Anthrax: pathological aspects in autopsy cases in Shiraz, Islamic Republic of Iran, 1960-2001

Anthrax, like tuberculosis, shows a new epidemic spread in industrialized countries, revealing some ambiguous aspects to the disease and providing new challenges to medicine. Shiraz University of Medical Sciences has records of 7130 autopsies performed in the past 40 years, 33 of which are anthrax cases. We reviewed all the pathology slides of these cases and classified the organs involved in a search for unrecognized microscopic findings. The most common cause of death was sepsis, caused by organ involvement and direct cytotoxicity of Bacillus anthracis, in addition to its exotoxin production. Novel findings included hyaline membrane formation in respiratory system cases that is similar to acute [adult] respiratory distress syndrome and evidence of primary gastrointestinal involvement, showing the ability of the organism to pass the gastric barrier

Audit of Neurosurgery Senior House Officer training in the United Kingdom and Eire: a postal survey

An audit was performed to describe the current training conditions of senior house officers in neurosurgery in the UK and Eire. A postal questionnaire was sent to all neurosurgery senior house officers in a 6-month training period between February and August 2003. The questionnaire covered most aspects of working pattern, training and job satisfaction by the end of the 6-month post. The results from the audit showed that there are deficiencies in certain areas of the current system being employed for senior house officer training. Improvements to this training system in line with the establishment of a generic neurosciences training programme will benefit future surgical trainees.

Anthrax: pathological aspects in autopsy cases in Shiraz, Islamic Republic of Iran, 1960-2001

Anthrax, like tuberculosis, shows a new epidemic spread in industrialized countries, revealing some ambiguous aspects to the disease and providing new challenges to medicine. Shiraz University of Medical Sciences has records of 7130 autopsies performed in the past 40 years, 33 of which are anthrax cases. We reviewed all the pathology slides of these cases and classified the organs involved in a search for unrecognized microscopic findings. The most common cause of death was sepsis, caused by organ involvement and direct cytotoxicity of Bacillus anthracis, in addition to its exotoxin production. Novel findings included hyaline membrane formation in respiratory system cases that is similar to acute (adult) respiratory distress syndrome and evidence of primary gastrointestinal involvement, showing the ability of the organism to pass the gastric barrier.

Detection of Cryptosporidium amongst diarrhoeic and asymptomatic children in Jeddah, Saudi Arabia

Between the March and May of 2000, stool specimens were collected from children aged <5 in six pre-school crèches and clinics in the Jeddah area of Saudi Arabia. Sixty-three (25%) of the children had diarrhoeal disease but the other 190 were asymptomatic. When the stool samples were stained and examined for the oocysts of Cryptosporidium spp. and other enteric protozoa, 20 (32%) of the symptomatic children but only nine (4.7%) of the asymptomatic were found to be excreting Cryptosporidium oocysts. Similarly, Cyclospora cayetanensis was found, always as a co-infection with Cryptosporidium sp., in seven (11%) of the children with diarrhoeal disease but only eight (4.2%) of the asymptomatics. One asymptomatic child was found to be co-infected with Isospora belli and Cryptosporidium. Giardia intestinalis and cysts of Entamoeba histolytica/dispar were detected in 18 (29%) and nine (14%) of the children with diarrhoeal disease and in eight (4.2%) and 13 (6.8%) of the asymptomatic children, respectively. This appears to be the first report of Cy. cayetanensis from Saudi Arabia and the highest prevalence of Cryptosporidium infection ever described.

Effect of post-mortem changes on peripheral and central whole blood and tissue clozapine and norclozapine concentrations in the domestic pig (Sus scrofa)

Interpretation of the results of psychoactive or other drug measurements in post-mortem blood specimens may not be straightforward, in part because analyte concentrations in blood may change after death. There is also the issue of comparability of plasma (or serum) results to those obtained in whole blood. To investigate these problems with respect to clozapine, this drug (10mg/kg daily) was given orally to two pigs. Blood was collected 3h post-dose on day 7, the animals were sacrificed, and blood taken from central and peripheral veins for up to 48 h after death. Tissue samples were also collected immediately after death and at 48 h. Ante-mortem whole blood clozapine/N-desmethylclozapine (norclozapine) concentrations were 0.86/1.07 and 1.11/1.15 mg/l in pigs 1 and 2, respectively. Blood clozapine and norclozapine concentrations generally increased after death (central vein: clozapine up to 300%, norclozapine up to 460%; peripheral vein: clozapine up to 155%, norclozapine up to 185%). Initial blood and kidney clozapine and norclozapine concentrations were comparable in both animals, but were some two-fold higher in heart, liver and striated muscle in pig 2. In both animals, the heart and striated muscle clozapine and norclozapine concentrations had increased some two- to three-fold at 48 h, whilst the liver and kidney concentrations were essentially unchanged. The reason for the increase in heart and striated muscle concentrations at 48 h is unclear, but could be simple variation in sample site. The plasma:whole blood distribution of clozapine and norclozapine was studied in vitro. In human blood (one volunteer donor, haematocrit 0.50) the plots of plasma versus whole blood concentration were linear for both analytes across the range 0.1-1.5mg/l, although clozapine favoured plasma (plasma:whole blood ratio=1.12), whereas norclozapine favoured whole blood (ratio 0.68). In pig blood, the plots of plasma versus whole blood were non-linear in both cases, although clozapine favoured plasma to a greater extent than norclozapine. This may be due to lower plasma clozapine and norclozapine protein binding capacity in the pig as compared to man.

Gastric adenocarcinoma missed at endoscopy

BACKGROUND AND PURPOSE

The diagnosis of gastric cancer is based on histological confirmation at endoscopy with the emphasis on early detection to improve prognosis. The aims of this study were to identify the proportion of patients with gastric adenocarcinoma in whom the diagnosis was missed at first endoscopy and the subsequent delay which occurred before the histological diagnosis was established.

METHODS

Retrospective review of 137 consecutive patients with biopsy-proven gastric adenocarcinoma presenting to one surgical unit over a five-year period.

RESULTS

Two patients with a biopsy diagnosis at laparotomy and 6 patients in whom case notes could not be traced were excluded from the study. Of the remaining 129 patients, the diagnosis of gastric adenocarcinoma was missed at first endoscopy in 18 (14%). The median delay to histological diagnosis in this subgroup of patients was 13 weeks (range 3-102).

CONCLUSION

Delays in establishing the diagnosis of gastric adenocarcinoma following initial endoscopy occur in a number of patients. Greater suspicion and a more rigorous protocol for repeat endoscopy and biopsy must be implemented in order to reduce the number of missed diagnoses after initial endoscopy.

Blocking the effects of IL-1 in rheumatoid arthritis protects bone and cartilage

Destruction of articular joints occurs progressively in patients with rheumatoid arthritis (RA). Although the exact aetiology of RA has not been fully elucidated, a large body of evidence supports a role for interleukin-1 (IL-1) in cartilage and bone erosion. In vitro studies suggest that IL-1 can cause cartilage destruction by stimulating the release of matrix metalloproteinases and other degradative products, and it can increase bone resorption by stimulating osteoclast differentiation and activation. In animal models of RA, blocking the effects of IL-1 with either IL-1 receptor antagonist (IL-1Ra; endogenous), anti-IL-1 monoclonal antibodies, or soluble IL-1 type II receptors significantly reduced cartilage destruction and bone erosion. Gene therapy with IL-1Ra was also effective in reducing joint destruction in experimental RA and osteoarthritis (OA) models. In clinical studies, anakinra, a human recombinant IL-1 receptor antagonist (IL-1ra; exogenous), significantly slowed radiographic progression of RA relative to placebo and significantly reduced clinical symptoms when used as monotherapy or in addition to existing methotrexate therapy. These results demonstrate that blocking IL-1 protects bone and cartilage from progressive destruction in RA.

Group B streptococcal serotype distribution of isolates from colonized pregnant women at the time of delivery in United Arab Emirates

OBJECTIVE

To determine the maternal colonization rate with group B streptococcus (GBS) and to identify the most frequent GBS serotypes occurring in UAE women during labour.

STUDY DESIGN

From February 1998 to January 1999, five hundred and sixty three pregnant women from a similar socio-economic and ethnic population were enrolled for the study. High vaginal swab cultures for GBS were obtained at the time of admission for delivery. Isolates were classified according to their capsular polysaccharide types (Ia, Ib, Ic, II-V) and c protein antigen compound.

RESULTS

Fifty-seven (10.1%) of 563 mothers were found to be carriers of GBS. Among the isolates, serotype IV (26.3%) predominated followed by type Ia (21.0%), type III (17.6%), type V (12.3%) and nontypeable, which accounted for 15.8%.

CONCLUSIONS

In view of the unknown status for GBS carrier rates in our community, this study suggests that about 10% of UAE women are colonized with group B streptococcus at delivery. The serotype distribution of the isolates in this population is different than those reported elsewhere with type IV predominating followed by type Ia and III.

Utilization of hydralazine hydrochloride in the Potentiometric Determination of Osmium(VIII): Analysis of Binary and Ternary Mixtures

A simple, rapid and accurate potentiolnetric method is described for tliedetermination of Os(VIII) in tlie co~icentrationr ange 0.4-4.0 mg/ml. Tlie method isbased on tlie addition of hydralazine hydrochloride to Os(VIII) to reduce it to Os(IV). The excess of hydralazine hydrocliloridew as oxidized by iodine dissolved ill acetic acid. The liberated iodide was then potentiometrically titrated against mercury(II) using silver amalgam as the indicator electrode. The potential of this method for sime- microdetermination is important in practical applications where tlie above reaction should proceed quantitatively towards completion. The relative standard deviation for six replicate deterinination of osmium(VIII) in binary andternary mixtures without the need for extraction or heating.

Typing of drug resistant isolates of Mycobacterium tuberculosis from India using the IS6110 element reveals substantive polymorphism

We investigated IS6110 polymorphism in clinical isolates of Mycobacterium tuberculosis from patients attending the outpatient department at various hospitals in northern India. DNA fingerprinting of 126 clinical isolates of M. tuberculosis was carried out using restriction fragment length polymorphism (RFLP) associated with the IS6110 element in M. tuberculosis genomes. A substantive degree of polymorphism was evident in the MDR M. tuberculosis isolates. The number of bands in the fingerprints varied from 0 to 19. However, the lack of common bands made it difficult to cluster the majority of these isolates. We were also unable to associate drug resistance with IS6110 copy number. Specific regions of the gyrA and katG genes from a representative number of these isolates were sequenced to determine the genotype. The majority of the isolates analyzed were found to belong to Group 1, indicating that these strains were evolutionarily older. We find no evidence of the W strain, prevalent in the US, in our study. The epidemiological patterns of the various strains in India seem to be very complex, as reflected by the presence of a large number of different strains (types) within north India.

Spectrophotometric Estimation of Cefuroxime and Ceftazidime in Bulk and in Dosage Forms

Three simple, accurate and sensitive spectrophotometric methods (A, B and C) for the determination of cefuroxime and ceftazidime in bulk samples and in dosage forms are described. They are based on the reaction with nitrous acid forming a nitroso derivatives which can be measured at λmax 350 and 355 nm for cefuroxime (I) and ceftazidime (II), respectively (method A) or by oxidation of drug I or II with an excess of freshly prepared hypobromite and the residual hypobromite was treated with sodium fluorescein at the optimum experimental conditions and measured at λmax at 517 nm (method B). Method C is based on the formation of tris (0-phenanthroline) iron(II) complex (ferroin) upon the oxidation of the studied drug I or II with an iron (III)-o-phenanthroline mixture in acetate buffer solution of pH 3.6 and measuring at λmax 509 nm. Regression analysis of Beer-Lambert plots showed good correlation in the concentration ranges 0.2 – 6.0, 0.2 – 3.2 and 0.1 – 5.6 μg ml−1 for methods A, B and C, respectively. The apparent molar absorptivity, Sandell sensitivity, detection and quantitation limits were calculated. For more accurate results, Ringbom optimum concentration range was 0.2 – 5.6 μg ml−1. The validity of the proposed methods was tested by analysing dosage forms containing the studied drugs I and II. The relative standard deviations were ≤ 1.25% with recoveries 98.6 – 101.4% .

Extractive Spectrophotometric Determination of Nortriptyline Hydrochloride Using Sudan II, IV and Black B

A simple spectrophotometric methods has been developed for the determination of nortriptyline hydrochloride in pure and in pharmaceutical formulations based on the formation of ion-pair complexes with sudun II (SII), sudan (IV) (SIV) and sudan black B (SBB). The selectivity of the method was improved through extraction with chloroform. The optimum conditions for complete extracted colour development were assessed. The absorbance measurements were made at 534, 596 and 649 nm for SII, SIV and SBB complexes, respectively. The calibration graph was linear in the ranges 0.5- 280. 0.5- 37.5 and 0.5 – 31.0 μg ml−1 of the drug usiny the same reagents, respectively. The precision of the procedure was checked by calculating the relative standard deviation of ten replicate determinations on 15 μg ml−1 of nortriptyline HCI and was found to be 1.7, 1.3 and 1.55% using SII, SIV, and SBB complexes, respectively. The molar absorptivity and Sandell sensitivity for each ion-pair were calculated. The proposed methods were successfully applied to the deterniination of pure nortriptyline HCI and in pharmaceutical formulations, and the results demonstrated that the method is equally accurate, precise and reproducible as the official method.

Activation of stress-activated protein kinase in osteoarthritic cartilage: evidence for nitric oxide dependence

OBJECTIVE

We have demonstrated in bovine chondrocytes that nitric oxide (NO) mediates IL1 dependent apoptosis under conditions of oxidant stress. This process is accompanied by activation of c-Jun NH2-terminal kinase (JNK; also called stress-activated protein kinase). In these studies we examined activation of JNK in explant cultures of human osteoarthritic cartilage obtained at joint replacement surgery and we characterized the role of peroxynitrite to act as an upstream trigger.

DESIGN

A novel technique to isolate chondrocyte proteins (<10% of total cartilage protein) from cartilage specimens was developed. It was used to analyse JNK activation by a western blot technique. To examine the hypothesis that chondrocyte JNK activation is a result of increased peroxynitrite, in vitro experiments were performed in which cultured chondrocytes were incubated with this oxidant.

RESULTS

Activated JNK was detected in the cytoplasm of osteoarthritis (OA) affected chondrocytes but not in that of controls. In vitro, chondrocytes produce NO and superoxide anion. IL-1 (48 h), which induces nitric oxide synthase, resulted in an activation of JNK; this effect was reversed by N-monomethylarginine (NMA). TNFalpha treated chondrocytes at 48 h produce superoxide anion (EPR method). Exposure of cells to peroxynitrite led to an accumulation of intracellular oxidants, in association with JNK activation and cell death by apoptosis.

CONCLUSION

We suggest that JNK activation is among the IL-1 elicited responses that injure articular chondrocytes and this activation of JNK is dependent on intracellular oxidant formation (including NO peroxynitrite). In addition, the extraction technique here described is a novel method that permits the quantitation and study of proteins such as JNK involved in the signaling pathways of chondrocytes within osteoarthritic cartilage.

Measurement of blood flow and oxygen tension in adjacent tissues in pedicled and free flap head and neck reconstruction

The purpose of this study was to evaluate blood flow and transcutaneous partial oxygen pressure (TcPO(2)) in adjacent tissues to free and pedicled flaps following reconstructive procedures used in conjunction with radical surgery for head and neck cancers. Fifty patients were included. Fourteen patients had reconstruction with pedicled flaps and 36 with free flaps. For each patient, TcPO(2) and laser Doppler flow measurements were taken at the center of the flap, in adjacent tissue, and in a corresponding contralateral site. Three laser Doppler measurements were performed at each site and a mean value recorded. All patients had undergone reconstruction up to 6 months prior to the time of the measurements. The collected data were analyzed using a Wilcoxon signed rank test. There were no statistically significant differences in partial oxygen tension or laser Doppler values between tissues adjacent to free compared to pedicled flaps. Although there is strong evidence to support that free flaps have improved blood flow and partial oxygen tension over pedicled flaps, further study is required to evaluate adjacent tissues. Flap choice may assist with alteration in blood flow in less favorable defects such as those in previously irradiated fields and those resulting from burn scars or chronic infections.