Prior COVID-19 infection may increase risk for developing endothelial dysfunction following hematopoietic cell transplantation

Endothelial dysfunction underlies many of the major complications following hematopoietic cell transplantation (HCT), including transplant-associated thrombotic microangiopathy (TA-TMA), veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS), and engraftment syndrome (ES). Emerging evidence similarly implicates endothelitis and microangiopathy in severe COVID-19-related multi-system organ dysfunction. Given the overlap in these two illness states, we hypothesize that prior COVID-19 infection may increase risk for HCT-related endotheliopathies. This retrospective, multicenter study included patients aged 0-25 years who underwent autologous or allogeneic HCT for any indication between January 1, 2020 and September 21, 2021, with close attention to those infected with COVID-19 in either the six months prior to transplant or twelve months following transplant. Incidences of TA-TMA, VOD/SOS, and ES were compared among patients with COVID-19 infection pre-HCT and post-HCT, as well as with historical controls who were never infected with SARS-CoV-2. Those who underwent HCT following COVID-19 infection displayed significantly increased rates of TA-TMA compared to those who were never infected. Additionally, our data suggests a similar trend for increased VOD/SOS and ES rates, although this did not reach statistical significance. Therefore, a history of COVID-19 infection prior to undergoing HCT may be a nonmodifiable risk factor for endothelial-related complications following HCT. Further studies are warranted to better clarify this relationship among larger cohorts and in the era of the Omicron SARS-CoV-2 variants.

A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy

Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Reports of inequity and related disparities in care are emerging. In this multicenter study of ALL patients admitted for anti-leukemia therapy, who required pediatric intensive care (ICU) support (n = 205), patients receiving tisagenlecleucel (n = 39) were compared to those receiving conventional chemotherapy (n = 166). The median time to ICU transfer was 6 (0–43) versus 1 (0–116) days, respectively (p < 0.0001). There was no difference in the use of vasopressor, ionotropic, sedating, and/or paralytic agents between groups, but use of dexamethasone was higher among tisagenlecleucel patients. Patients receiving tisagenlecleucel were more likely to have cardiorespiratory toxicity (p = 0.0002), but there were no differences in diagnostic interventions between both groups and/or differences in ICU length of stay and/or overall hospital survival. Toxicities associated with tisagenlecleucel are generally reversible, and our findings suggest that resource utilization once admitted to the ICU may be similar among patients with ALL receiving tisagenlecleucel versus conventional chemotherapy. As centers consider improved access to care and the feasibility of tisagenlecleucel certification, our study may inform strategic planning.

Neonatal testing leading to the identification of Bh (para-Bombay) phenotype in the mother: case report with review of the literature

Para-Bombay is a rare phenotype with a homozygous nonfunctional FUT1 gene and a normal FUT2 gene leading to H-deficient red blood cells (RBCs) with or without ABH substances, depending on inheritance of the ABO gene. This case is about a 5-day-old male baby suffering from sepsis who required a 45-mL packed RBC transfusion. The baby's sample tested as A₁B, D+ and mother's sample tested as group O, D+ with group 4 discrepancy due to ABO isoagglutinins. Further workup of the mother's sample with anti-H lectin was negative, which suggested the mother to be group O_h, D+. Antibody screening was panreactive with negative autocontrol, suggestive of anti-H. The titer of immunoglobulin (Ig)M anti-H was 64, IgG titer using dithiothreitol was 8, and anti-IH was absent. A negative adsorption and elution test suggested that RBCs were devoid of A and B antigens. The father's sample tested clearly as group A₁, D+; hence, the cis-AB blood group was ruled out in the baby. The secretor study of the mother's saliva revealed the presence of B and H substances that neutralized polyclonal B and H antisera. Therefore, we concluded that the mother was of the para-Bombay (B_h) phenotype. This case highlights the importance of reverse grouping and resolving blood grouping discrepancies between mother and child-in this case because of an incongruous ABO blood type of the baby and the mother who was previously tested as group O, D+.

Para-Bombay is a rare phenotype with a homozygous nonfunctional FUT1 gene and a normal FUT2 gene leading to H-deficient red blood cells (RBCs) with or without ABH substances, depending on inheritance of the ABO gene. This case is about a 5-day-old male baby suffering from sepsis who required a 45-mL packed RBC transfusion. The baby’s sample tested as A₁B, D+ and mother’s sample tested as group O, D+ with group 4 discrepancy due to ABO isoagglutinins. Further workup of the mother’s sample with anti-H lectin was negative, which suggested the mother to be group O_h, D+. Antibody screening was panreactive with negative autocontrol, suggestive of anti-H. The titer of immunoglobulin (Ig)M anti-H was 64, IgG titer using dithiothreitol was 8, and anti-IH was absent. A negative adsorption and elution test suggested that RBCs were devoid of A and B antigens. The father’s sample tested clearly as group A₁, D+; hence, the cis-AB blood group was ruled out in the baby. The secretor study of the mother’s saliva revealed the presence of B and H substances that neutralized polyclonal B and H antisera. Therefore, we concluded that the mother was of the para-Bombay (B_h) phenotype. This case highlights the importance of reverse grouping and resolving blood grouping discrepancies between mother and child―in this case because of an incongruous ABO blood type of the baby and the mother who was previously tested as group O, D+.

The impact of household energy poverty on the mental health of parents of young children

BACKGROUND

Energy poverty, typified by cold homes and/or an inability affording energy bills, presents risks to the mental health of occupants. Parents of young children may be especially susceptible to a mental health toll from energy poverty since they have a significant care obligation and spend much of their day at home.

METHODS

Data from the Growing Up in Ireland study inform this longitudinal analysis.

RESULTS

A 1.64 greater odds of maternal depression were estimated for households containing young children characterized by energy poverty [P = 0.000; 95% confidence interval (CI): 1.31-2.05]. For energy poor households with older children (9 years and above), the odds of maternal depression were also higher [odds ratio (OR) 1.74, P = 0.001; 95% CI: 1.27-2.39]. Fathers of young children had greater odds of depression in energy poor households (OR 1.59, P = 0.002; 95% CI: 1.19-2.12), though the deleterious effect on mental health was not statistically significant for fathers of older children.

CONCLUSIONS

Energy poverty increases the likelihood of depression in parents. These findings merit policy attention since a mental health burden is in itself important, and more widely, parental well-being can influence child development and outcomes.

Associated oral lesions in human immunodefeciency virus infected children of age 1 to 14 years in anti retroviral therapy centers in Tamil Nadu

Aim:

To evaluate the prevalence of oral lesions status in human immunodeficiency virus (HIV) infected children of age 1 to 14 years in Anti Retro viral therapy (ART) centres in Tamil Nadu.

Materials and Methods:

A of total 326 HIV infected children, age 1 to 14 years of which 174 male children and 152 female children were examined for Oral lesions in the Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University in association with the ART centers in Villupuram, Vellore and HIV Homes in Thiruvannamalai, Trichy and Salem in Tamil Nadu towns.

Statistical Analysis:

Statistical Package for Social Science for Windows (version 11 code: 3000135939012345).

Result:

Of the total 326 children, 201 (61.65%) had oral lesions. (68 [20.86%] with Oral Candidiasis [OC], 54 [16.56%] with Angular Cheilitis, 27 [8.28%] with Necrotizing Ulcerative Gingivitis [NUG], 25 [7.66%] with Necrotizing Ulcerative Periodontitis [NUP], 18 [5.53%] with Linear Gingival Erythema [LGE] and 9 [2.76%] with Apthous Ulcer.) Conclusion Among the oral lesions in HIV infected children, OC 20.86% was the predominant oral lesion followed by Angular Chelitis 16.56%, NUG 8.28%, NUP 7.66%, LGE5.53% and Apthous Ulcer 2.76%.

Pre-emptive, early, and delayed alendronate treatment in a rat model of knee osteoarthritis: effect on subchondral trabecular bone microarchitecture and cartilage degradation of the tibia, bone/cartilage turnover, and joint discomfort

OBJECTIVE

Bisphosphonates are considered potential disease modifying osteoarthritis (OA) agents. The present study investigated the efficacy of pre-emptive, early, and delayed alendronate (ALN) treatment initiation on subchondral trabecular bone and cartilage in low-dose monosodium iodoacetate (MIA)-induced knee OA in rats.

METHODS

Male rats received pre-emptive (n = 12, day 0-end of week 2), early (n = 12, end of week 2-end of week 6), or delayed (n = 12, end of week 6-end of week 10) ALN treatment (30 μg/kg/week). Pre-emptive ALN-treated rats were scanned using in vivo micro-computed tomography (micro-CT) after 2 weeks and then sacrificed, early ALN-treated rats were scanned after 2 and 6 weeks and sacrificed, and the delayed ALN-treated rats were scanned after 2, 6, and 10 weeks of OA induction and sacrificed. After sacrifice, bone histomorphometry and histology of the tibia and biomarker analyses were undertaken. Changes in hind limb weight-bearing were assessed from day -1 until day 14.

RESULTS

MIA-induced pathological features similar to progressive human OA in the cartilage and subchondral bone. Pre-emptive ALN treatment preserved subchondral trabecular bone microarchitecture, prevented bone loss, decreased bone turnover and joint discomfort. Pre-emptive ALN treatment had moderate effects on cartilage degradation. Early and delayed ALN treatments prevented loss of trabeculae and decreased bone turnover, but had no significant effect on cartilage degradation.

CONCLUSION

ALN prevented increased bone turnover and preserved the structural integrity of subchondral bone in experimental OA. The time point of treatment initiation is crucial for treating OA. Treating both the subchondral bone and cartilage in OA would be clinically more beneficial.

Olfactory cues increase avoidance behavior and induce Fos expression in the amygdala, hippocampus and prefrontal cortex of socially defeated mice

Genes and proteins of the Fos family are used as markers of neuronal activity and can be modulated by stress. This study investigated whether social defeat (SD) or exposure to an olfactory cue associated with the SD experience activated Fos and FosB/DeltaFosB (ΔFosB) expression in brain regions implicated in the development of post-traumatic stress disorder. Mice exposed to acute SD showed more Fos positive cells in the basolateral amygdala (BLA), CA1 of the hippocampus and the medial prefrontal cortex (mPFC) 1h after SD, and had greater expression of the more persistent FosB/ΔFosB protein in the BLA 24 h after SD compared to controls. Mice exposed to an olfactory cue 24 h or 7 days after SD had higher levels of Fos expression in all three regions 1h after exposure to the cue, and displayed increased avoidance behavior compared to controls. While the avoidance response dissipated with time (less at 7 day vs 24 h after social defeat), Fos expression in the mPFC and CA1 in response to an olfactory cue was greater at 7 days relative to 24 h after social defeat. The results suggest additional processing of the cue-stress association and may provide further support for a role of the mPFC in fear inhibition. These findings may have implications for brain regions and circuitry involved in the avoidance of cues associated with a stressful event that may lead to context-dependent adaptive or maladaptive behavior.

Serum lipoprotein (a) and lipid profile in young South Indian patients with myocardial infarction

Coronary artery disease is now a major health problem in India. In past few decades the battle to reduce the incidence of coronary artery disease has led the researchers to look for various clinical markers, which would help early diagnosis of the diseases. The present study was undertaken to assess the level of lipoprotein (a) [Lp(a)] and few other lipids in selected myocardial infarction (MI) patients below 45 years without having any traditional risk factors but with positive family history. Fasting blood samples were taken from 65 patients and their total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglycerides and serum Lp(a) were determined. The control group consisted of 50 age matched healthy individuals. The mean Lp(a) level was 58.6±3.20 mg/dl in patients and 19.70±0.18 mg/dl in controls. Thus Lp(a) levels were found significantly higher in patients with MI (p<0.05 for patients versus control) as compared to the controls. There was no significant difference in the levels of total cholesterol (TC), LDL, VLDL HDL, TGL as compared to controls but there was an increase in TC/HDL cholesterol ratio. The results of this study suggest that high level of Lp(a) and TC/HDL ratio has a distinctive association with MI, independent of other common coronary risk factors. Hence, Lp(a) level in serum emerges to be a promising marker for diagnosis of coronary artery diseases.

Homocysteine status and acute myocardial infarction among Tamilians

Myocardial infarction is a major consequence of coronary artery disease. Apart from the traditional risk factors of myocardial infarction, recently many reports have suggested that hyperhomocysteinemia plays important role in myocardial infarction. Plasma homocysteine level was determined in 60 myocardial infarction patients and in 35 age matched healthy individuals. Statistically significant differences (p<0.01) were observed in the mean of plasma homocysteine concentrations between the acute myocardial infarction patients (24.59±6.14 mM/L) and in normal healthy individuals (13.73 ±3.54 mM/L). The level of homocysteine in myocardial infarction patients is significantly high (p <0.01) among myocardial infarction patients when compared to that of the controls. The the present study indicates a strong association between plasma homocysteine and acute myocardial infarction among Tamilians, thus implying plasma homocysteine as a possible risk factor for myocardial infarction.

Early intervention for first-episode psychosis in India

OBJECTIVE

There have been very few studies of first-episode psychoses or early intervention programmes in India. This paper describes a pilot intervention programme for first-episode psychosis at the Schizophrenia Research Foundation, India.

METHODS

A total of 47 patients with the first episode of psychosis were followed up for 2 years. Based on the Positive and Negative Syndrome Scale for schizophrenia and Global Assessment of Functioning Scale scores, the data from 2 groups of patients, those who had remission and those who did not, were identified and compared. Assessments done at 3, 6, 12 and 24 months after recruitment enabled computation of time to achieve remission.

RESULTS

Complete data were available for 38 patients (28 patients in remission group and 10 patients in non-remission group) at 2 years. Baseline scores were not significantly different between the groups. In the remission group, more than 50% attained maximal improvement at 3 months, another 30% at 1 year, and the remaining 20% at 2 years. Maximal reduction in the mean Positive and Negative Syndrome Scale score was seen between 3 and 6 months after recruitment.

CONCLUSIONS

With regular treatment, most patients with early psychosis achieve remission within 2 years. Negative symptoms persisting for longer than 6 months could be an indicator of long-term outcome. Early intervention is feasible and effective in developing countries.

Assessment and comparison of microleakage of a fluoride-releasing sealant after acid etching and Er: YAG laser treatment - An in vitro study

Aim:

The aim of the present study was to estimate and compare the microleakage of a pit and fissure sealant after etching and Er:YAG laser treatment.

Materials and Methods:

Twenty non-carious premolars extracted for orthodontic reasons were equally divided into two groups. Samples in Group- I were treated with 37% phosphoric acid. Samples in Group II were irradiated with Er: YAG laser at 400 mJ at 4 Hz. Sealant was placed and light cured. Then, the samples were subjected to thermocycling. The samples were then immersed in 1% methylene blue. The samples were sectioned and examined under stereomicroscope at ×10 magnification.

Results:

Acid etched samples showed significantly less microleakage when compared to laser etching and it was statistically significant (P<0.01).

Mutations in WDR62, encoding a centrosomal and nuclear protein, in Indian primary microcephaly families with cortical malformations

Primary microcephaly is an autosomal recessive disorder characterized by smaller than normal brain size and mental retardation. It is genetically heterogeneous with seven loci: MCPH1-MCPH7. We have previously reported genetic analysis of 35 families, including the identification of the MCPH7 gene STIL. Of the 35 families, three families showed linkage to the MCPH2 locus. Recent whole-exome sequencing studies have shown that the WDR62 gene, located in the MCPH2 candidate region, is mutated in patients with severe brain malformations. We therefore sequenced the WDR62 gene in our MCPH2 families and identified two novel homozygous protein truncating mutations in two families. Affected individuals in the two families had pachygyria, microlissencephaly, band heterotopias, gyral thickening, and dysplastic cortex. Using immunofluorescence study, we showed that, as with other MCPH proteins, WDR62 localizes to centrosomes in A549, HepG2, and HaCaT cells. In addition, WDR62 was also localized to nucleoli. Bioinformatics analysis predicted two overlapping nuclear localization signals and multiple WD-40 repeats in WDR62. Two other groups have also recently identified WDR62 mutations in MCPH2 families. Our results therefore add further evidence that WDR62 is the MCPH2 gene. The present findings will be helpful in genetic diagnosis of patients linked to the MCPH2 locus.

Effect of therapy on serum zinc and copper in primary complex of children

Tuberculosis is a global problem especially in children, more so because of the difficulty in the diagnosis of the disease. There are about 0.5 million deaths every year by this disease, worldwide. There are some reports that, during the disease, there are changes in serum concentrations of zinc and copper, which reach towards normal levels during treatment. Such data for children are scarce, especially in reference to India. Our study indicates that there is an insignificant to significant rise in serum zinc levels in various age groups of children after antitubercular therapy (mean 61.89 +/- 3.21 to 65.24 +/- 3.60 microg/dl) and significant fall in serum copper levels in different age groups of children (mean 129.96 +/- 3.18 to 124.91 +/- 3.48 microg/dl). The Cu/Zn ratio also changed significantly from 2.11 +/- 0.12 to 1.92 +/- 0.12. Because evaluation of available diagnostic criteria for primary complex in children has been found to have high sensitivity, and although this criterion is presently not recommended for diagnosis of primary complex of children, further research can prove its utility in diagnosis and treatment of this disease.

Comparative study of misoprostol vs dinoprostone for induction of labour

Various methods of induction of labour may be associated with risk and complications. Therefore, this study has been undertaken to compare the safety and efficacy of intra-vaginal misoprostol (PGE1 analogue) with intra-cervical dinoprostone (PGE2) in progress and induction of labour, the maternal side effects and the foetal outcome. 40 pregnant women aged between 16-35 years with indication of induction of labour participated in the study. Twenty patients (control) were administered 0.5 mg dinoprostone intra-cervically, 12 hourly while 20 patients (study group) were given misoprostol 100 microg, 4 hourly, intravaginally. The mean induction of labour initiation interval was 2.08 +/- 1.46 hours in study group and 2.21 +/- 1.20 hours in dinoprostone group. The Induction delivery interval was 6.92 +/- 4.01 hours in misoprostol group and 12.54 +/- 7.73 in dinoprostone group, whereas vaginal route of delivery was 95% in misoprostol group and 85% in dinoprostone group. Average dosages required were 1.55 +/- 1.02 in misoprostol group and 1.30 +/- 0.46 in dinoprostone group. All these result were statistically significant. Very few maternal side effects were reported in study group. There was no significant difference in foetal out come in either group. Therefore, it can be concluded that misoprostol is easy to administer and is cheap, effective, safe and convenient drug for induction of labour.

Dietary phytoestrogens enhance spatial memory and spine density in the hippocampus and prefrontal cortex of ovariectomized rats

Long-term maintenance of ovariectomized rats (9 weeks) on chow containing high phytoestrogen levels (Purina LabDiet 5001) as compared to chow with minimal phytoestrogens (Harlan 2016 Teklad) was associated with better performance of the spatial memory task, object placement, increased dendritic spine density in CA1 and prefrontal cortex pyramidal neurons, and higher uterine weights. Object recognition memory, anxiety on an elevated plus maze and body weight were unaffected by phytoestrogen levels in the diet.

Zinc and copper in Indian patients of tuberculosis: impact on antitubercular therapy

The effectiveness and success of antitubercular therapy is mainly measured by identifying the organism in sputum. In certain patients, especially in geriatric patients, available tuberculosis tests are not satisfactory and do not provide enough information on the effectiveness of antitubercular therapy, as the symptoms might be confused with the existing symptoms of ongoing diseases. Therefore, 60 diagnosed and randomly selected patients with tuberculosis were included into this study. The patients with other associated diseases likely to influence serum copper and zinc were not included in the study. The estimations of serum copper and zinc were done in healthy volunteers and in tubercular patients before the start of treatment and after 4 wk of antitubercular treatment. The average plasma concentration of serum copper and zinc in healthy volunteers were 102 +/- 20 microg/dL and 96 +/- 18 microg/dL respectively. In tuberculosis patients, serum copper and zinc levels were 123.65 +/- 9.98 microg/dL and 64.14 +/- 3.97 microg/dL, respectively, before the start of treatment, which came down to 116.23 +/- 4.27 mug/dL and 74.31 +/- 3.60 microg/dL, respectively, after 4 wk of antitubercular treatment.

Estimation of serum zinc and copper in children with acute diarrhea

Diarrhea is, in reality, as much a nutritional disease as one of fluid and electrolyte loss. Children who die from diarrhea, despite good management of dehydration, are usually malnourished and often severely so. In this study, we determined the serum levels of zinc and copper before and after standard oral rehydration solution (ORS) therapy in children with acute diarrhea and correlated it with diarrheal duration and severity. One hundred ten children suffering from acute diarrhea were included. Serum zinc and copper levels of these children were estimated at the time of enrollment and after treatment with standard ORS therapy. This study shows that children suffering from acute diarrhea show a statistically significant decrease of 13.1% and 12.8% in serum zinc and copper concentrations, respectively, compared to normal. These levels further decrease by 22.6% and 22.4%, respectively, after treatment with standard ORS therapy. Our study shows that children with the lower plasma zinc and copper levels suffered with more severe and longer duration of diarrhea. Zinc and copper supplementation could be added to standard ORS therapy for the reduction in morbidity and mortality associated with acute diarrhea in children.

Measurement of 40k as an indicator of body potassium: implication for diabetes and other disease conditions

Potassium (K) content in 408 male workers of a rare earths processing plant was estimated using a shadow shield whole body counter. The average K content in the non-vegetarian and vegetarian group was found to be 1.5 g kg(-1) and 2.1 g kg(-1) respectively. The absorbed dose due to 40K is determined as 0.18 +/- 0.02 mGy. While the K content was found to be proportional to body build index, it is inversely proportional to slenderness. Body K was maximum in the middle aged group (35-45 y) and a minimum in younger and older persons. The correlation of potassium content with some disease patterns was also studied. Diabetes mellitus patients were observed to have low K content of 0.9 +/- 0.2 g kg(-1) and those who suffer from cardiovascular disorders were found to have high K content 2.7 +/- 0.3 g kg(-1). The studies showed that the depletion of body K content takes place a few years prior to the clinical detection of diabetes and it builds up a few years before the clinical detection of cardiovascular disorders. It is stressed that the medical information is preliminary as the number of subjects studied was not very large. Wider and in depth study by various groups can hopefully strengthen the observation.

Chromaproline and Chromaperidine, nicotine agonists, and Donepezil, cholinesterase inhibitor, enhance performance of memory tasks in ovariectomized rats

Chromaproline and Chromaperidine, two recently synthesized and pharmacologically characterized nicotinic agonists, and Donepezil (Aricept), an acetylcholinesterase inhibitor approved for the treatment of memory loss, were evaluated for effects on performance of a visual recognition memory task (object recognition) and a spatial memory task (object placement). Ovariectomized female rats received the drugs chronically via subcutaneous Alzet minipumps. None of the drugs altered activity in the open field or the time spent exploring objects in the field. One week following initiation of treatment, all three drugs enhanced performance of the visual recognition task, but only Donepezil enhanced performance of the spatial memory task. With a longer period of treatment (3 weeks), the nicotinic agonist Chromaproline also enhanced object placement performance. Current results show the memory-enhancing efficacy of Donepezil in two additional memory tasks in rats and suggest that the novel nicotinic agonists, Chromaproline and Chromaperidine, may also be useful new drugs for the treatment of memory impairments/loss.

Race and the decision to refer for coronary revascularization: the effect of physician awareness of patient ethnicity

OBJECTIVES

We sought to assess whether there were differences, relative to racial ethnicity, in coronary revascularization recommendations made by a panel that had no knowledge of the patients' ethnicity.

BACKGROUND

Coronary revascularization is employed less frequently in African American than in white patients. It is unclear whether this utilization pattern is driven by clinical differences between the two populations or by nonclinical factors.

METHODS

Data were reviewed from 938 (26.5% African American, 73.5% white) consecutive cardiac catheterizations done between 1993 and 1995. Revascularization recommendations were made by cardiologists and cardiothoracic surgeons provided with the patients' clinical and angiographic data, but without knowledge of their ethnicity. Revascularization recommendations were compared between African American and white patients and correlated with clinical characteristics.

RESULTS

No difference was noted in the percentage of African American and white patients recommended for revascularization, without reference to whether the recommendation was for percutaneous transluminal coronary angioplasty (PTCA) or for coronary artery bypass graft surgery (CABG) 40 vs. 46%, p = NS). African Americans were recommended more frequently for PTCA (22 vs. 18%, p = NS), whereas CABG was recommended for more white patients (28 vs. 18%, p = 0.002). Significantly fewer African Americans had disease in the left main or left anterior descending coronary artery or in multiple arteries. After adjusting for age, co-morbidity, left ventricular dysfunction and the extent of coronary disease, African Americans were more likely to have a recommendation for PTCA (odds ratio [OR] 1.42, 95% confidence interval [CI] 0.96 to 2.11, p = 0.08) and less likely to have a recommendation for CABG (OR 0.59, 95% CI 0.37 to 0.94, p = 0.02).

CONCLUSIONS

This study suggests that when only clinical factors are considered, the rates of recommendations for revascularization will be similar for white and African American patients; but the type of revascularization procedure may differ by ethnicity and may depend, in part, on clinical factors.

Relative prevalence of hepatitis B viral markers and hepatitis C virus antibodies (anti HCV) in Madurai, south India

(1) The positivity of HBsAg was 4% (75/1819) whereas anti HCV was present only in 0.75% (27/3574) of blood donors. (2) 5.3% (4/75) of hospital staff had HBsAg alone in their blood samples. One doctor, one Staff nurse, one Lascar and one Sanitary worker were positive for HBsAg. None of them were positive for anti HBcIgm and anti-HCV. (3) 29% (31/115) of suspected hepatitis cases were positive for any one of the viral markers or both. 21% (15/72) of males and 14% (6/43) of females were positive for HBsAg. Whereas only 4% (3/72) of males and 2% (1/43) of females were positive for anti HCW. Both HBsAg and anti HCV were found in 8% (6/72) of males only. The age group predominantly, i.e. in 29 out of 31 cases found positive for HBsAg and/or anti HCV, was above 15 years. Two remaining HBsAg positive cases belonged to the 5 to 14 years age group. 71% (84/115) of suspected hepatitis cases were negative for both HBsAg and anti HCV.

Microfilaria in a fine needle aspirate of primary solid malignant tumor of the maxillary antrum. A case report

BACKGROUND

Lymphatic filarial disease is very common in tropical countries like India. The incidental finding of microfilariae in various benign cytologic smears is very common. Microfilariae in malignant effusions have also been reported, but their coexistence with solid malignant tumor at the primary site has not been reported so far.

CASE

A 45-year-old male presented with a painful, rapidly growing swelling over the right maxilla that had been present for three months. On routine fine needle aspiration cytology, a microfilaria along with squamous carcinoma cells in a primary solid malignant tumor of the maxillary antrum was found.

CONCLUSION

This is the first case reported in English of the incidental finding of a microfilaria in a primary tumor of the maxillary antrum.

A confidential enquiry into deaths caused by asthma in an English health region: implications for general practice

AIM

To determine the factors contributing to death from asthma in patients aged under 65 years in East Anglia in the early 1990s.

METHOD

We have performed on ongoing confidential enquiry since January 1992. For the first time a general practitioner was included in the enquiry team.

RESULTS

A review of the clinical and pathological data of the 50 patients reported in the first 3 years suggested that 36 of these deaths were attributable to asthma. Thirty-one patients died out of hospital (3 en route to the hospital), 2 in the Accident and Emergency department, and only 3 in hospital. Adverse social factors were found in 25 out of 34 patients, and adverse psychological characteristics in 23 of the 31 patients where these could be assessed. Only 7 appeared to have no adverse psychological or social factors. Routine medical care was considered appropriate in 20 patients, and inappropriate in 14. Twenty-four had received appropriate advice and education. Nine of the 21 patients, where this could be assessed, and half the relatives, failed to respond appropriately to worsening asthma symptoms during the fatal attack. No potentially preventable factors were identified in two women who died of end stage asthma.

CONCLUSION

This enquiry has demonstrated that inadequacies in the medical care of asthma continue to occur, although less frequently than in previous asthma-death studies. In addition, 79% of the patients had experienced psychosocial factors which appeared important in contributing to their deaths. Recommendations for identifying and managing such "at risk' patients have been circulated to all general practitioners and chest physicians in the region.

Serum magnesium: a prognostic tool of acute myocardial infarction

In an attempt to find the prognostic value of serum magnesium in various complications, serum magnesium was estimated spectrophotometrically, in patients of acute myocardial infarction. There was a statistically insignificant difference in serum magnesium levels of complicated group of patients (1.627 +/- 0.192 mg/100 mL) and those who had uneventful recovery (1.412 +/- 0.132 mg/100 mL). However, this difference was highly significant when compared between control group (2.514 +/- 0.16 mg/100 mL) and complicated and uncomplicated cases separately. It was also observed that serum magnesium levels were lowest in patients who died due to major arrhythmias and cardiogenic shock followed by patients who had arrhythmias (especially ventricular tachycardia) and pump failure. The routine use of iv magnesium is recommended within first few hours of acute myocardial infarction to reduce mortality, arrhythmias and pump failure.

Effect of various cooling rates (from 30°C to 5°C) and thawing temperatures on the deep-freezing of and semen

A total of 36 semen ejaculates, six from each of three Holstein-Friesian bulls and three Murrah buffalo bulls, were frozen in tris citric acid-fructose-egg-yolk-glycerol diluent after 1 hour of equilibration to study the effect of various cooling rates (15, 30, 60 and 120 minutes from 10 degrees to 5 degrees C vs a control sample cooled for 120 minutes from 28 degrees to 5 degrees C) and thawing temperatures (40 degrees C 60 seconds , 60 degrees C 15 seconds and 80 degrees C 5 seconds ) on prefreeze and post-thaw sperm motility. Sperm motility differed significantly (P < 0.01) between various cooling rates in both the Holstein-Friesian bull semen and the Murrah buffalo semen at prefreezing, immediately post-thawing, and after 1 hour of post-thaw incubation at 38 degrees C. Post-thaw sperm motility and survival at 38 degrees C were significantly (P<0.01) higher in Holstein-Friesian bulls at 60 degrees C and 80 degrees C than at 40 degrees C (39.79+/-2.46% and 38.15+/-2.18% Vs 35.16+/-2.19%, and 20.22+/-2.14% and 19.05+/-2.05% vs 14.83+/-1.64%, respectively). In Murrah buffalo bulls the recovery percentage and survival rate increased significantly (P<0.01) with the increase in temperature from 40 degrees C to 80 degrees C (41.72+/-2.45%, 47.45+/-2.09% and 51.61+/-2.06%; and 9.22+/-1.47%, 11.79+/-1.63% and 12.27+/-1.53%, respectively). Prefreeze motility did not differ between cattle and buffalo bulls (64.97+/-1.08% Vs 67.11+/-0.89%, respectively) but post-thaw motility was significantly (P<0.01) higher in the buffalo (46.93+/- 1.39% Vs 37.70+/-1.32%). While incubation survival was higher in the cattle (18.04+/-1.16% Vs 10.96+/-0.89%). A fast cooling rate was found to be detrimental for cattle spermatozoa, whereas the post-thaw buffalo sperm motility deteriorated very quickly at 38 degrees C. The influence of species-by-cooling rate interaction was significant (P<0.01) for post-thaw motility and survival rate, but the species-by-thawing or cooling-by-thawing interactions were not significant. These results suggest that a cooling rate of 2 hour either at 10 degrees C or 28 degrees C is essential for cattle semen. However, buffalo semen can be frozen successfully after 30 minutes of cooling at 10 degrees C. A thawing temperature of 60 degrees C yielded a higher sperm motility rate than 40 degrees C. Thus, our findings can be applied under tropical conditions for the successful freezing-thawing of bovine semen provided conception rates are not affected adversely.

Effects of cold shock treatment on angiotensin-converting enzyme activity and on semen characteristics in roosters and bulls

Angiotensin-converting enzyme (ACE) activity has been determined in the semen of certain avian and mammalian species as well as its release during cold shock. The maximum and minimum levels of this enzyme were found in mammalian spermatozoa and in seminal plasma, respectively. It was found that ACE activity in mammalian spermatozoa was more pronounced than in the seminal plasma, whereas in the avian species a revers pattern was observed. However, there were no significant differences in ACE activity in spermatozoa and seminal plasma between layer and broiler strains of avian species. By contrast, ACE activity in the spermatozoa and seminal plasma of buffalo bulls was significantly higher (P/ 0.01) than in cattle bulls. Cold shock did not significantly alter semen characteristics in avian species, while a significant (P/ 0.01) decrease in sperm live counts and motility as well as a corresponding increase in morphological abnormalities were observed in the spermatozoa of cattle and buffalo bulls due to cold shock.

MHA-Tp testing on HIV positive and negative women in vigilance home at Madurai

In the study group of 94 cases of female prostitutes and their children 55 cases showed positive for HIV infection by ELISA and Western Blot tests. They showed positive also for syphilis in 37 cases by VDRL and in 43 cases by MHA-Tp tests among HIV positive and negative women. The association of HIV infection and syphilis was observed in this study due to sexual transmission of these infections. But congenital spread from infected mother to their children was not observed in this study since both mothers and their children were negative for these infections. MHA-Tp testing confirmed VDRL test results in 27 cases and also increased specificity of MHA-Tp test result over VDRL result in 16 cases and exclusion of biological false positive by VDRL in 10 cases were noticed in this study.