of 300 digital orthomopantographs were randomly selected from those stored at Oral Medicine and Radiology Department of Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune. Dental patterns were classified into nine types which are commonly observed in dental radiography. The diversity of dental patterns was calculated for full dentition, maxilla and mandible respectively.

Results:

Diversity of dental patterns observed for full dentition, maxilla and mandible were found to be 99.9%, 98.2% and 98.4% respectively.

Conclusion:

Findings suggests that orthopantomograms prove to be valuable aid in human identification.

ABO blood groups and oral premalignancies: A clinical study in selected Indian population

Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis) confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P < 0.05) between control versus leukoplakia and OSMF. Interestingly, 24% gutka chewers who had higher number of grades of dysplasia were falling in "A" blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient's risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.

Transarterial chemoembolization using DEBIRI for treatment of hepatic metastases from colorectal cancer

BACKGROUND/AIM

Dismal survival rates of metastatic colorectal cancer (mCRC) to the liver have been recorded. Transarterial chemoembolization (TACE) with irinotecan eluting beads (DEBIRI) may be a safe palliative treatment with fewer serious adverse effects (SAEs). We aimed to establish the safety and efficacy of DEBIRI TACE in the treatment of hepatic metastases from colorectal cancer (CRC).

PATIENTS AND METHODS

A retrospective analysis of DEBIRI TACE was performed. Response was assessed using the m-RECIST criteria. The Common Terminology Criteria for Adverse Events (CTCAE v3.0) were used to record toxicity. Survival was estimated using Kaplan Meier analysis.

RESULTS

Twenty-eight patients treated with 47 DEBIRI TACE procedures were followed from September 2008 until February 2012. Twenty-two had metastases from colonic cancer and six metastases from rectal cancer; three patients (15%) had complete response, six (30%) partial response, four (20%) stable disease and disease progression was recorded in seven (35%); computer tomography (CT) scans were unavailable for eight patients. AEs included gastrointestinal and acid-base disturbances, hypertension, fever, insomnia, chest pain, pruritus, and neutropenia; five patients did not present AEs. The median time from diagnosis of liver metastases to initial DEBIRI treatment was 19.6 months. The median follow-up was 6.9 months. The median overall survival from first treatment was 13.3 months (95% confidence interval=6.8-19.8 months).

CONCLUSION

DEBIRI is a well-tolerated treatment option that can be used safely in the palliative treatment of hepatic metastases from CRC.

Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma

PURPOSE

Treatment of unresectable locally advanced pancreatic cancer (LAPC) usually includes chemotherapy and/or radiation therapy in an attempt to downstage these tumors to the extent of resectability, but outcomes remain poor. Irreversible electroporation (IRE) is an ablative modality that may be useful in this population. The aim of this study was to evaluate the safety of percutaneous IRE in patients with pancreatic adenocarcinoma.

MATERIALS AND METHODS

IRE was performed in patients with pancreatic cancer whose tumors remained unresectable after, or who were intolerant of, standard therapy. The procedures were all done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival.

RESULTS

Fifteen IRE procedures were performed in 14 patients (one was treated twice). Three patients had metastatic disease and 11 had LAPC. All patients had received chemotherapy previously, and 11 had received radiation. The median tumor size was 3.3 cm (range, 2.5-7 cm). Immediate and 24-hour postprocedural scans demonstrated patent vasculature in the treatment zone in all patients. Two patients underwent surgery 4 and 5 months after IRE, respectively. Both had margin-negative resections, and one had a pathologic complete response; both remain disease-free after 11 and 14 months, respectively. Complications included spontaneous pneumothorax during anesthesia (n = 1) and pancreatitis (n = 1), and both patients recovered completely. There were no deaths directly related to the procedure. All three patients with metastatic disease at IRE died from progression of their disease.

CONCLUSIONS

Percutaneous IRE for pancreatic adenocarcinoma is feasible and safe. A prospective trial is being planned.

Clinicohistopathological concordance in leprosy - a clinical, histopathological and bacteriological study of 100 cases

Leprosy is a treatable chronic infectious disease, prevalent in South Asian countries, especially India. Before labeling a patient as a case of leprosy and starting multidrug treatment for particular type, the clinical findings should be correlated and confirmed with histopathological examination and bacteriological index of skin biopsy. Skin biopsy is an important tool in diagnosing leprosy and determining the type of leprosy. In the present study, one hundred untreated clinically diagnosed cases of leprosy were studied according to Ridley-Jopling scale for confirmation of diagnosis and classification of leprosy. The study was done by routine H & E (Haematoxylin & Eosin) staining and Fite-Faraco's staining for acid-fast bacillus. The data pertaining to age, sex, clinical and histopathological classification of the type of leprosy were collected and analyzed. In analyzing the histopathology of a lesion, special attention was given to the following features, viz., invasion of the epidermis with or without erosion, involvement of the sub-epidermal zone, character and extent of granuloma, density of lymphocytic infiltrate epithelioid cells and other cellular elements, nerve involvement and the presence of Mycobacterium leprae. Histological diagnosis of leprosy was established in 98% of clinically diagnosed cases. Clinicohistopathological concordance was maximum in LL(93.75%) followed by BL(87.5%), TT(78.5%), BT(73.8%) and least in IL(27.78%). Overall, it was 60.23%. Indeterminate type of leprosy was diagnosed more on histologythan on clinical evaluation.

Dentofacial characteristics in William's syndrome

William's syndrome is a chromosomal disorder characterized by multisystem, congenital and panethnic occurrence, characterized by a number of developmental and physical abnormalities. This case report describes the dental management of a 10-year-old male patient with William's syndrome who had multiple dental problems such as caries, periodontal disease and malocclusion.

Genetics of hyperpigmentation associated with the Fibromelanosis gene (Fm) and analysis of growth and meat quality traits in crosses of native Indian Kadaknath chickens and non-indigenous breeds

1. The study investigated the extent of hyperpigmentation (a trait fixed in native Indian Kadaknath chickens), bodyweight, carcase quality and leanness at 12 weeks of age in F(1) and back-crosses of Kadaknath with White Leghorn, White Plymouth Rock and Aseel Peela chickens. 2. The objective of the study was to determine if hyperpigmentation was affected by the major gene Fibromelanosis (Fm) and to evaluate the effects of different proportions of Kadaknath genes on growth and carcase quality. 3. The pigmentation pattern of skin indicated that Fm behaved as the primary locus affecting dermal-hyperpigmentation and that the sex-linked Id locus produced an epistatic effect. 4. The results suggested that variable allelic forms of Id were acting in different crosses, which resulted in variation in melanosis of the host. However, no conclusive pattern for shank pigmentation could be explained through genotyping of the Id and Fm loci. 5. Analysis of quantitative traits indicated the positive impact of a Kadaknath genomic proportion of 50% or more on meat texture and carcase leanness. Improvement in leanness occurred in White Rock crosses but not in White Leghorn and Aseel Peela crosses. 6. Thigh-meat texture was influenced more by enhanced Kadaknath genomic proportions than the breast-meat. It was concluded that introgression of Kadaknath genomic proportion beyond 50% in a cross with meat-type chickens, irrespective of the impact Fm, brought improvement in meat quality whereas no such advantage was obtained for growth traits. 7. The beneficial impact of the Kadaknath genome on meat quality calls for further studies to identify causative genes for their selective use to improve meat quality in Kadaknath crossbred chickens.

Cutaneous Tuberculosis : A Clinico-morphological Study

BACKGROUND

Cutaneous tuberculosis forms a small subset of extrapulmonary tuberculosis. The present study is an attempt to observe the clinico morphological pattern seen in cases of cutaneous tuberculosis over a period of 5 years, and to correlate them with mantoux reactivity and human immunodeficiency virus (HIV) status.

METHODS

All cases of cutaneous tuberculosis observed among the dermatology in patients and those attending out patient department were included in the study. The basis of diagnosis was clinical, histopathological and microbiological. Intradermal mantoux test and serological test in the form of enzyme-linked immunosorbent assay (ELISA) for tuberculosis was done. HIV screening was carried out in 32 cases. CD4 counts were done in all HIV positive cases.

RESULTS

A total 0.02% patient attending the dermatology centre had cutaneous tuberculosis. The spectrum of infection included 19 (51%) cases of lupus vulgaris, 7 (19%) cases of papulonecrotic tuberculids, six cases each of tuberculosis verrucosa cutis and scrofuloderma. One case had scrofuloderma and lupus vulgaris and another both scrofuloderma and papulonecrotic tuberculide. One case of lichen scrofulosorum was seen in a seven year old boy. 11 cases revealed evidence of systemic tuberculosis. Seven cases of HIV with CD4 counts between 50-500 cells/μl were observed in this study.

Severe supravalvar aortic stenosis in familial homozygous hypercholesterolemia

Familial homozygous hypercholesterolemia is a rare disease with diverse clinical presentations. Patients often present with cutaneous xanthomas, particularly in the Achilles' tendon. They may have significant cardiovascular involvement, including premature atherosclerotic coronary artery disease and valvar and supravalvar aortic stenosis. Standard therapy includes diet modulation, pharmacotherapy, and lipid apheresis. Rarely, patients require surgical intervention for coronary artery bypass grafting and/or relief of the aortic stenosis. We present the case of a patient with severe progressive supravalvar aortic stenosis that ultimately required surgical resection despite aggressive medical therapy.

Purification and characterization of an aminopeptidase from Lactobacillus casei subsp. rhamnosus S93

An aminopeptidase of broad specificity was extracted by cell lysis of a selected strain of Lactobacillus casei subsp. rhamnosus during the late exponential phase. The enzyme was purified 195-fold from crude extract by using an f.p.l.c. system. Native and SDS/PAGE of the purified enzyme showed a single protein band of 89 kDa. The maximum aminopeptidase activity was observed at pH 7.0 and 39 degrees C. The enzyme hydrolysed a range of nitroanilide-substituted amino acids, as well as dipeptides, and accounted for most of the aminopeptidase activity found in cell-free extracts. The enzyme activity was inhibited by metal chelators such as EDTA and 1,10-phenanthroline. Cobalt ions only stimulated aminopeptidase activity and were also able to re-activate the enzyme previously inhibited by metal chelators. The Km and Vmax. values of the aminopeptidase for leucine p-nitroanilide were 0.06 mM and 12.6 mmol/min per mg of protein respectively. This enzyme was stable over the pH range of 5-9 and below 45 degrees C.

A radioimaging technique for quantifying regional myocardial blood flow

We developed a radioimaging technique for measuring regional myocardial blood flow (rMBF) in 5 mm2 myocardial tissue using canine closed-chest models. RMBF was measured in three groups: (1) total occlusion of left anterior descending (LAD) coronary artery with microfibrillar collagen, (2) fixed stenosis of LAD with angioplasty balloon, and (3) comparison of clinical dose response of adenosine (AD) and dipyridamole (DP) on rMBF. In these studies, rMBF in every 5 mm2 tissue was measured throughout the epicardium and endocardium. In groups 1 and 2, rMBF was also measured during adenosine-induced coronary hyperemia (ADICH). In group 1 (n = 7), rMBF measured at 6 hours post-LAD occlusion in epicardial infarct center (IC), peri-infarct (PI) and normal zone (NZ) were 17 +/- 7, 55 +/- 8, and 132 +/- 12 ml/min/100 tissue, respectively. The area and location of infarct seen in TTC staining matched with rMBF images. During ADICH, the corresponding rMBF were 16.2 +/- 13.9, 98.3 +/- 53.0, and 226.0 +/- 103.6 ml/min/100 g tissue, respectively. RMBF measured during ADICH in group 2 (n = 4) in areas of LAD stenosis (LS), surrounding stenosis (SS), and no stenosis (NS) were 120 +/- 58, 249 +/- 123, and 432 +/- 181 ml/min/100 gm tissue, respectively. In group 3, rMBF measured during 3 min into 0.14 mg/kg/min adenosine infusion in areas perfused by LAD, circumflex (CX) and right coronary artery (RCA) were 244 +/- 22, 238 +/- 19, and 215 +/- 19 ml/min/100 g tissue, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Systematic errors in bone-mineral measurements by quantitative computed tomography

Bone-mineral measurements using quantitative computed tomography (QCT) are commonly based on comparisons with solutions in water of known concentrations of K2HPO4. In this paper are described theoretical and experimental studies that have led to the conclusion that large systematic errors can arise in these measurements, depending on the soft-tissue and fat concentrations in the vertebral spongiosa. In the case of single energy scanning, such large errors have been identified to be due to the varying water content (displacement effect) in the calibration samples and the varying fat content in the region of interest (ROI) within the patient. In the case of dual energy scanning, the error arises because when normalized to that of water, the mass attenuation coefficient of fat increases with photon energy while the reverse is true for K2HPO4. Our studies have also revealed that total trabecular bone density (which includes the mineral, soft tissue, and fat) can be much more accurately determined by the dual energy QCT method than bone mineral alone. This finding is especially interesting since there have been several reports in the literature suggesting that bone density rather than bone-mineral content is a better predictor of the risk of osteoporosis-related fractures.

Studies on the male antifertility agent--gossypol acetic acid. III. Effect of gossypol acetic acid on rat testis

Gossypol acetic acid at the dose of 5 mg/rat/day for 2 and 4 weeks did not cause any significant effect on the body weight, testis, epididymis, seminal vesicle and prostate weight, nor gossypol treatment had any significant effect on the activities of acid phosphatase and succinic dehydrogenase in the testis. Changes in the testis ATPase activity were, however, significant after gossypol treatment. During the course of present investigations no effect of gossypol treatment on 3H thymidine incorporation into DNA of testicular cells was observed, nor there were any changes in the DNA and total protein content of the testis after gossypol treatment. Gossypol treatment did not cause any effect on the plasma Na+ level. However, transient decrease in the plasma K+ level was observed; decrease in K+ level two weeks after gossypol treatment was restored to normal after 4 weeks of gossypol treatment. No changes in the histology of the testis were observed 2 weeks after gossypol treatment but marked inhibition of spermatogenesis was observed 4 weeks after gossypol treatment. Motility of vas deferens spermatozoa was also markedly inhibited 4 weeks after gossypol treatment. In the light of the present observations and those of others, there is a clear demonstration that gossypol acts directly on the spermatozoa and on the testis; at both the sites the drug interferes in the ATPase activity.