Measurement of Bone Mineral Density in the Transfusion Dependent Thalassemic Patients

Low bone mineral density represents as a major cause of morbidity in thalassemic patient. The mechanism depends upon several factors. Transfusion dependent iron over load cause decrease secretion of growth hormone, insulin, thyroid hormone, parathyroid hormone, sex hormone and vitamin D from different endocrine organs which ultimately causes impairment of adequate bone mass achievement. Other causes of low bone mass are iron chelating agent and bony expansion due to increase erythropoiesis. To find out the frequency of low bone mineral density in thalassemia patients who are transfusion dependent. This study was designed as a cross sectional observational study, which was analyzed in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka and National Institution of Nuclear Medicine and Allied Sciences (NINMAS), Bangladesh Atomic Energy Commission (BAEC) from September 2017 to August 2018. It had been performed over total 72 (Age ≥06 years to ≤40 years) thalassaemic patients who are transfusion dependent. Presence of bone diseases was detected by Bone mineral density (BMD). Seventy-two (72) patients with transfusion dependent thalassaemia, aged 6 to 39 years were enrolled. Mean age of patients was 20.9±7.2 years. Among them, 57(79.2%) patients were detected as a normal bone mineral density and fifteen (20.8%) patients were detected as a low bone mineral density in the left femoral neck. In transfusion dependent thalassaemic patient, Low bone mass was significantly associated with low BMI, total number of blood transfusion and serum ferritin level remarkably. This survey has established a new path for early detection of low bone mass and helped in prevention of bone loss and its sequel by starting early treatment in these groups of patients.

Clinical Scoring Versus Chlamydia Antibody Titre as a Tool in Predicting Tubal Patency in Subfertile Women

This study was done to compare the predictive capacity of Clinical scoring and Chlamydia antibody titre in predicting tubal patency. This cross sectional comparative study was done in Institute of Child and Mother Health, Dhaka, Bangladesh from January 2018 to December 2018. Eighty eight infertile women with normal ovarian reserve and their husbands with normal semen parameters were purposively included. After taking written informed consent, Clinical scoring, Chlamydia antibody titre and Hysterosalpingography of the study population were done. Data expressed as mean and standard deviation. Logistic regression analysis was done. The predictive capacity was analyzed by sensitivity, specificity, positive and negative predictive value and relative risk. Area under the Curve of Receiver Operating Characteristic was done. A p value <0.05 was considered as statistically significant. Fifty three and half percent had bilateral and 8% had unilateral tubal block and 38.5% had bilateral patent tubes. Clinical scoring versus Hysterosalphingography and Chlamydia antibody titre versus Hysterosalphingography of the study population had sensitivity 87.04% and 48.15%, specificity 76.47% and 58.82%, positive predictive value 82.95% and 52.27%, negative predictive value78.79% and 41.67% and relative risk 5.42 and 0.84 respectively. The Clinical Scoring is better than Chlamydia Antibody Titre as a tool in predicting tubal patency.

Red Cell Alloantibodies in Thalassaemia Patients Who Received Ten or More Units of Transfusion

Thalassaemia patients are the highest consumers of blood. Recurrent exposure to allogenic red cell antigen puts this population at increased risk of alloimmunization. This causes delayed hemolytic transfusion reactions. So transfusion requirement increases. But no data regarding alloimmunization was available in Bangladesh. Aim of this study was to estimate the prevalence of alloimmunization and to find out the potential factors associated with its development. This analytical cross sectional study was done by enrolling 97 patients, received at least 10 units transfusions, through convenient sampling. Indirect and direct antiglobulin tests were done to detect immunization by spin tube technique keeping an autocontrol and carried out in the Department of Haematology & Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2016 to March 2017. Polyclonal anti-AHG reagent was used. A total 21 patients developed alloimmunization (21.6%) and 4 patients (4.1%) developed autoimmunization. Age, gender, splenectomy and number of transfusion are shown significant risk factors for alloimmunization. Data from this study demonstrate that the RBC alloimmunization is significantly high in our country. So, pretransfusion antibody screening needs to be initiated in order to ensure safe transfusion and RBC phenotyping should be started before starting first transfusion to prevent alloimmunization.

Cytomegalovirus Retinitis during Maintenance Therapy in child with Acute Lymphoblastic Leukemia

We report three cases of acute lymphoblastic leukemia (ALL) those were suffered from cytomegalovirus retinitis (CMVR) during maintenance phase therapy. Ophthalmologic examination for loss of vision prompted diagnosis of cytomegalovirus retinitis. Administration of anticytomegalovirus drugs led to complete regression of active retinitis. CMVR should be in mind for children with ALL on maintenance of medical aid, even in those without hematopoietic stem cell transplantation state.

Status updates of Newcastle disease and amelioration effects of medicinal plants against Newcastle disease virus: A review

Recently, medicinal plants are achieving great interest because of their use in ethno medicine treatment of different common diseases and also other medicinal assertions are now reinforced by comprehensive scientific evidence. Almost 82 research articles and abstracts published, so far, were screened for evaluating antiviral efficiency of various plant samples and 23 different plants were found to be traditionally used against Newcastle disease (ND). ND is a most transmissible viral disease of avian species caused by virulent strain of Avula virus from the Paramyxoviridae family. The first epidemic of ND was perceived in Java, Indonesia and England in year 1926. ND causes great economic loses to the commercial poultry farmers around the world. Medicinal plants are traditionally used in the control of viral or other diseases and infections. Plants have been found useful in treating many microbial diseases in man and animals caused by bacteria and viruses. The ability to synthesize compounds retaining antiviral potential by secondary metabolism makes plants a vital source of pharmaceutical and therapeutic products, which can reduce chemotherapeutic load in birds. Current studies signify that the natural products posses a rich potential source of new antiviral compounds. Further ethnobotanical studies and laboratory investigations are established to identify species having potential to improve ND control.

Transcatheter Aortic Valve Replacement: A Review

Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve. Assessment of risk has evolved to include a more comprehensive functional and frailty evaluation. Long term-results are needed before the expansion of transcatheter aortic valve replacement into the low-risk category.

Fowl adenovirus: history, emergence, biology and development of a vaccine against hydropericardium syndrome

The poultry industry has emerged as one of the largest and fastest growing public sectors in the developed and developing countries. Unfortunately, this industry is under a major threat from diseases that are viral (Newcastle disease, infectious bursal disease, influenza, hydropericardium syndrome), bacterial (colibacillosis, pasteurellosis, salmonellosis, mycoplasmosis), parasitic (coccidiosis, histoplasmosis) or nutritional (dyschondroplasia, osteoporosis). Among these diseases, hydropericardium syndrome (HPS) is one of the important emerging diseases occurring in the specific areas of the world where broilers (chickens) are reared under intensive conditions. HPS was first observed in 1987 at Angara Goth, an area near Karachi, Pakistan, where broilers are raised. Since then, HPS has been reported in many countries of the world. From these reported cases, an adenovirus that was either isolated from or visualized electron microscopically in the liver of affected broilers has been implicated in the syndrome. The syndrome has been reproduced by inoculation of isolated fowl adenovirus (FAdV) strains, and hence, the syndrome is also called infectious hydropericardium syndrome. To our knowledge, HPS has not been observed in humans, so it is not considered a zoonotic disease, but it is of economic importance and causes huge losses to the poultry industry. Efforts have been made to develop conventional vaccines against this disease, which were formulated from infected liver homogenate. Formalin-inactivated liver organ vaccines have failed to protect the poultry industry. Hence, there is a dire need to develop a suitable vaccine to combat this disease. Currently, recombinant vaccine candidates are being developed by using molecular biology and biotechnological approaches for the prevention and control of infectious diseases, including HPS. Therefore, it is suggested that the immunogenicity of these recombinant proteins should be evaluated for their use as subunit vaccines.

Flooding adds pathogenic Escherichia coli strains to the water sources in southern Khyber Pakhtunkhwa, Pakistan

PURPOSE

Seasonal rains in Pakistan result in heavy floods across the country, whereby faecal contaminants will be added to the water bodies and cause numerous food-borne outbreaks. The present study was aimed to determine the prevalence of diarrheagenic Escherichia coli (DEC) strains in the water sources.

MATERIALS AND METHODS

Two hundred water samples collected during (2011-2012) were processed for the isolation of E. coli (EC) strains. EC strains were further analysed for antibiotic susceptibility patterns, and pathogroups-specific virulence factors stx1, stx2, stx2c, eae, tir, hlyA, bfpA, estA and eltA were detected using multiplex polymerase chain reaction.

RESULTS

Thirty-three percent of the water samples were contaminated with EC pathotypes. Fifty percent (33/66) of the DEC pathotypes were identified as enterotoxigenic EC (ETEC). Seventy-two percent (13/18) of the enteropathogenic EC (EPEC) strains were identified as typical EPEC and 28% (5/18) as atypical EPEC. Eleven percent (7/66) of the Shiga toxin EC (STEC) isolates carried a combination of stx1 and stx2 genes. Summer was found as a peak season with 47% (31/66) for EC pathogroups' activities. Eighty-nine percent of the strains showed resistance against tetracycline.

CONCLUSION

ETEC and EPEC are the primary causes of water contamination in southern regions of Khyber Pakhtunkhwa province, Pakistan. Firm adherence to the prescribed drugs can decrease trends in antibiotic resistance.

High-Risk Variant of a Rare Coronary Anomaly

A 61-year-old man presented with typical chest pain and was treated via acute coronary syndrome protocol. Findings on his initial diagnostic evaluations prompted cardiac catheterization. His angiographic findings were suspicious for anomalous coronary artery origin. Advanced imaging confirmed an aberrant course of the left coronary artery, with the vessel arising from the right aortic sinus of Valsalva. It was identified that the patient possessed all known high-risk features associated with this anomaly, findings not previously documented in a living adult. The patient ultimately underwent surgical revascularization to mitigate his risk for sudden cardiac death.

The role of in-depth reproductive health counseling in addressing reproductive health concerns in female survivors of nongynecologic cancers

The purpose of this study was to characterize reproductive concerns among female cancer survivors and determine the role of targeted counseling in improving overall reproductive quality of life (QOL). A survey was administered to women from the California Cancer Registry, ages 18-40, with nongynecologic cancers diagnosed from 1993 to 2007, who received fertility-compromising treatments. In total, 356 women completed the survey, which included questions regarding their reproductive health counseling history and the reproductive concerns scale (RCS), a validated reproductive QOL tool. Factors independently associated with higher RCS scores included a desire for children at the time of diagnosis, posttreatment infertility, treatment with chemoradiation or bone marrow transplant, and income less than $100,000 per year at diagnosis. Among the highest reported reproductive concerns were those related to loss of control over one's reproductive future and concerns about the effect of illness on one's future fertility. Across our population and independent of age, in-depth reproductive health counseling prior to cancer treatment was associated with significantly lower RCS scores. Our findings highlight the importance of early counseling and targeting high-risk groups for additional counseling after completion of cancer treatment. This approach may be an effective strategy for optimizing long-term reproductive QOL in this vulnerable population.

Molecular cloning, expression and characterization of 100K gene of fowl adenovirus-4 for prevention and control of hydropericardium syndrome

Fowl adenovirus-4 is an infectious agent causing Hydropericardium syndrome in chickens. Adenovirus are non-enveloped virions having linear, double stranded DNA. Viral genome codes for few structural and non structural proteins. 100K is an important non-structural viral protein. Open reading frame for coding sequence of 100K protein was cloned with oligo histidine tag and expressed in Escherichia coli as a fusion protein. Nucleotide sequence of the gene revealed that 100K gene of FAdV-4 has high homology (98%) with the respective gene of FAdV-10. Recombinant 100K protein was expressed in E. coli and purified by nickel affinity chromatography. Immunization of chickens with recombinant 100K protein elicited significant serum antibody titers. However challenge protection test revealed that 100K protein conferred little protection (40%) to the immunized chicken against pathogenic viral challenge. So it was concluded that 100K gene has 2397 bp length and recombinant 100K protein has molecular weight of 95 kDa. It was also found that the recombinant protein has little capacity to affect the immune response because in-spite of having an important role in intracellular transport & folding of viral capsid proteins during viral replication, it is not exposed on the surface of the virus at any stage.

Statin-associated polymyositis following omeprazole treatment

Statins are an extensively used class of drugs, and myopathy is an uncommon, but well-described side effect of statin therapy. Inflammatory myopathies, including polymyositis, dermatomyositis, and necrotizing autoimmune myopathy, are even more rare, but debilitating, side effects of statin therapy that are characterized by the persistence of symptoms even after discontinuation of the drug. It is important to differentiate statin-associated inflammatory myopathies from other self-limited myopathies, as the disease often requires multiple immunosuppressive therapies. Drug interactions increase the risk of statin-associated toxic myopathy, but no risk factors for statin-associated inflammatory myopathies have been established. Here we describe the case of a man, age 59 years, who had been treated with a combination of atorvastatin and gemfibrozil for approximately 5 years and developed polymyositis after treatment with omeprazole for 7 months. Symptoms did not resolve after discontinuation of the atorvastatin, gemfibrozil, and omeprazole. The patient was treated with prednisone and methotrexate followed by intravenous immunoglobulin, which resulted in normalization of creatinine kinase levels and resolution of symptoms after 14 weeks. It is unclear if polymyositis was triggered by interaction of the statin with omeprazole and/or gemfibrozil, or if it developed secondary to long-term use of atorvastatin only.

A subunit vaccine against hydropericardium syndrome using adenovirus penton capsid protein

Hydropericardium syndrome (HPS) is a disease of poultry that is caused by fowl adenovirus-4. Inactivated liver homogenate from diseased birds is still the choice of vaccine in some countries which disseminates numerous pathogens along with inactivated virus. Moreover incomplete attenuation or inactivation, reversion to virulence and the oncogenic potential/genetic instability of the adenoviruses have prevented their use in routine vaccines. To address this problem an effort is made to develop a subunit vaccine. For this purpose penton base protein of HPS virus was expressed in Escherichia coli and used as subunit vaccine in broilers. Immunogenicity of the recombinant penton base protein and challenge protection test against pathogenic virus demonstrated the ability of recombinant penton base protein to confer (90%) protection. Results suggest that the recombinant penton base protein is a candidate for subunit vaccine against HPS.

To evaluate the extent of awareness about hazards of blood transfusion among the blood recipients

This cross-sectional, observational study was carried out among the blood receiving patients conducted in the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University from April 2008 to August 2009, over 126 purposively selected, to evaluate the extent of awareness about hazards of blood transfusion among the blood recipient. In this study 74.1% of male and 73.3% of female respondents had correct knowledge of blood transfusion (p>0.05). In literate group 85(91.4%) had knowledge about blood donation and transfusion compared to 8(8.6%) in illiterate group with significant statistical difference (p=0.001). Different misconception and lack of awareness about safe blood transfusion is present among people receiving blood and blood products. Illiterate persons have significant less level of knowledge about safe blood transfusion. So the number of educational programs on blood-donation should be expanded and transmitted to encourage possible receivers to take blood from nonprofessional volunteer donor and to carry out relevant screening tests before receiving blood products. Furthermore, they should know that all measures besides screening tests are implemented by blood banks to ensure that blood donation is safe for donors and that transfusion of the donated blood is safe for recipients.

Effect of maternal oral hydration therapy in oligohydramnios

This was a randomized controlled trial on 64 pregnant women from 32 to 35 weeks gestation, in one year period to determine the effect of maternal hydration by oral water in oligohydramnios amniotic fluid index (AFI) ≤ 5. Studied women were randomly divided into two groups. Group A (intervention group) women were instructed to drink 2 liters of water within 2 hours and from the next day extra 2 liters of water daily for 7 days. Group B (control group) women were allowed for routine water intake. AFI was done after 2 hours, 24 hours and 7 days of oral hydration therapy in both the groups. P values less than 0.05 was considered statistically significant. Pre-treatment mean AFI was 4.77 ± 0.42 (mean ± SD) vs. 4.80 ± 0.43 (mean ± SD) and post treatment AFI after 2 hours was 6.35 ± 0.65 vs. 4.81 ± 0.42; after 7 days was 7.08 ± 0.21 vs. 5.0 ± 0.20 in oral hydration group and control group respectively. Delivery at 37-40 weeks was 53.1% vs. 12.4%, normal vaginal delivery in 71% vs. 21.8%, caesarean section in 29% vs. 78.2% and low birth weight babies were 12.5% vs. 81.25% in intervention and control group respectively. Foetal outcome was healthy in 87.1% vs. 59.4%, asphyxiated in 12.9% vs. 50% and perinatal death was 3.22% vs. 21.8% between intervention and control group. Still born were 6.3% cases in control group. Maternal oral hydration therapy significantly increases the AFI, reduces the caesarean section rate and improves the foetal outcome.

Validity of Weech's formulae in detecting undernutrition in children

Primary care physicians in developing countries frequently use Weech's formulae to estimate the expected weight and height of children using age as a variable. The present study was undertaken to assess the validity of Weech's formulae in diagnosing undernutrition. We collected anthropometric information from 294 consecutive children, aged 12-59 months, who visited a health centre. Age was calculated from birth records and was recorded in completed months as well as completed years. Weight and height/length were measured using standard methods. Weight-for-age and height-for-age Z scores were calculated using WHO Anthro. Weech's formulae were used to calculate weight-for-age (%) and height-for-age (%). A cut off of < or =80.0% weight-forage and < or = 95.0% height-for-age were used to evaluate the validity of underweight and stunting respectively; a cut off of < or = 60.0% weight-for-age and <85.0% height-for-age were used for severe underweight and severe stunting respectively. Weech's formulae were found to be 100% sensitive in detecting underweight (weight-for-age Z score<-2) and stunting (height-for-age Z score<-2). When evaluating severe underweight (weight-for-age Z scorc<-3) and severe stunting (height-for-age Z scorc<-3), Weech's formulae were found to be 100% specific but the sensitivity was very low, 25.0% and 15.4% respectively. Based on the findings of our study Weech's formulae appear to be a sensitive tool to detect underweight and stunting in children between 12-59 months of age. Such formulae should however be used with caution when evaluating severe forms of undernutrition.

Percutaneous closure of patent foramen ovale: a case series and literature review

Patent foramen ovale (PFO) is an anatomical variant of the interatrial septum with an overall prevalence of 27% in autopsy studies. PFOs have a potential role in causation of stroke, platypneaorthodeoxia, decompression sickness, right to left shunt and migraine headaches. Data regarding percutaneous closure of PFO in low volume tertiary care centers is lacking. Retrospective review of 14 percutaneous PFO closures done in our facility from March 2005 to August 2006 was performed for efficacy of procedure and safety. All patients received clopidogrel for a period of 3 months, and aspirin and subacute bacterial endocarditis prophylaxis for 6 months. Mean age of the study population was 54 years. Fifty percent (7 of 14) of patients experienced an atrial septal aneurysm and 14% (2 patients) exhibited a hypercoagulable state. The indication for closure in 13 patients was transient ischemic attacks or strokes, while one patient had persistent hypoxia due to a severe right to left shunt at PFO. Patients received either a CardioSEAL or Amplatzer device. Deployment rate was 100%. All patients completed a minimum of 6 months of follow-up, with a mean follow-up time of 14.9 +/- 7.6 months. No immediate or late bleeding complication occurred in any patient. One patient developed paroxysmal atrial fibrillation and one patient developed thrombotic complications at 7 months post-procedure secondary to the progression of her anal carcinoma and subsequently died. Pending the results of the four large randomized trials that are enrolling patients, percutaneous closure of PFO for cryptogenic strokes is an attractive alternative to lifelong anticoagulation with relatively few complications, even in low volume centers. There are many challenges in the management of this subset of patients, the foremost being the selection of a target patient population. Role of PFO in migraines is less clear.

Estimation of vocal tract shape for VCV syllables for a speech training aid

Display of vocal tract shape can be used in speech training aids for the hearing impaired children, as it provides a visual feedback of the articulatory efforts. Estimation of vocal tract shape, based on LPC and other analysis techniques, works satisfactorily for vowels but generally fails during stop closures. Indication of correct place of articulation is very important, particularly for non-labial consonants. In order to study the dynamics of the vocal tract shape estimation during transitions at vowel-consonant boundaries, we have used "areagram", a spectrogram-like two-dimensional (2D) display of estimated vocal tract cross-sectional area as a function of time and position along the tract length. Area estimation is based on reflection coefficients obtained from LPC analysis of speech. Based on estimated area during the transition segments preceding and following the stop closure, bivariate polynomial surfaces are obtained and these are used for estimation of the vocal tract shape during stop closure by performing 2D interpolation. The place of closure for various stop consonants could be estimated satisfactorily from the conic surface approximation.

Chromosomal loci that influence oral nicotine consumption in C57BL/6J x C3H/HeJ F2 intercross mice

Several studies have demonstrated that there are genetic influences on free-choice oral nicotine consumption in mice. In order to establish the genetic architecture that underlies individual differences in free-choice nicotine consumption, quantitative trait loci (QTL) mapping was used to identify chromosomal regions that influence free-choice nicotine consumption in male and female F(2) mice derived from a cross between C57BL/6J and C3H/HeJ mice. These two mouse strains were chosen not only because they differ significantly for oral nicotine consumption, but also because they are at or near phenotypic extremes for all measures of nicotine sensitivity that have been reported. A four-bottle choice paradigm was used to assess nicotine consumption over an 8-day period. The four bottles contained water or water supplemented with 25, 50 or 100 microg/ml of nicotine base. Using micrograms of nicotine consumed per milliliter of total fluid consumed per day as the nicotine consumption phenotype, four significant QTL were identified. The QTL with the largest LOD score was located on distal chromosome 1 (peak LOD score = 15.7). Other chromosomes with significant QTL include central chromosome 4 (peak LOD score = 4.1), proximal chromosome 7 (peak LOD score = 6.1) and distal chromosome 15 (peak LOD score = 4.8). These four QTL appear to be responsible for up to 62% of the phenotypic variance in oral nicotine consumption.

The thyroid during pregnancy: a physiological and pathological stress test

Pregnancy and the postpartum are times of marked and rapid change in the thyroid gland. Normal physiological changes include enhanced thyroid hormone production, modulation of thyroid hormone metabolism by placental deiodinases, and decreasing titers of thyroid antibodies in thyroid antibody positive women. Hyperemesis gravidarum is associated with suppressed thyroid stimulating hormone levels and free T4 elevations. Graves' disease typically becomes quiescent during pregnancy, followed by a postpartum flare. Women with pre-existing hypothyroidism frequently require an increase in their levothryoxine requirement in the 1(st) trimester, and subclinical hypothyroidism early in pregnancy is linked to both miscarriage and impaired neurological development in the unborn child. Postpartum thyroiditis occurs in 7.2% of women, and euthyroid women who are thyroid antibody positive in the 1(st) trimester of pregnancy have a doubling of the miscarriage rate.

Bilateral radial head fractures in a martial arts athlete

Isolated radial head fractures, which are rare, comprise about 2% of all fractures around the elbow. A case is reported of bilateral radial head fracture in an international female athlete. Early recognition and aggressive rehabilitation is essential if an abrupt end to a promising sporting career is to be prevented.

Lupeol, a triterpene, inhibits early responses of tumor promotion induced by benzoyl peroxide in murine skin

The modulating effect of Lupeol [lup-20(29)-en-3 beta -ol], a triterpene found in many fruits and medicinal plants, on benzoyl peroxide-induced tumor promotion responses or tumor promotion in murine skin is described. Benzoyl peroxide is an effective cutaneous tumor promoter acting through the generation of oxidative stress, the induction of ornithine decarboxylase activity and the enhancement of DNA synthesis. Benzoyl peroxide treatment increases cutaneous microsomal lipid peroxidation and hydrogen peroxide generation. The activity of the cutaneous antioxidant enzymes, namely catalase, glutathione peroxidase, glutathione reductase and glutathione S-transferase, is decreased and levels of cutaneous glutathione are depleted. Benzoyl peroxide treatment also induces ornithine decarboxylase activity and enhances [3H]thymidine uptake in DNA synthesis. Prophylactic treatment of mice with lupeol (0.75 and 1.5 mg per animal) 1 hour before benzoyl peroxide treatment resulted in a diminution of benzoyl peroxide-mediated damage. The susceptibility of cutaneous microsomal membrane to lipid peroxidation and hydrogen peroxide generation was significantly reduced (P< 0.01 and P< 0.01, respectively). In addition, depleted levels of glutathione and inhibited activity of antioxidant enzymes were recovered to a significant level (P< 0.01, P< 0.05 and P< 0.01, respectively). Similarly, the elevated ornithine decarboxylase activity and enhanced thymidine uptake in DNA synthesis were inhibited significantly (P< 0.05) in a dose-dependent manner. The protective effect of lupeol was dose dependent in all parameters. The results suggest that lupeol is an effective skin chemopreventive agent that may suppress benzoyl peroxide-induced cutaneous toxicity.

Review and consideration of coagulopathies

Blood components bring nutrients to the tissues, remove wastes, provide defenses against microorganisms and foreign bodies, and retain sufficient fluidity to keep the system functioning properly. Coagulation factors are also present in the blood as part of a sensitive system that stems the flow of blood from a wound and maintains homeostasis. These factors include anuclear platelets that originate from megakaryocytes in the bone marrow, as well as soluble factors in precursor form, and calcium ion. Faults in single or multiple parts of this system, which can be determined in the patient's history, may result in bleeding problems that may be clinically relevant. Clarification of coagulation defects requires cooperation with a hematologist before medication that affects the coagulation system is prescribed or before any procedures that may result in bleeding are undertaken.

Comparison of mortality rates and progression of left ventricular dysfunction in patients with idiopathic dilated cardiomyopathy and dilated versus nondilated right ventricular cavities

This study assesses the influence of right ventricular (RV) dilation on the progression of left ventricular (LV) dysfunction and survival in patients with idiopathic dilated cardiomyopathy (IDC). Using transthoracic echocardiography, we studied 100 patients with IDC aged 20 to 80 years (mean 55 +/- 14); 67% were men. In the apical 4-chamber view, diastolic LV and RV chamber area measurements classified patients into 2 groups: group RV enlargement+ (RV area/LV area > 0.5) included 54 patients; group RV enlargement- (no RV enlargement) had RV area/LV area < or = 0.5. Echocardiographic studies were repeated in all patients after a mean of 33 +/- 16 months. At the time of the initial study, the 2 groups did not differ in age, gender, incidence of atrial fibrillation and diabetes, left ventricular mass, and LV ejection fraction, but the RV enlargement+ group had more severe tricuspid regurgitation and less LV enlargement. After 47 +/- 22 months (range 12 to 96), patients in group RV enlargement+ had lower LV ejection fraction (29% vs 34%, p = 0.006) than patients with initial RV enlargement-. At clinical follow-up, mortality was higher (43%) in patients with initial RV enlargement+ than the RV enlargement- patients (15%), p = 0.002. For survivors, the mitral deceleration time averaged 157 +/- 36 ms; for nonsurvivors or patients who required transplant, the mitral deceleration time averaged 97 +/- 12 ms (p < 0.0001). With use of a multivariate Cox model adjusting for LV ejection fraction, LV size, and age, the relative risk ratio of mortality from initial RV enlargement+ was 4.4 (95% confidence limits 1.7 to 11.1) (p = 0.002). Thus, patients with significant RV dilation had nearly triple the mortality over 4 years and more rapidly deteriorating LV function than patients with less initial RV dilation. In IDC, RV enlargement is a strong marker for adverse prognosis that may represent a different morphologic subset.

Percutaneous transluminal coronary angioplasty in distal lesions

Of 210 patients in whom percutaneous transluminal coronary angioplasties [PTCA] were performed during the period of 2 years (June 1987 to August 1989), 55 had distal lesions. These included 50 males and 5 females with the lesions in left anterior descending [LAD] artery after the origin of the second diagonal branch, circumflex [Cx] artery after the origin of the obtuse marginal [OM], and right coronary artery [RCA] after the acute marginal branch. There were a total of 71 distal lesions, involving the LAD [51%], Cx [20%], and RCA [29%]. The overall success rate with PTCA was 91%. There were 4 acute closures of vessels; all were redilated with balloon angioplasty. One of these was sent for emergency bypass surgery after balloon dilatation. There was no death. With improvement in balloon catheters and guidewires, the feasibility and success of PTCA in distal lesions have increased remarkably, thus expanding the horizon of PTCA.

Studies on glutamic acid decarboxylase from Listeria monocytogenes

The isolation and characterization of glutamic acid decarboxylase from Listeria monocytogenes has been described. Effects of various concentrations of glutamic acid as a substrate and pyridoxal phosphate as coenzyme on the activity of the partially purified enzyme have been examined and their Km and Vmax values determined. The enzyme exhibits relatively higher activity in 0.1 M pyridine-pyridine hydrochloride buffer with a pH value of 4.6.