The status of lower-limb amputation in Bangladesh: a 6-year review

We conducted a review of 450 single lower-limb amputations performed in our hospital in Bangladesh between July 1982 and June 1987. The incidence of amputation in the specific area of 1000000 inhabitants covered by the hospital was 0.75/10(3) per year. The indications for amputation were: limb ischemia in 366 patients (81%), traumatic crush injury in 45 (10%), diabetes-associated complications in 20 (5%), severe limb infection in 10 (2%), and neoplasm growth in 10 (2%). The ratio of above-knee (AK) to below-knee (BK) amputation was 1:65, and 36 patients (8%) required reamputation, 22 of whom had undergone BK amputation previously. Thus, the number of patients with a final amputation at AK level was 302 (67%). The operative mortality was 21% and the uncomplicated primary wound healing rate was 89% within the survivors. Among the 355 patients who survived the amputation, 265 (75%) were given a prosthesis, 50 (14%) refused a prosthesis, and the remaining 40 (11%) were unfit for a prosthesis. Rehabilitation was successful in 44% of the AK and 86% of the BK amputees. In conclusion, when amputation is inevitable, maximum consideration should be given to the type of surgery performed to avoid rehabilitation failure.

Reversibility of furazolidone-induced changes in testes and secondary sex characters of White Leghorn cockerels

Furazolidone (Fz) was fed to 4 groups of cockerels 15 w of age at 0, 400, 800 and 1200 mg/kg feed for 3 w and then was withdrawn for another 3 w. In a second experiment conducted simultaneously cockerels were fed these same Fz levels for 6 w and then were withdrawn from Fz feed for 4 w. In both experiments, 800 and 1200 mg Fz/kg feed resulted in decreases in comb and wattle size and in the weight of testes. The testes had smaller seminiferous tubule diameters and increased relative and decreased absolute volumes of interstitium. Spermatogenesis was not observed in cockerels fed 800 and 1200 mg Fz/kg feed. Withdrawal of Fz resulted in increased comb and wattle size, weight of testes and diameter of the seminiferous tubules. There was also an increase in absolute volume of interstitium along with decreased relative interstitium volume. Spermatogenesis was restored.

Antisense and sense poly(A)-RNAs from the Xenopus laevis pyruvate dehydrogenase gene loci are regulated with message production during embryogenesis

The structure and temporal expression of two Xenopus cDNAs encoding the beta subunit of pyruvate dehydrogenase (XPdhE1 beta) have been determined. XPdhE1 beta was 88% homologous to mature human PdhE1 beta, but the putative N-terminal mitochondrial signal peptide was poorly conserved. Zygotic expression of XPdhE1 beta mRNA was detected at neural tube closure and increased until stage 40. RT-PCR cloning identified a short homology to a protein kinase open reading frame within the 3' non-coding sequence of the XPdhE1 beta cDNAs. This homology, which occurred on the antisense cDNA strand, was shown by strand specific RT-PCR to be transcribed in vivo as part of an antisense RNA. Northern analysis showed that this RNA formed part of an abundant and heterogeneous population of antisense and sense poly(A)-RNAs transcribed from the XPdhE1 beta loci and coordinately regulated with message production.

Catalytic and non-catalytic forms of the neurotrophin receptor xTrkB mRNA are expressed in a pseudo-segmental manner within the early Xenopus central nervous system

The induction of anterior-posterior and medio-lateral patterning within the Xenopus neural plate leads to the rapid establishment of a functional nervous system. Here we describe two Xenopus TrkB neurotrophin receptor genes which are expressed in discrete sets of neuroblasts during this developmental process. The xTrkB mRNAs encode both catalytic and non-catalytic receptors and exhibit membrane-spanning-domain proximal splicing. Expression begins at neural tube closure within the trigeminal ganglion and within the Rohon-Beard neurons of the dorsal spinal cord, providing an excellent dorsal marker of early neural tube patterning. Expression occurs later in the facial ganglia and possibly within the Kolmer-Agduhr neurons. The predominant xTrkB transcripts within the trigeminal and Rohon-Beard neurons and the exclusive early transcripts of the facial ganglia encode C-terminally truncated non-catalytic receptors. Such Trk mRNAs have previously been observed in rodents. However, our observations suggest that they may play a specific role during early development. Anterior-posterior segmentation of the neural tube occurs rostrally within the prospective brain, but previous studies have suggested that segmentation does not extend caudally into the spinal cord. We show that the xTrkB positive Rohon-Beard neurons of the spinal cord do in fact display clear segmental groupings soon after neural tube closure. This is consistent with a role for segmentation in the anterior-posterior patterning of the trunk central nervous system.

Cardiac malignant lymphoma in severe combine immunodeficient mice

Extranodal malignant lymphomas are known to occur with increased frequency in patients with human immunodeficiency virus infection. Although cardiac malignant lymphomas are rare, recently an increasing number of patients with acquired immune deficiency syndrome (AIDS) and cardiac lymphoma have been reported. To clarify the relationship between AIDS and cardiac lymphomas, we used 60 severe combine immunodeficient (SCID) mice as animal models in whom five different types of human lymphoma cell lines were injected. Primary lymphomas at the site of cell line injection developed within 14-30 days in 58 mice. Cardiac malignant lymphoma was detected in 10 cases (17%), among which tumour was macroscopically evident in 2. Tumour was present on the pericardial aspects of the heart extending into the myocardium in most cases, but no intracavitary lesion was observed. In one case, obstructive features were marked near the root of the great vessels by direct pressure of the growth. This study indicates that lymphomas have a predilection to invade the heart in immunocompromised conditions.

Production of fruits and vegetables at the homestead is an important source of vitamin A among women in rural Bangladesh

BACKGROUND

Vitamin A deficiency is considered to be an important public health problem in Bangladesh. A universal biannual distribution of high-dose vitamin A capsules has been in place for over the past two decades. This supplementation has been beneficial for preschool children. Bangladesh has been exploring more sustainable approaches for all segments of the population. To support this initiative, Helen Keller International has implemented a homegardening promotion project since 1993. This project is executed on a large scale and currently reaches an estimated 244,000 families.

METHODS

This paper presents data from 7341 women of reproductive age which were collected as part of the baseline census of a community monitoring system whose objective is to track progress and measure the impact of home-gardening activities.

RESULTS

Vitamin A intake in this population derived almost entirely from the consumption of fruits and vegetables. Logistic regression analyses showed that maternal vitamin A intake was determined by qualitative indicators of homestead gardens (type of home garden, the total quantity of provitamin A-rich food produced and the number of fruits and vegetables varieties grown in the garden) after adjusting for socio-economic status.

CONCLUSIONS

These results indicate that traditional production of provitamin A-rich fruits and vegetables in the homestead may provide a valuable contribution to vitamin A intake in communities where alternative dietary sources of vitamin A are scarce.

Front-line management of pulmonary tuberculosis: an analysis of tuberculosis and treatment practices in urban Sindh, Pakistan

SETTING

Karachi and Hyderabad, Pakistan.

OBJECTIVE

To describe the level and quality of tuberculosis (TB) case management by non-TB control program (TCP) physicians in urban Sindh, Pakistan.

DESIGN

We interviewed 152 adults with pulmonary TB confirmed by Karachi's TB control program regarding the initial management of their TB symptoms before entering the TCP. We also surveyed 65 general practitioners (GPs) attending continuing education seminars with a multiple choice test to assess their management of suspected pulmonary TB. We compared both results to guidelines from the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD).

RESULTS

Eighty percent (122/152) of patients first sought GPs. Only 14% of GPs performed any sputum test. At most, 17 (40%) of the 42 patients recalling their GP's treatment, received the recommended 4-drug regimen. However, 68% (45/65) of surveyed GPs chose correct treatment from a multiple choice format. But their initial laboratory investigations, follow-up, and treatment cessation criteria (9%, 9-31%, and 11% correct, respectively) demonstrated under-utilization of sputum tests and over-reliance on unhelpful tests.

CONCLUSIONS

GPs first saw most of these TCP patients, but their weak management likely hinders TB control. A partnership between TB control programs and GPs could improve case management and hasten TB control.

Diabetes in pregnancy in Pakistani women: prevalence and complications in an indigenous south Asian community

The aim of this study was to determine the prevalence and complications as well as to correlate maternal and fetal outcome with glycaemic control, in a community of Pakistani women. This was a retrospective study of 6830 deliveries over a 5-year period in a tertiary care hospital in Karachi. Either a 75 g glucose tolerance test or a screening 50 g glucose challenge was administered depending on risk factors for Gestational Diabetes Mellitus (GDM). Case records of deliveries during this period were analysed for presence of GDM or pre-existing diabetes; glycaemic control and complications were ascertained for those with diabetes. During this period 267 (3.9%) of the 6380 deliveries were identified as diabetic pregnancies. Of these 223 (3.3%) had GDM and 44 (0.6%) women had pre-existing diabetes mellitus. Overall maternal complications were high; pre-eclampsia (19%), polyhydramnios (4.6%), and threatened abortion (3.4%). Fetal complications of macrosomia (13.1%), intrauterine growth retardation (7.1%), intrauterine deaths (5.3%) were noted. Complications were higher in poorly controlled groups. We conclude that the prevalence of GDM in Pakistani women in our study was comparable to their Western counterparts but complication rates were higher, possibly due to poorer glycaemic control.

Induction of Fos expression following anodal polarization in rat brain

Expression of c-fos immunoreactivity was investigated in rat brain after unilateral application of a weak anodal direct current (anodal polarization) to the sensorimotor cortex of rats. Increases in Fosimmunopositive neurons were observed transiently in the neocortex, cingulate cortex, piriform cortex, and hippocampal formation, which were ipsilateral to the polarization, as a function of the duration and intensity of the current applied. It is likely that anodal polarization enhances the neuronal activities in the cortex dependent on polarization paradigms.

Induction of depersonalization by the serotonin agonist meta-chlorophenylpiperazine

Sixty-seven subjects, including normal volunteers and patients with obsessive-compulsive disorder, social phobia, and borderline personality disorder, received ratings of depersonalization after double-blind, placebo-controlled challenges with the partial serotonin agonist meta-chlorophenylpiperazine (m-CPP). Challenge with m-CPP induced depersonalization significantly more than did placebo. Subjects who became depersonalized did not differ in age, sex, or diagnosis from those who did not experience depersonalization. There was a significant correlation between the induction of depersonalization and increase in panic, but not nervousness, anxiety, sadness, depression, or drowsiness. This report suggests that serotonergic dysregulation may in part underlie depersonalization.

Furazolidone toxicosis in young broiler chicks: morphometric and pathological observations on heart and testes

Broiler chicks 1 d and 3 w of age were given 0, 400, 800, or 1000 mg furazolidone (Fz)/kg feed for 4 w. Bi-ventricular heart dilatation (as measured by increases in ventricular diameter and thinning of the ventricular walls) was present in 1-d-old chicks fed 800 mg Fz, whereas in 3-w-old groups these changes occurred at 1000 mg Fz. There was no heart hypertrophy. Microscopic changes in the heart were not discernible in and Fz-fed birds. The liver had congestion and cytoplasmic vacuolation of hepatocytes. About 37-50% of the male birds in the different Fz-fed groups had testicular degeneration varying from mild to cystic enlargement. The degenerated testes had dilatation of seminiferous tubules; in cystic testes the seminiferous tubules were extremely dilated and had flattened epithelium. The interstitial tissue between the dilated tubules was compressed and atrophic.

Increase in the calcium level following anodal polarization in the rat brain

The accumulation of calcium ions (Ca) was examined in the rat brain by means of 45Ca autoradiography following the application of a weak anodal direct current to the surface of the sensorimotor cortex. Repetition of the anodal polarization with 3.0 microA for 30 min caused more Ca to accumulate in the cerebral cortex. The degree and extent of accumulation was greater in the hemisphere ipsilateral to the polarization than in the other. Accumulation was also noted in the hippocampus and thalamus. Ca accumulation was detected after 24 h and it remained virtually constant up to 72 h after the last polarization. The results suggest that a long-lasting disturbance of Ca homeostasis is involved in the cortical plastic changes seen following anodal polarization.

Thrombosis and inflammation as multicellular processes: significance of cell-cell interactions

Platelet activation as a result of vascular injury provokes endothelial cells to respond in a manner which limits or reverses the occlusive consequences of platelet accumulation. If the agonistic forces are strong, platelet accumulation is irreversible. In vitro data from our laboratory have repeatedly demonstrated that platelets become unresponsive to all agonists when in proximity to endothelial cells. This unresponsiveness is due to at least three separate endothelial "thromboregulatory" systems: eicosanoids, endothelium-derived relaxing factor (EDRF/NO), and most importantly an endothelial cell ecto-nucleotidase which metabolizes released platelet adenosine diphosphate (ADP) with consequent restoration of platelets to the resting state. This nucleotidase is operative in the complete absence of EDRF/NO and eicosanoids, indicating that the latter two are dispensable thromboregulators. We have solubilized the human endothelial cell ectoADPase, as well as that from placental tissue. Candidate proteins from a purified ADPase fraction are now being studied in further detail. An understanding of the molecular biology of the ADPase gene may lead to development of therapeutic agents such as soluble forms of the enzyme as well as approaches toward up-regulation of ectoADPase activity. This could result in "early thromboregulation", i.e. prevention and/or reversal of platelet accumulation at sites of vascular damage via immediate metabolic removal of the prime platelet agonist-ADP.

Co-localization of c-fos protein and protein kinase C gamma in the rat brain following anodal polarization

The expression of protein kinase c gamma (PKC gamma) and c-fos protein was examined by means of double labeling in the rat brain in relation to the molecular mechanism of central plastic changes associated with anodal polarization. Under normal, non-polarized condition, approximately 75% of all fos positive neurons in the neocortex were immunopositive for PKC gamma. Conversely, nearly all PKC gamma positive neurons were fos immunopositive. Although both pyramidal and non-pyramidal neurons express both types of protein, the pyramidal cell type represents the vast majority. An anodal direct current of 3.0 microA for 30 min to the surface of the left sensorimotor cortex resulted in a pronounced increase in the intensity of immunoreactivity for both PKC gamma and c-fos protein ipsilateral to the polarization. Approximately, 91% of fos positive neurons in the polarized neocortex was also intensely immunoreactive for PKY gamma. The high degree of codistribution of both transduction proteins in specific neurons following anodal polarization suggests the functional connection between PKY gamma activation and c-fos expression in polarization phenomenon.

c-Fos expression mediated by N-methyl-D-aspartate receptors following anodal polarization in the rat brain

c-Fos protein-like immunoreactivity (IR) was investigated in the rat brain following an application of weak anodal direct current to the surface of the unilateral sensorimotor cortex in an attempt to elucidate the cellular and molecular bases of central plasticity. Anodal polarization resulted in a massive increase in c-Fos protein-like IR in neurons of the cingulate, piriform, frontoparietal cortices, and hippocampus ipsilateral to the polarization. The effects were dependent upon the duration and intensity of currents applied. The time-dependent induction of c-Fos protein-like IR was maximal at 1 h, became weaker by 6 h, and almost returned to the baseline within 24 h following polarization. When MK-801 [(+)-5-methyl-10,11-di-hydro-5H- dibenzo[a,d]cyclohepten-5,10-imine hydrogen maleate], a noncompetitive antagonist for N-methyl-D-aspartate (NMDA) receptors, was injected intraperitoneally, the induction of this nuclear protein was reduced or completely blocked in both hemispheres, except around the polarized point itself, as a function of the time and dosage. These results suggest that the proto-oncogene c-fos is rapidly and transiently activated in the brain following anodal polarization and this activation is mediated by NMDA receptors.

Effect of concurrent feeding of furazolidone and sodium chloride upon some clinical, pathological and cardiac morphometric parameters in broiler chicks

Broiler chicks in different groups were fed furazolidone (0, 400 and 800 mg/kg feed) and sodium chloride (500 and 1510 mg/kg feed) separately and concurrently from 1 to 30 days of age. Furazolidone (Fz) induced ascites, leg weakness, convulsions, depression and mortality was exacerbated by concurrent feeding of 1510 mg NaCl. Hemorrhages in the liver, swollen kidneys, pallor of the kidneys and cystic testes were present in all birds fed furazolidone either alone or in combination with NaCl. However, at microscopic level, necrotic changes were observed in the liver and kidneys of birds fed NaCl only. Fz-induced cardiac ventricular dilatation and thinning of walls were more severe when 400 mg Fz was fed concurrently with 1510 mg NaCl but feeding of 800 mg Fz with the same level of NaCl resulted in partial amelioration of cardiac changes. It is suggested that high dietary NaCl may exacerbate and alter the clinical and morphological picture of Fz toxicosis.

Detection of DNA damage induced by apoptosis in the rat brain following incomplete ischemia

To clarify the pathogenesis and molecular basis of ischemia-related nerve cell death, we examined the occurrence of DNA fragmentation as a hallmark of apoptotic cell death following incomplete ischemia in the rat brain by means of in situ end labeling of fragmented DNA. Incomplete ischemia was produced by permanently occluding one carotid artery, while temporarily occluding the other. The condensed nuclei of ischemic neurons in the neocortex, and in the subiculum and CA1 area of the hippocampus were positively stained 24 h and 3 days following vessel occlusion, respectively, and their morphology was typically apoptotic. The ischemic neurons with condensed nuclei gradually increased in number and were clearly stained for fragmented DNA in these areas. The labeled nuclei in the neocortex became pyknotic 72 h later, and in the hippocampus 7 days later incomplete ischemia. After attaining a peak, the number of labeled nuclei decreased with the duration of recovery in all areas. These results suggest that an apoptotic process plays, at least primarily, a role in the degeneration of neurons associated with incomplete forebrain ischemia in rat.

Formation of thymine-lysine and cytosine-lysine adducts in DNA-lysine photoconjugate

Lysine was covalently conjugated to calf thymus DNA by irradiation with UV light (wavelength, 253.7 nm). The results showed monofunctional covalent photobinding of lysine molecules with bases in DNA. Only the epsilon-amino group of lysine participated in the photoconjugation reaction. Thymine and cytosine were modified by 60% and 25% respectively. The kinetics of the DNA-lysine photoreaction showed that one lysine molecule was in the photobound state per 10, 6, 5 and 4 nucleotide base pairs of DNA on irradiation for 20, 30 40 and 60 min respectively.

Acute myocardial infarction: A complication of left atrial myxoma

A 58-year-old female patient, immediately after an acute myocardial infarction underwent an echocardiographic examination and emergency coronary arteriography which led to the discovery of left atrial infarction. Successful emergency coronary arterial by-pass graft (CABG) and excision of the myxoma was done within 24 h of the onset.

Immunocytochemical distribution of gamma isoform of protein kinase C (PKC-gamma) following incomplete ischaemia

Immunocytochemical distribution of PKC-gamma was examined in rat brain in relation to molecular mechanisms of post-ischaemic neuronal modulation following incomplete ischaemia. Incomplete ischaemia was developed by either permanent occlusion of one common carotid artery (CA) or permanent occlusion of one CA with temporary occlusion of opposite CA. Unilateral CA (UCA) occlusion resulted in a pronounced increase in the intensity of staining and number of PKC-gamma positive neurons in the neocortex ipsilateral to the insult after 3 h. The effect was maximum at 6-12 h and was undetectable after 7 days. CA1 neurons showed an increase immunoreactivity (IR) after 1 day, reached to a peak by 3 days, then reduced to basal levels after 7 days. Bilateral CA (BCA) occlusion showed almost similar changes in the neocortex, but on both sides and short durated. The altered patterns of PKC-gamma IR in the neocortex and hippocampus following CA occlusion may reflect activation and/or down-regulation of PKC-gamma in ischaemic neurons. PKC-gamma may, therefore, potentially play an important role in the post-ischaemic modulation of synaptic efficacy in these neurons and in the neuronal damage following incomplete ischaemia.

Management of isolated radial or ulnar arteries at the forearm

The effects of management of single forearm arterial injuries without other associated major muscular, vascular, or neurological trauma were studied. Ninety-six patients with acute injuries to either radial or ulnar arteries without obvious associated major injuries were evaluated. No patient had an ischemic hand secondary to arterial injury. The selection of operative treatment by arterial repair or ligation was by surgeon choice (50 injuries were ligated, and 46 were repaired). Six months to six years postoperative follow-up was done. The overall patency rate for all repaired vessels was 52% (24 cases). The collateral arteries appeared to be a factor causing the low patency rate. The remaining intact artery demonstrated a consistent increase in flow velocity. No subject had hand claudication; there were 51 cases (53%) of hand weakness, 27 incidents (28%) of parasthesia, and 14 incidents (15%) of cold sensitivity independent of patency of the damaged forearm vessel. In the absence of acute hand ischemia, ligation of a lacerated radial or ulnar artery is safe and cost effective.

Induction of N-methyl-D-asparate receptor mediated c-fos protein in the rat brain by incomplete ischaemia

The expression of c-fos protein was examined by means of immunocytochemistry in the rat brain following incomplete ischaemia, to elucidate the molecular mechanisms of post-ischaemic neuronal death and of the modulated neurotransmission of surviving neurons. Incomplete ischaemia was produced by permanent unilateral or bilateral common carotid artery (CCA) occlusion. After 1 h of unilateral occlusion, the level of c-fos protein-like nuclear immunoreactivity increased in cortical neurons ipsilateral to the insult, especially in cingulate and piriform cortices. The reactivity peaked at 3-6 h, and was undetectable after 3 days. A number of scattered immunostained neurons in the ipsilateral subiculum, CA 1 and dentate gyrus became visible after 1 day. The effect reached a peak between 1-3 days, then returned to basal levels by 7 days. Bilateral CCA occlusion showed a similar distribution of immunoreactivity, but on both hemispheres. Immunoreactive neurons were more numerous and intensely stained but more transient. The induction of c-fos was completely blocked or reduced by treatment with MK-801. Our results suggest that c-fos expression after CCA occlusion is NMDA receptor mediated, and that it has a specific role in neurons after ischaemic insult.