Fluctuation of pain by weather change in musculoskeletal disorders

In order to find out the fluctuation of pain by weather change, a descriptive cross-sectional study was conducted among 138 individuals having musculoskeletal disorders (MSDs) attending the out patient department (OPD) of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, during March 2004 to June 2004. Data were collected by face to face interview employing a pre-tested interview schedule containing structured questions. Among 138 respondents, male were predominant (52.2%). Mean age of the respondents was 39.42±10.79 years, while the most common age group was found as '31 to 40 years'. By occupation, majority were housewives (40.58%), followed by businessmen (29.71%), service holder (15.22%), laborer (7.97%), and students (6.52%). The primary sites of pain were back and low back (38.4%), knee (24.6%), leg (8.7%), ankle and heel (8.0%), hand and wrist (6.5%), neck (5.8%), shoulder (5.8%), and elbow (2.2%). Highest number (47.8%) patients reported aching pain, while one fifth (20.3%) of them experienced burning pain. About 36.2 percent respondents mentioned 'prolonged standing' as the main cause of pain aggravation, while almost half (48.6%) of the patients perceived that 'application of heat' was the key relieving factor of their pain. About two third (63%) of the respondents were sensitive to weather change; among them 56.3 percent reported that their pain increased during cold weather. Moreover, more than two third (67.4%) study-patients experienced deterioration of pain due to seasonal variation; of them 59.1 percent reported that their pain was exacerbated in winter season. Of all respondents, less than one third (30.4%) experienced aggravation of pain due to lunar change; of them majority (85.7%) experienced increased pain during dark fortnights. Our study concluded that weather change might have an important role in fluctuation of pain among individuals having musculoskeletal disorders.

Breast cancer 1 (BRCA1) protein expression as a prognostic marker in sporadic epithelial ovarian carcinoma: an NCIC CTG OV.16 correlative study

BACKGROUND

Breast cancer 1 (BRCA1) protein inactivation in sporadic ovarian carcinoma (OC) is common and low BRCA1 expression is linked with platinum sensitivity. The clinical validation of BRCA1 as a prognostic marker in OC remains unresolved.

PATIENTS AND METHODS

In 251 patient samples from the NCIC CTG clinical trial, OV.16, BRCA1 protein expression was determined by immunohistochemistry.

RESULTS

For all patients, when BRCA1 score was analyzed as a continuous variable, there was no significant correlation between BRCA1 protein expression and progression-free survival (PFS) [adjusted hazard ratio (HR) = 1.15 (0.96-1.37), P = 0.12] or response rate [HR = 0.89 (0.70-1.12), P = 0.32]. In the 116 patients with minimal residual disease (RD), higher BRCA1 expression correlated significantly with worse PFS [HR = 1.40 (1.04-1.89), P = 0.03]. Subgroup analysis divided patients with minimal RD into low (BRCA1 ≤2.5) and high (BRCA1 >2.5) expression groups. Patients with low BRCA1 expression had a more favorable outcome [median PFS was 24.7 and 16.6 months in patients with low and high BRCA1, respectively; HR = 0.56 (0.35-0.89), P = 0.01].

CONCLUSIONS

This study suggests that BRCA1 protein is a prognostic marker in sporadic OC patients with minimal RD. Further research is needed to evaluate BRCA1 as a predictive biomarker and to target BRCA1 expression to enhance chemotherapeutic sensitivity.

Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study

AIMS/HYPOTHESIS

Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status.

METHODS

The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed.

RESULTS

In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15% (1.10) in the 6,761 MI patients and 5.85% (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4%) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (≥ 6.12%) being 1.55 (95% CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1% higher HbA(1c) value was associated with 19% (95% CI 14-23) higher odds of MI, while every 0.5% higher HbA(1c) was associated with 9% higher odds of MI (95% CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities.

CONCLUSIONS/INTERPRETATION

The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1% increment independently predicts a 19% higher odds of MI after accounting for other MI risk factors including diabetes.

Monitoring technologies in the neonatal intensive care unit: implications for the detection of necrotizing enterocolitis

Necrotizing enterocolitis is the most common and fulminant gastrointestinal disease affecting neonates. Its pathogenesis is heterogeneous and not clearly understood. Early detection could prevent some of the devastating consequences of this disease, but currently there is no noninvasive method of reliable early-stage detection. Here, we review various noninvasive monitoring technologies that have already been employed or show promise for early detection. Each method may have an important role after its technical difficulties are resolved. These are discussed in detail as they relate to various aspects of the putative pathophysiology of this devastating disease.

Cryptococcosis in organ transplantation

Opportunistic infection is one of the important cause of graft dysfunction after organ transplantation. It usually occurs one year after post transplantation in a immunocompromised transplant recipient. Among the opportunistic infections fungal infection is important cause of graft dysfunction as well as increase morbidity and mortality of post transplant recipient. Cryptococcosis is the third most common invasive fungal infection in an organ transplant recipient next to Candidiasis and Aspergillosis. A 27 years young male is known case of live related renal allograft recipient on immunosuppression for last one and half years. Patient was admitted with irregular fever, severe headache, nausea and vomiting in the department of Nephrology on July 2007. After admission patient was thoroughly evaluated and clinically found features of meningitis. Subsequent investigation report revealed swollen of 3rd ventricle on CT scan brain and growth of Cryptococcus in CSF culture and diagnosis was made post renal transplant cryptococcal meningitis. Treatment was given with Injection Amphotericin B along with immunosuppression and other supportive measured. But inspite of treatment, within few days after diagnosis patient was underwent coma and died. In conclusion, cryptococcal meningitis is a serious invasive fungal infection in post transplant immunocompromised recipient and responsible for graft lose and increase morbidity of the transplant patients.

Education and risk for acute myocardial infarction in 52 high, middle and low-income countries: INTERHEART case-control study

OBJECTIVE

To determine the effect of education and other measures of socioeconomic status (SES) on risk of acute myocardial infarction (AMI) in patients and controls from countries with diverse economic circumstances (high, middle, and low income countries).

DESIGN

Case-control study.

SETTING

52 countries from all inhabited regions of the world.

PARTICIPANTS

12242 cases and 14622 controls.

MAIN OUTCOME MEASURES

First non-fatal AMI.

RESULTS

SES was measured using education, family income, possessions in the household and occupation. Low levels of education (< or =8 years) were more common in cases compared to controls (45.0% and 38.1%; p<0.0001). The odds ratio (OR) for low education adjusted for age, sex and region was 1.56 (95% confidence interval 1.47 to 1.66). After further adjustment for psychosocial, lifestyle, other factors and mutually for other socioeconomic factors, the OR associated with education < or =8 years was 1.31 (1.20 to 1.44) (p<0.0001). Modifiable lifestyle factors (smoking, exercise, consumption of vegetables and fruits, alcohol and abdominal obesity) explained about half of the socioeconomic gradient. Family income, numbers of possessions and non-professional occupation were only weakly or not at all independently related to AMI. In high-income countries (World Bank Classification), the risk factor adjusted OR associated with low education was 1.61 (1.33 to 1.94), whereas it was substantially lower in low-income and middle-income countries: 1.25 (1.14 to 1.37) (p for interaction 0.045).

CONCLUSION

Of the SES measures we studied, low education was the marker most consistently associated with increased risk for AMI globally, most markedly in high-income countries.

Successful oral tolerance induction in severe peanut allergy

BACKGROUND

Peanut allergy is common, potentially severe and rarely resolves causing impaired quality of life. No disease-modifying treatment exists and there is therefore a need to develop a therapeutic intervention.

AIMS OF THE STUDY

The aim of this study was to investigate whether peanut oral immunotherapy (OIT) can induce clinical tolerance to peanut protein.

METHODS

Four peanut-allergic children underwent OIT. Preintervention oral challenges were performed to confirm clinical allergy and define the amount of protein required to cause a reaction (dose thresholds). OIT was then administered as daily doses of peanut flour increasing from 5 to 800 mg of protein with 2-weekly dose increases. After 6 further weeks of treatment, the oral challenge was repeated to define change in dose threshold and subjects continued daily treatment.

RESULTS

Preintervention challenges confirmed peanut allergy and revealed dose thresholds of 5-50 mg (1/40-1/4 of a whole peanut); one subject had anaphylaxis during challenge and required adrenaline injection. All subjects tolerated immunotherapy updosing to 800 mg protein and i.m. adrenaline was not required. Each subject tolerated at least 10 whole peanuts (approximately 2.38 g protein) in postintervention challenges, an increase in dose threshold of at least 48-, 49-, 55- and 478-fold for the four subjects.

CONCLUSIONS

We demonstrated a substantial increase in dose threshold after OIT in all subjects, including the subject with proven anaphylaxis. OIT was well tolerated and conferred protection against at least 10 peanuts, more than is likely to be encountered during accidental ingestion.

Potentially modifiable risk factors associated with myocardial infarction in China: the INTERHEART China study

BACKGROUND

Lifestyle changes associated with the rapidly developing economy increase cardiovascular disease (CVD), myocardial infarction (MI) and cardiovascular risk factors (CVRFs) in China.

OBJECTIVE

To assess and compare regionally, and with other regions of the world, distribution of the nine INTERHEART CVRFs, their relationship to MI and the CVD epidemic in China in order to determine how this may influence the future of CVD in China.

METHODS

Patients with first acute MI (n = 3030) and age- and sex-matched controls (n = 3056) were enrolled from 26 centres in China.

RESULTS

Northern Chinese had higher rates of smoking and hypertension, whereas southern Chinese reported lower fruit and vegetable intake and higher rates of depression. Compared with other regions, participants from China were older, with lower body mass index and waist to hip ratios, lower total and low-density lipoprotein cholesterol levels, ApoB lipoprotein and ApoB to ApoA-1 ratios, but higher high-density lipoprotein cholesterol and ApoA-1. All nine INTERHEART CVRFs, education and income were significantly associated with MI in the Chinese cohort. There was significant heterogeneity in the strength of association between certain CVRFs and MI for China versus other regions, with stronger associations for the Chinese for diabetes (OR 5.10 vs 2.84), depression (2.27 vs 1.37) and permanent stress (2.67 vs 2.06); and lower for the Chinese for abdominal obesity (1.33 vs 2.62) (p for heterogeneity, all <0.001).

CONCLUSIONS

Diabetes and psychosocial factors have strong associations with risk of MI in China, indicating that future increases in these risk factors with societal change in China may hasten rapid increases in CVD.

Ewing tumors of the chest wall: Local control and long-term outcomes

e21501

Background: Primary sarcomas of the lungs and mediastinum are rare and few data are reported on treatment and results of therapy. Methods: We reviewed our experience from 1980 and 2008 including 31 patients (pts). Pts characteristics: median age 41 (19–80 y), male/female 19/12; symptoms at diagnosis: dyspnoea (42%), chest and shoulder pain (39%), cough (35%), hemophtoae (13%), discomfort (10%). 4 pts had a previous history of mediastinal radiation for Hodgkin's and non-Hodgkin's linfomas. 5 mediastinal tumours were located as follows: 2 in anterior part, 1 in posterior and 2 in the middle (sarcomas of the heart). 26 lung sarcomas presented as a singular mass in 23 cases and as a metastatic disease in 3. Results: In 20/31 cases the tumour was immediately resected (3 mediastinal masses and 17 lung sarcomas). In 8/31 cases only biopsy was possible. FNA was done in 25 pts. Neoadjuvant chemotherapy was performed in 4 cases (3 resected). Resection was complete in 11/23 cases and in 12/23 incomplete. The histology were: peripheral nerve tumour 7, leiomyosarcoma 4, MFH 2, fibrosarcoma 2, liposarcoma 1, angiosarcoma 2, undifferentiated sarcoma 1, solitary fibrous tumour 2, rhabdomyosarcoma 2, synovialsarcoma 2, pulmonary artery sarcoma 1, pleuropolmonary blastoma 1, malignant hemangiopericytoma 1, mixoid chondrosarcoma 1, ectopic osteosarcoma 1, aggressive fibromatosis 1. Only 4 pts received neoadjuvant chemotherapy, 11 adjuvant CT, 5 exclusive CT + RT for inoperable disease. Radiotherapy was completed in 26 pts (21 adjuvant). Local relapse or metastatic progression were recorded in 16/23 pts and 12 received one or more lines of palliative CT. Data about survival are disposable only for the more recently recorded pts (1998–2008: 17 pts). Of these only 8 are alive (2 with disease). Volume of disease, complete resection and grading are the dominant prognostic factors. Conclusions: Primary sarcomas of the lungs and mediastinum have a very severe prognosis. Surgical resection is the fundamental therapy, but in the future the role of neoadjuvant CT will increase.

No significant financial relationships to disclose.