Influence of a multidisciplinary paediatric allergy clinic on parental knowledge and rate of subsequent allergic reactions

BACKGROUND

Studies have demonstrated that families of children with food allergy have significant deficiencies in their knowledge of how to avoid allergen exposure and how to manage allergic reactions. This study aims to assess the impact of a multidisciplinary paediatric allergy clinic consultation on parental knowledge of food allergy and to determine the rate of subsequent allergic reactions.

METHODS

Sixty-two subjects (<17 years) referred with food allergy were prospectively enrolled. Parental knowledge was assessed by questionnaire and EpiPen trainer. Families saw a paediatric allergist, clinical nurse specialist and dietician. Knowledge was reassessed after 3 months and rate of allergic reactions after 1 year.

RESULTS

After one visit to the paediatric allergy clinic, there was a significant improvement in parental knowledge of allergen avoidance (26.9%, P < 0.001), managing allergic reactions (185.4%, P < 0.0001) and EpiPen usage (83.3%, P < 0.001). Additionally, there was a significant reduction in allergic reactions (P < 0.001). Children with egg, milk or multiple food allergies were more likely to suffer subsequent reactions.

CONCLUSIONS

A single visit to a multidisciplinary allergy clinic considerably improves families' abilities to manage allergic reactions to foods with an accompanying reduction in allergic reactions. Young children with egg, milk or multiple food allergies were at greatest risk of further reactions.

Surface enhanced Raman scattering of benzotriazole: a molecular orientational study

Surface enhanced Raman scattering of benzotriazole in aqueous silver sol at pH approximately 9 has been investigated. The spectra of the molecule at various concentrations were recorded and the maximum enhancement was observed with a 10(-5) M solution. From the comparison of the surface enhanced Raman spectra with the conventional Raman spectra and applying "surface selection rule", it is inferred that the molecular ion interacts with the silver sol via the nitrogen atoms of the benzotriazole ring and the molecule assumes a near "end-on" orientation.

Spasmolytic activity of Toddalia asiatica Var. floribunda

The spasmolytic activity of the aerial parts of Toddalia asiatica var. floribunda (family Rutaceae) was evaluated. The ethanol extract exhibited significant spasmolytic activity and was then partitioned into five fractions. The activity was found to be concentrated only in the hexane and chloroform fractions. This activity was shown not to be due to the coumarins, toddalolactone and toddanone, as was previously thought.

Cephalometric evaluation of Class II malocclusions in transitional dentition

Studying malocclusion during active growth period is important because this period has the maximum impact on dentofacial structures. The present study comprises of computerised cephalometric evaluation of 100 North Indian children in the age group of 9-12 years, with 50 children in normal occlusion group. The samples were segregated according to sex with 25 females and 25 males in each group. It was concluded from the study that changes or deviations in SNB, Saddle, Articular and Gonial angles are the potential indicative factors in the development of a class II malocclusion and that class II pattern is associated with short and posteriorly placed mandible in relation to the cranial base.

Protection of radiation-induced protein damage by curcumin

Free radical reactions of lysozyme (Lz), tryptophan and disulfides were studied with curcumin, a lipid-soluble antioxidant from turmeric, in aqueous solution using a pulse radiolysis technique. The binding of curcumin with lysozyme was confirmed using absorption, fluorescence and stopped-flow techniques. The free radicals of curcumin generated after repairing radicals of disulfides, lysozyme and tryptophan absorb at 500-510 nm. Implication of this in evaluating the antioxidant behavior of curcumin in protecting proteins is discussed.

Oral glycoprotein IIb/IIIa antagonism in patients with coronary artery disease

Dose-finding studies and trials of interaction of oral glycoprotein IIb/IIIa antagonists with other antiplatelet agents have been limited. We hypothesized that these detailed assessments could be first performed in patients with stable coronary artery disease (CAD) and then extrapolated to the target population. To this end, we performed 2 sequential studies. The first study examined the dose-related effects on indexes of platelet and vascular function induced by the oral inhibitor RPR 109891, when given alone and in combination with aspirin, in patients (n = 100) with stable CAD. The second study (the Antagonism of the FIbrinogen Receptor after Myocardial Events trial) assessed the pharmacodynamics and safety of derived regimens in patients (n = 320) with unstable coronary syndromes. In patients with stable CAD, platelet aggregation was dose dependently inhibited by RPR 109891, and the dose-response relation was shifted to the right by the concomitant administration of aspirin (p = 0.0001). The degree of platelet inhibition induced by 3 doses of RPR 109891 (plus aspirin) was lower in patients with unstable than stable CAD. No drug-related major bleeding occurred in either study. RPR 109891 treatment was associated with acute and delayed thrombocytopenia. In conclusion, chronic treatment with an oral glycoprotein IIb/IIIa antagonist (1) induces antiplatelet effects that are potentiated by concomitant administration of aspirin, (2) may require dose adjustment in syndromes of platelet activation, (3) is associated with a low rate of clinically significant bleeding when doses inducing incomplete inhibition of platelet aggregation are used, and (4) requires frequent monitoring of platelet count unless reliable predictors of delayed thrombocytopenia become available.

The intubating laryngeal mask airway after induction of general anesthesia versus awake fiberoptic intubation in patients with difficult airways

We performed the current study to compare tracheal intubation (TI) using awake fiberoptic intubation (AFOI) and TI using the intubating laryngeal mask airway (ILMA) in patients with difficult airway. Our hypothesis was that patients with difficult airways could be safely intubated after induction of anesthesia using the ILMA. After ethics approval and informed consent, 38 patients who were identified to have difficult airways were randomly assigned to AFOI or TI using the ILMA. Patients in the AFOI group had the usual sedation and airway topicalization. Patients in the ILMA group were induced with propofol for ILMA insertion and succinylcholine for TI. The first TI attempt was done blindly via the ILMA and all subsequent attempts were performed with fiberoptic guidance. All patients in the ILMA group were successfully ventilated. Successful TI was achieved in all patients in both groups. However, in 10% of the patients in the ILMA group, TI was achieved by a second anesthesiologist who was more experienced with the use of the ILMA. In a postoperative questionnaire, patients in the ILMA group were more satisfied with their method of TI (P < 0.01). The ILMA is a useful device in the management of patients with difficult airways and may be a valuable alternative to AFOI when AFOI is contraindicated or in the patient with the unanticipated difficult airway.

IMPLICATIONS

The intubating laryngeal mask airway is a useful device in the management of patients with difficult airways and may be a valuable alternative to awake fiberoptic intubation (AFOI) when AFOI is contraindicated or in the patient with the unanticipated difficult airway.

One- and Two-Electron Oxidation Reactions of Trolox by Peroxynitrite

One and two electron oxidation reactions of peroxynitrite with trolox, an analogue of vitamin E were studied. Kinetics of the reaction was studied using a single mixing stopped-flow spectrometer in the pH range from 6 to 11 and the products were analyzed by HPLC/HPIC. One-electron oxidation reaction produced the phenoxyl radical of trolox having a characteristic absorption spectrum in the 300-500 nm region with absorption maximum at 430 nm. The rate constant for the formation of the trolox radical at 430 nm was determined to be 1.8 x 10(5) M(-1) s(-1). At low concentration of peroxynitrite the radical did not show any noticeable decay in the time scale of 20-50 s. However, when the concentration of peroxynitrite was increased, there was an appreciable increase in the decay of the trolox radical due to its reaction with excess peroxynitrite yielding a bimolecular rate constant of 6.0 x 10(3) M(-1) s(-1) for the reaction of trolox radical with peroxynitrite. The released nitrite and nitrate anions, and the two-electron oxidation product quinone produced as a result of these reactions, were estimated using ion chromatography and HPLC analysis. By following the changes in the yields of nitrite and quinone as a function of peroxynitrite concentration and from the above determined rate parameters, the relative importance of the one and two electron processes has been discussed.

An open label safety study of topical imiquimod 5% cream in the treatment of Molluscum contagiosum in children

The objective of this study was to evaluate the safety of imiquimod 5% cream, a potent inducer of interferons, in children with molluscum contagiosum. The lesions of thirteen subjects (mean age 7 years) were treated every night for 4 weeks. A visual analog scale was used to assess any adverse local skin reactions, and for the presence of systemic side effects characteristic of interferon (IFN). Temperature and total white blood cell count were measured at baseline and compared with results at weeks 2 and 4. In the twelve subjects who completed the study, adverse reactions were limited to application site reactions. We did not find any evidence of systemic toxicity. In conclusion, imiquimod 5% cream appears to be a safe treatment in children with molluscum contagiosum.

HARTMANN'S PROCEDURE REVISITED

Between July 1991 and June 1999 out of 176 patients undergoing colonic surgery (elective and emergency), Hartmann's procedure was performed in 63. There were 39 males and 24 females. Mean age was 43 years (range 12 to 81). To assess the utility of Hartmann's procedure the documents of all these 63 patients were retrospectively analysed. In 47 bowel continuity was reestablished. The over all mortality in first stage operation (Hartmann's procedure) was 12.7% and mortality in the second stage procedure (reestablishing bowel continuity) was nil. Complication rate was drastically less in second operation. The authors conclude that Hartmann's procedure is safe and effective while dealing with colorectal pathologies as resection and primary anastomosis is fraught with danger.

Pulse radiolytic oxidation of beta-carotene with halogenated alkylperoxyl radicals in a quaternary microemulsion: formation of retinol

Pulse radiolytically generated halogenated alkylperoxyl radicals, namely CCl3OO*, CBr3OO*, CHCl2OO*, CHBr2OO*, etc. have been employed for a study of the oxidation of beta-carotene in a quaternary microemulsion. All these halogenated alkylperoxyl radicals produce a radical cation (absorption maximum at 840 nm), either via the initial formation of an adduct (absorption maximum at 740 nm), or by direct reaction. There was a considerable blue shift of both absorption peaks in the present system as compared to those earlier reported in non-polar as well as in micellar media. An additional intense absorption peak at approximately 345 nm was noted at a longer time scale and was stable up to 5 ms. On irradiation with a large number of electron pulses, a stable product with an absorption maximum at 315 nm appeared. On excitation at 315 nm, this product gave a fluorescence spectrum with an emission maximum at 525 nm. The absorption and fluorescence spectra of the stable product compared with those of retinol; this was further confirmed by HPLC analysis. A suitable mechanism has been proposed.

Predictive performance study of two digoxin assays in subjects with various degrees of renal function

This prospective study was conducted to compare the predictive performance of fluorescence polarization immunoassay (FPIA, Abbott TDx Digoxin II) and radioimmunoassay (RIA, Kallestad Labs) with combined low-pressure liquid chromatography/RIA (LPLC/RIA) digoxin assay in measuring 15-17 serum digoxin concentrations (SDC) obtained after a single 10 microg/kg intravenous digoxin dose in patients with various degrees of renal function and at different SDC ranges. Eighteen men and women were stratified into 3 age- and gender-matched groups based upon renal function [N = 6 in each, group I (Cl(cr) < 10 mL/min), group II (Cl(cr) = 10-50 mL/min), and group III (Cl(cr) > 50 mL/min)]. Serum digoxin concentrations were measured at time zero; at 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, and 12 hours; and at 2, 3, 4, and 5-7 days after the digoxin dose, using the three different digoxin assays. TDx Digoxin II was unbiased [mean error -0.09 (95% CI -0.19, 0.01)] and RIA biased [mean error -0.29 (95% CI -0.36, -0.21)] to over-predict SDC by 14.2%. In group I patients, the analysis revealed a bias to over-predict SDC by 6.0% for TDx Digoxin II [mean error -0.16 (95% CI -0.29, -0.07)] and an unbiased performance by RIA. In groups II and III, both TDx Digoxin II and RIA showed biased performance, the mean magnitude of bias was low (< 20%). For intermediate SDC range (> 0.5 ng/mL and < or = 3.0 ng/mL), TDx Digoxin II was unbiased in predicting SDC, whereas RIA was biased to under-predict SDC [mean error 0.13 (95% CI 0.10, 0.16)] by 9.9%. The magnitude of bias observed in all cases was less than 20%. Both assays, TDx Digoxin II and RIA, imprecisely measured SDC for all samples combined, different groups and SDC ranges. In all time-paired samples, TDx Digoxin II (FPIA) performed better than the RIA. In conclusion, the magnitude of bias observed with either assay at different groups and SDC ranges was not likely to be clinically relevant. Therefore, either assay may be used to measure SDC in clinical practice.

Redox reactions of sanazole (AK-2123) in aqueous solutions: a pulse radiolysis study

The redox chemistry of sanazole, an efficient hypoxic cell radiosensitizer, generally referred to as AK-2123, was studied by pulse radiolysis with eaq-, CO2-., 2-propanol radicals and CH2OH radicals. AK-2123 reacts with eaq-, CO2-. and 2-propanol radicals at almost diffusion-controlled rates, producing a nitro radical anion (lambda max = 290 nm) within a few microseconds. The decay kinetics of the radical anion was independent of the pH. The radical anion reacts with oxygen with a rate constant of 3.4 x 10(6) dm3 mol-1 s-1. An electron-transfer reaction was observed from the thymine radical anion to AK-2123. From redox equilibria with methyl viologen, the one-electron reduction potential of AK-2123 in aqueous solution, determined by pulse radiolysis, was estimated to be -0.33 +/- 0.02 V vs. NHE. Depletion of intracellular nonprotein thiols did not mitigate the radiosensitizing affect of the hypoxic radiosensitizer, AK-2123.

Age prediction based on skeletal morphology

Treatment plan for a child requires a complete diagnosis with monitoring of the skeleto-dental morphological changes during active period of growth. Growth modifications are done while the forces of growth are still at the peak of activity in a developing child. This study was undertaken on lateral cephalograms of 100 North Indian samples in the age group of 9-12 years consisting of 50 males and 50 females divided into normal occlusion and malocclusion groups, to predict and assess age by evaluating the skeleto-dental morphology in developing normal children having flush terminal plane molar relationship and children with developing class II pattern. It was concluded that based on measurements used in the study of dentofacial morphology, the age of a child could be statistically determined.

Cytological features of chondroblastoma: a case report with review of the literature

Chondroblastoma is an uncommon benign tumor of bone with a characteristic epiphyseal location. This report documents the cytological features on fine-needle aspiration biopsy (FNAB) of a chondroblastoma which appeared as a lytic lesion, predominantly in the metaphysis of the medial condyle of right femur in a 20-year-old male. Smears characteristically revealed hyper- to hypocellular lobules comprising small round to polyhedral cells (chondroblasts) embedded in an abundant myxoid stroma. The cytological diagnosis of chondroblastoma was confirmed on histopathology. The radiological appearance and differential diagnosis in this case is discussed.

Recurrent medulloblastoma following pediatric double-lung transplant

We report a case of recurrent medulloblastoma following successful pediatric double-lung transplant for chemotherapy-induced pulmonary fibrosis. The patient had an apparent 10-year malignancy-free period prior to the transplant. This case demonstrates a potential complication of lung transplantation in individuals with prior malignancies, and questions whether patients with a history of medulloblastoma are suitable candidates for lung transplantation.

Occult primary adenocarcinoma causing pseudomyxoma peritonei with pleural and hepatic metastases

Pseudomyxoma peritonei is characterized by diffuse collections of gelatinous flux resulting from implantation of malignant tumors or irritation from ruptured benign cysts. We report a patient with pseudomyxoma peritonei caused by an occult primary adenocarcinoma, who had both pleural and hepatic metastases.

Clinical implications of hepatitis G virus (HGV) infection in patients of acute viral hepatitis & fulminant hepatic failure

BACKGROUND & OBJECTIVES

Viral hepatitis is a major public health problem especially in developing countries such as India. Hepatitis viruses A, B, C, D and E are all well characterized and molecularly defined agents with unequivocal association with human liver disease but there is evidence of hepatitis in humans caused by certain transmissible agents which cannot be classified with the above hepatotoric viruses. The role of recently discovered hepatitis G virus (HGV/GBV-C) as an independent heaptitis agent is controversial. Recently, we have shown a relatively high frequency of HGV infection in fulminant hepatic failure but the virus was often detected in co-infection with hepatitis B or E virus. The present study has therefore been carried out to evaluate the clinical significance of HGV infection in acute viral hepatitis (AVH) and fulminant hepatic failure (FHF) through follow up of HGV positive patients till their clinical and biochemical recovery.

METHODS

The study included 50 patients comprising 35 of AVH and 15 of FHF. These patients were evaluated on the basis of history, physical examination, liver function profile and serological markers for hepatitis A, B, C and E. Those patients serologically negative for HBV and HCV infection were further screened for HBV DNA and HCV RNA by PCR. All the samples were screened for presence of HGV-RNA by RT-PCR using inner and outer primers sequences selected from NS3 helicase region of the HGV genome. FHF patients who died were subjected to postmortem liver biopsy and these biopsy specimens were also screened for HGV-RNA. Repeat detection of HGV-RNA was done after clinical and biochemical recovery of the patients.

RESULTS

Of 35 AVH patients, HGV infection was detected in 5 patients (14.3%) while 4 of 15 patients (26.6%) in the FHF group were positive for HGV-RNA. Five HGV positive AVH patients were followed till clinical and biochemical recovery and all of them tested positive for HGV-RNA at follow up (6 weeks to 6 months). Out of 4 HGV positive FHF patients, only one survived and his repeat sample after clinical and biochemical recovery tested positive for HGV-RNA.

INTERPRETATION & CONCLUSIONS

The results suggest that HGV infection does occur in patients of AVH and FHF and HGV viraemia persists for a long time even after clinical and biochemical recovery. These observations point towards a possible non-pathogenic role of hepatitis G virus infection.

Reattachment of a fractured non-vital central incisor fragment: a case report

Reattachment of the original tooth fragment to the fractured tooth provides benefits of maintaining the tooth's shape, colour texture and translucency in the restoration. This paper describes fragment reattachment of a non-vital central incisor five months after trauma.

The Ilizarov method in infected nonunion of fractures

Thirty patients with infected non-union of long bones were treated with radical resection of the necrotic bone and bone transport or compression/distraction osteosynthesis. Non-union, infection, deformity, bone gap and shortening were all addressed simultaneously using the Ilizarov principles. There were 15 cases with bone loss ranging from 4 to 12 cm (median bone gap of 7 cm), 10 cases of stiff non-union (six of which had an associated deformity) and five cases of mobile non-union. The median time in the Ilizarov frame was 150 days. Median follow up time after frame removal was 23.5 months. Bone grafting at the docking site was only required in three cases (10%). There were three cases of refracture (10%) and three cases of recurrence of infection (10%). The bone result was excellent in 21 patients (70%), good in three (10%), fair in none (0%) and poor in six (20%). The functional results were excellent in eight patients (26.7%), good in 12 (40.0%), fair in three (10%) and poor in seven (23.3%). It is difficult to precisely define the indications for preservation and reconstruction of severe injuries. The surgical team has to take into account the length, disability, complications and cost of treatment. Patients must be aware of the limitations of functional results and the possible difficulty of return to work despite the reconstructive attempt.

The changing epidemiological pattern of hepatitis A in an urban population of India: emergence of a trend similar to the European countries

The present study was undertaken to determine the seroprevalence of the antibody against hepatitis A virus (IgG anti-HAV) in an urban population sample from Delhi (India) and to assess any change in the epidemiological pattern of HAV infection in this part of the world. A total of 500 healthy subjects were enrolled and divided into groups on the basis of age, sex and per capita income and evaluated for the presence of IgG anti HAV antibodies using a commercially available kit. The mean age of all the subjects was 32.6 +/- 13.2 yr. and the male:female ratio was 1.5:1. The overall prevalence of IgG anti-HAV in all subjects was 71.2% (356/500). The prevalence in subjects >35 years (92.1% [186/202]) was significantly higher than that in subjects <35 years (92.1% [186/202]) was significantly higher than in subjects <35 years (57% [170/298]). No statistically significant difference was observed between male and female subjects (71.4% [217/304] vs. 70.9% [139/196]) or between subjects belonging to middle and low socioeconomic groups (68.9% [135/196] vs. 72.7% [221/304]). These findings when compared with the results that were obtained in 1982, showed a decreasing prevalence of IgG anti-HAV, most significantly in younger age groups (16-35 years). Thus, we may conclude that the seroepidemiology of hepatitis A virus infection in urban population of India seems to be changing with seroprevalence in the younger population approaching a figure similar to that of the more developed European countries.

Enthalpies of solution of ampicillin, amoxycillin and their binary mixtures at 310.15 K

Enthalpies of solutions of ampicillin, amoxycillin and their binary mixtures have been determined at pH 2, 5, and 7 using C-80 calorimeter. The systems showed endothermic behaviour; molar enthalpies of solutions of ampicillin were determined to be 13.32, 15.89 and 23.21 kJ mol(-1) and amoxycillin were 16.32, 18.45 and 26. 25 kJ mol(-1) at pH 2, 5, and 7, respectively. The excess molar enthalpies of solution have also been calculated to find any interaction between these two drugs.

Effect of regulated expression of human cyclooxygenase isoforms on eicosanoid and isoeicosanoid production in inflammation

To examine the role of cyclooxygenase (COX) isozymes in prostaglandin formation and oxidant stress in inflammation, we administered to volunteer subjects placebo or bolus injections of lipopolysaccharide (LPS), which caused a dose-dependent increase in temperature, heart rate, and plasma cortisol. LPS caused also dose-dependent elevations in urinary excretion of 2,3-dinor 6-keto PGF(1alpha) (PGI-M) and 11-dehydro thromboxane B(2) (Tx-M). Platelet COX-1 inhibition by chronic administration of low-dose aspirin before LPS did not alter the symptomatic and febrile responses to LPS, but the increment in urinary PGI-M and Tx-M were both partially depressed. Pretreatment with ibuprofen, a nonspecific COX inhibitor, attenuated the febrile and systemic response to LPS and inhibited prostanoid biosynthesis. Both celecoxib, a selective COX-2 inhibitor, and ibuprofen attenuated the pyrexial, but not the chronotropic, response to LPS. Experimental endotoxemia caused differential expression of the COX isozymes in monocytes and polymorphonuclear leucocytes ex vivo. LPS also increased urinary iPF(2alpha)-III, iPF(2alpha)-VI, and 8,12-iso-iPF(2alpha)-VI, isoprostane (iP) indices of lipid peroxidation, and none of the drugs blunted this response. These studies indicate that (a) although COX-2 predominates, both COX isozymes are induced and contribute to the prostaglandin response to LPS in humans; (b) COX activation contributes undetectably to lipid peroxidation induced by LPS; and (c) COX-2, but not COX-1, contributes to the constitutional response to LPS in humans.

A clinical study of the patients with dengue hemorrhagic fever during the epidemic of 1996 at Lucknow, India

This paper describes the clinical findings in 206 patients with dengue fever (DF) or with dengue hemorrhagic fever (DHF) during the epidemic of 1996 at Lucknow. The age group affected most was 11 to 30 years and 21% of the patients were less than 10 years old. The male:female ratio was 1.9:1. The onset was abrupt in all the patients, severe frontal headache was observed in 97%, myalgia in 90%, skin rash in 40%, vomiting in 29% and arthralgia in knee and hip joints in 9%. Anuria was seen in two patients. Lymphadenopathy was noted in 14%, hepatomegaly in 4%, being associated with mild jaundice in one patient, and splenomegaly in 2% of the patients. Involvement of the heart and lungs was seen in one patient each and no case with encephalitis was recorded. Hemorrhages from various sites were observed in 54% patients and 17 patients had profound shock. The commonest bleeding site was gums. Profound shock was preceded by various warning signs, the commonest being sudden hypotension. Among the patients with profound shock the mortality was 47% while the overall fatality rate was 3.8%. A number of the risk factors existed for a long time in this part of the world, but what precipitated the present epidemic at this time, is not known.

Long-term histologic effects of the CO2 laser

The long-term histologic effects of CO2 laser resurfacing previously were unknown. Prior investigations have clearly defined the photothermal effect. Collagen shrinkage as a reaction to increased tissue temperature between 60 and 70 degrees C has also been previously described. Twenty-two patients completed a 1-year study in which biopsy specimens from the upper lip were taken preoperatively and 6 weeks, 6 months, and 1 year after CO2 laser resurfacing. Trichrome stains and Verhoeff-van Gieson stains were used to demonstrate tissue collagen and tissue elastin. Neocollagenesis beginning at 6 weeks and progressively increasing at 6 months and 1 year was clearly demonstrated. Neoelastogenesis showed significant increases at 6 months and 1 year. It is hypothesized that the additive effects of initial collagen shrinkage and the long-term effect of neocollagenesis and neoelastogenesis are the significant factors contributing to the long-lasting and excellent results of CO2 laser skin resurfacing.

The effect of dehydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine profiles, lipid parameters, and health-related quality of life

Dehydroepiandrosterone (DHEA), an androgenic steroid hormone, exhibits an age-related decline. Perimenopausal women have only approximately 50% of peak DHEA levels. Despite limited scientific data, DHEA has gained recognition as a dietary supplement to reduce the symptoms of aging and improve well-being. This randomized, double-blind placebo-controlled trial examined the effects of 50 mg/day of oral DHEA supplementation, for 3 months, on 60 perimenopausal women with complaints of altered mood and well-being. Changes in the serum endocrine profile of women in the DHEA group were significantly greater than the placebo group, including a 242% [95% confidence interval (CI) +60.1, +423.9] increase in DHEAS, a 94.8% (95% CI +34.2, +155.4) increase in testosterone, and a 13.2% (95% CI -27.88, +0.5) decline in cortisol compared to baseline. Women receiving DHEA had a 10.1% (95% CI -15.0, -5.1) decline in high-density lipoprotein and an 18.1% (95% CI -32.2, -3.9) decline in Lp(a) from baseline, but these declines did not significantly differ from women who received placebo. Women receiving DHEA did not have any improvements significantly greater than placebo in the severity of perimenopausal symptoms, mood, dysphoria, libido, cognition, memory, or well-being. DHEA supplementation significantly effects the endocrine profile, may affect the lipid profile, but does not improve perimenopausal symptoms or well-being compared to placebo.

Identification of two essential sequence elements in the nonconsensus type II PatpB-290 plastid promoter by using plastid transcription extracts from cultured tobacco BY-2 cells

In higher plants, plastid genes are transcribed by at least two types of DNA-dependent RNA polymerases. One of them is the well-known plastid-encoded prokaryotic type of polymerase that recognizes sigma(70)-type promoters consisting of -35 and -10 consensus elements. The other recently recognized RNA polymerase has been found to be encoded entirely in the nucleus, and it recognizes a completely different set of promoters, designated previously as nonconsensus type II (NCII) promoters. Here, we report the development of an in vitro transcription system using nonphotosynthetic plastids of cultured tobacco BY-2 cells. This system preferentially and accurately initiates transcription from NCII promoters. The conditions for in vitro transcription were optimized by using the tobacco PatpB-290 promoter, which has been found to be the most highly expressed NCII promoter in vivo. Analysis of in vitro transcription initiation in a series of PatpB-290 5' deletion constructs revealed that sequences upstream of nucleotide -41 do not influence the transcriptional activity of this promoter. A 43-bp region (nucleotides -35 to +8) was further analyzed by introducing single or multiple nucleotide substitutions into two regions (box I and box II) of high sequence conservation. We report here that the ATAGAA sequence comprising box II and the -11 to +4 region (relative to transcription initiation) in box I significantly influence the activity of this NCII promoter.

Fine needle aspiration biopsy of the spleen in pyrexia of unknown origin

To evaluate the diagnostic utility, value and potential risk of fine needle aspiration biopsy of spleen (sFNAB) in patients with splenomegaly in pyrexia of unknown origin (PUO), a retrospective analysis of medical records and cytological material of 31 patients on whom FNAB was performed between April 1994 and October 1997 was done. The patients were HIV- and presented with PUO. All other relevant investigations were negative. The spleen was either palpable or detected to have space-occupying lesions on ultrasonography (USG). The splenic aspirates showed tuberculosis in 11 patients (35.4%) and inconclusive or reactive changes in nine patients (25.8%). One case out of this group proved to be Kaposi's sarcoma on autopsy. The other diseases encountered were leishmaniasis (n = 3), non-Hodgkin's lymphoma (n = 4), fungal infections (n = 2), Hodgkin's lymphoma (n = 1). The patients who were diagnosed as having tuberculosis had epithelioid cells, giant cells, necrosis and inflammatory cells in various combinations. AFB positivity was 63.6%. The other cases which showed granulomas but no AFB were diagnosed on empirical grounds and all responded to the anti-tuberculosis therapy. No complications were encountered with the procedure. Therefore the authors conclude that sFNAB is rewarding in patients where all other non-invasive modalities of diagnosis have failed.

Effects of specific inhibition of cyclooxygenase-2 on sodium balance, hemodynamics, and vasoactive eicosanoids

Conventional nonsteroidal anti-inflammatory drugs inhibit both cyclooxygenase (Cox) isoforms (Cox-1 and Cox-2) and may be associated with nephrotoxicity. The present study was undertaken to assess the renal effects of the specific Cox-2 inhibitor, MK-966. Healthy older adults (n = 36) were admitted to a clinical research unit, placed on a fixed sodium intake, and randomized under double-blind conditions to receive the specific Cox-2 inhibitor, MK-966 (50 mg every day), a nonspecific Cox-1/Cox-2 inhibitor, indomethacin (50 mg t.i.d.), or placebo for 2 weeks. All treatments were well tolerated. Both active regimens were associated with a transient but significant decline in urinary sodium excretion during the first 72 h of treatment. Blood pressure and body weight did not change significantly in any group. The glomerular filtration rate (GFR) was decreased by indomethacin but was not changed significantly by MK-966 treatment. Thromboxane biosynthesis by platelets was inhibited by indomethacin only. The urinary excretion of the prostacyclin metabolite 2,3-dinor-6-keto prostaglandin F1alpha was decreased by both MK-966 and indomethacin and was unchanged by placebo. Cox-2 may play a role in the systemic biosynthesis of prostacyclin in healthy humans. Selective inhibition of Cox-2 by MK-966 caused a clinically insignificant and transient retention of sodium, but no depression of GFR. Inhibition of both Cox isoforms by indomethacin caused transient sodium retention and a decline in GFR. Our data suggest that acute sodium retention by nonsteroidal anti-inflammatory drugs in healthy elderly subjects is mediated by the inhibition of Cox-2, whereas depression of GFR is due to inhibition of Cox-1.

Prospective observational study of primary angioplasty of the infarct-related artery for acute myocardial infarction

Primary angioplasty has been shown to reduce rates of in-hospital mortality, recurrent ischaemia and infarction. However, the role of primary stenting and abciximab is presently undergoing evaluation. This study attempted to examine the feasibility, safety and outcomes of primary angioplasty in the treatment of acute myocardial infarction. Data in 100 patients who underwent primary angioplasty for evolving acute myocardial infarction was prospectively analysed to assess the safety and efficacy of various modalities. Twenty patients were in Killip class III and above. Multivessel (2 or more vessels) disease was noted in more than 52 cases. Procedural success was 99 percent; 86 patients received primary stenting, majority of them had Kalam-Raju stent implantation. Adjunct treatment included abciximab infusion in 22 and intra-aortic balloon pump support in 12. Overall mortality rate was six percent with a mortality of 2.2 percent in non-cardiogenic shock patients. Recurrent ischaemic events were noted in five, three of them had successful reperfusion with repeat angioplasty. None of the patients had emergency coronary artery bypass surgery. It is concluded that primary angioplasty is safe and effective with high procedural success. Recurrent ischaemic events are low, possibly due to routine use of stenting and selective use of abciximab.

Systemic biosynthesis of prostacyclin by cyclooxygenase (COX)-2: the human pharmacology of a selective inhibitor of COX-2

Prostaglandins (PG) are synthesized by two isoforms of the enzyme PG G/H synthase [cyclooxygenase (COX)]. To examine selectivity of tolerated doses of an inhibitor of the inducible COX-2 in humans, we examined the effects of celecoxib on indices of COX-1-dependent platelet thromboxane (Tx) A2 and on systemic biosynthesis of prostacyclin in vivo. Volunteers received doses of 100, 400, or 800 mg of celecoxib or 800 mg of a nonselective inhibitor, ibuprofen. Ibuprofen, but not celecoxib, significantly inhibited TxA2-dependent aggregation, induced ex vivo by arachidonic acid (83 +/- 11% vs. 11. 9 +/- 2.2%; P < 0.005) and by collagen. Neither agent altered aggregation induced by thromboxane mimetic, U46619. Ibuprofen reduced serum TxB2 (-95 +/- 2% vs. -6.9 +/- 4.2%; P < 0.001) and urinary excretion of the major Tx metabolite, 11-dehydro TxB2 (-70 +/- 9.9% vs. -20.3 +/- 5.3%; P < 0.05) when compared with placebo. Despite a failure to suppress TxA2-dependant platelet aggregation, celecoxib had a modest but significant inhibitory effect on serum TxB2 4 hr after dosing. By contrast, both ibuprofen and celecoxib suppressed a biochemical index of COX-2 activity (endotoxin induced PGE2 in whole blood ex vivo) to a comparable degree (-93.3 +/- 2% vs. -83 +/- 6.1%). There was no significant difference between the doses of celecoxib on COX-2 inhibition. Celecoxib and ibuprofen suppressed urinary excretion of the prostacyclin metabolite 2,3 dinor 6-keto PGF1alpha. These data suggest that (i) platelet COX-1-dependent aggregation is not inhibited by up to 800 mg of celecoxib; (ii) comparable COX-2 inhibition is attained by celecoxib (100-800 mg) and ibuprofen (800 mg) after acute dosing; and (iii) COX-2 is a major source of systemic prostacyclin biosynthesis in healthy humans.

Increased formation of distinct F2 isoprostanes in hypercholesterolemia

BACKGROUND

F2 isoprostanes are stable, free radical-catalyzed products of arachidonic acid that reflect lipid peroxidation in vivo.

METHODS AND RESULTS

Specific assays were developed by use of mass spectrometry for the F2 isoprostanes iPF2alpha-III and iPF2alpha-VI and arachidonic acid (AA). Urinary excretion of the 2 F2 isoprostanes was significantly increased in hypercholesterolemic patients, whereas substrate AA in urine did not differ between the groups. iPF2alpha-III (pmol/mmol creatinine) was elevated (P<0.0005) in homozygous familial hypercholesterolemic (HFH) patients (85+/-5. 5; n=38) compared with age- and sex-matched normocholesterolemic control subjects (58+/-4.2; n=38), as were levels of iPF2alpha-VI (281+/-22 versus 175+/-13; P<0.0005). Serum cholesterol correlated with urinary iPF2alpha-III (r=0.41; P<0.02) and iPF2alpha-VI (r=0. 39; P<0.03) in HFH patients. Urinary excretion of iPF2alpha-III (81+/-10 versus 59+/-4; P<0.05) and iPF2alpha-VI (195+/-18 versus 149+/-20; P<0.05) was also increased in moderately hypercholesterolemic subjects (n=24) compared with their controls. Urinary excretion of iPF2alpha-III and iPF2alpha-VI was correlated (r=0.57; P<0.0001; n=106). LDL iPF2alpha-III levels (ng/mg arachidonate) were elevated (P<0.01) in HFH patients (0.32+/-0.08) compared with controls (0.09+/-0.02). The concentrations of iPF2-III in LDL and urine were significantly correlated (r=0.42; P<0.05) in HFH patients.

CONCLUSIONS

Asymptomatic patients with moderate and severe hypercholesterolemia have evidence of oxidant stress in vivo.

Elevated levels of IL-8 in dengue hemorrhagic fever

Dengue virus causes dengue fever, a mild febrile illness, and at times dengue hemorrhagic fever (DHF), a severe illness the pathogenesis of which is not fully understood. Given the crucial roles played by interleukin-8 (IL-8) as a chemoattractant cytokine and in inflammatory processes, levels of circulating IL-8 in the sera and IL-8 mRNA in the peripheral blood mononuclear cells (PBMC) were measured in 99 patients of a recent dengue epidemic that occurred in India in 1996 and in 21 normal healthy controls. Twenty-six of the patients had dengue fever (DF) and the remaining 73 were diagnosed as having different grades of DHF. All the control normal sera were negative for IL-8, so were their PBMC for IL-8 mRNA. Increased levels of IL-8 in the sera and IL-8 mRNA in their PBMC were observed in patients with severe illness of DHF grades III and IV. Only two out of 26 patients of DF and one out of 10 DHF grade I patient were positive for IL-8 and all three deteriorated to DHF grade IV within 24 hr. All six patients of DHF grade IV who died had higher serum level of IL-8 above 200 pg/ml, the highest being 5,568 pg/ml in one patient; the presence of mRNA for IL-8 was very high in all patients. A striking correlation was observed between increased levels of IL-8 and severe DHF, with greater levels in patients with increased grade of the disease and death. These results suggest that IL-8 may have an important role and may be an indicator of increasing severity of the disease and death.