Phlebectomy versus Sclerotherapy in Varicose Vein Patients: A Comparative Study

Varicose veins are part of the spectrum of chronic venous disease and include spider telangiectasias, reticular veins, and true varicosities. It may present without advanced signs of chronic venous insufficiency. Sclerotherapy is a treatment choice for patients with varicose veins of lower extremity; it uses the intravenous injection of chemical drugs to achieve the goal of inflammatory occlusion. Phlebectomy, a minimally invasive procedure usually used for higher diameter of varicose veins at the surface of the skin. Objective of the study was to compare the outcome of Phlebectomy and Sclerotherapy in varicose vein patients. It was a quasi experimental study was conducted in the Department of Vascular Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of June 2019 to May 2020. Patients admitted with varicose vein and varicosity of the lower limbs with valves and perforator incompetence in the Department of Vascular Surgery, BSMMU, Dhaka, Bangladesh. During this period 60 patients were selected purposive randomly. Patients were divided to 30 patients were treated with Phlebectomy (Group I) 30 patients were treated with Sclerotherapy (Group II). Data were collected according to the pre-designed semi-structured data collection sheet. After editing data analysis were carried out by using the Statistical Package for Social Science (SPSS) version 22.0 Windows software. This study shows average age 40.73±15.50 years in Phlebectomy (Group I) and 38.43±11.08 years in Sclerotherapy (Group II). Males are more commonly involved than females between two groups which was 76.7% in Phlebectomy (Group I) and 70.0% in Sclerotherapy (Group II). The change CEAP improved to 93.3% in patients who underwent phlebectomy when compared to 83.3% in patients who underwent sclerotherapy. During the follow-up with duplex at treated veins showed 93.3% complete occlusion of treated veins in the phlebectomy group, while only 70.0% of the patients in the sclerotherapy group showed evidence of complete occlusion. In phlebectomy group recurrence of leg varicosities were found 6.7% of the patients, while 26.7% of the patients in the sclerotherapy group. The difference was statistically significant between two groups (p=0.038). This study shows phlebectomy to be much better option than sclerotherapy for the treatment of varicose veins and hence can be used routinely. Both phlebectomy and sclerotherapy not only revealed minimal time taken for return to normal activity but also proved to be safer with regard to complications.

Impact of nitrogen and phosphorus fertilizers on Cry1Ac protein contents in transgenic cotton

Application of different fertilizers to check the efficiency of expression of Bt (Bacillus thuringiensis) gene in one of the leading commercialized crops (cotton) against Lepidopteran species is of great concern. The expression of Cry protein level can be controlled by the improvement of nutrients levels. Therefore, the myth of response of Cry toxin to different combinations of NP fertilizers was explored in three Bt cotton cultivars. Combinations include three levels of nitrogen and three levels of phosphorus fertilizers. Immunostrips and Cry gene(s) specific primer based PCR (Polymerase Chain Reaction) analysis were used for the presence of Bt gene that unveiled the presence of Cry1Ac gene only. Further, the ELISA (enzyme-linked immunosorbent assay) kit was used to quantify the expression of Cry1Ac protein. Under various NP fertilizers rates, the level of toxin protein exhibited highly significant differences. The highest toxin level mean was found to be 2.3740 and 2.1732 µg/g under the treatment of N150P75 kg ha-1 combination while the lowest toxin level mean was found to be 0.9158 and 0.7641 µg/g at the N50P25 kg ha-1 level at 80 and 120 DAS (Days After Sowing), respectively. It was concluded from the research that the usage of NP fertilizers has a positive relation with the expression of Cry1Ac toxin in Bt cotton. We recommend using the N150P50 kg ha-1 level as the most economical and practicable fertilizer instead of the standard dose N100P50 kg ha-1 to get the desired level of Cry1Ac level for long lasting plant resistance (<1.5). The revised dose of fertilizer may help farmers to avoid the cross-resistance development in contradiction of insect pests.

Physicochemical features, functional characteristics, and health benefits of cottonseed oil: a review

Vegetable oils have their specific physicochemical properties due to which they are playing vital role in human nutritional diet for health benefits. Cottonseed oil is obtained from various species of cotton seeds that are famous to be grown mainly for their fiber quality. The most prominently used specie is Gossypium hirsutum. It is obvious that the seeds of different variety of cotton vary as grown in diverse agroclimatic conditions with respect to oil, fats and protein contents. Cottonseed oil is routinely used for cooking and food manufacturing products. Cottonseed oil obtained after proper extraction/processing steps from crude state to refined oil in a variety of ways. Cotton crop is considered for their dual-use purpose, for fiber quality and oil production to promote health benefits in the world. Keeping in view the above facts, this review clearly demonstrated an overview about physicochemical and functional properties of cottonseed oil to promote health benefits associated with the use of this oil. The overall characteristics and all concerned health benefits of CSO will further improve their usefulness is a compact way. We have summarized a brief multi-dimensional features of CSO in all aspects up to the best of our knowledge for the end researchers who can further research in the respective aspect.

Identification and comprehensive analysis of the CLV3/ESR-related (CLE) gene family in Brassica napus L

The CLE (CLAVATA3/ESR) gene family, encoding a group of small secretory peptides, plays important roles in cell-to-cell communication, thereby controlling a broad spectrum of development processes. The CLE family has been systematically characterized in some plants, but not in Brassica napus. In the present study, 116 BnCLE genes were identified in the B. napus genome, including seven unannotated, six incorrectly predicted and five multi-CLE domain-encoding genes. These BnCLE members were separated into seven distinct groups based on phylogenetic analysis, which might facilitate the functional characterization of the peptides. Further characterization of CLE pre-propeptides revealed 31 unique CLE peptides from 45 BnCLE genes, which may give rise to distinct roles of BnCLE and expansion of the gene family. The biological activity of these unique CLE dodecamer peptides was tested further through in vitro peptide assays. Variations in several important residues were identified as key contributors to the functional differentiation of BnCLE and expansion of the gene family in B. napus. Expression profile analysis helped to characterize possible functional redundancy and sub-functionalization among the BnCLE members. This study presents a comprehensive overview of the CLE gene family in B. napus and provides a foundation for future evolutionary and functional studies.

Could exotic mosquito-borne diseases emerge in Canada with climate change?

Of the 3,500 species of mosquitoes worldwide, only a small portion carry and transmit the mosquito-borne diseases (MBDs) that cause approximately half a million deaths annually worldwide. The most common exotic MBDs, such as malaria and dengue, are not currently established in Canada, in part because of our relatively harsh climate; however, this situation could evolve with climate change. Mosquitoes native to Canada may become infected with new pathogens and move into new regions within Canada. In addition, new mosquito species may move into Canada from other countries, and these exotic species may bring exotic MBDs as well. With high levels of international travel, including to locations with exotic MBDs, there will be more travel-acquired cases of MBDs. With climate change, there is the potential for exotic mosquito populations to become established in Canada. There is already a small area of Canada where exotic Aedes mosquitoes have become established although, to date, there is no evidence that these carry any exotic (or already endemic) MBDs. The increased risks of spreading MBDs, or introducing exotic MBDs, will need a careful clinical and public health response. Clinicians will need to maintain a high level of awareness of current trends, to promote mosquito bite prevention strategies, and to know the laboratory tests needed for early detection and when to report laboratory results to public health. Public health efforts will need to focus on ongoing active surveillance, public and professional awareness and mosquito control. Canadians need to be aware of the risks of acquiring exotic MBDs while travelling abroad as well as the risk that they could serve as a potential route of introduction for exotic MBDs into Canada when they return home.

A systematic review and Bayesian network meta-analysis of risk of intracranial hemorrhage with direct oral anticoagulants

Essentials Risk of intracranial hemorrhage (ICH) may differ between direct oral anticoagulants (DOACs). We compared the risk of ICH between DOACs using network meta-analysis. Dabigatran 110 mg and 150 mg were safer than rivaroxaban on Bayesian analysis. Dabigatran 110 mg ranked as the safest DOAC while rivaroxaban ranked last.

SUMMARY

Background The comparative risk of intracranial hemorrhage (ICH) among direct oral anticoagulants (DOACs) (dabigatran, rivaroxaban, apixaban and edoxaban) remains unclear. Objective To determine the difference in risk of ICH between DOACs Methods Seventeen randomized controlled trials (RCTs) were selected using PubMed/MEDLINE, EMBASE and CENTRAL (Inception, 31 December 2017). Estimates were reported as odds ratio (OR) with 95% credible interval (CR.I) in Bayesian network meta-analysis (NMA), and OR with 95% confidence interval (CI) in traditional meta-analyses. Relative ranking probability of each group was generated based on surface under the cumulative ranking curve (SUCRA). Results In NMA of 116 618 patients from 17 RCTs (apixaban = 19 495 patients, rivaroxaban = 14 157 patients, dabigatran = 16 074 patients, edoxaban = 11 652 patients, and comparator = 55 315 patients), all DOACs were safer than warfarin for risk of ICH. Dabigatran 110 mg ranked as the safest drug (SUCRA, 0.85) and reduced the risk of ICH by 56% compared to rivaroxaban (OR, 0.44; 95% Cr.I, 0.22-0.82). Pairwise meta-analysis validated these findings, showing that DOACs were safer than warfarin (OR, 0.46; 95% CI, 0.35-0.59). Subgroup analysis showed that the benefit was present when DOACs were used in non-valvular atrial fibrillation (NVAF) (OR, 0.51; 95% CI, 0.38-0.68) or venous thromboembolism (VTE) (OR, 0.32; 95% CI, 0.18-0.58). Conclusion Dabigatran 110 mg may be the safest choice among any anticoagulant regarding risk of ICH. Both dabigatran 110 mg and 150 mg were safer than rivaroxaban.

Raising Backyard Poultry in Rural Bangladesh: Financial and Nutritional Benefits, but Persistent Risky Practices

Poultry is commonly raised by households in rural Bangladesh. In 2007, the Government of Bangladesh began a mass media campaign to disseminate 10 recommended precautions to prevent transmission of H5N1 from poultry to humans. This longitudinal study explored the contribution of backyard poultry on household economy and nutrition and compared poultry-raising practices to government recommendations. From 2009 to 2012, we enrolled a nationally representative sample of 2489 primary backyard poultry raisers from 115 rural villages selected by probability proportional to population size. Researchers interviewed the raisers to collect data on poultry-raising practices. They followed the raisers for 2-12 months to collect data on household income and nutrition from poultry. Income from backyard poultry flocks accounted for 2.8% of monthly household income. Return on annual investment (ROI) per flock was 480%. Yearly, median family consumption of eggs was one-fifth of the total produced eggs and three poultry from their own flock. Respondents' reported practices conflicted with government recommendations. Sixty per cent of raisers had never heard of avian influenza or 'bird flu'. Among the respondents, 85% handled sick poultry or poultry that died due to illness, and 49% slaughtered or defeathered sick poultry. In 37% of households, children touched poultry. Fifty-eight per cent never washed their hands with soap after handling poultry, while <1% covered their nose and mouth with a cloth when handling poultry. Only 3% reported poultry illness and deaths to local authorities. These reported practices did not improve during the study period. Raising backyard poultry in rural Bangladesh provides important income and nutrition with an excellent ROI. Government recommendations to reduce the risk of avian influenza transmission did not impact the behaviour of poultry producers. Further research should prioritize developing interventions that simultaneously reduce the risk of avian influenza transmission and increase productivity of backyard poultry.

Bat Hunting and Bat-Human Interactions in Bangladeshi Villages: Implications for Zoonotic Disease Transmission and Bat Conservation

Bats are an important reservoir for emerging zoonotic pathogens. Close human–bat interactions, including the sharing of living spaces and hunting and butchering of bats for food and medicines, may lead to spillover of zoonotic disease into human populations. We used bat exposure and environmental data gathered from 207 Bangladeshi villages to characterize bat exposures and hunting in Bangladesh. Eleven percent of households reported having a bat roost near their homes, 65% reported seeing bats flying over their households at dusk, and 31% reported seeing bats inside their compounds or courtyard areas. Twenty percent of households reported that members had at least daily exposure to bats. Bat hunting occurred in 49% of the villages surveyed and was more likely to occur in households that reported nearby bat roosts (adjusted prevalence ratio [aPR] 2.3, 95% CI 1.1–4.9) and villages located in north‐west (aPR 7.5, 95% CI 2.5–23.0) and south‐west (aPR 6.8, 95% CI 2.1–21.6) regions. Our results suggest high exposure to bats and widespread hunting throughout Bangladesh. This has implications for both zoonotic disease spillover and bat conservation.

Efficiency of the Clinical Veterinary Diagnostic Practices and Drug Choices for Infectious Diseases in Livestock in Bangladesh

As in most low-income countries, adequate laboratory facilities are not available in Bangladesh to assist veterinarians in diagnosing animal diseases. We aimed to determine the efficiency of veterinary diagnoses for two common ruminant diseases in Bangladesh: Peste des petits ruminants (PPR) and foot-and-mouth disease (FMD). We conducted the study from May 2009 to August 2010 in three government veterinary hospitals where veterinarians collected samples from sick livestock and recorded the presumptive diagnosis on the basis of clinical presentations. Samples were tested for PPR and FMD using real-time RT-PCR. We estimated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the presumptive diagnoses when compared to laboratory tests. We tested 539 goats for PPR and 340 cattle and goats for FMD. Our results indicate that the veterinarians' presumptive diagnoses were different from laboratory findings for both PPR (P < 0.05) and FMD (P < 0.05). The overall sensitivity of the presumptive clinical diagnoses was 54% (95% CI: 47-61%) while specificity was 81% (95% CI: 78-84%) compared to real-time RT-PCR tests. The kappa value obtained in our validation process for PPR (kappa: 0.25) and FMD (kappa 0.36) indicated a poor performance of the presumptive diagnoses. Most of the animals (93%) were treated with antibiotics. Our findings indicate that veterinarians can detect animals not infected with FMD or PPR but miss the true cases. The clinical competency of these veterinarians needs to be improved and access to laboratory diagnostic facilities could help veterinarians to improve the diagnostics and outcomes. The rational use of antibiotics by veterinarians in animals must be ensured.

A Series of Oral Lesions Presenting to an Otolaryngology Department

This study was performed to assess the incidence and intraoral distribution of different mucosal lesions in a representative population. Retrospective review of clinical notes and assessment of histology reports of patients were performed, who presented with different oral lesions to University Hospital Galway, between January 2007 and December 2008.Of the 106 histology reports evaluated, 94 were identified as benign lesions while 12 were malignant lesions. 96 of these patients were referred from G.P services, 6 patients were referred from other departments while 4 patients came through emergency department by self referral. The numbers and incidence of the commonest lesions in order of frequency were chronic inflammation 20 (18.8%), papilloma 19 (17.1%), fibroma 09 (8.4%), mucocele 09 (8.4%) and leukoplakia 08 (7.5%).We concluded that majority of the presented oral lesions are benign (88.%). Chronic inflammation (18.8%) is the commonest benign oral lesion and all white lesions which represents 34% of oral lesions are not true leukoplakia.

Unusually High Mortality in Waterfowl Caused by Highly Pathogenic Avian Influenza A(H5N1) in Bangladesh

Mortality in ducks and geese caused by highly pathogenic avian influenza A(H5N1) infection had not been previously identified in Bangladesh. In June-July 2011, we investigated mortality in ducks, geese and chickens with suspected H5N1 infection in a north-eastern district of the country to identify the aetiologic agent and extent of the outbreak and identify possible associated human infections. We surveyed households and farms with affected poultry flocks in six villages in Netrokona district and collected cloacal and oropharyngeal swabs from sick birds and tissue samples from dead poultry. We conducted a survey in three of these villages to identify suspected human influenza-like illness cases and collected nasopharyngeal and throat swabs. We tested all swabs by real-time RT-PCR, sequenced cultured viruses, and examined tissue samples by histopathology and immunohistochemistry to detect and characterize influenza virus infection. In the six villages, among the 240 surveyed households and 11 small-scale farms, 61% (1789/2930) of chickens, 47% (4816/10 184) of ducks and 73% (358/493) of geese died within 14 days preceding the investigation. Of 70 sick poultry swabbed, 80% (56/70) had detectable RNA for influenza A/H5, including 89% (49/55) of ducks, 40% (2/5) of geese and 50% (5/10) of chickens. We isolated virus from six of 25 samples; sequence analysis of the hemagglutinin and neuraminidase gene of these six isolates indicated clade 2.3.2.1a of H5N1 virus. Histopathological changes and immunohistochemistry staining of avian influenza viral antigens were recognized in the brain, pancreas and intestines of ducks and chickens. We identified ten human cases showing signs compatible with influenza-like illness; four were positive for influenza A/H3; however, none were positive for influenza A/H5. The recently introduced H5N1 clade 2.3.2.1a virus caused unusually high mortality in ducks and geese. Heightened surveillance in poultry is warranted to guide appropriate diagnostic testing and detect novel influenza strains.

Digital Subtraction Angiography is Superior to Magnetic Resonance Angiography in Diagnosis of Cerebral Arteriovenous Malformation

This study was carried out to compare MRA and DSA in diagnosis of cerebral AVM. It was a retrospective observational study conducted in the Department of Neurology Dhaka Medical College Hospital (DMCH), Dhaka during the period of January 2010 to December 2010. Thirty patients with haemorrhagic stroke age ranging from 13 to 65 years were selected on the basis of inclusion and exclusion criteria as the study sample. MRA and DSA were done in all the selected patients. The mean age of the patients of haemorrhagic stroke was 30.3 ± 14.3 years and male female ratio was 2.7:1. Regarding the venous drainage of AVM 13 and 12 were superficial and deep respectively, and evaluated 100% by MRA. In the diagnosis of cerebral AVM nidus size S1: <3 and S2: 3-6 cm sensitivity was 100% but accuracy was 100% and 73.3% respectively. DSA was 100% sensitive in the diagnosis of superficial and deep venous drainage AVM. Regarding the eloquence of brain area 15 had no eloquence by both MRA and DSA and identification of eloquence of brain area sensitivity was 73.3% and accuracy was 86.7%. The main feeding vessels was found (22, 73.3%) in both DSA and MRA findings. Distal vessels was seen (8, 26.7%) in DSA but not seen in MRA findings. Intranidal aneurysm and Angiopathic AVM were seen in 3(10.0%) and 4(13.3%) respectively in DSA. This study was carried out to diagnose the patients presented with cerebral AVM by MRA and DSA. MRA could not be evaluated flow status of AVM, distal feeding arteries, intranidal aneurysm and angiopathic AVM which could be detected by DSA. So, DSA is superior to MRA in diagnosis of cerebral AVM.

Stroke in Bangladeshi patients and risk factor

To evaluate comprehensively the distribution of established risk factors of stroke among Bangladeshi patients. This is an observational study. It involved 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years. Common established risk factors of stroke e.g. age, sex, family history, hypertension, diabetes, ischemic heart disease, smoking, obesity, dyslipidaemia, alcoholism, use of oral contraceptive pill, lack of fresh fruit consumption etc. were evaluated in these patients through a preformed questionnaire and data were analyzed. Majority of the stroke events occurred after the age of forty (82.3%) and the ischemic stroke (72%) is the most common. Apart from non modifiable risk factors (advancing age, sex, Family history of stroke) hypertension was the most common modifiable risk factor found in stroke patients (57.6%) followed by smoking (44.6%), tobacco use (24.3%), OCP use in female (40% of female stroke), diabetes (23%), ischemic heart disease (17.1%), obesity (10.6%) and dyslipidaemia (5.3%). Lack of fresh fruit consumption and alcoholism were found in some of the patients. Stroke is common after the age of forty. Ischemic events are commonest type of stroke. Hypertension, smoking, tobacco use, diabetes and ischemic heart disease were five most common risk factors of stroke. Outlining the common stroke risk factors in our settings, may help the physicians and care givers in managing this disabling disease properly.

Into the night: factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement

BACKGROUND

Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care.

AIMS

To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff.

METHODS

Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts.

RESULTS

During 2360 observed bed days 109 patients triggered NEWS>=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS>=6 had lower escalation rates.

CONCLUSION

Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.

Endovascular management of a young patient of stroke with absent right upper limb pulse

A 39 years old, right handed, hypertensive non-diabetic smoker presented with ischemic stroke with left sided hemiplegia and absent right upper limb peripheral pulses. Possible causes of young stroke were searched. Cerebral digital subtraction angiography (DSA) revealed 95% stenosis at origin of brachiocephalic trunk with absent flow in right sub-clavian artery and 75% stenosis at osteum of left vertebral artery with flow reversal through right vertebral artery. Subsequently, stents were placed within the stenosed portion Right brachiocephalic trunk and left vertebral artery. The intervention resulted in immediate restoration of right upper limb pulses and cessation of flow reversal in vertebral artery.

Prevalence of stroke above forty years

Number of elderly persons gradually increased in Bangladesh due to improved health awareness and health care. Age is the single most important risk factor for stroke. This study aims at finding the prevalence of stroke in a Bangladeshi population aged forty years and above. The cases of stroke were ascertained in two phases of door-to-door survey. In phase-I, trained interviewers performed face-to-face interview with subjects for the detection stroke cases using the World Health Organization (WHO) screening protocol for neurological diseases. In phase-II, subjects suspected to have a stroke underwent a clinical evaluation for diagnosis or exclusion of stroke by a neurological team. The study involved 15627 participants aged 40 years and above. A total of 47 participants found to have stroke, expressing an overall prevalence rate of 3.00 per 1000 (95% CI 0.95 to 2.45). Prevalence of stroke were 2.0, 3.0, 2.0, 10.0, and 10.0 per 1000 within age groups of 40-49 years, 50-59 years, 60-69 years, 70-79 years and 80 years and above age group respectively. Prevalence of stroke in people with age range 70-79 years compared to 40-49 years age range is 4.988 (95% CI 2.309 to 10.77) times and people with age range ≥80 years compared to 40-49 years age range is 4.798 (95% CI 1.597 to14.416) times. Prevalence was higher among men in comparison with women. The male: female ratio is 3.44:2.41 per 1000 respectively. Bangladeshi male populations in rural areas are found to have stroke more than urban people. A large community based study should be undertaken to further confirm the result of this present study.

Moyamoya disease presented as a case of hemiplegic migraine

Moyamoya disease is a rare cerebral vasculopathy characterised by progressive narrowing of the major intracranial vessels and development of collateral vessels. Clinically, it presents with cerebral ischaemic or haemorrhagic events, with eventual severe morbidity and mortality. A 10-year-old girl presented with episodic vascular headache and transient left sided hemiparesis, which persisted for a few hours and was clinically labelled as sporadic hemiplegic migraine according to International Headache Society criteria. We investigated all possible causes of unusual headache. Cerebral digital subtraction angiogram was carried out and moyamoya disease was finally diagnosed.

Endovascular embolization of life threatening intracranial arterio-venous malformation

Haemorrhagic stroke from cerebral arteriovenous malformations (AVMs) represents 2% of all hemorrhagic strokes. A clear understanding of the diagnostic and treatment algorithms of cerebral AVM management is very important, because AVMs are a cause of hemorrhage in young adults. Surgery, endovascular therapy, and radiosurgery can be used alone or in combination to treat an AVM. We reported a 40 years old man of cerebral arteriovenous malformation (AVM), complicated with intracerebral hemorrhage (ICH). Digital subtraction angiogram was done for diagnosis and endovascular embolization for treatment of the case. This is the first successful cerebral arteriovenous malformations (AVMs) embolization in any government hospital of Bangladesh. The aim of this case report is to inform about this new technologies and emerging treatment strategies in these areas.

Epilepsy and abnormal electroencephalogram in children with autism spectrum disorder

Epilepsy occurs in 30 to 40% of individuals with autism spectrum disorder (ASD). However the association of epilepsy or abnormal electroencephalogram is not known in our population. This study addresses the incidence of epilepsy and or abnormal electroencephalogram in Bangladeshi children with autism spectrum disorder. The clinical history and electroencephalogram of 18 children diagnosed with autism spectrum disorder were retrospectively reviewed. Forty four percent were diagnosed with epilepsy or abnormal electroencephalogram. This abnormal electroencephalogram or epilepsy occurred at significantly higher rates in children with more impaired range of autism spectrum disorder. These finding suggest that the use of neurological investigative technique such as electroencephalogram (EEG) should be considered routinely in children with autism spectrum disorder especially in more impaired individuals.

Fahr's disease: a very rare cause of epilepsy

Fahr's disease, first described by Karl Theodor Fahr in 1930, refers to sporadic or familial idiopathic basal ganglia calcification that is associated with many neurological and psychiatric abnormalities, but may also be secondary to other diseases. Most cases present with extrapyramidal symptoms. But here we describe a case of Fahr's disease, who presented with complex partial seizure and behavioral abnormalities. On screening, the cause of seizure was found to be bilateral calcification of cerebellum, basal ganglia and thalamus, due to abnormal calcium and phosphate metabolism. A clinical diagnosis of complex-partial seizure with secondary generalization due to secondary Fahr's disease was done on the basis of clinical features, investigations, and exclusion of other causes of intracranial calcification.

Role of elements in pathophysiology of hypertension and antihypertensive drug development

Cadmium and Zinc levels were determined in 100 patients of Essential hypertension by Atomic Absorption Spectrophotometer. It was shown that the mean levels of Serum cadmium were 43.34% +/- 6.5% higher and zinc were 28.42% +/- 5.4% lower in hypertensive when compared with normotensive controls. A statistically significant relationship between the height of diastolic blood pressure and Serum cadmium levels was observed. Ajmaloon a preparation from Rauvolfia serpentina with corrective herbs lowered the blood pressure effectively and significantly P less than 0.001. The side effects were minimal. It also tends to decrease the elevated serum cadmium levels in hypertensive individuals. A plea for development of Catecholamine depleting agents as drug for hypertension is advanced.

Mutations in the P2RY5 gene underlie autosomal recessive hypotrichosis in 13 Pakistani families

BACKGROUND

Autosomal recessive hypotrichosis is a rare genetic irreversible hair loss characterized by sparse scalp hair, sparse to absent eyebrows and eyelashes, and sparse axillary and body hair. Affected male individuals have normal beard hair.

OBJECTIVES

To search for pathogenic mutations in the human P2RY5 gene in Pakistani families with autosomal recessive hereditary hypotrichosis.

METHODS

In the present report, 16 unrelated consanguineous Pakistani families having multiple affected individuals with autosomal recessive hypotrichosis were investigated. Linkage in these families was searched by genotyping microsatellite markers linked to autosomal recessive hypotrichosis loci LAH1, LAH2 and LAH3. Thirteen of the families showed linkage to the LAH3 locus on chromosome 13q14.11-q21.32. These families were then subjected to direct sequencing of the P2RY5 gene, which encodes a G protein-coupled receptor.

RESULTS

Sequence analysis of the P2RY5 gene revealed two novel missense mutations (c.742A>T; p.N248Y and c.830C>T; p.L277P) in three families. Five previously described mutations including three missense (c.188A>T; p.D63V, c.436G>A; p.G146R, c.562A>T; p.I188F), one insertion (c.69insCATG; p.24insHfsX52) and one complex deletion (c.172-175delAACT; 177delG; p.N58-L59delinsCfsX88) were detected in the other 10 families.

CONCLUSIONS

Mutations revealed in the present study extend the body of evidence implicating the P2RY5 gene in the pathogenesis of human hereditary hair loss.

Pregnancy causing gallstone disease

A cross sectional study was done on patient, who were diagnosed and admitted with gallstone disease in different hospitals during June 1997 to June 2001. The aim of the study was to determine any significant association between pregnancy and cholilithiasis in female. A standard written questionnaire, which is duly filled by, concerned doctor and examination done. Records were made about age at marriage, first pregnancy after marriage and number of pregnancies. Incidence of gallstone shows that in 21-30 years age group 05 (1.37%) patient having no pregnancy, 35 (9.62%) patient having one pregnancy, 26 (7.14%) patient having two pregnancies, 22 (6.04%) having three pregnancy and 12 (3.30%) patient having four and more pregnancies. In 31-40 years age group 02 (0.55%) having no pregnancy, 05 (1.37%) patients having one pregnancy, 22 (6.04%) patient having two pregnancies, 30 (8.24%) patients having three pregnancies and 46 (12.64%) patients having four and more pregnancies. In 41-50 years age group 3 (0.82%) patients are having no pregnancy, 2 (0.55%) patient having one pregnancy, 16 (4.40%) patient having two pregnancies, 16 (4.40%) patient having three pregnancies and 47 (12.91%) patient having four and more pregnancies. In 51-60 years age group, 02 (0.55%) patient having one pregnancy, 04 (1.10%) patients having two pregnancy, 09 (2.47%) patient having three pregnancies, 52 (14.29%) patient four and more pregnancies. The numbers of pregnancy is associated with gall stone diseases. The risk of developing gall stone disease increases in association with increased number of parity, particularly among the younger women.

Prevalence of primary multidrug resistance to anti-tuberculosis drugs in Pakistan

SETTING

Pakistan ranks sixth in the world in terms of tuberculosis (TB) burden, with a World Health Organization estimated incidence of 181 per 100000, or 286000 new cases annually. Hospital-based data indicate a significant problem of multidrug-resistant TB (MDR-TB) in the country and highlight the need to assess its extent at community level. In this cross-sectional study, sputum samples from 742 untreated newly diagnosed pulmonary TB patients from all over the country were used.

OBJECTIVE

To assess the prevalence of primary drug resistance in Pakistan.

RESULTS

Of 672 culture-positive patients, 76 (11.3%) showed resistance to one or more drugs. Resistance to streptomycin (10 microg/ml) was found in 36 (5.4%) patients, isoniazid (INH) (1 microg/ml) in 51 (7.6%), rifampicin (RMP) (5 microg/ml) in 15 (2.2%), ethambutol (10 microg/ml) in 12 (1.8%) and pyrazinamide in 22 (3.3%) samples. Forty-six (6.8%) of the isolates tested were resistant to a single drug, 10 (1.5%) to two drugs, 12 (1.8%) to three drugs, and 6 (0.9%) to four drugs, while 2 (0.3%) isolates were resistant to all five first-line agents. Primary MDR-TB was 1.8% (n=12) (INH 1 microg/ml, RMP 5 microg/ml).

CONCLUSION

The results of this study show a prevalence of primary MDR-TB in Pakistan of <2%, which needs to be addressed through an effective DOTS strategy.

Cefaclor AF vs Clarithromycin in acute exacerbation of chronic bronchitis (B3M-PK-AJBG)

OBJECTIVE

To compare the efficacy and safety of Cefaclor AF vs Clarithromycin in the treatment of acute exacerbation of chronic bronchitis in adult subjects.

PATIENTS AND METHODS

This study was conducted on 300 patients suffering from acute exacerbation of chronic bronchitis, who attended the out patient clinics of ten different hospitals throughout Pakistan. Pneumonia, bronchiectasis and tuberculosis were excluded with the help of chest radiography and sputum smear examination. Pretherapy sputum culture and sensitivity (c/s) were tested and patients were randomized and supplied with either tablet Cefaclor 375 mg or tablet Clarithromycin 250 mg to be taken twice daily. Patients were evaluated at day 0 and then at day 3-5 and day 10-11. Post therapy sputum c/s was done on day 10-11. A fourth and final visit was planned on day 20-24 which was optional. At each visit, the severity of disease and the signs and symptoms were recorded on the clinical report forms according to the preset standards.

RESULTS

Of 136 patients in the Cefaclor group and 142 patients in the Clarithromycin group, cure was achieved in 44 vs 35 subjects, improvement in 78 vs 91 subjects and failure in 16 vs 18 subjects among Cefaclor vs Clarithromycin groups respectively. The overall clinical efficacy (cure and improvement combined ) was 88.4% in the Cefaclor group and 87.5% in the Clarithromycin group. Nine patients in the Cefaclor group and patients in the Clarithromycin group had one adverse event whereas twelve patients in each group had two or more adverse events.

CONCLUSIONS

The above results show that both Cefaclor AF and Clarithromycin are equally effective and safe in the treatment of acute exacerbation of chronic bronchitis in adult patients.

Intrathoracic migration of a humeral orthopedic pin

Intrathoracic migration of orthopedic fixation pins occurs infrequently but can have dire consequences if not recognized. Described herein is the case of an orthopedic pin that migrated from the proximal humerus into lung parenchyma. After preoperative computed tomography and fluoroscopy, the pin was removed via thoracotomy.

Influence of organic acids on the mobility of heavy metals in soil amended with some insecticides

The mobility (Rf value) of some heavy metals, such as: Co, Zn, Ag, Cu, and Pb was measured through soil amended with some insecticides, such as: endosulfan, chlorpyrifos, dimethoate and methyl demeton using distilled water, formic, acetic and oxalic acids as mobile phase. The enhancement in the mobility of metal ions in all the amended soils formic, acetic and oxalic acids as mobile phase. The enhancement in the mobility of metal ions in all the amended soils followed the order: Co > Zn > Ag > Cu > Pb. On the otherhand the mobility followed the order: endosulfan > chlorpyrifos > dimethoate > methyl dementon for the amended insecticides and the order: formic > acetic > oxalic acids for the mobile phase in natural as well as amended soils. Mobility of ions increased upto a concentration of 0.25 mg 100 g-1 of soils thereafter it was decreased in all the systems. The results have been explained on the basis of the nature of heavy metals, insecticides, organic acids and the solubilities of the salts formed in the soil-insecticide-amended systems.

Separation and purification of Echis coloratus venom and some biological and biochemical effects of the proteins

Crude venom of Echis coloratus was separated into seven protein fractions using 7% preparative native polyacrylamide gel electrophoresis. The effect of crude venom and seven venom protein fractions (F1-F7) from Echis coloratus on key metabolic activities of fibroblast cultures was investigated. Confluent cultures were incubated with the venom proteins for 3 h at 37 degrees C. The specific activity of phosphofructokinase, was significantly lowered upon incubation with the crude venom and with fractions 2, 3, 4 and 6. Citrate synthase activity was significantly lowered by the crude venom and by fractions 2 and 3. Glycogen phosphorylase activity was significantly increased by the crude venom and by fractions 2, 3, 4 and 6 leading to a significant concurrent drop in glycogen content. Creatine kinase activity was significantly increased by the crude venom and by fractions 3, 4, 5 and 6. Cellular ATP levels rose significantly upon incubation with the crude venom and with fractions 3, 4, 5 and 6. Incubation of cell sonicates with all the venom proteins did not significantly alter the activity or content of any of the studied parameters.

Evaluation and selection of bio-relevant dissolution media for a poorly water-soluble new chemical entity

The purpose of this work is to develop a bio-relevant dissolution method for formulation screening in order to select an enhanced bioavailable formulation for a poorly water-soluble drug. The methods used included a modified rotating disk apparatus for measuring intrinsic dissolution rate of the new chemical entity (NCE) and the USP dissolution method II for evaluating dissolution profiles of the drug in three different dosage forms. The in vitro dissolution results were compared with the in vivo bioavailability for selecting a bio-relevant medium. The results showed that the solubility of the NCE was proportional to the concentration of sodium lauryl sulfate (SLS) in the media. The apparent intrinsic dissolution rate of the NCE was linear to the rotational speed of the disk, which indicated that the dissolution of the drug is a diffusion-controlled mechanism. The apparent intrinsic dissolution rate was also linear to the surfactant concentration in the media, which was interpreted using the Noyes and Whitney Empirical Theory. Three formulations were studied in three different SLS media using the bulk drug as a reference. The dissolution results were compared with the corresponding bioavailability results in dogs. In the 1% SLS--sink conditions--the drug release from all the formulations was complete and the dissolution results were discriminative for the difference in particle size of the drug in the formulations. However, the data showed poor IVIV correlation. In the 0.5% SLS medium--non-sink conditions--the dissolution results showed the same rank order among the tested formulations as the bioavailability. The best IVIV correlation was obtained from the dissolution in 0.25% SLS medium, an over-saturated condition. The conclusions are: a surfactant medium increases the apparent intrinsic dissolution rate of the NCE linearly due to an increase in solubility. A low concentration of surfactant in the medium (0.25%) is more bio-relevant than higher concentrations of surfactant in the media for the poorly water-soluble drug. Creating sink conditions (based on bulk drug solubilities) by using a high concentration of a surfactant in the dissolution medium may not be a proper approach in developing a bio-relevant dissolution method for a poorly water-soluble drug.

Objective measures of the efficacy of noninvasive positive-pressure ventilation in amyotrophic lateral sclerosis

The impact of noninvasive positive-pressure ventilation (NIPPV) on pulmonary function studies, quality of life, and survival was assessed in patients with amyotrophic lateral sclerosis. NIPPV did not change the rate of decline of the forced vital capacity (FVC) and forced expiratory volume in the first second (FEV(1)) (2.31 and 2.09 percent-predicted points per month, respectively). NIPPV resulted in a drop of FEV(1) by 5.94 percent-predicted points (P = 0.07), and of maximal inspiratory pressure by 6.33 percent-predicted points (P = 0.11). The change in FEV(1) and FVC pre- and postintervention correlated with the corresponding change in maximal inspiratory pressure. Fatigue and mastery scores were improved by NIPPV. Median survivals in patients intolerant and tolerant of NIPPV were 5 and 20 months, respectively (P = 0.002). Although NIPPV has no impact on the rate of decline of lung function and may have deleterious effects on spirometric measures, it may improve quality of life and survival.

Simultaneous determination of carbaryl, malathion, fenitrothion, and diazinon residues in sesame seeds (Sesamum indicum L.)

A method is described for the simultaneous determination of carbaryl (1-naphthyl methylcarbamate), malathion [diethyl (dimethoxythiophosphorylthio) succinate], fenitrothion (O,O-dimethyl O-4-nitro-m-tolyl phosphorothioate), and diazinon (O,O-diethyl O-2-isopropyl-6-methylpyrimidin-4-yl phosphorothioate) in sesame (Sesamum indicum L.) seeds. Sesame seeds were Soxhlet extracted with n-hexane, and the extract was subjected to a liquid-liquid partitioning and column cleanup to remove the oily coextractives prior to analysis by high performance liquid chromatography (HPLC). The mean percent recoveries (+/- standard deviations) from sesame seeds fortified with carbaryl (0.004 to 0.035 microgram/g), malathion (0.53 to 4.25 microgram/g), fenitrothion (0.22 to 1.78 microgram/g), and diazinon (0.54 to 4.35 microgram/g) were 83.3 +/- 5.7, 85.5 +/- 6.6, 85. 6 +/- 7.2, and 88.4 +/- 4.8, respectively. The method was used for the simultaneous analysis of carbaryl, malathion, fenitrothion, and diazinon residues in sesame seeds obtained from an Ethiopian field crop that had been treated with the pesticides during its growing period.

Role of Tc-99m MIBI in the evaluation of single pulmonary nodules: a preliminary report

BACKGROUND

Survival in bronchial carcinoma is closely related to the stage of the disease at the time of diagnosis and a single pulmonary nodule represents a potentially curable stage. This study was conducted to assess the feasibility of using Tc-99m labelled 2-methoxy isobutyl isonitrile (MIBI) to differentiate benign from malignant single pulmonary nodules.

METHODS

A prospective study was conducted in the outpatient pulmonary clinic at the Cleveland Clinic Foundation. Twenty five patients with single pulmonary nodules considered indeterminate by their physicians and undergoing a procedure for tissue diagnosis were evaluated by Tc-99m MIBI SPECT scanning prior to definitive testing. Assessment of MIBI uptake was done qualitatively (subjectively) and quantitatively and correlated with the histopathology and nodule size.

RESULTS

Of the 21 patients with malignant lesions, 18 had increased uptake of MIBI corresponding to the location of the nodule and were considered positive. The predominant tumour types were large cell (n = 5) and adenocarcinoma (n = 10). All four patients with benign lesions had negative MIBI scans. For malignancy the overall specificity was 100%, sensitivity was 85.7%, positive predictive value was 100%, and negative predictive value was 57%. Quantitative uptake of MIBI correlated with the diameter of the nodule with a correlation coefficient of 0.61 by Spearman's rank sum test. This relationship was statistically significant (p = 0.02).

CONCLUSION

This preliminary study suggests that Tc-99m MIBI has a very high specificity and positive predictive value for malignant single pulmonary nodules and might be a useful non-invasive diagnostic modality in their management.

Does the donor-recipient ABO blood group compatibility status predict subsequent lung transplantation outcomes?

BACKGROUND

The study was conducted to compare lung transplantation outcomes between ABO-identical (AI) and ABO-compatible (AC) recipients.

METHODS

Charts of lung allograft recipients transplanted between February, 1990 and October, 1995 were reviewed. Standard triple-drug immunosuppression and general antimicrobial prophylaxis were provided. Surveillance spirometry was administered every three months. Flexible bronchoscopy (FB) with transbronchial biopsies (TBBs) were undertaken for clinical indications. Time to event analysis on acute (AR) and chronic (CR) rejection and actuarial survival were determined by Kaplan-Meier analysis. Cumulative curves were compared with a log rank test. Comparisons of age, maximum forced expiratory volume in one second (FEV1) in the single (SLT) and double (DLT) lung recipients, duration of intensive care unit and hospital stay were carried out using the Wilcoxon Rank Sum test. Gender, race, underlying diagnoses, cytomegalovirus (CMV) status and pulmonary reimplantation response (PRR) were compared by Chi-square or Fisher's exact test where appropriate.

RESULTS

Of the 100 lung recipients (age = 42.5 +/- 13.4 years; M:F = 50:50), 64 were AI and 36 AC. Median follow-up was 22 (range = 0-78) months. Outcome did not differ significantly between the 2 groups in terms of intensive care unit and hospital stay, PRR incidence and grade, incidence and frequencies of AR, median time and grade of first AR, maximum FEV1 for SLT and DLT recipients, incidence of CR and survival at 12 months.

CONCLUSIONS

As the donor supply remains limited, this could considerably simplify the logistics of future transplantation.

Acute pulmonary edema after lung transplantation: the pulmonary reimplantation response

BACKGROUND

Although the development of noncardiogenic pulmonary edema or pulmonary reimplantation response (PRR) after lung transplantation has been well described, the incidence has not been established and the relationship of PRR to clinical risk factors has not been analyzed.

STUDY OBJECTIVES

(1) To describe the incidence of PRR in lung transplant recipients, (2) to identify the predictors of PRR, (3) to examine the correlation of suspected predictors with the severity of PRR, and (4) to evaluate the impact of PRR on morbidity and mortality of lung transplant recipients.

DESIGN

Retrospective review of clinical records and radiographic studies.

SETTING

Tertiary care referral center.

PATIENTS

Ninety-nine consecutive patients with end-stage lung disease undergoing lung transplantation between February 1990 and October 1995.

METHODS

Review of clinical records and postoperative chest radiographs of all lung transplant recipients to identify patients who experienced PRR. Chest radiographs of patients with PRR were graded for severity on a scale of 0 (none) to 5 (very severe). Demographic, pre- and perioperative factors were also evaluated along with short- and long-term survival of patients with PRR.

RESULTS

Fifty-six of 99 lung transplant recipients (57%) experienced PRR. The median ischemia time of patients with and without PRR was 168 and 180 min, respectively (p = 0.62). The incidence of PRR was 51% in patients without preoperative pulmonary hypertension, 78% in mild to moderate pulmonary hypertension, and 58% in patients with severe pulmonary hypertension (p = 0.10). Incidence and severity of PRR was similar in patients receiving right, left, or double-lung transplantation. Similarly, age and sex of the recipients and underlying lung disease did not affect the incidence or severity of PRR. The incidence and severity of PRR was higher in patients undergoing cardiopulmonary bypass during lung transplantation. Patients with PRR had prolonged duration of mechanical ventilation and ICU stay. Overall, PRR did not affect the survival of the patients. However, survival of female lung transplant recipients was significantly better than male recipients (median survival, 60 vs 21 months; p = 0.02).

CONCLUSIONS

Acute pulmonary edema or PRR occurs frequently (57%) after lung transplantation. In this series, PRR was not associated with a prolonged ischemia time, preoperative pulmonary hypertension, the type of lung transplant, underlying lung disease, or age or sex of recipients. However, use of cardiopulmonary bypass during surgery was associated with increased incidence and severity of PRR. Also, the development of PRR resulted in prolonged mechanical ventilation and a longer ICU stay, but did not affect survival. Female lung transplant recipients survived significantly longer than male recipients. The reason for this difference in survival is unclear.

Effect of acute coronary occlusion on the size of the dynamically perfused coronary capillary bed in the dog

The aim of the present study was to investigate the influence of reduced left anterior descending (LAD) coronary arterial blood flow on the size of the perfused coronary capillary surface area (CCSA) in dogs. The transcoronary hydrolysis (v) of the specific ACE substrate, [3H]benzoyl-Phe-Ala-Pro, was estimated and the parameter Amax/Km (proportional to the size of the perfused CCSA) was calculated. By means of a ligature placed around the LAD, LAD blood flow was transiently reduced to 36.0 +/- 4.1 (E1) and 17.4 +/- 4.3% (E2) of control; in a separate maneuver the first diagonal branch of the LAD was ligated to achieve 40.0 +/- 6.7% (E3) of control flow. The v values remained unchanged at around 0.7 for E1, E2, and E3 determinations, suggesting unaltered substrate transit time through the coronary capillary bed. Amax/Km values decreased to 36 +/- 5, 17 +/- 4, and 47 +/- 10% of control for E1, E2, and E3 determinations, respectively, reflecting a flow-proportional decrease in CCSA. Values of the transpulmonary measures of v and Amax/Km performed at the beginning and end of the protocol were unchanged. These results support the hypothesis that reduction in coronary blood flow will produce proportional decreases in the size of the CCSA. This new procedure can thus serve as a useful tool for investigating alterations in the size of the CCSA in different species and under various pathophysiologic challenges.

Paired pulse suppression and facilitation in human epileptogenic hippocampal formation

Paired pulse stimulation has commonly been employed to investigate changes in excitability in epileptic hippocampal tissue employing the in vitro slice preparation. We used paired pulse stimulation in the intact temporal lobe of patients with temporal lobe seizures to compare the excitability of pathways in the epileptogenic hippocampus (located in the temporal lobe in which seizures arise) with those in the non-epileptogenic hippocampus of the contralateral temporal lobe (in the hemisphere to which seizures spread). A total of 20 patients with temporal lobe seizure onsets were studied during chronic depth electrode monitoring for seizure localization. Intracranial in vivo stimulation and recording sites included the hippocampus, entorhinal cortex, subicular cortex and parahippocampal gyrus. A comparison of all hippocampal pathways located in the temporal lobe where seizures typically started (n = 37) with those in temporal lobes contralateral to seizure onset (n = 53) showed significantly greater paired pulse suppression of population post-synaptic potentials on the epileptogenic side (F(1,87) = 6.1, P < 0.01). Similarly, mean paired pulse suppression was significantly greater for epileptogenic perforant path responses than for contralateral perforant path responses (F(1,13) = 7.5, P < 0.01). In contrast, local stimulation activating intrinsic associational pathways of the epileptogenic hippocampus showed decreased paired pulse suppression in comparison to the epileptogenic perforant path. These results may be a functional consequence of the formation of abnormal recurrent inhibitory and recurrent excitatory pathways in the sclerotic hippocampus. Enhanced inhibition may be adaptive in suppressing seizures during interictal periods, while abnormal recurrent excitatory circuits in the presence of enhanced inhibition may drive the hypersynchronization of principal neurons necessary for seizure genesis.

Bioavailability in rats of bound pesticide residues from tolerant or susceptible varieties of soybean and canola treated with metribuzin or atrazine

Susceptible or tolerant varieties of soybean treated with metribuzin, or canola treated with atrazine were grown in a controlled environment. Shoots and fruits were harvested at maturity and extracted exhaustively with methanol. The extracted materials containing bound 14C residues were subsequently fed to rats for two days. The elimination of 14C in urine and feces was monitored for 4 days and the distribution of radioactivity in liver, kidney and heart was studied. Higher 14C residues in urine were present in animals fed fruits compared to shoots of soybean or canola of both susceptible and tolerant varieties. The bound atrazine residues from the pods of Atr Tower (tolerant variety of canola) were more bioavailable than Tower (susceptible variety of canola). Bioavailability of bound atrazine from the shoots of canola in both varieties was very low. In soybean fed animals, bound metribuzin derived 14C from the susceptible variety (Maple Amber) was more bioavailable than from the resistant variety (Maple Arrow). However, feeding the animals with susceptible or tolerant varieties of soybean or canola containing bound residues of 14C metribuzin or 14C atrazine for two days did not result in the accumulation of radioactivity in the body organs studied. Thus our data show that the bioavailability of these bound pesticides was dependent on the type of plant parts ingested and the variety of plant species.

Effect of noninvasive positive-pressure ventilation on survival in amyotrophic lateral sclerosis

BACKGROUND

Noninvasive positive-pressure ventilation may benefit patients with amyotrophic lateral sclerosis and respiratory insufficiency.

OBJECTIVE

To determine 1) whether patients tolerant of noninvasive positive-pressure ventilation have better survival than intolerant patients and 2) whether bulbar symptoms account for intolerance of noninvasive positive-pressure ventilation.

DESIGN

Observational cohort study.

SETTING

Tertiary care referral center.

PATIENTS

39 patients with amyotrophic lateral sclerosis who were treated with noninvasive positive-pressure ventilation.

INTERVENTION

Noninvasive positive-pressure ventilation was started for patients with new orthopnea, new hypercapnia, or both. Patients were divided into two groups: those tolerant of and those intolerant of noninvasive positive-pressure ventilation.

RESULTS

The risk for death from onset of respiratory insufficiency was higher for intolerant patients than for tolerant patients (relative risk, 3.1 [95% CI, 1.8 to 9.6]). Moderate or severe bulbar symptoms were more prevalent among intolerant patients than among tolerant patients (67% compared with 33%; P = 0.04).

CONCLUSIONS

Among patients with amyotrophic lateral sclerosis, those who are tolerant of noninvasive positive-pressure ventilation have better survival than do those who are intolerant. Bulbar symptoms partially account for intolerance of noninvasive positive-pressure ventilation.

Bioavailability of bound pesticide residues and potential toxicologic consequences - an update

The growing demand for enhanced food productivity to meet the needs of the global population has led farmers to use sophisticated agricultural technology in which pesticides play a crucial role. Pesticide use has a positive and dramatic impact on agricultural production through protection of crops against insects, pests, and disease, but every effort must be made to ensure that application is safe and, more importantly, to assure safety for human and environmental health. Since our initial review (1), global usage of pesticides has increased and knowledge regarding the biological significance of bound pesticide residues has expanded. The fact that more reports are appearing in the literature signifies an increased awareness of the presence of bound pesticide residues and indicates that a greater number of scientists are attempting to establish the potential toxicologic consequences of this pesticides residue fraction. Rico (2), in a review in 1990, concluded that covalently bound residues in edible animal tissues were not carcinogenic, were not readily bioavailable, and hence produced little, if any, adverse effects. Whether this conclusion is applicable to the presence and consequences of bound pesticide residues in plants and food commodities remains unanswered. Thus, the aim of this updated review is not simply to list studies on bioavailability of bound pesticide residues in grains subsequent to the review in 1992 (1) but also to establish the toxicological impact of this chemical fraction on health.

Right ventricular mass measurement by electron beam computed tomography. Validation with autopsy data

RATIONALE AND OBJECTIVES

Validation of right ventricular mass quantitation by electron beam computed tomography in humans has not been performed. The ability of electron beam computed tomography to accurately determine the septal component of the right ventricle also has not been determined. This article addresses both issues.

METHODS

Twenty human adult hearts obtained at autopsy were scanned by electron beam computed tomography in a short-axis projection. Planimetry of the right ventricular free wall and septal components of each slice was performed and summed to determine right ventricular mass. These measurements were compared against comparable measurements obtained by autopsy weights of the hearts.

RESULTS

Right ventricular free wall weights by electron beam computed tomography (53.9 +/- 18.4 g) correlated well (slope = .92, r = .92, standard error of the estimate = 7.4 g, P < .001) with autopsy weights (55.8 +/- 18.4 g). Right ventricular septal weights by electron beam computed tomography (6.1 +/- 2.3 g) correlated poorly (slope = .04, r = .11, standard error of the estimate = 2.4 g, P = .65) with autopsy weights (13.9 +/- 6.3 g).

CONCLUSIONS

Electron beam computed tomography quantitation of right ventricular mass is accurate in humans if only the free wall and not the septal component is utilized.