Reference equation for the 6-minute walk test in healthy North Indian adult males

SETTING

Lala Ram Swarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.

BACKGROUND

The 6-min walk distance (6MWD) correlates well with functional capacity. However, previous reference equations for the 6MWD have failed to accurately predict the 6MWD due to variations in population ethnicity and geography.

OBJECTIVE

The aims of this study were 1) to measure 6MWD in healthy North Indian adult males, 2) to determine the applicability of Enright and Sherrill's reference equation to healthy North Indian adult males, and 3) to develop a regression equation for Indian males.

DESIGN

After physical examination and investigations, the 6-minute walk test was conducted in male subjects aged 40-60 years.

RESULTS

The mean (±SD) 6MWD was 536.1 ± 46.9 m. Enright and Sherrill's reference equation did not correctly predict distance in an Indian population: walk distance was overestimated by a mean (±SD) of 46.8 ± 32.9 m. The regression equation developed for males was 6MWD (m) = 3.654 × height (cm) - 4.139 × age (years) + 127.121, and accounted for 63.9% of total variance.

CONCLUSIONS

Enright and Sherrill's equation cannot be used to predict the 6MWD in healthy North Indian adult males. The new regression equation is expected to prove useful for various purposes in healthy North Indian adult males.

Accuracy of routinely recorded ethnic group information compared with self-reported ethnicity: evidence from the English Cancer Patient Experience survey

OBJECTIVE

To describe the accuracy of ethnicity coding in contemporary National Health Service (NHS) hospital records compared with the 'gold standard' of self-reported ethnicity.

DESIGN

Secondary analysis of data from a cross-sectional survey (2011).

SETTING

All NHS hospitals in England providing cancer treatment.

PARTICIPANTS

58 721 patients with cancer for whom ethnicity information (Office for National Statistics 2001 16-group classification) was available from self-reports (considered to represent the 'gold standard') and their hospital record.

METHODS

We calculated the sensitivity and positive predictive value (PPV) of hospital record ethnicity. Further, we used a logistic regression model to explore independent predictors of discordance between recorded and self-reported ethnicity.

RESULTS

Overall, 4.9% (4.7-5.1%) of people had their self-reported ethnic group incorrectly recorded in their hospital records. Recorded White British ethnicity had high sensitivity (97.8% (97.7-98.0%)) and PPV (98.1% (98.0-98.2%)) for self-reported White British ethnicity. Recorded ethnicity information for the 15 other ethnic groups was substantially less accurate with 41.2% (39.7-42.7%) incorrect. Recorded 'Mixed' ethnicity had low sensitivity (12-31%) and PPVs (12-42%). Recorded 'Indian', 'Chinese', 'Black-Caribbean' and 'Black African' ethnic groups had intermediate levels of sensitivity (65-80%) and PPV (80-89%, respectively). In multivariable analysis, belonging to an ethnic minority group was the only independent predictor of discordant ethnicity information. There was strong evidence that the degree of discordance of ethnicity information varied substantially between different hospitals (p<0.0001).

DISCUSSION

Current levels of accuracy of ethnicity information in NHS hospital records support valid profiling of White/non-White ethnic differences. However, profiling of ethnic differences in process or outcome measures for specific minority groups may contain a substantial and variable degree of misclassification error. These considerations should be taken into account when interpreting ethnic variation audits based on routine data and inform initiatives aimed at improving the accuracy of ethnicity information in hospital records.

Morphological studies of SnO2 thin films fabricated by using e-beam method

This paper studies the variations in morphology of SnO2 nanostructures thin films deposited by using e-beam technique with the substrate temperature, oxygen partial pressure and the film thickness. The e-beam conditions were optimized to get crystalline nanosheets of SnO2. The films of 100-700 nm thickness were deposited on quartz substrates at temperatures ranging from room temperature (RT) to 300 degrees C and oxygen partial pressure ranging from 0 to 200 sccm. The nanostructured films have been characterized by means of X-ray diffraction (XRD), field emission scanning electron microscope (FE-SEM) and Energy dispersive spectroscopy (EDS) measurements. XRD results show that the films deposited at RT and 100 degrees C were amorphous, however, for 200 degrees C and 300 degrees C, the films showed crystalline nature with rutile structure. Also, the crystallinity increased with the increase of oxygen partial pressure. FE-SEM images revealed that at RT and 100 degrees C of substrate temperature, the film consist of spherical particles, whereas, the films deposited at 200 degrees C and 300 degrees C consist of sheet like morphology having thickness -40 nm and lateral dimension of 1 microm, respectively. The size of the nanosheets increased with the increase of substrate temperature and oxygen partial pressure due to the enhancement in the crystallinity of the films. A possible growth mechanism of the formation of SnO2 nanosheets is discussed.

What about us? Recent advances in the treatment of chronic hepatitis C threaten to leave some parts of the world behind

Summary.  Directly acting antiviral (DAA) agents are currently revolutionizing the treatment of chronic hepatitis C infection. The first generation of these agents have significant limitations including cost issues that are of particular concern in the developing world and a lack of efficacy in genotype 3 patients. Both of these concerns are of particular relevance in Pakistan.

Adult recall of childhood female genital cutting and perceptions of its effects: a pilot study for service improvement and research feasibility

This study aimed to gather information from service users of an African Women's Clinic for the purposes of planning service improvement and estimating research feasibility. The report is based on 17 interviews with Somali speaking women who had experienced female genital cutting in childhood. With language barriers removed, a high percentage of clinic attendees responded positively to the invitation to participate in research. They willingly discussed their experiences of FGM and expressed their negative viewpoints about the practice of FGM, suggesting that psychosocial and psychosexual research may be feasibly carried out in specialist contexts. The results also point to the need for psychological and educational input for service improvement.

Serotype and serovar distribution of Neisseria gonorrhoeae isolated from high-risk populations in Bangladesh

Neisseria gonorrhoeae, the causative agent of gonococcal infection, is known to frequently change their characteristics to evade host immune mechanism. Characterization of the clinical isolates of the organism can lead to identification of the circulating strains and often a sexual network in a community to help in designing the control strategy. Keeping in mind the above consideration, a total of 239 N. gonorrhoeae, isolated from high-risk populations, were characterized for serotypes and serovars by monoclonal antibodies against protein 1 of the organism. Majority of the serotypes were serotype B (142, 59.4%). Majority of the isolates showing resistance to at least one of the antibiotics tested were also serotype B (139, 59.2%), whereas, majority of the isolates showing resistance to any three of the antibiotics (multidrug resistant, MDR) (63%) was serotype A. A total of 41 different serovars were also identified and five of which (Arst, Bropt, Bopt, Arost, and Brop) included the highest percent (49.3%) of the isolates. Many serovars (23/41, 56.1%) were new emergent and included 58 (24.3%) of the isolates investigated. All of the new serovars were resistant to at least one of the antibiotics tested and the highest rate (40/102, 39.2%) was MDR. Serotyping and serovar determination was found contributory to understand the microepidemics of the N. gonorrhoeae isolates. Further studies including antibiogram and contact tracing can efficiently help in control of the disease.

IL-4 gene polymorphisms and their association with atopic asthma and allergic rhinitis in Pakistani patients

BACKGROUND AND OBJECTIVE

Interleukin (IL) 4 is a cytokine that mediates allergic responses. Different single nucleotide polymorphisms (SNPs) can influence the immune response mediated by cytokines. The aim of the present study was to investigate the possible association between IL-4 polymorphisms and allergic rhinitis and atopic asthma.

METHODS

A total of 214 atopic patients (108 with asthma and 106 with allergic rhinitis) and 120 healthy controls from Pakistan were genotyped for IL-4 SNPs C-589T (rs2243250), T+2979G (rs2227284), and C-33T (rs2070874) using restriction fragment length polymorphism-polymerase chain reaction. Statistical analysis was performed using the statistical software package StatCalc, Epilnfo v.6.

RESULTS

The SNP rs2243250 was significantly associated with both asthma (P = .004, chi2 = 11.0) and allergic rhinitis (P < .001, chi2 = 20.2), as was T-2979G (P < .001, chi2 = 22.51 for asthma and P < .001, chi2 = 57.6 for allergic rhinitis). The most frequent genotypes in the asthma and allergic rhinitis groups were TT for SNP rs2243250, and GG for SNP rs2227284. rs2070874 was not found to be associated with either of the 2 atopic respiratory diseases analyzed in the Pakistani cohort.

CONCLUSIONS

rs2243250 and rs2227284 are significantly associated with asthma and allergic rhinitis. The results of this study indicate that in addition to environmental factors, genetic risk factors also play an important role in the development of atopic respiratory diseases.

Waterlogging tolerance of crops: breeding, mechanism of tolerance, molecular approaches, and future prospects

Submergence or flood is one of the major harmful abiotic stresses in the low-lying countries and crop losses due to waterlogging are considerably high. Plant breeding techniques, conventional or genetic engineering, might be an effective and economic way of developing crops to grow successfully in waterlogged condition. Marker assisted selection (MAS) is a new and more effective approach which can identify genomic regions of crops under stress, which could not be done previously. The discovery of comprehensive molecular linkage maps enables us to do the pyramiding of desirable traits to improve in submergence tolerance through MAS. However, because of genetic and environmental interaction, too many genes encoding a trait, and using undesirable populations the mapping of QTL was hampered to ensure proper growth and yield under waterlogged conditions Steady advances in the field of genomics and proteomics over the years will be helpful to increase the breeding programs which will help to accomplish a significant progress in the field crop variety development and also improvement in near future. Waterlogging response of soybean and major cereal crops, as rice, wheat, barley, and maize and discovery of QTL related with tolerance of waterlogging, development of resistant variety, and, in addition, future prospects have also been discussed.

Differential diagnosis of normal pressure hydrocephalus by MRI mean diffusivity histogram analysis

BACKGROUND AND PURPOSE

Accurate diagnosis of normal pressure hydrocephalus is challenging because the clinical symptoms and radiographic appearance of NPH often overlap those of other conditions, including age-related neurodegenerative disorders such as Alzheimer and Parkinson diseases. We hypothesized that radiologic differences between NPH and AD/PD can be characterized by a robust and objective MR imaging DTI technique that does not require intersubject image registration or operator-defined regions of interest, thus avoiding many pitfalls common in DTI methods.

MATERIALS AND METHODS

We collected 3T DTI data from 15 patients with probable NPH and 25 controls with AD, PD, or dementia with Lewy bodies. We developed a parametric model for the shape of intracranial mean diffusivity histograms that separates brain and ventricular components from a third component composed mostly of partial volume voxels. To accurately fit the shape of the third component, we constructed a parametric function named the generalized Voss-Dyke function. We then examined the use of the fitting parameters for the differential diagnosis of NPH from AD, PD, and DLB.

RESULTS

Using parameters for the MD histogram shape, we distinguished clinically probable NPH from the 3 other disorders with 86% sensitivity and 96% specificity. The technique yielded 86% sensitivity and 88% specificity when differentiating NPH from AD only.

CONCLUSIONS

An adequate parametric model for the shape of intracranial MD histograms can distinguish NPH from AD, PD, or DLB with high sensitivity and specificity.

Adaptive toothbrush handle: case report of a Thalidomide patient

Thalidomide poisoning can result in malformation of limbs, specifically upper limbs, compromising manual dexterity. Although Thalidomide has long since been withdrawn for use in pregnant patients, its affects on those exposed pose significant challenges for patients' oral hygiene maintenance. This case reports a novel technique of adaptation to facilitate a Thalidomide poisoned patient in maintenance of oral hygiene via an adaptive toothbrush handle.

Genetic dissection of sympatric populations of brown planthopper, Nilaparvata lugens (Stål), using DALP-PCR molecular markers

Direct amplified length polymorphism (DALP) combines the advantages of a high-resolution fingerprint method and also characterizing the genetic polymorphisms. This molecular method was also found to be useful in brown planthopper, Nilaparvata lugens species complex for the analysis of genetic polymorphisms. A total of 11 populations of Nilaparvata spp. were collected from 6 locations from Malaysia. Two sympatric populations of brown planthopper, N. lugens, one from rice and the other from a weed grass (Leersia hexandra), were collected from each of five locations. N. bakeri was used as an out group. Three oligonucleotide primer pairs, DALP231/DALPR′5, DALP234/DALPR′5, and DALP235/DALPR′5 were applied in this study. The unweighted pair group method with arithmetic mean (UPGMA) dendrogram based on genetic distances for the 11 populations of Nilaparvata spp. revealed that populations belonging to the same species and the same host type clustered together irrespective of their geographical localities of capture. The populations of N. lugens formed into two distinct clusters, one was insects with high esterase activities usually captured from rice and the other was with low esterase activities usually captured from L. hexandra. N. bakeri, an out group, was the most isolated group. Analyses of principal components, molecular variance, and robustness also supported greatly to the findings of cluster analysis.

Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population

BACKGROUND & OBJECTIVES

Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions.

METHODS

Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group.

RESULTS

Mean age of participants was 40.9 ± 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and >3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while it continued to be high in the control arm without interventions (both within group and between group P<0.001). The proportion of 'low risk phenotype' increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P<0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 13.3 to 17.8 per cent in the control arm (P<0.001).

INTERPRETATION & CONCLUSIONS

Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.

Successful outcome of pregnancy with mechanical heart valve with home heparin therapy

There is high incidence of rheumatic valvular heart disease in developing countries like Bangladesh, for which large number of young females undergo valve replacement with mechanical prosthetic heart valve. Pregnancy with mechanical heart valve carries risk of warfarin embryopathy and increased incidence of maternal thrombo-embolism. We had successful outcome of pregnancy of a patient with mechanical prosthetic heart valve with home heparin therapy.

Early outcomes of pandemic influenza (H1N1) 2009 surveillance in Abu Dhabi Emirate, May-August 2009

Soon after the initial detection of cases of pandemic H1N1 infection in Mexico, a new H1N1 surveillance system was set up in Abu Dhabi Emirate in May 2009. This paper reports on the outbreak from May to August 2009. A total of 356 cases were confirmed from 20 May 2009 to 16 August 2009. The incidence of confirmed H1N1 cases was 18.5 per 100 000. Their ages ranged from <1 month to 62 years, with a median age of 20 years. The incidence was 18.6 per 100 000 among both males and females. The incidence among United Arab Emirates nationals was higher than expatriates (66.6 versus 5.2 per 100 000). No death attributable to H1N1 was reported. A low-grade H1N1 infection evolved in the Emirate with an incidence lower than some other countries, possibly because of the pandemic being in the early stages, perhaps coupled with under-reporting.

Evaluation of wound-healing formulation against sulphur mustard-induced skin injury in mice

Sulphur mustard (SM) is a bifunctional alkylating agent that causes cutaneous blisters in human and animals. Remedies to SM-induced dermatotoxicity are still in experimental stage. Due to inevitable requirement of a wound-healing formulation against SM-induced skin lesions, efficacy of formulations including povidone iodine, Aloe vera gel, betaine or framycetin sulphate was evaluated in present study. SM was applied percutaneously (5 mg/kg) once on back region of Swiss albino mice; and after 24 hours, DRDE/WH-02 (Defence Research and Development Establishment/ Wound Healant- 02, containing polyvinylpyrrolidone [PVP], A. vera gel and betaine), Ovadine, Soframycin or A. vera gel were applied topically, daily for 3 or 7 days in different groups. Skin sections were subjected to histopathology, histomorphologic grading, tissue leukocytosis, terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay and immunohistochemistry of inflammatory-reparative biomarkers. DRDE/WH-02 treated mice received highest score on the basis of histomorphologic scale and lowest number of TUNEL-positive cells compared to other groups. DRDE/WH-02 showed better wound healing as evidenced by widespread re-epithelialization, homogenous fibroplasias well supported by the expression of transforming growth factor-α, endothelial nitric oxide synthase (eNOS) and fibroblast growth factor. Upregulation of interleukin 6 in DRDE/WH-02-treated mice skin resulted in increased tissue leukocytosis and an early removal of tissue debris that initiated reparative process at faster rate compared to other groups. In conclusion, DRDE/WH-02 provided better healing effect and can be recommended as an effective wound healant against SM-induced skin injury.

Why are tuberculosis patients not treated earlier? A study of informal health practitioners in Bangladesh

SETTING

Five districts and four cities of Bangladesh.

OBJECTIVE

To study the role of informal health practitioners in delays in initiating tuberculosis (TB) treatment in new smear-positive TB patients.

DESIGN

A cross-sectional study of all patients registered within specific projects in Bangladesh using routine records from projects. Definitions were as follows: 1) total delay: duration from onset of symptoms to initiation of treatment; 2) patient delay: onset of symptoms to first visit to any practitioner; and 3) health system delay: first visit to practitioner to treatment initiation.

RESULTS

A total of 7280 cases were enrolled. Prolonged delay was calculated as ≥ 5 weeks for patient delay, ≥ 10 weeks for health system delay and ≥ 13 weeks for total delay. Prolonged patient delay was less frequent when patients first consulted informal as compared to qualified health practitioners (30% vs. 68%). Similar figures for prolonged health system delay were respectively 52% and 16%, while those for total delay were 47% and 27%. The differences were statistically significant (P < 0.05).

CONCLUSION

Patients seeking care from informal practitioners access care more promptly, but have prolonged delays in initiating treatment. Further investigation on how to involve these practitioners in the programme should be evaluated.

Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results)

INTRODUCTION

Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date.

METHODS

The authors estimated short-term and lifetime predicted CVD risk among 10,054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (≥ 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups.

RESULTS

The mean age (SD) of the study population (men=63%) was 40.8 ± 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively.

CONCLUSION

Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.

Association of high sensitive C-reactive protein (hsCRP) with established cardiovascular risk factors in the Indian population

Introduction

Inflammation, the key regulator of C-reactive protein (CRP) synthesis, plays a pivotal role in atherothrombotic cardiovascular disease.

Methods

High sensitivity CRP (hsCRP) analysis was carried out in randomly selected 600 individuals from the sentinel surveillance study in Indian industrial population (SSIP). The hsCRP was measured quantitatively by turbid metric test using kits from SPINREACT, Spain. We analyzed the association between hsCRP and traditional CVD risk factors in this sub-sample.

Results

Complete risk factor data and CRP levels were available from 581/600 individuals. One half (51.2%) of the study subjects were males. Mean age of the study group was 39.2 ± 11.2 years. The Pearson correlation coefficients were in the range of 0.12 for SBP (p = 0.004) to 0.55 for BMI (p < 0.001). The linear regression coefficients ranged from 0.01 for SBP, PG and TC (p < 0.001) to 0.55 for log_eTAG (p < 0.001) after adjustment for age, sex and education. The mean of log_ehsCRP significantly increased (P < 0.001) from individuals with ≤1 risk factors (-0.50) to individuals with three or more risk factors (0.60). In the multivariate model, the odds ratios for elevated CRP (CRP ≥ 2.6 mg/dl) were significantly elevated only in females in comparison to males (1.63, 95% CI; 1.02-2.58), overweight individuals in comparison to normal weight individuals (3.90, 95% CI; 2.34-6.44, p < 0.001), and abdominal obese individuals (1.62, 95% CI; 1.02-2.60, p = 0.04) in comparison to non-obese individuals.

Conclusion

Clinical measurements of adiposity (body mass index and abdominal obesity) correlate well and can be surrogate for systemic inflammatory state of individuals.

Boron Phosphide on Silicon for Radiation Detectors

We report on radiation detectors fabricated from boron phosphide (BP) layers. These devices were fabricated by growing 1 to 10 μm thick layers of BP by chemical vapor deposition (CVD) on (100) oriented n-type silicon substrates. Ohmic contacts were applied to the Si (Au-Sb). Schottky barrier contacts (also Au-Sb) were applied to the BP layer. The devices were tested as radiation detectors and were found to be capable of detecting individual 5.5 MeV alpha particles. With some improvements we hope to fabricate neutron detectors from these devices, making use of the very high cross-section of boron for thermal neutrons.

Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate

BACKGROUND

The locking compression plate (LCP) with combination holes is a newer device in fracture fixation. We undertook a study comparing the LCP with limited contact dynamic compression plate (LC-DCP) in the treatment of diaphyseal fractures of both bones of the forearm.

MATERIALS AND METHODS

This is a prospective comparative study, 36 patients (18 in each group) with fractures of both the forearm bones (72 fractures) were treated with one of the two devices. The average age of the patients was 30.5 years (range 16-60 years) with mean followup of 2.1 years (range 1.5-2.8 years). The patients were assessed for fracture union and function and complications and by Disabilities of the Arm, Shoulder and Hand (DASH) score for patient related outcome at the latest followup.

RESULTS

There was no significant difference in two groups with respect to the range of movements or grip strength. One case had delayed union (LC-DCP group) and another had synostosis (LCP group). Plate removal was done in four cases within the study period with no refracture till the presentation of this report.

CONCLUSION

LC plating is an effective treatment option for fractures of both bones of forearm. The present study could not prove its superiority over LC-DCP.

Promoter polymorphisms of the CD14 gene are associated with atopy in Pakistani adults

BACKGROUND

Several studies have shown that promoter polymorphisms of the CD14 gene are associated with atopic asthma. However, the results of association studies in different populations are conflicting. This study aimed to investigate the possible association between the CD14 polymorphisms A-1145G and C-159T and atopic phenotypes in Pakistani cohorts.

METHODS

Healthy controls (n = 120) and atopic patients (n=220) were genotyped for the single-nucleotide polymorphisms C-159T (rs2569190) and A-1145G (rs2569191) using restriction fragment length polymorphism-polymerase chain reaction.

RESULTS

The genotype and allelic frequencies were in Hardy-Weinberg equilibrium. Overall, strong associations were observed between both C-159T (P = .02; chi2 = 7.16) and A-1145G (P = .01; chi = 7.88) and atopy. The G allele of A-1145G was significantly associated with atopy (P < .009; chi2 = 6.72). When the data were stratified, the associations observed were due to the individual phenotypes: atopic asthma was significantly associated with A-1145G (P = .02; chi2 = 7.18), whereas the association between C-159T and atopy was attributed to patients with allergic rhinitis (P = .01; chi2 = 8.13).

CONCLUSION

In Pakistani adults, the A-1145G polymorphism is associated with atopic asthma, whereas the C-159T polymorphism is significantly associated with allergic rhinitis.

Ganglion cyst of the posterior cruciate ligament

A ganglion is a fluid cyst with a myxoid matrix that arises close to the tendons and joints. Its occurrence inside a joint is rare. Among the various pathological conditions producing impairment of the knee function, ganglia of the cruciate ligaments are quite rare. It may be painful or asymptomatic. Some patients may have a trauma history. Ganglia may mimic intra-articular lesions like tears of the anterior cruciate ligament (ACL) or meniscus. Ganglia, though commonly arise from the ACL, can also arise from other structures such as the posterior cruciate ligament (PCL) or meniscus. Ganglia are typically treated by arthroscopic excision and debridement. We report a case of ganglion of the PCL in a 28-year-old man; the lesion was incidentally discovered during ACL reconstruction with double bundle (Rigid fix technique). The patient underwent arthroscopic excision of the ganglion. At the end of 1-year follow-up the patient was pain free; a full range of motion of his right knee was restored, and he returned to his preinjury sport activity.

Combination therapy of lamivudine and interferon-alpha in pediatric patients with chronic hepatitis B in Bangladesh: a safe and effective therapeutic approach for pediatric CHB patients in developing countries

Hepatitis B virus (HBV) is mainly transmitted during birth or perinatal period, however, treatment is not usually recommended for pediatric patients with chronic hepatitis B (CHB). Twelve pediatric patients with CHB in Bangladesh were treated with both lamivudine and interferon. Lamivudine was given at a dose of 3 mg/kg, daily for 12 months. Two months after commencement of lamivudine therapy, all patents were given interferon-alpha (3 million IU/square meter of body surface area) three times weekly, subcutaneously for 10 months. Combination therapy was safe for all pediatric CHB patients. The levels of serum HBV DNA became undetectable (less than 500 copies/ml) in 8 patients and reduced in 4 patients after the end of therapy. Anti-HBe was detected in 10 of 12 patients at this time point. The levels of serum alanine aminotransferase (ALT) were significantly reduced in these patients (p less than 0.05) due to therapy. Neither flare of HBV DNA nor elevation of serum ALT were detected during follow-up. In conclusion, combination therapy with lamivudine and interferon-alpha represents a new and novel therapeutic option for treatment of pediatric CHB patients.

Public-private partnership scenario in the health care system of Pakistan

Public-private partnerships (PPP) in basic health services delivery aim to improve service provision, such as better coverage, quality and infrastructure of health care, as well as raising the demand for health by the community. This paper outlines some examples of public-private partnerships in Pakistan and examines barriers to further development of such initiatives. We argue that to meet the challenges of globalization and achievement of the Millennium Development Goals, Pakistan needs to improve the health status of its society by promoting and practising PPP in providing health care services.

The Effect of Transdermal Nitroglycerine on Intrathecal Fentanyl with Bupivacaine for Postoperative Analgesia following Gynaecological Surgery

Fentanyl is a short-acting synthetic opioid with spinal analgesic properties and dose-dependent side-effects. The analgesic effect of opioids is mediated in part through activation of inhibitory descending pain pathways involving nitric oxide (as a central neurotransmitter) through the NO-cGMP system. This NO-cGMP pathway plays an important role in spinal nociception. The aim of the study was to evaluate the effect of transdermal nitroglycerine on the analgesic action of intrathecal fentanyl in patients undergoing abdominal hysterectomy. Patients (n=120) were randomised into one of four groups. All received 3 ml bupivacaine 0.5% plus 0.5 ml of an intrathecal test drug. Twenty minutes after lumbar puncture, a transdermal patch of either nitroglycerine or placebo was applied. Group B received spinal bupivacaine plus saline 0.5 ml and a placebo patch. Group B-N received bupivacaine plus saline 0.5 ml and a nitroglycerine patch. Group F received bupivacaine plus fentanyl 25 μg and a placebo patch. Group F-N received bupivacaine plus fentanyl 25 μg and a nitroglycerine patch. The duration of effective analgesia was longer in group FN (363.53±34.09 min) compared from the other groups (P <0.001). The times to two-segment regression in group F-N and group F were 132.87±31.2 min and 126.40±26.81 min respectively. The visual analog scale pain score at the time of the first rescue analgesic was similar in all groups. We conclude that nitroglycerine does not result in postoperative analgesia but enhances the analgesic effect of intrathecal fentanyl.

Impact of alcohol on coronary heart disease in Indian men

BACKGROUND

Moderate alcohol consumption is known to be protective against coronary heart disease (CHD). However, the INTERHEART study, a case-control study of acute myocardial infarction (MI) patients, revealed that alcohol consumption in South Asians was not protective against CHD. We therefore planned to study cardiovascular risk factor and CHD prevalence among male alcohol users as compared to age matched lifetime abstainers.

METHODS

The subjects for this study were recruited from a cross-sectional survey carried out among employees and their family members aged 20-69 years in 10 medium-to-large industries from diverse sites in India, using a stratified random sampling technique. Information on education, behavioral, clinical and biochemical risk factors of CHD and alcohol use was obtained through standardized instruments. CHD diagnosis was based on Rose Questionnaire or a prior physician diagnosed CHD.

RESULTS

A total of 4465 subjects were present or past alcohol users. The mean age of alcohol users and lifetime abstainers was 42.8+/-11.0 years and 42.8+/-11.1 years, respectively (p=0.90). Systolic blood pressure and diastolic blood pressure were significantly higher in alcohol users (128.7+/-17.6 mmHg/80.1+/-11.3 mmHg) as compared to lifetime abstainers (126.9+/-15.9 mmHg/79.5+/-10.3 mmHg, p<0.01). Fasting blood sugar in alcohol users (98.7+/-30.5 mg%) was also significantly higher than lifetime abstainers (96.6+/-26.0 mg%, p<0.01). Total cholesterol was lower in alcohol users (179.1+/-41.1 mg%) as compared to lifetime abstainers (182.7+/-38.2 mg%, p<0.01). HDL cholesterol was higher in alcohol users (42.9+/-10.8 mg%) as compared to lifetime abstainers (41.3+/-10.0 mg%, p<0.01). Body mass index (BMI) was lower in alcohol users as compared to lifetime abstainers (22.7+/-4.1 kg/m2 vs. 24.0+/-3.3 kg/m2, p<0.001). Tobacco use was significantly higher in alcohol users (63.1% vs. 20.7%). The odds ratio (OR) of having CHD after adjusting for tobacco use, BMI and education was 1.4 (95%CI 1.0-1.9) in alcohol users as compared to controls. The OR was 1.2 (95%CI 0.8-1.6) in occasional alcohol users, 1.6 (95%CI 1.0-2.2) in regular alcohol users and 2.1 (95% CI 1.1-3.0) in past alcohol users as compared to controls.

CONCLUSION

We did not observe an inverse (protective) association between alcohol intake and the prevalence of CHD. In contrast, our study indicated an association in the reverse direction, suggesting possible harm of alcohol for coronary risk in Indian men. This relationship needs to be further examined in large, prospective study.

Strong association between the -308 TNF promoter polymorphism and allergic rhinitis in Pakistani patients

BACKGROUND

Allergic rhinitis (AR) is a common complex allergic inflammatory disorder. The tumor necrosis factor (TNF) alpha polymorphism G-308A is present in the promoter region of the gene and considered to be important due to its role in different allergic diseases.

OBJECTIVES

We aimed to identify genetic associations between this polymorphism and AR in patients of Pakistani origin.

METHODS

We analyzed the distribution of G-308A in 153 unrelated AR patients and 116 unrelated healthy controls. Samples were genotyped for G-308A using restriction fragment length polymorphism.

RESULTS

The TNF -308A allele (TNF2) was significantly more frequent in patients with AR (37%) than in controls (16%, P<.001; chi2=32.15). Genotype distribution was also significantly different between patients and controls (P<.001; chi2=40.81). The TNF2 homozygous genotype and TNF1/2 heterozygous genotype were significantly more common in AR patients (TNF2, 12%; TNF1/2, 49%) than in controls (TNF2, 4%; TNF1/2, 23%), whereas the normal TNF1 homozygous genotype was more frequent in controls (73%) than in patients (39%).

CONCLUSION

Our results suggest a strong association between the promoter polymorphism of TNF-alpha and AR in Pakistani cohorts.