Massive renal infarction due to spontaneous renal artery thrombosis-a rare case report

Spontaneous renal artery thrombosis is a rare medical emergency. The signs and symptoms of the disease are variable and non specific making it difficult to diagnose on time and easily missed for other more common pathologies. Proper evaluation and timely intervention can prevent the loss of renal function. We present a case of 45 year old male with no comorbidity who presented with complaints of right flank pain, fever and vomiting for one day. With physical examination within normal limits, evaluation revealed right renal artery thrombosis.

Synchronization of Fractional Order Neurons in Presence of Noise

The firing rate of some biological neurons such as neocortical pyramidal neurons is consistent with fractional order derivative, and the fractional-order neuron models depict the firing rate of neurons more accurately than other integer order neuron models do. For this reason, first, the dynamical characteristics of fractional order Hindmarsh Rose (HR) neuron are investigated, here and then a two coupled neuronal system based on Hindmarsh Rose neuron is presented. The results show several differences in the dynamical cha.racteristics of integer order and fractional order Hindmarsh Rose neuron model. The integer order model shows only one type of firing characteristics when the parameter of the model remained the same. The fractional-order model depicts several dynamical behaviors even for the same parameters as the order of the fractional operator is varied with the same parameter values. The firing frequency increases as the order of the fractional operator decreases. The fractional-order is therefore key in determining the firing characteristics of biological neuron models. A linearized model of HR neuron is also given for hardware resource minimizations and to implement this neuronal network on a large scale. A synchronized system of two fractional-order fractional Hindmarsh-Rose (HR) neurons in the presence of noise is also presented. The dynamical characteristics of the modified coupled neuron are determined by the parameters of the neuron model and the coupling function. The robustness of the network in the presence of noise is verified by both amplitude and phase synchronization techniques. A simplification of the coupling function is also presented to reduce the hardware cost. The synchronization results show that the model can produce the desired behavior with acceptable error.

Differential response of antioxidant defense in HepG2 cells on exposure of Livotrit®, in a concentration dependent manner

Livotrit^®, a polyherbal formulation (Zandu, India) is commonly prescribed for liver health. The present study was undertaken to elucidate possible mechanism of antioxidant potential of Livotrit^®. Livotrit^® exhibited concentration dependent radical scavenging activity, inhibition of lipid peroxidation as well as activation and gene expression of antioxidant enzymes. Interestingly, lower concentration of Livotrit^® (0.05%) significantly increased activities and gene expression of catalase, Glutathione reductase (GR) and Gluthathione peroxidase (GPx), while higher concentration of Livotrit^® (0.5%) significantly increased antioxidant enzyme Heme-oxygenase 1(HO-1) and not catalase (CAT), GR and GPx. Transcription factor, Nuclear factor erythroid 2-related factor 2 (Nrf2) required for expression of catalase, GR, GPx and HO-1 was efficiently translocated into the nucleus at both concentrations. Inspite of this, concentration dependent activation of these enzymes was found to be mediated through miRNAs involved in regulation of their gene expression.

Prevalence of chronic airflow limitation in Kashmir, North India: results from the BOLD study

BACKGROUND: Data on spirometrically defined chronic airflow limitation (CAL) are scarce in developing countries.

OBJECTIVE: To estimate the prevalence of spirometrically defined CAL in Kashmir, North India.

METHODS: Using Burden of Obstructive Lung Disease survey methods, we administered questionnaires to randomly selected adults aged ⩾40 years. Post-bronchodilator spirometry was performed to estimate the prevalence of CAL and its relation to potential risk factors.

RESULTS: Of 1100 participants initially recruited, 953 (86.9%) responded and 757 completed acceptable spirometry and questionnaires. The prevalence of a forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC) ratio less than the lower limit of normal was 17.3% (4.5) in males and 14.8% (2.1) in females. Risk factors for CAL included higher age, cooking with wood and lower educational status. The prevalence of current smoking was 61% in males and 22% in females; most smoked hookahs. CAL was found equally in non-smoking males and females, and was independently associated with the use of the hookah, family history of respiratory disease and poor education. A self-reported doctor's diagnosis of chronic obstructive pulmonary disease was reported in 8.4/1000 (0.9% of females and 0.8% of males).

CONCLUSION:Spirometrically confirmed CAL is highly prevalent in Indian Kashmir, and seems to be related to the high prevalence of smoking, predominantly in the form of hookah smoking.

Laser Myringotomy Versus Ventilation Tubes In Otitis Media With Effusion

BACKGROUND

Otitis media with effusion (OME) is a leading cause of difficulty in hearing in paediatric population. Otitis media with effusion must be detected and managed early to prevent conductive hearing loss in children. It was aimed to compare results of laser myringotomy and ventilation tube insertion, in terms of hearing improvement and recurrence of Middle ear effusion (MEE).

METHODS

This randomized controlled trial was conducted from February 2012 to January 2015. Children of 4- 12 years of age with decreased hearing due to OME were included in the study. These children were investigated with pure tone audiometry (PTA) and tympanometry to confirm conductive hearing loss. Patients were put in 2 groups, group one comprised of patients treated with laser myringotomy and group 2, treated with ventilation tube insertion. The objective was to evaluate and compare results of the two procedures in terms of resolution of middle ear effusion (MEE) and improvement of hearing. The two procedures were also compared in terms of complications like otorrhea, persistence of perforation, hypertrophic scar and thinning of tympanic membrane (TM).

RESULTS

Middle ear effusion cleared in 35 out of 68 ears with laser myringotomy (LM) as compared to 52 out of 62 ears with ventilation tubes (VT). The myringotomy was still patent in 21 ears treated with LM while tube was in site in 50 years with VT after 3 months. The hearing level improved with LM by 10-15 dB after first 3 months.

CONCLUSIONS

The aim in Otitis media with effusion is ventilation of tympanic cavity. Laser myringotomy can be substitute to ventilation tube insertion (VT). But it remains patent for shorter time and less effective than VT. The ears with refractory or recurrent MEE should have VT insertion.

Future strategies in treatment of parkinson’s disease

Parkinson’s disease (PD) is a neurodegenerative disorder. COMT inhibitors, MOA-B inhibitors, Levodopa, Levodopa in combination with Dopa Decarboxylase (DDC) inhibitors, Entacapone, Tolcapone, Pramipexole, Ropinirole, Zonisamide, Cholinesterase inhibitors such as rivastigmine, galantamine and donepezil are used for treatment of Parkinson’s disease. Gene therapy of cellular and brain circuit pathways for the treatment of PD is under trials. Recently nuclear transfer embryonic stem cells or induced pluripotent stem derived cells can be used. The presence of Lewy bodies, reduced dopamine transporter and tyrosine hydroxylase expression within transplanted cells indicated that grafted cells are pathological. Adult and fetal neural stem cells are self-renewable.Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-2, 67-71DOI: http://dx.doi.org/10.3126/jcmsn.v7i2.6687

Isolation, identification, and phylogenetic analysis of reassortant low-pathogenic avian influenza virus H3N1 from Pakistan

During routine avian influenza surveillance in Pakistan, a low-pathogenic avian influenza virus (LPAI) subtype H3N1 was isolated for the first time from domestic chickens. The higher seroprevalence of H3N1 was recorded in both commercial and domestic poultry in ecological zones of Pakistan where the geographical proximity with neighboring countries and attractive birding sites provide better opportunities for frequent movements of wild and migratory birds, and their intermingling with the local domestic and commercial poultry. Subsequent whole genome sequencing of this virus revealed a new introduction of a reassortant Eurasian avian strain, which was distinguishable from corresponding human and swine strains isolated elsewhere. Phylogenetically, the HA gene was mostly clustered with Nordic (Scandinavian) strains of influenza viruses, whereas the NA and PB1 genes showed a maximum nucleotide sequence homology with the Indian H11N1, and the PB2 gene was found to be closely related to the Altai H5N2. The Matrix and NP genes of H3N1 mostly clustered with the European avian influenza viruses (AIV), whereas its NS and PA genes showed maximum nucleotide homologies with the African (Egypt) AIV strains. A sequence and amino acid analysis revealed an LP motif, avian-like receptor specificity, potential glycosylation sites, and sensitivities to oseltamivir, zanamivir, and amantadine. Some point mutations possessed by this Pakistani AIV H3N1 were also found in human, equine, and swine H3 influenza viruses. This H3N1 isolate showed less nucleotide sequence homology with the previously known Pakistani AIV as compared with other Eurasian AIV strains.

Methodology: a modified method for high-quality DNA extraction for molecular analysis in cereal plants

Cereal crops that have rigid non-cellulose components in the cell wall tissues of leaves and high starch and protein content in grains face limitations in DNA extraction. Advanced molecular genetic techniques such as mapping and marker-assisted selection programs require pure and quick DNA extraction. In this study, we developed methods for isolating high-quality genomic DNA from leaves and seeds of major cereal crops with minor modifications. DNA yields ranged from 300 to 1800 ng for 0.01 g seed or leaf tissue.

Injury pattern of suicide bomb attacks in Pakistan

PURPOSE

The aim of our study was to analyze the pattern of injuries, hospital care, and outcome of the victims of suicide bomb attacks in Pakistan.

METHODS

This prospective, cohort study was conducted at the Combined Military Hospital Rawalpindi during the last 3 years. Seriously injured patients in the "immediate category" were resuscitated in the emergency operation theater adjacent to the emergency room and, after resuscitation, the patients were transferred to the main operation theaters, where consultant surgeons were available.

RESULTS

During the study period, 1,296 terrorist victims presented to the emergency department and (86.9%) were admitted, with a mean hospital stay of 8.2 ± 2.1 days. The majority of patients arrived by ambulance (91%) and only 38 (3%) were evacuated by air. Penetrating splinter injuries were the most prevalent (87%), and 29% patients also had associated injuries. Open bone fractures were found in 48% and 42% had injured hollow and solid viscous. Overall, 33% of patients had thoracic injuries and neuro-trauma was observed in 16% of the study population. Deafness was a feature in 33% patients, 121 had to undergo limb amputations, and mortality remained in 7% of patients.

CONCLUSION

Most of the problems encountered were logistic in nature. Early evacuation of the victims remains pivotal in saving lives. The major causes of death in peripheral patients was hypovolemic shock, sepsis, and hypothermia. Mortality and morbidity can be enhanced by ample fluid resuscitation, tetanus prophylaxis, and proficient first aid at the site of injury.

Necrotizing fasciitis of the lower extremity: a case report and current concept of diagnosis and management

Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge.

Comparative distribution of the scalp hair trace metal contents in the benign tumour patients and normal donors

The scalp hair samples of benign tumour patients (n = 77) and normal donors (n = 86) were analysed for selected trace metal contents using atomic absorption spectrophotometry. In the scalp hair of benign tumour patients, highest average levels were found for Ca (1,401 microg/g), followed by Na (476.9 microg/g), Mg (441.6 microg/g), Zn (438.3 microg/g), K (119.2 microg/g) and Fe (96.38 microg/g) while in comparison, the maximum mean levels in the scalp hair of normal donors were shown by Ca (556.5 microg/g), followed by Zn (154.2 microg/g), Mg (153.4 microg/g), Na (97.45 microg/g) and Fe (81.68 microg/g). Almost all metal levels revealed higher dispersion and asymmetry in the scalp hair of benign tumour patients compared with the normal donors. The average concentrations of Ca, Cd, Co, K, Mg, Mn, Na, Ni, Pb, Sb, Sr and Zn were significantly higher in the hair of benign tumour patients compared with the normal donors. Significant gender-based differences were also observed in the scalp hair metal contents of benign tumour patients. Strong positive correlations were found between Cd-Cr (0.547) and Cd-Co (0.507) in the hair of benign tumour patients whereas Ca-Mg, Mg-Sr, Co-Cd, Cr-Cd, Li-Cr, Li-Co, Li-Cd, Na-Cd, Na-Co and Na-Li exhibited strong relationships (r > 0.50) in the hair of normal donors. Cluster analysis (CA) and principal component analysis (PCA) were used for the source identification and apportionment of scalp hair trace metals in the two donor groups. The scalp hair of benign tumour patients and normal donors revealed six and five main clusters of trace metals, respectively. PCA extracted seven principal components of trace metals in the scalp hair of benign tumour patients while six principal components were observed in the case of normal donors. The study evidenced significantly different patterns of metal distribution in the hair of benign tumour patients in comparison with normal donors.

Plasma lipid profile in gynecologic cancers

BACKGROUND

Lipids are associated with cancer because they play a key role in the maintenance of cell integrity. We studied the relationship of plasma lipids with gynecologic cancer.

METHODS

A total of 196 female individuals were included in the study. Of these 50 were normal subjects. The remaining were cancer patients: 80 breast cancer, 40 ovarian cancer and 26 patients with other gynecologic cancers. Plasma levels of triglycerides, total cholesterol, LDL-cholesterol and HDL-cholesterol were estimated by using spectrophotometer.

RESULTS

In breast cancer patients there is moderate increase in the plasma levels of triglycerides (18%) and cholesterol (21%), and a high increase in LDL-cholesterol (43%), while there is a moderate decrease in HDL-cholesterol levels (30%) when compared with normal subjects. In ovarian cancer patients, there is a high decrease in the plasma levels of triglycerides (31%) and HDL-cholesterol (39%), while a moderate decrease in cholesterol (28%) and LDL-cholesterol levels (11%) when compared with normal subjects. In gynecologic cancers other than breast and ovarian cancer, there is a moderate decrease in plasma levels of the triglycerides (25%), cholesterol (21%), and HDL-cholesterol levels (27%), while a non-significant decrease in LDL-cholesterol (6.2%) when compared with normal subjects.

CONCLUSIONS

Plasma lipid levels, except HDL-cholesterol, are raised in breast cancer and are decreased in other gynecologic cancers. HDL-cholesterol is decreased in all gynecologic cancers. As there is an alteration in the plasma lipid profile during gynecologic cancers, it may be helpful for diagnosis of the disease.

Burns from a stove burst: analysis of 34 cases

Burns continue to be a major environmental factor responsible for significant morbidity and mortality in developing countries and, in particular, burns due to stove bursts are a major problem. Two types of stoves are available in Pakistan: gas stoves and kerosene stoves. The state is considered of patients burned by stove bursts in general, and also with specific reference to 34 adult patients admitted with stove burns to our hospital in Pakistan. Various treatment options were used, and the patients' treatment and outcome are reported. The continued commercialization of such stoves, and especially of the gas stove, is is a cause of serious and permanent consequences that represent a danger for the population. Proper care should be observed when handling them because, as always, prevention is better than cure.

Experience of burn injuries at the pakistan institute of medical science, islamabad, pakistan*

The objective of this prospective study was to consider the demographical data of burn patients admitted to the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The study was carried out at PIMS from January 2002 to December 2003. Only admitted patients of either sex of age more than 12 yr were included. Patients below 12 yr were excluded. Patients requiring outpatient treatment were also excluded. A total number of 77 males and 65 females fulfilled the criteria. The mean age of the males was 32.2 yr and of the females 24.4 yr, while the male/female ratio was 1/1.18. Burns were commonest during the winter season (42.2%). In 6% of the patients, the burns were due to suicide attempts and in 15% to homicidal intent. The burns were accidental in 79% of cases. The major mechanism in females was stove burst (22%) and in males direct flame (18%). The kitchen was the commonest site of the accident in females (27%). Housewives were the most frequently affected (35%). More married males (39%) were burned than unmarried females (18%). Inhalational injury was present in 23% of the patients. Males had average total body surface area burned of 27.4% compared with 39.5% in females. Eighteen per cent of the deaths occurred among males and 16% among females. This study provides a comprehensive overview of hospitalized burn patients in Pakistan. Prevention is always the rule to be safe from burns but, once they occur, immediate and proper care should be given with aggressive treatment in order to minimize post-burn problems.

Pattern of bacterial invasion in burn patients at the pakistan institute of medical sciences, islamabad

A prospective study was carried out in the Department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad, from January 2002 to December 2003. A total number of 142 patients were included in the study. The patients' mean age was 32.2 yr for males and 24.4 yr for females. The male/female ratio was 1.18:1.0. Micro-organisms from 86 patients were cultured for the first five days and in 77 patients from day 6 onwards. Staphylococcus aureuswas found in 24.4%, which decreased to 18.2% after the first week. Pseudomonas aeruginosawas found in 27.3% of patients. Methicillin-resistant Staphylococcus aureuswas observed in 11.7% of cases. No case of methicillin-sensitive Staphylococcus aureuswas found. Seven patients, after admission day 6, showed no growth. Eighteen per cent of males and 16% of females died during their stay in hospital. This study highlights the predominant bacterial pathogens among the infected burn wounds treated in our centre.

Relation of serum sialic acid with serum lipids in cardiac patients

Elevated serum sialic acid concentration is a risk factor for coronary heart disease in general population along with dyslipidemia. Sialic acid and lipid profile was determined in healthy subjects (Group A1 and A2) and sixty cardiac patients, divided into two groups, group B comprising of thirty male patients and group C comprising of thirty female patients. A highly significant increase was observed in the level of sialic acid and different variables of lipid profile except HDL-C in all patients. HDL-C showed a significant decrease in patients. An increase in the level of sialic acid in cardiac patients showing the implications of raised level of sialic acid in the development of cardiovascular complications.

Evaluation of Pathogenic Potential of Avian Influenza Virus Serotype H9N2 in Chickens

Recently seven isolates of avian influenza virus (AIV) serotype H9N2 recovered from an outbreak of AI were analyzed on the basis of their biological and molecular characteristics. All the isolates belonged to the low-pathogenicity group of AIV. To further evaluate their pathogenic potential in association with other organisms, an isolate was inoculated experimentally in chickens using different routes and subsequently challenged with infectious bronchitis virus, Ornithobacterium rhinotracheale or Escherichia coli. The virus isolation and seromonitoring data revealed a significant role of Escherichia coli in aggravating the clinical condition of the birds earlier infected with AIV (H9N2). The AIV-antigen was detected in lung, trachea, kidney, and cloacal bursa among the infected birds, using immunofluorescent antibody technique. In another experiment, chickens that were immunosuppressed chemically showed high mortality when challenged with AIV H9N2. The results indicated that this low pathogenicity AIV (H9N2) isolate could produce severe infection depending on the type of secondary opportunistic pathogens present under field conditions. This may explain the severity of infection with the present H9N2 outbreak in the field. A prolonged antibacterial therapy in flocks infected with AIV H9N2 and use of oil-based vaccine at an early age in new flocks has helped to control this infection and the disease.

Decrease in rat taste receptor cell intracellular pH is the proximate stimulus in sour taste transduction

Taste receptor cells (TRCs) respond to acid stimulation, initiating perception of sour taste. Paradoxically, the pH of weak acidic stimuli correlates poorly with the perception of their sourness. A fundamental issue surrounding sour taste reception is the identity of the sour stimulus. We tested the hypothesis that acids induce sour taste perception by penetrating plasma membranes as H(+) ions or as undissociated molecules and decreasing the intracellular pH (pH(i)) of TRCs. Our data suggest that taste nerve responses to weak acids (acetic acid and CO(2)) are independent of stimulus pH but strongly correlate with the intracellular acidification of polarized TRCs. Taste nerve responses to CO(2) were voltage sensitive and were blocked with MK-417, a specific blocker of carbonic anhydrase. Strong acids (HCl) decrease pH(i) in a subset of TRCs that contain a pathway for H(+) entry. Both the apical membrane and the paracellular shunt pathway restrict H(+) entry such that a large decrease in apical pH is translated into a relatively small change in TRC pH(i) within the physiological range. We conclude that a decrease in TRC pH(i) is the proximate stimulus in rat sour taste transduction.

Bone marrow changes in human malaria: a retrospective study

The bone marrow reports of 1966 patients admitted to a provincial teaching hospital between January, 1992 to April, 1995 were retrospectively analyzed. Twenty-six (1.3%) bone marrows showed the presence of malarial parasites. Sixteen (62%) patients had Plasmodium falciparum 9 (34%) Vivax malaria and one (4%) mixed infection. All these patients gave a history of prolonged illness and had low parasite counts. Plasmodium vivax malaria was not associated with any significant pathology in the bone marrow, except iron deficiency anaemia. The bone marrows with Plasmodium falciparum malaria showed myeloid hyperplasia, erythroid hyperplasia, megaloblastosis and hypoplasia in different proportions. No evidence of dyserythropoiesis was found in this series. The possible mechanisms producing these changes and the factors responsible for the discrepancy in bone marrow findings in different geographical areas are discussed.

Tumor necrosis factor in falciparum malaria

To investigate the relationship of TNFalpha levels to Plasmodium falciparum (PF) infection, plasma TFNalpha concentrations were measured in Pakistani adults and children with mind, severe, cerebral and chronic falciparum malaria and healthy (control) subjects. The initial geometric mean plasma concentrations of TFNalpha in adult patients with severe malaria (187.6 pg/mL) were significantly higher than mild malaria patients (87.1 pg/mL, P < 0.001). TNFalpha levels were not correlated to parasite density, cerebral malaria, young age, hypoglycemia or fatal outcome; however, they were associated with severe anemia, and hepatic and kidney dysfunction. TNFalpha levels were not significantly increased in 16 patients with hyperparasitemia and were significantly elevated (P < 0.02) in chronic malaria patients as compared to control subjects. TNFalpha levels were elevated independently in patients with anemia, hypoglycemia (P < 0.001, P < 0.05), and hepatic and kidney (P < 0.001 each) dysfuntion. In this study, high TNFalpha levels were associated with several manifestations of severe malaria and were not specific to cerebral malaria and hyperparasitemia.

Haematological changes in falciparum malaria and tumor necrosis factor

Tumor necrosis factor and various haematological parameters were studied in 90 patients suffering from falciparum malaria. They were divided into three groups on the basis of haemoglobin level. The difference in haemoglobin level between group-1 (Hb < 7 gm/dl) and group-2 (Hb 7-10 gm/dl), as well as group-1 and group-3 was statistically significant. The geometric mean TNF alpha concentrations in group-1 (193.9 pg/ml) and group-2 (132.2 pg/ml) were higher as compared to group-3; however, the difference was statistically non-significant. The TNF concentration in group-2 correlated negatively with haemoglobin level (r = .43, p = .05). As a whole, 21% patients had leukocytosis, 3% leukopenia, 46% increased ESR and 26% elevated levels of fibrin degradation products. The platelet count was done only in 4 patients with bleeding problems. Twenty-five healthy subjects were included in the study as controls. The difference between TNF and haemoglobin level in group-1 and controls was statistically significant (p < .05, p < .001 each). The role of tumor necrosis factor in the production of these changes is discussed.

Immunosuppressive potential and pathogenicity of an avian adenovirus isolate involved in hydropericardium syndrome in broilers

The role of avian adenovirus isolate PARC-1 as an immunosuppressive agent was investigated using a Newcastle disease virus (NDV) vaccine immune response procedure. The immunosuppressive effect on the humoral immune response was investigated up to 21 days after inoculation with adenovirus. Infected chickens showed a serologic response to NDV that was reduced compared with that of the controls. To further investigate the effect of the virus on major lymphoid organs, the pattern of virus dissemination in various organs was studied at various time intervals after inoculation. Spleen, thymus, bursa of Fabricius, and cecal tonsils of broilers were examined using a dot-immunobinding assay. The virus was found to have a predilection for lymphoid organs, and virus from lymphoid organs was capable of producing disease when inoculated into healthy chickens. The relationship of virus predilection to its immunosuppressive effect also was studied.

Heroin addiction and sex hormones in males

To investigate the effects of illicit heroin abuse on the endocrine system a study was carried out in North West Frontier Province (NWFP) where heroin addiction is prevalent. Sixty-eight subjects were included in this study. Thirty-three were untreated heroin addicts visiting "drug abuse treatment centres" in Peshawar and 35 age matched normal males. Urine samples of all addicts showed the presence of morphine. The serum concentrations of testosterone (T) in addicts was 228 ng/ml, leutinizing hormone (LH) 10.7 mlU/ml and folical stimulating hormone (FSH) 4.9 mlU/ml whereas the corresponding values for control males were T 630 ng/ml, LH 14.3 mlU/ml and FSH mlU/ml, respectively. Heroin exerts a depletion effect on T and FSH levels in more or less all the groups studied irrespective of age, amount of heroin intake per day and period of contact with heroin. LH levels remained affected and are within clinically accepted normal range.

Chediak-Higashi syndrome: clinical, hematologic, and immunologic improvement after splenectomy

A 10-year-old boy with Chediak-Higashi syndrome in accelerated phase failed to respond to treatment with ascorbic acid, vincristine, and prednisone. Splenectomy resulted in clinical, hematologic, and immunologic improvement: his leukocyte chemotactic and phagocytic functions returned to normal. We suggest that splenectomy be considered in treatment of the accelerated phase of Chediak-Higashi syndrome unresponsive to other forms of therapy.

An infant with multiple congenital abnormalities and biochemical findings suggesting a variant of galactosialidosis

A female newborn probably with a variant form of galactosialidosis is described. The patient, in addition to the common findings seen in early infantile forms of classical galactosialidosis, displayed an unusual combination of congenital malformations including complex cyanotic congenital heart disease with dextrocardia and situs inversus.

Effect of malathion and methyl-parathion on rat liver enzymes

The effect of sub-lethal doses of Malathion and Methyl-parathion was studied on the rat liver enzymes. Intravenous administration of both insecticides at weekly interval for four weeks resulted in increase in heart and spleen weight. Short term (24 hr.) and long term (4 weeks) treatment with insecticides resulted in increased specific activities of liver enzymes, Acid phosphatase, Alkaline phosphatase, Glutamate dehydrogenase, Glutamate oxaloacetate transaminase and Glutamate pyruvate transaminase. The increase in enzyme activity was not as profound when the insecticide administration was spread over 4 weeks. Malathion had greater effect than Methyl-parathion on the biochemical parameters studied.

Effect of malathion and methyl-parathion on rat liver enzymes

The effect of sub-lethal doses of Malathion and Methyl-Parathion was studied on the rat liver enzymes. Intravenous administration of both insecticides at weekly interval for four weeks resulted in increase in weight of various tissues, i.e., heart and spleen. Short term (24 hr) and long term (4 weeks) treatment with insecticides resulted in increased specific activities of liver enzymes, Acid phosphatase, Alkaline phosphatase, Glutamate dehydrogenase, Glutamate oxaloacetate transaminase and Glutamate pyruvate transaminase. The increase in enzyme activity was not as profound when the insecticide administration was spread over 4 weeks. Malathion had greater effect than Methyl-parathion on the biochemical parameters studied.

Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications

This is a prospective study of 500 consecutive patients having coronary artery bypass surgery; mean hospital charge from time of surgery to discharge was +11,900 +/- 12,700. Multiple regression analysis was performed using preoperative variables and postoperative complications. No preoperative clinical feature was a significant predictor of higher average charge. Sternal wound infection (p = 0.0001), respiratory failure (p = 0.0001) and left ventricular failure (p = 0.017) were associated with higher average hospital charge. The absence of any complication predicted a lower average charge, and postoperative death (4.4 +/- 4.5 days after surgery) was also associated with lower average charge. A cost equation was developed: hospital charge equalled $11,217 + $41,559 of sternal wound infection, + $28,756 for respiratory failure, + $5,186 for left ventricular failure, - $1,798 for no complication and - $6,019 for death. Recognition of the influence of complications on charges suggests that low average charges can only be achieved by surgical programs with a low complication rate.

Isoniazid acetylation and polymorphism in humans

Phenotypes of slow and fast acetylators of isoniazid (INH) were determined in 157 subjects (80 normals and 77 patients with tuberculosis) from the twin cities of Rawalpindi and Islamabad. Plasma INH concentrations were determined chemically six hours after the drug ingestion. The findings indicate that 31.8% subjects were fast acetylators of the drug.

Cervicofacial sinuses

One hundred consecutive cases of cervicofacial sinuses are reviewed in terms of aetiology, diagnosis and subsequent management. One hundred and thirty-eight cases recorded in the world literature are reviewed for comparison.

Inherited defect in hereditary pancreatitis

Definite inherited defect in hereditary pancreatitis (HP) is not known. A new kindred with 3 definite and 6 suspected cases of HP was investigated for possible inherited abnormalities. No aminoaciduria (except for a slight rise in urinary histidine in one patient) and no hyperparathyroidism, hyperlipidemia, or chromosomal abnormality was present. An increase in serum IgM level of a polyclonal type was noted in 3 definitely affected sisters and also in 2 nonaffected members. Serum alpha-1-antitrypsin and serum trypsin inhibition were normal. However, very marked dilatation and ectasia of the pancreatic duct were found in the propositus. Reviewing the data from this family and previously described kindreds, it is postulated that the genetic abnormality in HP encompasses a wide variety of structural and anatomical defects in the sphincter of Oddi or the pancreatic ductal system. These predispose to intermittent obstruction of the duct with concomitant activation of enzymes and ductal metaplasia. In suspected cases an early effort should be made to outline the pancreatic duct as the defect may be amenable to surgery.