Pneumocystis jirovecii dihydropteroate synthase (DHPS) genotypes in non-HIV-immunocompromised patients: a tertiary care reference health centre study

Studies on Pneumocystis jirovecii dihydropteroate synthase (DHPS) genotypes among non-HIV immunocompromised patients from developing countries are rare. In the present prospective investigation, 24 (11.8%) cases were found to be positive for Pneumocystis jirovecii out of 203 non-HIV patients with a clinical suspicion of Pneumocystis pneumonia (PCP). Dihydropteroate synthase (DHPS) genotype 1 (Thr55+Pro57) was noted in 95.8% P. jirovecii isolates in the present study in contrast to only 4.1% of patients with DHPS genotype 4 (Thr55Ala + Pro57Ser).

Angiogenesis in the degeneration of the lumbar intervertebral disc

The goal of the study is to show the histological and biochemical changes that indicate the angiogenesis of the intervertebral disc in lumbar intervertebral disc hernia and the existence of epidemiological correlations between these changes and the risk factors of lumbar intervertebral disc hernia, as well as the patient's quality of life (QOL). We have studied 50 patients aged between 18 and 73 years old, who have undergone lumbar intervertebral disc hernia surgery, making fibroblast growth factor and vascular endothelial growth factor level measurements, as elements in the process of appreciating the disc angiogenesis. Also, pre-surgery and post-surgery QOL has been measured, as well as the intensity of the pain syndrome. We have identified factors capable of stimulating vascular endothelial growth (VEGF, FGF-2) for the examined disc material, but histological examination did not show angiogenesis. The process of angiogenesis at the degenerated intervertebral disc level affects the patient's quality of life both pre and postoperatively, and may be a predictive factor for the post-operative results. Patients can prevent the appearance of angiogenesis type degenerative processes of the intervertebral disc by avoiding angiogenesis correlated factors (weight control, physical effort, and smoking).

1-{[(Cyclo-hexyl-oxy)carbon-yl]-oxy}ethyl 3-{[2'-(2-ethyl-2H-tetra-zol-5-yl)biphenyl-4-yl]meth-yl}-2-oxo-2,3-dihydro-1H-benzimidazole-4-carboxyl-ate

In the title compound, C(33)H(34)N(6)O(6), the dihydro-benzimidazol-2-one ring system is essentially planar (r.m.s. deviation = 0.021 Å). The cyclo-hexane ring adopts a chair conformation. In the 5-(biphenyl-2-yl)-2H-tetra-zole fragment, the tetra-zole ring is twisted away from the attached benzene ring by 35.73 (11)° and the two benzene rings form a dihedral angle of 68.00 (9)°. An intra-molecular C-H⋯O inter-action is observed. In the crystal, the mol-ecules are linked into a zigzag chain running along the b axis by inter-molecular N-H⋯O hydrogen bonds.

Plasma DNA level in predicting therapeutic efficacy in advanced nonsmall cell lung cancer

Assessment of total plasma DNA can be a promising noninvasive tool for monitoring the effect of cytotoxic therapies in order to predict therapeutic efficacy at an early stage. Cell-free plasma DNA levels were quantified before the first, second and third cycle of chemotherapy in 42 patients with advanced nonsmall cell lung cancer and correlated with response to therapy, as assessed by computed tomography following the third chemotherapy cycle. A significantly lower plasma DNA level, measured before various treatment cycles, was found in patients with remission or stable disease than in those with progression. Higher levels and insufficient decrease in plasma DNA levels during the course of chemotherapy indicated poor outcome. For predicting insufficient therapy response, a sensitivity of 26.9% was achieved at 100% specificity using plasma DNA levels before the first therapy cycle. Prediction of disease progression was achieved with a sensitivity of 35.7% at 100% specificity using plasma DNA levels before the first therapy cycle. Monitoring of plasma DNA levels during the course of chemotherapy could identify patients who are likely to exhibit an insufficient therapeutic response and disease progression at an early stage. This may help in individualising treatment, and could lead to better management of advanced-stage lung cancer.

Prognostic implications of circulating anti-p53 antibodies in lung cancer--a review

Many independent prognostic markers have been identified for predicting survival and helping in the management of lung cancer cases. p53 protein overexpression and mutation have been the topic of numerous such publications. However, little is known about the role of anti-p53 antibodies as a prognostic marker in lung cancer. We searched the MEDLINE database and the bibliographies of the retrieved manuscripts and reviews. The retrieved studies are grouped according to the cohort studied. Out of 179 citations retrieved, 17 met our criteria. Seven studies used only non-small-cell lung cancer; four studies used only small-cell lung cancer; and six studies used the mixed cohort of both types of lung cancer. The studies varied in the concept design, cohort studied and the methodology. The prognostic role of anti-p53 antibodies in lung cancer remains contradictory and as some studies show an association with poor prognosis, others show a favourable association and still others showing no association what so ever. The frequency of detection of anti-p53 antibody is very low, highly specific with result being independent of the cohort studied. Adequate clinical trials, with optimized cohort, antigen and assay validation, are needed to address patients and physician's concerns regarding these associations.

Effect of tripod position on objective parameters of respiratory function in stable chronic obstructive pulmonary disease

OBJECTIVE

To examine changes in respiratory dynamics in patients with chronic obstructive pulmonary disease (COPD) sitting leaning forward with hands supported on the knees (tripod position), a posture frequently assumed by patients in respiratory distress.

METHODS

Spirometry, maximal inspiratory and expiratory pressures (MIP and MEP) generated at the mouth, and diaphragmatic excursion during tidal and vital capacity maneuver breathing measured by B-mode ultrasonography were studied in 13 patients with stable COPD in sitting, supine and tripod positions.

RESULTS

Mean +/- SD age of patients was 52.2 +/- 6.8 years. Median disease duration was three years. There was no statistically significant difference in spirometry for sitting, supine and tripod positions (FEV1: 1.11 +/- 0.4L, 1.14 +/- 0.5L and 1.11 +/- 0.4L; p = 0.99), respectively, (FEV1/FVC: 49.2 +/- 11.0, 53.7 +/- 8.5 and 48.5 +/- 11.3, p = 0.37), mouth pressures (MIP: 102.9 +/- 28.9, 90.6 +/- 29.1 and 99.2 +/- 32.9 cm H2O, p = 0.61 and MEP: 100.8 +/- 29.9, 100.4 +/- 34.4 and 90.6 +/- 32.6 cm H2O, p = 0.74) and diaphragmatic movements during tidal (16.1 +/- 5.9, 20.1 +/- 6.8 and 16.6 +/- 6.2 mm, p = 0.22) and forced breathing (33.9 +/- 11.0, 43.1 +/- 19.6 and 37.4 +/- 17.1 mm, p = 0.35).

CONCLUSION

Commonly measured indices of respiratory function were not different in the tripod compared to sitting and supine positions.

Comparative results of non-operative multi-modal therapy for filarial lymphoedema

A comparative analysis of different conservative modes of therapy for lymphoedema, largely of Filarial origin, was conducted in a trial therapy unit in Chengalpattu, a Filarial endemic district in Tamil Nadu. Results were compared using a single chambered intermittent pneumatic compression pump, heat therapy, and interferential therapy machines. The results showed improvement of limb size between 20% and 60% of possible reduction (where 100% would mean return of limb circumference to the same as that of the normal side). Pneumatic compression therapy, when used alone, showed the best results, which were significantly better than all others whether alone or in combination.

Ethics and contemporary urology practice: Setting out principles

Several situations of great ethical implications are encountered by physicians in daily urological practice. Informed consent for interventions, selection of patients for operative demonstrations and educational workshops, enrollment of patients in clinical trials, and the use of technology are some issues that call for stringent application of ethical principles in decision making. The issues of autonomy, privacy, rights, duties, and privileges that arise have to pass the tests prescribed by contemporary social mores and regulations. Some of the issues encountered, principles applicable, and covenants and documents that guide decision making are discussed.

Comparative results of non-operative multi-modal therapy for filarial lymphoedema

A comparative analysis of different conservative modes of therapy for lymphoedema, largely of Filarial origin, was conducted in a trial therapy unit in Chengalpattu, a Filarial endemic district in Tamil Nadu. Results were compared using a single chambered intermittent pneumatic compression pump, heat therapy, and interferential therapy machines. The results showed improvement of limb size between 20% and 60% of possible reduction (where 100% would mean return of limb circumference to the same as that of the normal side). Pneumatic compression therapy, when used alone, showed the best results, which were significantly better than all others whether alone or in combination.

Sulfur containing optical plastics and its ophthalmic lenses applications

Plastics produced from the sulfur-based monomer are excellent materials with many optical applications such as ophthalmic lenses, fiber optics and non- linear optics. High refractive index plastic materials are able to reduce the curvature, edge and center thickness of lenses. Sulfur containing plastics such as sulfide, polysulfide, and sulfur containing vinyl compound, thioacrylate, polythiol and isocyanate/isothiocyanate based monomers have demonstrated high refractive index, high Abbe number, good impact strength, excellent machinability, good tintability and good transmittance. In the present article, various sulfur containing plastics with different types of monomers for ophthalmic lens applications are reviewed.

Computational model of extracellular glutamate in the nucleus accumbens incorporates neuroadaptations by chronic cocaine

Chronic cocaine administration causes instability in extracellular glutamate in the nucleus accumbens that is thought to contribute to the vulnerability to relapse. A computational framework was developed to model glutamate in the extracellular space, including synaptic and nonsynaptic glutamate release, glutamate elimination by glutamate transporters and diffusion, and negative feedback on synaptic release via metabotropic glutamate receptors (mGluR2/3). This framework was used to optimize the geometry of the glial sheath surrounding excitatory synapses, and by inserting physiological values, accounted for known stable extracellular, extrasynaptic concentrations of glutamate measured by microdialysis and glutamatergic tone on mGluR2/3. By using experimental values for cocaine-induced reductions in cystine-glutamate exchange and mGluR2/3 signaling, and by predicting the down-regulation of glutamate transporters, the computational model successfully represented the experimentally observed increase in glutamate that is seen in rats during cocaine-seeking. This model provides a mathematical framework for describing how pharmacological or pathological conditions influence glutamate transmission measured by microdialysis.

Derivation of a prognostic equation to predict in-hospital mortality and requirement of invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

OBJECTIVE

Predicting in-hospital mortality and formulating a scoring system derived from predictors of mortality may aid prognostication.

METHODS

One hundred and fifty-one consecutive patients admitted with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were followed to discharge or death in hospital stay. Secondary variables studied were duration of hospital stay, and need for and duration of mechanical ventilation (MV).

RESULTS

Mean (SD) age of patients was 60.5 (11.4) years; 65.6% were mechanically ventilated, and 25.2% died in hospital. Independent predictors of mortality at admission were serum creatinine (odds ratio [OR] 2.1, 95% Confidence intervals [CI] 1.03 to 4.30; p = 0.04), and serum sodium (OR 0.94, 95% CI 0.90 to 0.99; p = 0.03). An equation derived [Score = 8+ (0.74 x creatinine) = (0.015 x sodium)] to predict mortality, had an area under receiver operating characteristic (ROC) curve of 73%, with a cut-off of 6.74 having sensitivity, specificity, positive and negative predictive values for predicting death of 71%, 64%, 40% and 87%, respectively. Glasgow coma scale (GCS), partial pressure of oxygen in arterial blood (PaO2) and partial pressure of carbon dioxide in arterial blood (PaCO2) at admission independently predicted need for invasive ventilation. An equation derived [Score = 2.36+(0.02 x PaO2)+(0.05 x PaCO2)-(0.47 x GCS)] to predict need for MV, had an area under ROC curve of 85%, with a cut-off of 0.54 having sensitivity, specificity, positive and negative predictive values for predicting need for MV of 82%, 81%, 89% and 70%, respectively.

CONCLUSIONS

Serum creatinine and sodium at admission are independent predictors of mortality for patients admitted with AECOPD. The equation derived from these two variables is a simple and useful method for predicting outcome.

An unusual penile spindle cell malignancy

Primary non-epithelial malignancies of the penis are rare. We report a patient with an unusual presentation of an unexpected spindle cell malignancy at this site. A 35- year-old man presented with a mass in the shaft of the penis with inguinal lymphadenopathy. A malignant spindle cell neoplasm was seen involving the corpora, consistent with leiomyosarcoma. Immunohistochemically, the tumour was positive for S100, HMB-45 and negative for SMA. A final diagnosis of amelanotic spindle cell melanoma was made. This case is being presented to reiterate the importance of including melanoma in the differential diagnosis of spindle cell sarcomas at uncommon sites.

Development of High Refractive Index Plastics

Optical plastics have been the priority area of research for material scientists worldwide, mainly, to find alternative materials to glass, a conceptual optical material in use over the years. There are numerous advantages of using plastics for optical applications, in particular for ophthalmic applications over glass. Recently, the researchers have been putting their efforts to develop novel plastic materials to meet requirements of ophthalmic industries. The present review compiles the recent developments in the area of optical plastics. The aim is to present the current state-of-the-art in the field, besides analyzing the various aspects of developing optical plastics. The review presents various possible approaches to achieve the desired properties e.g. high refractive index of the optical plastic materials.

Quality of life in lung cancer patients: impact of baseline clinical profile and respiratory status

As cure is attainable in very few cases of lung cancer, the imperative issue is to make quality of life (QOL) as good as possible as part of the palliative care package. The aim of this paper was to evaluate the baseline QOL of lung cancer patients and observe its association with various clinical parameters and overall respiratory status. A total of 101 patients were administered the European Organization for Research and Treatment of Cancer core quality of life (EORTC QLQ-C30, version 3) questionnaire. Clinical profile and measures of respiratory status, including spirometry, measures of dyspnoea, and 6-min walk test, were recorded. Higher Karnofsky Performance Status (KPS) significantly correlated with better global health status (P < 0.001) and healthy level of functioning (P < 0.001). The cumulative symptom burden was significantly associated with global QOL (P = 0.01) and physical, role and cognitive function scales (P < 0.05). All dyspnoea measures negatively correlated with global QOL and functioning scales. Spirometric indices showed a positive correlation with all functional scales (P < 0.05) except social. In conclusion, lung cancer patients have unsatisfactory QOL, with the global health status and physical functions being most affected. Number of symptoms, KPS, dyspnoea and spirometry significantly affect QOL.

Characterization of anatomically compliant linear cardiac lesions created by the CARDIMA radiofrequency surgical ablation system

This study investigated anatomical cardiac linear lesion characteristics created by the CARDIMA RF surgical ablation system. We developed an in vitro porcine cardiac model that simulates cardiac tissue during an on-pump open chest procedure. We used the INTELLITEMP energy management device to deliver RF energy to an 8 electrode, 8 thermocouple deflectable linear surgical probe, to form curvilinear and linear lesions on porcine myocardium. Ablations were at two target temperatures (70 degrees C and 80 degrees C) and durations (60 sec. and 90 sec.). The results show that this system is capable of forming clinically relevant deep and contiguous lesions of desired length.