Overlapping drug-induced vasculitis, ANCA-associated vasculitis, and lupus nephritis caused by low-dose hydralazine

INTRODUCTION

We present a case of drug-induced vasculitis secondary to low-dose hydralazine with overlapping features of antineutrophil cytoplasmic antibody-associated vasculitis and drug-induced lupus nephritis.

CASE PRESENTATION

A 52-year-old Hispanic woman with a medical history of resistant hypertension treated with hydralazine 10 mg twice daily for 1 year presented with generalized weakness, dizziness, nausea, vomiting, and gross hematuria. There was fever, tachycardia, leukocytosis, lactic acidosis, hyperkalemia, renal failure, and anemia. Chest computed tomography and bronchoscopy revealed a left lower lobe infiltrate and diffuse alveolar hemorrhage. Serologic testing was positive for anti-double-stranded DNA, anti-Smith, lupus anticoagulant, anti-histone, anti-cardiolipin IgM antibodies, and antineutrophil cytoplasmic antibodies (myeloperoxidase and proteinase 3). A kidney biopsy revealed crescentic glomerulonephritis with an overlapping finding of membranous nephropathy. Broad-spectrum antibiotics, immunosuppressants, corticosteroids, and plasmapheresis were initiated. The patient survived but required continuous hemodialysis.

CONCLUSIONS

Although a few cases of simultaneous antibody-associated vasculitis and drug-induced lupus nephritis secondary to hydralazine use have been reported, this case is singular. Similar findings were previously reported with doses of 50-100 mg two to three times daily over 1-5 years. In our patient, a dose of only 10 mg twice daily for a year caused a severe disease presentation. This brings to light the combination of different vasculitides that can coexist and the potentially life-threatening adverse effects of low-dose hydralazine that should be kept in mind.

Atrial Fibrillation: Rate Versus Rhythm Control

Description Atrial fibrillation (AF) remains the most common arrhythmia worldwide and is expected to affect approximately 12 million individuals in the United States alone by 2030. Thromboembolic events remain a feared complication of AF and should be treated and risk-stratified utilizing the CHA2DS2-VASc scoring system. Other complications of AF span a wide spectrum from impaired quality of life (QoL) to an increase in all-cause mortality. Rate control strategies consist of controlling the ventricular rate and have been shown to be a safe and effective strategy for asymptomatic AF patients. In patients who are plagued with symptoms leading to impaired QoL or a decrease in exercise capacity, rhythm control with antiarrhythmic drugs or catheter ablation may be suitable options. Mortality benefits when comparing rate versus rhythm control remain equivocal when comparing multiple studies over the past decade.

A Rare Case Report of Flecainide-Induced Left Bundle Branch Block (LBBB) and Transient Cardiomyopathy

Flecainide is an antiarrhythmic agent that has been reported to have numerous cardiotoxic effects, including the development of arrhythmias and the reduction of left ventricular ejection fraction (LVEF). However, it is not commonly reported as a cause for left bundle branch block and cardiomyopathy. In this case report, we present the case of a 67-year-old female patient who developed transient cardiomyopathy and left bundle branch block (LBBB) secondary to flecainide therapy. The patient's condition improved upon cessation of flecainide.

My Heart

Description A poem expressing a daughter's love for her father through their shared passions for cardiology and medicine.

The optical response of artificially twisted MoS[Formula: see text] bilayers

Two-dimensional layered materials offer the possibility to create artificial vertically stacked structures possessing an additional degree of freedom-the interlayer twist. We present a comprehensive optical study of artificially stacked bilayers (BLs) MoS[Formula: see text] encapsulated in hexagonal BN with interlayer twist angle ranging from 0[Formula: see text] to 60[Formula: see text] using Raman scattering and photoluminescence spectroscopies. It is found that the strength of the interlayer coupling in the studied BLs can be estimated using the energy dependence of indirect emission versus the A[Formula: see text]-E[Formula: see text] energy separation. Due to the hybridization of electronic states in the valence band, the emission line related to the interlayer exciton is apparent in both the natural (2H) and artificial (62[Formula: see text]) MoS[Formula: see text] BLs, while it is absent in the structures with other twist angles. The interlayer coupling energy is estimated to be of about 50 meV. The effect of temperature on energies and intensities of the direct and indirect emission lines in MoS[Formula: see text] BLs is also quantified.

Plasma fireball: A unique tool to fabricate patterned nanodots

A large plasma fireball is formed using a reverse biased planar sputter magnetron source. The magnetic field considerably reduces the contact area of the anode with the plasma and results in the formation of the fireball. Ions are extracted from the fireball using a large voltage cathode sheath of the grounded sample holder. The physical mechanism for the extraction of the ions from the fireball along with the effect of the sample holder on the fireball and the discharge current is discussed. The device is shown as a novel tool for developing nanodot patterns on a GaSb substrate without the use of additional ion source or power supplies. Variable nanodot patterns produced simply by the alteration of discharge conditions demonstrate unique surface wettability and reflection properties.

Genetic mutations associated with status epilepticus

This paper reports the results of a preliminary search of the literature aimed at identifying the genetic mutations reported to be strongly associated with status epilepticus. Genetic mutations were selected for inclusion if status epilepticus was specifically mentioned as a consequence of the mutation in standard genetic databases or in a case report or review article. Mutations in 122 genes were identified. The genetic mutations identified were found in only rare conditions (sometimes vanishingly rare) and mostly in infants and young children with multiple other handicaps. Most of the genetic mutations can be subdivided into those associated with cortical dysplasias, inborn errors of metabolism, mitochondrial disease, or epileptic encephalopathies and childhood syndromes. There are no identified 'pure status epilepticus genes'. The range of genes underpinning status epilepticus differs in many ways from the range of genes underpinning epilepsy, which suggests that the processes underpinning status epilepticus differ from those underpinning epilepsy. It has been frequently postulated that status epilepticus is the result of a failure of 'seizure termination mechanisms', but the wide variety of genes affecting very diverse biochemical pathways identified in this survey makes any unitary cause unlikely. The genetic influences in status epilepticus are likely to involve a wide range of mechanisms, some related to development, some to cerebral energy production, some to diverse altered biochemical pathways, some to transmitter and membrane function, and some to defects in networks or systems. The fact that many of the identified genes are involved with cerebral development suggests that status epilepticus might often be a system or network phenomenon. To date, there are very few genes identified which are associated with adult-onset status epilepticus (except in those with preexisting neurological damage), and this is disappointing as the cause of many adult-onset status epilepticus cases remains obscure. It has been suggested that idiopathic adult-onset status epilepticus might often have an immunological cause but no gene mutations which relate to immunological mechanisms were identified. Overall, the clinical utility of what is currently known about the genetics of status epilepticus is slight and the findings have had little impact on clinical treatment despite what has been a very large investment in money and time. New genetic technologies may result in the identification of further genes, but if the identified genetic defects confer only minor susceptibility, this is unlikely to influence therapy. It is also important to recognize that genetics has social implications in a way that other areas of science do not. This article is part of a Special Issue entitled "Status Epilepticus".

Melatonin protects against alterations in hippocampal cholinergic system, trace metals and oxidative stress induced by gestational and lactational exposure to cadmium

Dietary exposure to cadmium, even at lower doses, can lead to free radical induced neurotoxicity, neurobehavioral changes and alteration in neurotransmitters. Such changes are likely to be more pronounced in the developing brain due to incompleteness of blood brain barrier (BBB). Hippocampus being the seat of intelligence has a role in learning and cognitive behavior and any damage to hippocampus during developmental stage is likely to result in neurodegenerative changes in later life. To this end, fetal and neonatal exposure to cadmium was induced by exposing pregnant dams of Swiss albino strain throughout the period of gestation and following parturition up till 5^th day post partum (pp) through drinking water (3ppm/animal/day). The neonates were sacrificed on day 6 pp and indices of oxidative stress, levels of trace elements and changes in cholinergic system were evaluated in the hippocampus. Increased lipid peroxidation, surge in reactive oxygen species (ROS), depressed antioxidant defense, increased accumulation of cadmium, differential alterations in trace elements and decreased activity of AChE were the features of cadmium toxicity. Simultaneous administration of melatonin to cadmium challenged animals offset these detrimental changes. The results suggest that melatonin co-administration can effectively protect against the adverse effects of cadmium on endogenous antioxidant status, changes in trace metal concentrations and compromised hippocampal cholinergic system.

Hepatoprotective activity of Eugenia jambolana Lam. in carbon tetrachloride treated rats

OBJECTIVE

To estimate the hepatoprotective effects of the methanolic seed extract of Eugenia jambolana Lam. (Myrtaceae), in Wistar albino rats treated with carbon tetrachloride (CCl(4)).

MATERIALS AND METHODS

Liver damage in rats treated with CCl(4) (1ml/kg/Bw, administered subcutaneously, on alternate days for one week) was studied by assessing parameters such as serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), alkaline phosphatase (ALP), acid phosphatase (ACP) and bilirubin (total and direct). The effect of co-administration of Eugenia jambolana Lam. (doses 100, 200 and 400 mg/kg p. o.) on the above parameters was investigated. These biochemical observations were supplemented by weight and histological examination of liver sections. Liv.52((R)) was used as positive control. Data were analyzed by one way ANOVA, followed by Scheff's/Dunnett's test.

RESULTS

Administration of Eugenia jambolana Lam. (doses 100, 200 and 400 mg/kg p. o.) significantly prevented carbon tetrachloride induced elevation of serum SGOT, SGPT, ALP, ACP and bilirubin (total and direct) level. Histological examination of the liver section revealed hepatic regeneration, after administration of various doses of Eugenia jambolana Lam. The results were comparable to that of Liv.52((R)).

CONCLUSION

The study suggests preventive action of Eugenia jambolana Lam. in carbon tetrachloride induced liver toxicity. Hepatic cell regeneration process was dose dependent.

Obstetric history and reproductive tract infections among married female (15-44 yrs.) in rural area of district Meerut, U.P

The prevalence of RTIs in 600 married females (15-44 yrs.) representing 12 subcentre villages of Daurala block of Meerut was 35.3%. The reproductive tract infections were significantly associated with place of last delivery (P< 0.001), person conducted the last delivery (P< 0.001) and in women had history of abortions (P< .005).

Physiology ofAnabaena khannae andChlorococcum humicola under fluoride stress

Sodium fluoride showed pH-dependent physiological responses in the two test microalgae Anabaena khannae and Chlorococcum humicola. A. khannae showed severe membrane damage with fluoride at low pH with leakage of pigments and electrolytes. Annihilation of photosynthesis along with inhibition in 14C uptake was observed at pH 6 with 50 mg/L fluoride. While respiration was less affected in the cyanobacterium, C. humicola showed 30 % inhibition in respiratory activity. Resistance of C. humicola to fluoride toxicity has been attributed to the hindrance provided by the thick cell envelope, intracellular compartmentation and increase in extracellular pH as a consequence of its metabolism.

Neuroprotective effects of Withania somnifera Dunn. in hippocampal sub-regions of female albino rat

The neuroprotective effects of W. somnifera were studied on stressed adult female Swiss albino rats. Experimental rats were subjected to immobilization stress for 14 h and were treated with a root powder extract of W. somnifera available as Stresscom capsules (Dabur India Ltd). Control rats were maintained in completely, non stressed conditions. Thionin stained serial coronal sections (7 microm) of brain passing through the hippocampal region of stressed rats (E(1) group) demonstrated 85% degenerating cells (dark cells and pyknotic cells) in the CA(2) and CA(3) sub-areas. Treatment with W. somnifera root powder extract significantly reduced (80%) the number of degenerating cells in both the areas. The study thus demonstrates the antistress neuroprotective effects of W. somnifera.

Distribution of somatostatin (SS) immunoreactivity using specific rabbit antibodies in preoptic-anterior hypothalamus (PO-AH) of female rat brain

Distribution of somatostatin (SS) immunoreactivity was observed in the preoptic-anterior hypothalamus (PO-AH) of the female rat brain. Six specific rabbit antibodies A (SS-14), B (SS-28), C (SS-28 complete), D (SS 14 and SS-28 both), E (SS preprohormone) and F (GHRH) were used for immunostaining using Avidin-Biotin Complex (ABC) method (Hsu et al., 1981). Immunostaining was observed with all the six antibodies, in the serial sections passing through various bregma levels (-0.3 to -3.3 mm) of preoptic-anterior hypothalamic (PO-AH) region including median eminence (ME). In conclusion, the present study suggests that immunoreactive nerve terminals for both SS-14 and SS-28 are present in internal (IZ) and external zones (EZ) of ME. High intensity of SS-14 and SS-28 containing terminals in EZ suggests that both SS fractions are involved in regulating GH secretion in anterior pituitary. This is a first report on comparative distribution of immunoreactivities of four different fractions of SS, SS-preprohormone and GHRH in PO-AH.

Prevalence of anaemia among adolescent girls in rural area of District Meerut, U.P

The prevalence of anaemia in 504 adolescent girls (10-18 yrs) representing 24 subcentre villages of Daurala block of Meerut was 34.5%. The prevalence of mild, moderate and severe anaemia among adolescent girls was 19.0%, 14.0% and 1.4% respectively. Majority (55.2%) were having mild anaemia and only 4.0% had severe anaemia. Anaemia was found to be significantly associated with educational status (P < 0.05), birth order (P < 0.05), awareness regarding anaemia (P < 0.05) and marital & obstetric status (P < 0.05) with no association with age, anthropometry and menarcheal age (P > 0.05).

Stress induced neuron degeneration and protective effects of Semecarpus anacardium Linn. and Withania somnifera Dunn. in hippocampus of albino rats: an ultrastructural study

Effects of herbal formulations were studied on hippocampal neuron cell bodies. Study was carried out in adult Swiss albino rats. Experimental rats (E) were divided into three groups. Group E1 rats were given immobilization stress for 14 hr/day for 30 days. Rats in E2 and E3 group were given daily single dose (40 mg/kg/body wt.) of alcoholic extract of S. anacardium and W. somnifera. After 1 hr giving the plant extract, the rats were subjected to stress. Treatment continued for 14 hr for 30 days. Control rats were kept in complete nonstress condition. Ultrastructural characteristics of neuron cell bodies in hippocampal sublayer (CA1-CA4 and Dg) was studied in rats of E1, E2 and E3 groups and compared with control. Results of the present study demonstrated, that both CA2 and Dg, 85% of neuron cell bodies exhibited degenerating characteristics, (which includes karyorrhexis, membrane blebbing, chromatin condensation, chromatin fragmentation and intracellular spacing). Interestingly, after the treatment with S. ancardium cells demonstrating degenerating characteristics was significantly reduced (80%) as compared to treatment with W. somnifera. Study suggests that probably both the herbal drugs have cytoprotective properties.

Gluco- and mineralocorticoid receptor-mediated regulation of neurotrophic factor gene expression in the dorsal hippocampus and the neocortex of the rat

Gluco- and mineralocorticoid receptors (GR and MR) act via common promoter elements but may exert different effects on gene regulation in various regions of the forebrain. In order to separately analyse the role of GR and MR in the regulation of neurotrophic factor genes and their receptors, we used adrenalectomy and subsequent hormone injections in the rat as a model system. Twenty-four hours after adrenalectomy rats were injected with a single dose of corticosterone (2 and 10 mg/kg), aldosterone (0.5 mg/kg) or the synthetic glucocorticoid agonist RU 28362 (4 mg/kg). Gene expression of basic fibroblast growth factor (bFGF) and its high-affinity receptors [fibroblast growth factor receptor subtypes 1-3 (FGF-R1, FGF-R2, FGF-R3)], as well as brain-derived growth factor (BDNF) and neurotrophin-3 (NT-3) was analysed at 4 h after the hormone injection in CA1-CA4 (cornus of Ammon areas of the hippocampus) and dentate gyrus of the dorsal hippocampus and in neocortex by means of in situ hybridization. We found that bFGF is regulated in CA2, CA3 and dentate gyrus by GR and MR together, and in CA1, CA4 and neocortex by GR alone. FGF-R2 expression in the hippocampus seems to be regulated only by MR, while BDNF expression appears to depend on both receptors. FGF-R1, FGF-R3 and NT-3 were only moderately affected by the hormone activation of GR and MR acting in concert or alone in the various regions. Thus, the present findings suggest that the adrenal cortical system through GR and MR participate in the control of neurotrophic factor signalling in a highly subregion- and cellular-dependent manner.

Anemia in children: early iron supplementation

Iron deficiency anemia is the most wide spread micronutrient deficiency disorder in the world, being most prevalent in women and young children. The present study was conducted to find out the prevalence of anemia in children and its contributory factors with reference to early iron supplementation. It was a cross sectional study done on 137 children of age 1-2 years in urban slums of Meerut. Prevalence of anemia in the study group was 59.9%. The socio-economic status, mother's educational status, birth weight, sibling order, and type of weaning food did not show any significant relationship with the prevalence of anemia in these children, whereas, weaning time, nutritional status and early iron supplementation had a positive impact on it. Exclusive breast feeding upto 4 months followed by weaning, adequate nutritional status and early iron supplementation have a definite role in prevention of anemia in children.

Reproductive tract infections among rural women in Meerut

The present study was done among 500 women of reproductive age group. Study revealed overall prevalence rate of RTI of 44.8%. Excessive vaginal discharge was the most common presenting symptom (42.0%). Inspite of such an high prevalence of reproductive tract infections, only 22.8% of the women sought treatment for their problem. The study suggests to improve the awareness about RTI and its treatment facility among women and also recommends to develop a strategy to train and reorient the health personnel.

Low-dose midazolam infusion for oculoplastic surgery under local anesthesia

PURPOSE

Oculoplastic surgery with infiltration of local anaesthesia at the operative site performed as a day-case procedure is both efficient and cost-effective. Patients considered unsuitable for this because of fear or apprehension may, however, benefit from per-operative conscious sedation. We sought to study the efficacy and safety of this using midazolam, a water-soluble benzodiazepine.

METHOD

We have performed a controlled clinical trial comparing the effect of a low-dose intravenous infusion of midazolam (0.2 mg/ml of normal saline at a rate of 1 mg/h) with saline placebo on 48 subjects undergoing oculoplastic surgery with local anaesthesia. Patients were given pre- and post-operative questionnaires assessing, amongst other factors, anxiety levels, pain, degree of reported amnesia and psychomotor recovery.

RESULTS

Using the low-dose midazolam infusion no adverse cardiorespiratory reactions occurred. Patients receiving midazolam reported remembering significantly less about their operation than controls (p = 0.04) and showed significantly lower state-anxiety after their operation than before (p < 0.02). This change was not noted in the placebo group. There was no significant difference in the psychomotor performance of patients given midazolam compared with controls 2 h after surgery.

CONCLUSIONS

A low-dose continuous infusion of midazolam can be used to safely provide effective anxiolysis and conscious sedation with good psychomotor recovery during oculoplastic procedures in a day-case setting.

Somatostatin (SRIF) like immunoreactivity in median eminence (ME) of female rat brain: evidence of compartmentalization in ME

Somatostatin (SRIF) immunoreactivity was observed in rostrocaudal extent (Bregma levels-1.8 mm to -3.8 mm) of the median eminence (ME) in female rat brain using Avidin-Biotin Complex (ABC) method (Hsu et al, 1981). SRIF immunoreactivity (IR) was observed in entire-rostrocaudal extent of both internal (IZ) and external zone (EZ) of ME. Image analysis of SRIF stained sections showed that in rostral ME (Bregma -1.8 to -2.3 mm) dense immunoreactive nerve terminals were observed in EZ. In medial ME (Bregma -2.3 mm to 3.3 mm) SRIF-IR was low in IZ and dense in EZ. In this region dense immunoreactive nerve terminals were observed in lateral margin of EZ. In caudal ME (Bregma -3.3 mm to -3.8 mm) nerve terminals in lateral EZ and median IZ and EZ showed dense reactivity in nerve terminals. These results led us to hypothesize that each region-lateral IZ and EZ and medial IZ and EZ are independent functional units in ME. Six functionally independent compartments could be identified-Compartment I and III of IZ and IV in EZ (Lateral margins in ME), Compartment V (IZ) and Compartment VI (medial EZ).

Comparison of carcinoembryonic antigen in tissue and serum with grade and stage of colon cancer

BACKGROUND

Serial plasma carcinoembryonic antigen (CEA) levels are routinely used to detect postoperative recurrence of colon cancers. However, levels of intrinsic CEA production by individual tumors, which might be helpful for interpreting serum CEA levels, are not routinely available.

MATERIALS AND METHODS

CEA levels were determined in twenty tissue biopsy specimens of colon carcinoma and sixteen normal colonic tissue specimens from India, by immunohistochemistry (IH) and by quantitative enzyme immunoassay (EIA). Serum samples from 62 colon cancer patients and 25 healthy blood donors were analyzed for CEA by EIA.

RESULTS

Tissue CEA levels were highest for well differentiated adenocarcinomas (5.2-37 micrograms/g protein) with progressively lower levels seen in moderately differentiated and poorly differentiated tumors, and in normals. The intensity of immunostaining paralleled the levels determined quantitatively. Mean serum CEA levels were 1.5 ng/ml for normals and 4.2, 6.4, 23, and 102 ng/ml for Dukes' A, B, C and D stage tumors, respectively.

CONCLUSION

Preoperative serum CEA levels do not, in themselves, take into account differences in CEA production between individual tumors. Determination of tumor CEA content by quantitative or immunohistochemical methods, could be a useful adjunct for the clinical management of colon carcinoma, by improving interpretation of serum CEA levels.

Poliomyelitis in western Uttar Pradesh

The studies on prevalence of lameness in Western Uttar Pradesh revealed the overall poliomyelitis prevalence rate of 6.47/1000 children and an annual incidence rate of 19.3 per lac population with an average age of onset at 17.2 months. The overall OPV coverage was 53.2% with a vaccine efficacy of 94.2%. The incidence of poliomyelitis was negatively correlated to OPV immunization strongly suggesting the need of achieving high level of OPV coverage as a first step for eradication of poliomyelitis.

Neurochemical changes in the hippocampus of the brown Norway rat during aging

Microdensitometrical and stereological techniques were applied to study the effects of aging on the hippocampus of 3-, 6-, 12-, 18-, 24-, 30-, and 36-month-old male Brown Norway rats. Stereological analysis of basic fibroblast growth factor (bFGF) immunoreactive glial cells in the CA1 area showed an age-dependent decrease in the number of cells, starting at 18 months of age. Specific mean gray values of the immunoreactivity for bFGF were reduced in the CA3 area, in the dentate gyrus, and in fields of the CA1 area, starting at 24 months of age. There were no differences between the age groups in the number of glial fibrillary acidic protein or glucocorticoid receptor (GR) immunoreactive cells of the CA1-CA2 areas. However, the intensity of the GR immunoreactivity was decreased in the 18-month-old and older rats. No changes in the immunoreactivity for the mineralocorticoid receptor were observed in the CA1-CA2 areas of any of the age groups. Spontaneous alternation test and reactivity in an open field did not reveal marked differences between the age groups. These findings give evidence that there is a loss of neural GR immunoreactivity, but no loss of GR immunoreactive neurons, in the CA1-CA2 areas of the aged Brown Norway rat. Aging may also be characterized by substantial deficits of glially derived growth factors, such as bFGF in the hippocampus. The changes in immunoreactivities were not correlated to alterations in selected behaviors dependent on normal hippocampal function.

Tuberculous chylous ascites: pathognomonic CT findings

The computed tomographic (CT) appearance of chylous ascites is usually that of water with corresponding attenuation coefficients. This case report depicts the fat-fluid level sign on CT (shown by supine and decubitus scans), which is pathognomonic of chylous ascites.

Prepyloric diaphragm detected following foreign body ingestion

Prepyloric diaphragms are unusual and are usually detected in adulthood. We report a five-year-old boy who presented with history of ingestion of a coin and was found to have a prepyloric diaphragms on laparotomy.

On the role of glucocorticoid receptors in brain plasticity

1. The mapping of glucocorticoid receptors (GR) in the rat central nervous system (CNS) has demonstrated their widespread presence in large numbers of nerve and glial cell populations also outside the classical stress regions. 2. The present paper summarizes the evidence that glucocorticoids via GR in the CNS can act as lifelong organizing signals from development to aging. The following examples are given. (a) In the prepubertal and adult offspring, prenatal corticosterone treatment can produce long-lasting changes in striatal dopaminergic communication. (b) In adulthood, the evidence suggests complex regulation by adrenocortical hormones of neurotrophic factors and their receptors in the hippocampal formation. (c) In aging, the strongly GR-immunoreactive pyramidal cell layer of the CA1 hippocampal area appears to be preferentially vulnerable to neurotoxic actions of glucocorticoids, especially in some rat strains. 3. Strong evidence suggests that each nerve cell in the CNS is supported by a trophic unit, consisting of other nerve cells and glial cells, blood vessels, and extracellular matrix molecules. Due to multiple actions on nerve and glial cell populations of the different trophic units, the glucocorticoids may exert either an overall trophic or a neurotoxic action. It seems likely that with increasing age, the endangering actions of glucocorticoids on nerve cells prevail over the neurotrophic ones, leading to reduced nerve cell survival in some trophic units.

Neurotensin-like immunoreactivity in odontoblasts and their processes in rat maxillary molar teeth and the effect of pulpotomy

A strong neurotensin-like immunoreactivity (NT-like IR) was detected in the odontoblast cells of the rat teeth. 4 h after a partial pulpotomy performed in two maxillary molar teeth a decreased NT-like IR was observed in the odontoblast layer located at the vicinity of the lesion together with edema and nuclear pyknosis. NT-like IR became further decreased after 24 h. After 7 days NT-like IR had almost fully disappeared with signs of necrosis of the dental pulp and infiltration of polymorphonuclear lymphocytes. It seems possible that NT like peptides in the odontoblast cell layer may play a role, e.g., in dentinogenesis and/or nociception.

Immunocytochemical detection of ornithine decarboxylase (ODC) in paraffin-embedded tissues as a possible prognostic indicator for oral lesions

Intracellular levels of ornithine decarboxylase (ODC) are raised following mitogenic stimulus and in neoplasia. Because lesions of the oral cavity are often difficult to assess histologically, we have determined the value of immunocytochemical detection of ODC as a prognostic indicator in 74 routinely fixed and paraffin-embedded oral biopsies using peroxidase-antiperoxidase and immunogold-silver staining. The latter proved more sensitive, yielding positive reactions in 32 of 43 oral carcinomas (11/14 well differentiated, 16/21 moderately differentiated and 3/5 poorly differentiated) and 7/11 potentially malignant lesions, compared with 19/45 carcinomas and 1/15 potentially malignant lesions, by peroxidase anti-peroxidase. Hyperplastic lesions (n = 7) and normal non-keratinized buccal mucosa (n = 7) were all negative. Follow-up was possible in 13 of the carcinoma patients. Of 7 positive ODC reactions but clinically node-free at biopsy, 2 died and 2 had recurrences within 3 years, whereas all of 6 with no immunoreactivity were symptom-free after 3-5 years. Immunostaining for ODC may be helpful for the prognostic assessment of routinely processed oral lesions and in choosing treatment.

Glial and neuronal glucocorticoid receptor immunoreactive cell populations in developing, adult, and aging brain

A detailed mapping of glucocorticoid receptor (GR) immunoreactivity (IR) in rat CNS was performed employing a mouse monoclonal antibody against rat liver GR. Subjective comparisons were made between the present results and the available data in the literature. A semiquantitation of GR immunostaining was found necessary and was obtained by microdensitometric and morphometric techniques, which enabled the distinction of neuronal and glial cell populations containing GR IR in various CNS regions. GR IR in the CNS was mainly found in the nuclear compartment. The GR was present in neuronal populations with classical neurotransmitters, especially monoamines and glutamate and with various neuropeptides. The degree of colocalization varied according to the function of the brain area. Functional implications were made in relation to stress sensitivity, mood and nociception/antinociception. The global control of networks by glucocorticoids may allow an optimal integration of different types of circuits. The GR is found already in the fetal rat and the development of GR mRNA and receptor protein was followed during the pre- and postnatal periods. The GR appears to be a major factor in brain maturation and in modulation of stress responses. In aged Brown Norway rat brain GR IR but not mineralocorticoid receptor (MR) IR is reduced in the hippocampal nerve cells. The intensity of GR IR but not the number of nerve cells is altered, indicating a reduced activation of the GR in aging in this rat strain. Overall GR participates in neuronal plasticity from fetal and postnatal life to adult life and aging.

Neonatal mortality in Meerut district

A study of neonatal mortality in Meerut district revealed an infant mortality rate of 50.1 per 1000 live births. Neonatal mortality accounted for 37.8% of infant mortality with a neonatal mortality rate of 19.0 per 1000 live births. 90.5% of these neonates were delivered at home largely by untrained personnel (57.2%). Only 28.6% of these neonates were treated by qualified doctors and only 30.9% of their mothers were fully immunized against tetanus. At least 2/3rd of neonatal mortality was due to exogenous factors with tetanus neonatorum and septicaemia being the principal causes of mortality each accounting for a mortality rate of 4.7 per 1000 live births.

Fluoride toxicity: a biochemical and scanning electron microscopic study of enamel surface of rabbit teeth

The present study has been carried out to investigate the effect of fluoride toxicity on the morphology as well as inorganic chemical constituents of rabbit teeth. Rabbits were administered sodium fluoride at a dose of 10 mg NaF/kg body weight every 24 h for 18 and 23 months. The incisor and molar teeth (whole tooth) were investigated for fluoride, calcium and phosphorus content in 18- and 23-month treated animals. The enamel surfaces of incisor teeth of 23-month treated animals were examined under scanning electron microscope. A significant increase in fluoride levels and significant decrease in calcium content was found following fluoride administration for 18 and 23 months as compared to control. Ca/P ratio was significantly increased only in 23-month treated animals. The scanning electron micrographs revealed hypoplastic, rough, uneven, pitted and cracked enamel surfaces covered with granular deposits as a result of excessive intake of fluoride. It can be concluded that long term fluoride administration leads to severe structural alterations on the enamel surface, possibly through defective mineralization.

Socioeconomic factors and prevalence of endemic goitre

The present study was conducted on 2611 school children of a rural area of Meerut, with the objectives to find out the prevalence and distribution of endemic goitre and the socioeconomic variables associated with the distribution of the endemic goitre. Grading of goitre was done as per the criteria laid down by the WHO-1979 (1). The overall prevalence rate of endemic goitre was 50.1%, the prevalence was more among females (55.1%) as compared to males (47.2%). Maximum number of goitre cases were having grade Ia enlargement (46.9%) followed by grade Ib (34.1%), grade 2(15.0%) and grade 3 (4.0%). Prevalence increased with increase in age. Statistically significant differences were found in the prevalence of endemic goitre in relation to different religions and caste groups, different occupations of the parents/guardians of children and types of houses used for the purpose of living.

Ranitidine--rifampicin interaction

Newly diagnosed patients of pulmonary tuberculosis (n = 112) were put on a rifampicin-containing drug regimen. Fifty six patients were also given a placebo tablet twice daily while the other fifty-six were given ranitidine 150 mg twice daily. Gastric pH, gastric emptying time, serum rifampicin levels, urinary total and unchanged rifampicin, serum bilirubin and ALT levels were measured serially. Clinical record of adverse symptoms was maintained. Ranitidine increased the basal as well as post-drug gastric pH without altering the gastric emptying time. Concomitant administration of ranitidine and rifampicin did not alter the absorption, metabolism or excretion of the latter but reduced the frequency of gastrointestinal symptoms.

Influence of prior information of drug toxicity on patient compliance

Sixty patients with pulmonary tuberculosis, who had not received any chemotherapy in the past, were divided into two groups. All the patients were put on isoniazid, rifampicin and pyrazinamide for 8 weeks followed by isoniazid and rifampicin for another 18 weeks. Group A patients were informed of the likely occurrence of anorexia and/or vomiting but Group B patients were not. Routine and default retrieval home visits were given to ensure maximal drug compliance. Drug toxicity related early defaults were significantly less common in Group A patients (1 of 30) as compared to Group B (6 of 30).

Cross-axis synchronous flow-through coil planet centrifuge (type XLL). I. Design of the apparatus and studies on retention of stationary phase

The fourth prototype holds a pair of column holders in the lateral position at 15 cm from the center of the rotary shaft horizontally mounted on the rotary frame at 7.6 cm from the central axis of the apparatus. Using short coils of 2.6 mm I.D. PTFE (polytetrafluoroethylene) tubing with 7.6 cm and 24 cm helical diameters, retention of the stationary phase was measured in ten pairs of two-phase solvent systems under various experimental conditions. Satisfactory retention was obtained by choosing proper combinations of three factors, i.e., the direction of planetary motion, head-tail elution mode, and inward-outward elution mode. The polar butanol solvent systems showed excellent retention from 65 to 80% in the 7.6 cm helical diameter left-handed coil.

Separation of rare earth elements by high-speed counter-current chromatography

Besides being widely used in electronic and glass industries, rare earth elements have recently been found to have important biological effects including the ability to stabilize and enhance interferon activity [J.J. Sedmak and S.E. Grossberg, J. Gen. Virol, 52 (1981) 195]. In this paper, the rare earth elements have been separated using a high-speed counter-current chromatography (HSCCC) centrifuge equipped with three multilayer coils connected in series. Two-phase solvent systems were composed of n-heptane containing di-(2-ethylhexyl)phosphoric acid (stationary phase) and dilute hydrochloric acid (mobile phase) where the partition coefficient of each can be optimized by selecting the proper hydrochloric acid concentration. The mobile phase was eluted through the column at a flow-rate of 5 ml/min, while the apparatus was rotated at 900 rpm. Continuous detection of the rare earth elements was effected by means of a post-column reaction with arsenazo III and the elution curve was obtained by on-line monitoring at 650 nm. Excellent isocratic separations of closely related rare earth elements were achieved at high partition efficiencies up to several thousand theoretical plates. Versatility of the present method was demonstrated in an exponential gradient elution of hydrochloric acid concentration where fourteen rare earth elements were all resolved in about 4.5 h.