Cardiovascular risk assessment scoring system for the determination of cardiovascular mortality in renal transplant patients

It is well known that the greatest risk for mortality post-renal transplant is cardiovascular death. We compared a modified cardiac risk assessment system among renal transplant patients who subsequently died versus the group that survived. There was a good correlation between the low, medium, and high scores with survival. The deceased group had significantly greater cardiovascular scores than case controls.

A simple cardiovascular risk score can predict poor outcome in NHBD renal transplantation

A simple cardiovascular risk score used in our center to plan cardiovascular workup for renal transplantation can predict outcome in non-heart-beating donor (NHBD) renal transplantation. Patients in the higher risk group, with a score of >12 out of a maximum of 36 are likely to have a longer duration of delayed graft function, poorer glomerular filtration rate at 6 months, and inferior graft and patient survival, together with an relative rate of graft loss within 60 days of >4 (P = .053). Although a high cardiovascular risk score should not be regarded as a contraindication to NHBD transplantation, the score can be used to facilitate recipient selection.

Filarial dance in a breast mass on colour Doppler imaging

Filarial dance in breast lesions is a very rare entity. It is difficult to show the characteristic vigorous movement of the adult worms on static images although pulse wave Doppler and colour power Doppler have been used. Filarial dance on colour Doppler imaging has not been reported earlier to the best of our knowledge.

Adult botulism type F in the United States, 1981-2002

BACKGROUND

Clostridium botulinum neurotoxin types A, B, and E cause most cases of the paralytic disease botulism. Little is known about the epidemiology, clinical features, or microbiology of botulism type F.

METHODS

Cases of adult type F botulism were identified by review of data collected by CDC's National Botulism Surveillance System between 1981 and 2002. A case was either an individual whose serum or stool demonstrated type F toxin or whose stool culture yielded an organism producing toxin type F. A detailed review of cases' medical charts and laboratory data from CDC and local health departments was performed.

RESULTS

Between 1981 and 2002, 1,269 cases of botulism among adults and infants were reported to CDC; 13 (1%) were adult type F. The median age of type F cases was 54 years; 7 (54%) were female. None were part of outbreaks. A toxigenic Clostridium baratii was identified in 9 (69%) of 13 cases. Among 11 cases for which clinical data were available, all required mechanical ventilation for a median duration of 17 days (range, 10 to 84); 8 (73%) were intubated within 24 hours of symptom onset. All patients had nearly complete or complete quadriplegia at the nadir of neurologic dysfunction, which occurred on average on day 5. On average by day 8, improvement in neuromuscular function was noted. The median duration of acute hospitalization was 31 days (range, 20 to 60). No deaths were reported. In only one case was a possible foodborne etiology identified.

CONCLUSIONS

Toxigenic C baratii are the sole documented causes of type F botulism in the United States since 1981. These cases are characterized by a fulminant course with rapid progression to respiratory failure and paralysis, making early recognition and intervention critical to appropriate management.

Ultrasound biomicroscopic quantification of the change in anterior chamber angle following laser peripheral iridotomy in early chronic primary angle closure glaucoma

AIMS

To prospectively evaluate by ultrasound biomicroscopy (UBM) and gonioscopy the anterior chamber angle widening following laser peripheral iridotomy (LPI) in eyes with early chronic primary angle closure glaucoma (CACG).

METHODS

A total of 55 eyes of 55 patients with CACG presenting with less than 180 degrees peripheral anterior synechiae (PAS) were enrolled in the study. Angles were assessed by gonioscopy (Shaffer's grading) and UBM, before and 4 weeks after LPI. The angle opening distance at 250 and 500 microm from the scleral spur (AOD 250 and AOD 500) was computed. Results were analysed using the Wilcoxon signed-rank test.

RESULTS

In the quadrant with LPI, the mean gonioscopy grade increased significantly from 0.45 to 1.45 (P<0.001) and the mean AOD 250 and AOD 500 increased from 38.5+/-25.9 to 83.5+/-48.4 microm (P<0.001) and 110.2+/-80.9 to 170.6+/-83.4 microm (P<0.001), respectively. The angles widened significantly in the opposite quadrant on UBM (AOD 250: 48.8+/-31.5-82.7+/-43.9 microm, P<0.001; AOD 500:117.2+/-65.5-172.2+/-81.7 microm; P<0.001), but the median gonioscopy grade remained unchanged.

CONCLUSIONS

LPI significantly widened the anterior chamber angle in the quadrant with LPI and the quadrant furthest away in patients of CACG with established glaucomatous damage. This change was much better appreciated by the UBM than gonioscopy.

Effects of tamoxifen therapy on plasma lipid profile in patients of breast cancer

AIM

To evaluate the effects of tamoxifen therapy on plasma lipid profile in patients of breast cancer.

METHOD

A total of 55 postoperative patients of breast cancer were given tablet tamoxifen 20mg orally daily for 6 months. Estimation of plasma lipid by standard method was carried out in both pre-menopausal and postmenopausal new patients of early stage breast cancer at 0 day, 3rd month and 6th months of therapy.

RESULTS

Suggested that in pre-menopausal and postmenopausal patient's TC and LDL-c levels were reduced significantly, whereas, TG, VLDL-c and HDL-c were not altered. Comparison of the effects of tamoxifen in pre-menopausal and postmenopausal patients on lipid profile revealed that fall in TC and LDL-c was significantly higher at both 3 and 6 months in postmenopausal patients.

CONCLUSION

The study demonstrates that tamoxifen to favorably alter the markers of cardiovascular risk in both pre-menopausal and postmenopausal patients of breast cancer.

Mother and child service coverage: reproductive and child health programme in Alwar district, Rajasthan state

Present study was conducted to assess the child immunization coverage and availability of safe motherhood intervention services for expecting mothers under RCH programme in Alwar district. WHO-30 cluster sampling method was used and 26 rural and 4 urban clusters were surveyed. Fully immunized children were more in urban areas (82.1%) as compared to rural (45.1%) areas. The immunization coverage was more or less similar in both sexes. BCG and Measles coverage was also higher i.e. 89.3% and 85.7% in urban areas than 69.61%, and 52.2% in rural respectively. High drop out rate was found for DPT (25.3%) and OPV (23.2%) in rural areas as compare to urban (7.70/ each). Failure of immunization in rural areas was mainly due to unawareness of need for immunization (35.4%), mother too busy in 16.8%, place and time not known in 9.7%, place for immunization too far 8.8% and 7.1% each for unaware of need to return for subsequent doses, fear of side reactions and vaccinator absent. TT immunization coverage was mainly through Government source and two third of the mothers were immunized in both urban and rural areas. 71.4% of urban and 36.1% of the rural mothers received ANC >=3. However the iron folic acid supplementation was similar in urban and rural areas. Place of delivery was mainly hospital in urban areas (71.4%) and were home (61.7%) in rural areas. Hospital staff (Govt. or pvt.) conducted 82.1% of the deliveries in urban areas as compared to 58.5% in rural. The ANM/ Health staff (56.4%) and family members (27.0%) were main source of information for mother for the need of mother and child immunization.

A spin triplet supercurrent through the half-metallic ferromagnet CrO2

In general, conventional superconductivity should not occur in a ferromagnet, though it has been seen in iron under pressure. Moreover, theory predicts that the current is always carried by pairs of electrons in a spin singlet state, so conventional superconductivity decays very rapidly when in contact with a ferromagnet, which normally prohibits the existence of singlet pairs. It has been predicted that this rapid spatial decay would not occur if spin triplet superconductivity could be induced in the ferromagnet. Here we report a Josephson supercurrent through the strong ferromagnet CrO2, from which we infer that it is a spin triplet supercurrent. Our experimental set-up is different from those envisaged in the earlier predictions, but we conclude that the underlying physical explanation for our result is a conversion from spin singlet pairs to spin triplets at the interface. The supercurrent can be switched with the direction of the magnetization, analogous to spin valve transistors, and therefore could enable magnetization-controlled Josephson junctions.

Evaluation of community-based serologic screening for identification of chronic Salmonella typhi carriers in Vietnam

OBJECTIVES

To determine the utility of screening anti-Vi antibodies to detect chronic Salmonella Typhi carriers in an endemic community.

METHODS

We conducted a community-based serologic survey for anti-Vi antibodies to identify chronic Salmonella Typhi carriers in a typhoid endemic region in Vietnam.

RESULTS

We tested sera from 3209 (67.2%) of 4772 eligible adults. The median age was 37 years (range 20-92), 57.3% were female, 4.6% reported a history of typhoid fever and 0.3% reported typhoid vaccination. Anti-Vi antibody titers tested in Vietnam were < 1:40 in 2759 (86.0%), 1:40 in 194 (6.0%), 1:80 in 168 (5.2%), 1:160 in 57 (1.8%), and > or = 1:320 in 31 (1.0%). On re-testing in the USA, an additional 19 sera with titers > or = 1:160 were identified. We collected 589 rectal swabs from 103 (96.3%) of 107 persons with Vi antibody titers > or = 1:160 and 183 swabs from 33 persons with antibody titers < 1:80. No Salmonella Typhi was isolated.

CONCLUSIONS

Community-based serologic screening is a feasible, but impractical method for identifying chronic Salmonella Typhi carriers. Background levels of anti-Vi antibody titers in this endemic area may be high despite a low prevalence of chronic carriers.

Quantitative analysis of alcohol, sugar, and tartaric Acid in alcoholic beverages using attenuated total reflectance spectroscopy

Mid-infrared (MIR) spectroscopy in attenuated total reflectance (ATR) mode was used for quantifying ethanol, sucrose, and tartaric acid in alcoholic beverages. One hundred synthetic samples were prepared with different ethanol, sucrose, and tartaric acid concentrations. Experiments were carried out on Bio-Rad 175 C FTS using an ATR accessory. Spectra were recorded in the wavelength region 600-4000 cm-1. Calibration was performed using partial least squares (PLS) algorithm. Commercially available alcoholic beverages (gin, rum, vodka, etc.) were experimented and concentration of ethanol in these samples was predicted using the developed calibration model. Chemical analysis of these commercial samples was carried out in order to compare the results. The agreement between ATR results with those of chemical analysis revealed good reliability and repeatability of the technique used.

Moderation of psychosocial risk factors through dysfunction of the hypothalamic–pituitary–adrenal stress axis in the onset of chronic widespread musculoskeletal pain : Findings of a population-based prospective cohort study

OBJECTIVE

To test the hypothesis that abnormalities in the hypothalamic-pituitary-adrenal (HPA) stress-response system would act as an effect moderator between HPA function and the onset of chronic widespread pain (CWP).

METHODS

We conducted a population-based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. Of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function. Diurnal function was measured by assessing levels of salivary cortisol in the morning (9:00 AM) and evening (10:00 PM). Serum cortisol levels were measured after an overnight low-dose (0.25 mg) dexamethasone suppression test and a potentially stressful clinical examination. All subjects were followed up 15 months later to identify cases of new-onset CWP.

RESULTS

A total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post-dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17-10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52-3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64-8.42) were all associated with CWP. These 3 factors were found to be independent and additive predictors of CWP (OR for all 3 factors 8.5, 95% CI 1.5-47.9) in analyses controlling for age, sex, depression, sleep disturbance, recent traumatic life events, and pain status. One or more of these 3 HPA factors identified 26 (92.9%) cases of new-onset CWP.

CONCLUSION

Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new-onset CWP.