The Use and Efficacy of Oral Phenylephrine Versus Placebo Treating Nasal Congestion Over the Years on Adults: A Systematic Review

Nasal congestion is a common issue stemming from various factors such as allergies and anatomical variations. Allergic rhinitis frequently leads to nasal congestion. The pathophysiology involves inflammation, swelling, and mucus production in the nasal mucosa. Multiple treatments are available, including oral phenylephrine, an over-the-counter or prescription option. However, the effectiveness and safety of phenylephrine have been subjects of debate. This systematic review aims to provide an updated perspective on the efficacy of oral phenylephrine versus placebo in addressing nasal congestion in adults. We conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic review involving searches on PubMed, Cochrane, and Scopus databases. Inclusion/exclusion criteria were defined to identify high-quality studies. The focus was on randomized controlled trials (RCTs) and case-control studies published in English between 1998 and 2023, involving adult populations. The interventions compared oral phenylephrine with placebo or standard care, with outcomes centering on changes in nasal congestion symptoms and nasal airway resistance. We identified four articles that met the criteria. These studies exhibited varied designs and populations. The findings consistently indicated that phenylephrine was not more effective than a placebo in relieving nasal congestion. This systematic review demonstrates that oral phenylephrine did not offer substantial relief from nasal congestion compared to a placebo in adults. The studies featured diverse designs, yet the prevailing conclusion was that phenylephrine's efficacy was limited. Safety assessments showed no life-threatening adverse events, with common side effects including headaches and mild discomfort. In summary, this systematic review indicates that oral phenylephrine is not significantly more effective than a placebo in alleviating nasal congestion in adults. Clinicians should explore alternative treatment options, considering the review's limitations. Additional research may be needed to clarify the role of oral phenylephrine in managing nasal congestion.

Effectiveness and safety of Levofloxacin containing regimen in the treatment of Isoniazid mono-resistant pulmonary Tuberculosis: a systematic review

Background

We aimed to determine the effectiveness and safety of the Levofloxacin-containing regimen that the World Health Organization is currently recommending for the treatment of Isoniazid mono-resistant pulmonary Tuberculosis.

Methods

Our eligible criteria for the studies to be included were; randomized controlled trials or cohort studies that focused on adults with Isoniazid mono-resistant tuberculosis (HrTB) and treated with a Levofloxacin-containing regimen along with first-line anti-tubercular drugs; they should have had a control group treated with first-line without Levofloxacin; should have reported treatment success rate, mortality, recurrence, progression to multidrug-resistant Tuberculosis. We performed the search in MEDLINE, EMBASE, Epistemonikos, Google Scholar, and Clinical trials registry. Two authors independently screened the titles/abstracts and full texts that were retained after the initial screening, and a third author resolved disagreements.

Results

Our search found 4,813 records after excluding duplicates. We excluded 4,768 records after screening the titles and abstracts, retaining 44 records. Subsequently, 36 articles were excluded after the full-text screening, and eight appeared to have partially fulfilled the inclusion criteria. We contacted the respective authors, and none responded positively. Hence, no articles were included in the meta-analysis.

Conclusion

We found no "quality" evidence currently on the effectiveness and safety of Levofloxacin in treating HrTB.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290333, identifier: CRD42022290333.

Antifungal potential of Azotobacter species and its metabolites against Fusarium verticillioides and biodegradation of fumonisin

AIMS

In the study, seven Plant Growth Promoting Rhizobacteria (PGPR) Azotobacter species were screened against three strains of Fusarium verticillioides to test its antifungal activity. Azotobacter strains were tested for the degradation of fumonisin produced by F. verticillioides. Secondary metabolites were isolated and characterized from the Azotobacter strains for the first time.

METHODS AND RESULTS

Potential seven Azotobacter species antifungal activity was tested following the dual culture assay against three starins of Fusarium verticillioides namely FVM-42, FVM-86, MTCC156 estimating the substantial zone of inhibition. Azotobacter species AZT-31 and AZT-50 strains significantly inhibited the growth of F. verticillioides recording drastic growth enhancement of maize under in-vitro conditions by calculating the infection incidence, vigour index and germination percentage. As confirmation, dereplication studies were conducted for the reconfirmation of Azotobacter strains by isolating from rhizoplane. Azotobacter strains played a key role in degradation of fumonisin produced by F. verticillioides reporting 98% degradation at 2hr of incubation with the pathogen. Furthermore, in the study first time we have tried to isolate and characterize the secondary metabolites from the Azotobacter strains exhibiting six compounds from the species AZT-31 (2) and AZT-50 (4). Preliminary in-vitro experiments were carriedout using the compounds extracted to check the reduction of infection incidence (90%) and increase in germination percentage upto 50 to 70% when compared to test pathogen.

CONCLUSION

Azotobacter strains referred as PGPR on influencing the growth of plant by producing certain substances that acts as stimulators on inhibiting the growth of pathogen.

SIGNIFICANCE AND IMPACT OF THE STUDY

Future perspective would be the production of active combination of carboxamide compound and Azotobacter species for preventively controlling the phytopathogenic fungi of plants and crops and also towards the treatment of seeds.

An unusual presentation of posterior reversible encephalopathy syndrome—a case report

Background

Acute neurological emergencies in pregnant and postpartum women presenting as headache, visual disturbances, seizures, and elevated blood pressure are usually attributed to preeclampsia and eclampsia. However cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two important, rare conditions which should be considered. PRES is a rare neuroradiological syndrome characterised by vasogenic oedema of subcortical white matter, commonly involving posterior cerebral hemispheres. Preeclampsia and eclampsia are the common causes of PRES. However, late postpartum eclampsia concurrent to PRES is rare. Here, we report a rare case of PRES secondary to late postpartum eclampsia with atypical radiological findings.

Case presentation

A 25-year-old married woman with prior history of two spontaneous abortions presented to us on day 5 postpartum, post lower segment caesarean section (LSCS) with complaints of headache followed by one episode of new onset generalised tonic-clonic seizures. There was no history of seizures prior to the pregnancy and no history of hypertension or diabetes during any of her pregnancies. On examination, BP was 140/90 mm Hg and PR 98 bpm. Systemic examination revealed GCS 15/15, no focal neurological deficits, and bilateral flexor plantar response. Fundus examination was normal with no evidence of hypertensive retinopathy. Preliminary haematological and biochemical tests including antiphospholipid antibody (APLA) profile were done in view of prior abortions and were within normal limits. Lumbar puncture was done—normal study. EEG was normal. MRI with MRV was suggestive of atypical posterior encephalopathy. In view of late onset postpartum seizure, the patient was started on injection of magnesium sulphate, anti-hypertensives, and antiepileptics; following which, she improved and was discharged.

Conclusion

Though preeclampsia and eclampsia are usually screened entities, we should also follow women in puerperium for late postpartum eclampsia which is defined as seizures beyond 48 h of delivery up to 4 weeks postpartum. So it is important to follow-up postpartum women for complications like PRES because early detection and treatment can lessen the morbidity and mortality as they are completely reversible. Thus, health care professionals should be educated about the same. Apart from antenatal and intrapartum care, postpartum care should also be given equal importance.

Scientific research publications in dengue: A global and Indian bibliometric analysis from 1997 to 2018

Dengue fever is common in tropical and subtropical countries of the world and its present impact is 30 times more than what it was 50 yr ago. The aim of the study was to analyze the research output/publications on dengue across the world as well as in India, using the Web of Science database. Literature search was done using the keyword 'dengue' in the title field to find global and Indian publications on dengue from 1 June 1997 to 20 July 2018. Bibliometric analysis was done on the basis of the magnitude of research output; year, type and language of publications; citations and h-index, impact factor, keywords, most productive institutes etc. Descriptive analysis was performed using MS Office, Word Cloud Generator and SPSS software. The analysis of the records obtained indicated that globally 11,742 articles were published on dengue during the period of 21 yr of which 1114 were Indian. The country with highest number of publications was United States (3449; 29.37%) while India ranked third (1114; 9.48%). Majority of the published articles where in the American Journal of Tropical Medicine and Hygiene (1366; 11.63%) and the leading journal in India was Indian Journal of Medical Research (56; 5.02%) followed by the Journal of Vector Borne Diseases (42; 3.77%). The most productive Institute at global level was 'Mahidol University, Thailand' while in the Indian context it was 'All India Institute of Medical Sciences, New Delhi'. The elevated metrics of citation, impact factor, and h-index are based on the magnitude of scientific research outputs. Increasing trend in the number of publications over the years both globally as well as in India indicates overall growth in dengue research. Even though it is a good sign of productivity it is still significantly related to the magnitude of occurrence of dengue cases across the globe. Further, it is a good indication that the scientific community is dynamic and responding well in bringing out the regional scenarios to the public for health promotion.

Magnitude and pattern of various cancers from tertiary health care center registry: A study in three southern states of India

Many research studies have looked into the epidemiological aspects including various potential risk factors associated with cancers, namely environmental, dietary, genetic, and hormonal. The present article studies the magnitude and pattern of various cancers registered at tertiary health-care centers in three South Indian states. Data from hospital-based cancer registries compiled by the ICMR-National Centre for Disease Informatics and Research for the time periods 2007-2011 and 2012-2014 for three South Indian states, namely Tamil Nadu, Kerala, and Karnataka, were analyzed using R software. Summarizing the type and proportions of cancers seen at the three registries during the periods 2007-2011 and 2012-2014, it was found that, among men, hypopharyngeal cancer, esophageal cancer, lung cancer, stomach cancer, and oral cancer were the major cancer types prevalent and, among females, cervical cancer, mouth cancer, breast cancer, ovary cancer, and thyroid cancer were the common cancer types. With multidisciplinary approach, cancers can be prevented to a certain extent by insisting behavioural changes through recommendation of increase in physical activities and intake of micro nutrient-rich food items with fiber component.

Addition of biomarker high sensitivity troponin I (hSTROPI) to QRISK3 score in predicting significant coronary artery disease (CAD)

Background

The current models to predict CAD in general population is not universally accepted. Many risk scores do not take into account factors such as south Asian ancestry, type 2 diabetes mellitus or family history of premature CAD. There is still no clarity on the position of biomarkers in addition to traditional risk factors.

Purpose

This study evaluates the role of biomarker hSTROPI in addition to QRISK3 score in predicting significant CAD.

Methods

This observational study included 103 consecutive subjects who had non cardiac pain as per ESC criteria and wanted to assess their future cardiovascular risk and to know the coronary anatomy. None had documented CAD prior. The inclusion criteria consisted of subjects who were >18 years of age asymptomatic or with non-cardiac chest pain and absence of clinical cardiovascular disease. Exclusion criteria were heart failure, chronic kidney disease (CKD) and anemia (hemoglobin <10 gms%). They underwent risk stratification based on QRISK3 score and measurement of hSTROPI. All of them underwent Computerized Tomography coronary angiogram (CTCA). Subjects with more than 50% lesions on CT coronary angiogram were deemed to have significant CAD. We analyzed the impact of hSTROPI in addition to QRISK3 score in picking up significant lesions by CTCA.

Results

The analysis showed sensitivity of QRISK3 >17.5% of 46.43%, specificity of 75.68%, positive predictive value (PPV) of 41.94%, negative predictive value (NPV) of 78.87% and diagnostic accuracy of 67.65%.

hSTROP I >3.5pg/ml showed a sensitivity of 37.93%, specificity of 81.08%, PPV of 44%, NPV of 76.92% and diagnostic accuracy of 68.93%.

When both hSTROPI >3.5pg/ml and QRISK3 >17.5% are combined, the sensitivity was found to be 27.59%, specificity of 91.89%, PPV of 57.14%, NPV of 76.4% and diagnostic accuracy of 73.79%.

In the study population, significant CAD was found in QRISK3 >17.5% in 41.9% and QRISK3<17.5% in 22.2% and (p=0.04).

Significant CAD was found in 44% of population with HSTROPI >3.5 pg/ml and in 23.1% whose HSTROP I <3.5pg/ml (p=0.04).

Significant CAD was found in 57.1% of population with both parameters positive (QRISK3 >17.5% and hSTROPI >3.5 pgm/ml), 23.6% of the population in which both parameters were negative (p=0.009).

Conclusion

Combining QRISK3 score of more than 17.5% and hSTROP I more than 3.5pg/ml have significant association with more than 50% lesion by CTCA with a specificity of 91.89%.

This may be useful in counselling intermediate risk group patients to have aggressive pharmacological primary preventive strategies like high dose statins. This may be a cost effective method of screening south Asian population who have much more risk factors and CAD at much younger age.

Funding Acknowledgement

Type of funding source: None

Bioconjugated nano-bactericidal complex for potent activity against human and phytopathogens with concern of global drug resistant crisis

The present study emphasizes the need for novel antimicrobial agents to combat the global drug resistant crisis. The development of novel nanomaterials is reported to be of the alternative tool to combat drug resistant pathogens. In present investigation, bioconjugated nano-complex was developed from secondary metabolite secreted from endosymbiont. The endosymbiont capable of secreting antimicrobial metabolite was subjected to fermentation and the culture supernatant was assessed for purification of antimicrobial metabolite via bio-assay guided fraction techniques such as thin layer chromatography (TLC), high performance liquid chromatography (HPLC) and column chromatography. The metabolite was characterized as 2,4-Diacetylphloroglucinol (2,4 DAPG) which was used to develop bioconjugated nano-complex by treating with 1 mM silver nitrate under optimized conditions. The purified metabolite 2,4 DAPG reduced silver nitrate to form bioconjugated nano-complex to form association with silver nanoparticles. The oxidized form of DAPG consists of four hard ligands that can conjugate on to the surface of silver nanoparticles cluster. The bioconjugation was confirmed with UV-visible spectroscopy which displayed the shift and shoulder peak in the absorbance spectra. This biomolecular interaction was further determined by the Fourier-transform spectroscopy (FTIR) and nuclear magnetic resonance (NMR) analyses which displayed different signals ascertaining the molecular binding of 2,4,DAPG with silver nanoparticles. The transmission electron microscopy (TEM) analysis revealed the cluster formation due to bioconjugation. The XRD analysis revealed the crystalline nature of nano-complex with the characteristic peaks indexed to Bragg's reflection occurring at 2θ angle which indicated the (111), (200), (220) and (311) planes. The activity of bioconjugated nano-complex was tested against 12 significant human and phytopathogens. Among all the test pathogens, Shigella flexneri (MTCC 1457) was the most sensitive organisms with 38.33 ± 0.33 zone of inhibition. The results obtained in the present investigation attribute development of nano-complex as one of the effective tools against multi-drug resistant infections across the globe.

Omics based approach for biodiscovery of microbial natural products in antibiotic resistance era

The need for a new antibiotic pipeline to confront threat imposed by resistant pathogens has become a major global concern for human health. To confront the challenge there is a need for discovery and development of new class of antibiotics. Nature which is considered treasure trove, there is re-emerged interest in exploring untapped microbial to yield novel molecules, due to their wide array of negative effects associated with synthetic drugs. Natural product researchers have developed many new techniques over the past few years for developing diverse compounds of biopotential. Taking edge in the advancement of genomics, genetic engineering, in silico drug design, surface modification, scaffolds, pharmacophores and target-based approach is necessary. These techniques have been economically sustainable and also proven efficient in natural product discovery. This review will focus on recent advances in diverse discipline approach from integrated Bioinformatics predictions, genetic engineering and medicinal chemistry for the synthesis of natural products vital for the discovery of novel antibiotics having potential application.

Nanoagroparticles emerging trends and future prospect in modern agriculture system

Increment of technical knowledge has remarkably uplifted logical thinking among scientific communities to shape the theoretical concepts into near product-oriented research. The concept of nanotechnology has overwhelmed almost all forms of lives and has traded its applications in myriad fields. Despite rapid expansion of nanotechnology, sustainable competitions still do exist in the field of agriculture. In current scenario, agriculture is a manifestation demand to provide adequate nutrition for relentless growing global population. It is estimated that nearly one-third of the global crop production is destroyed annually. The loss owes to various stresses such as pest infestation, microbial pathogens, weeds, natural calamities, lack of soil fertility and much more. In order to overcome these limitations, various technological strategies are implemented but a majority of these have their own repercussions. Hence there is a scrawling progress on the evaluation of nanoparticles into agriculture sector which can reform the modern agricultural system. Applications of these nanomaterials can add tremendous value in the current scenario of a global food scarcity. Nanotechnology can address the adverse effects posed by the abundant use of chemical agrochemicals which are reported to cause biomagnification in an ecosystem. Based on these facts and consideration, present review envisages on nanoparticles as nanoherbicides, nanopesticides, onsite detection agro-pathogens and nanoparticles in post harvest management. The review also elucidates on the importance of nanoparticles in soil fertility, irrigation management and its influence on improving crop yield. With scanty reports available on nanotechnology in agriculture system, present review attributes toward developing nanoagroparticles as the future prospect which can give new facelift for existing agriculture system.

Hypercapnic Respiratory Failure in Case of Chiari 1.5 Malformation: Case Report and Review of the Literature

Type 2 respiratory failure is defined as hypercapnia associated with hypoxia. Chiari 1.5 is known as herniation of the cerebellar tonsils along with brain stem and fourth ventricle. We report a 35-year-old male who presented with acute hypercapnic respiratory failure (Type 2), without any preexisting neurological or respiratory abnormality. Analysis of blood gases in emergency revealed a pH of 7.12, pCO₂ of 132 mmHg, and arterial oxygen tension of 118 mm Hg. He was intubated and ventilated. Magnetic resonance imaging brain revealed herniation of the cerebellar tonsils along with brain stem and fourth ventricle. The patient underwent surgery and gradually weaned off. He was mobilized and discharged on day 6. Acute respiratory failure has not been reported with Chiari 1.5 malformation. The lesson to be learned from this case is that craniospinal pathology must be looked for in a patient with hypercapnic respiratory failure.

Extracellular synthesis of silver nanoparticles by novel Pseudomonas veronii AS41G inhabiting Annona squamosa L. and their bactericidal activity

In present investigation extracellular synthesis of silver nanoparticles were synthesized using cell free supernatant of Pseudomonas veronii AS41G isolated from Annona squamosa L. The bacterium significantly reduced silver nitrate to generate silver nanoparticles which was characterized with hyphenated techniques. Synthesis of silver nanoparticles preliminary confirmed by UV-Visible spectrophotometry with the intense peak at 410nm, Further FTIR analysis revealed the possible role of biomolecules in the supernatant responsible for mediating the nanoparticles formation. The XRD spectra exhibited the characteristic Bragg peaks of 100, 111, 200, and 220 facets of the face centred cubic symmetry of nanoparticles suggesting that these nanoparticles were crystalline in nature. TEM microgram showed polydispersity of nanoparticles with size ranging from 5 to 50nm. Synthesized silver nanoparticles showed antibacterial activity against human and environmental pathogens including MRSA. The study enlightens the role of biosynthesized silver nanoparticles as an emerging alternative for drug resistant microorganisms. The obtained results are promising enough to pave the environmentally benign nanoparticle synthesis processes without use of any toxic chemicals and also envision the emerging role of endophytes towards synthesis of nanoparticles. With scanty reports available on P.veronii species, a new role has been reported in this study which will be very valuable for future researchers working on it.

Cross-cultural standardization of the South Texas Assessment of Neurocognition in India

BACKGROUND & OBJECTIVES

Despite the central role of cognition for mental disorders most studies have been conducted in western countries. Similar research from other parts of the world, particularly India, is very limited. As a first step in closing this gap this cross-cultural comparability study of the South Texas Assessment of Neurocognition (STAN) battery was conducted between USA and India.

METHODS

One hundred healthy adults from Kerala, India, were administered six language independent subtests of the Java Neuropsychological Test (JANET) version of the STAN, assessing aspects of general intellectual ability (Matrix Reasoning), attention (Identical Pairs Continuous Performance, 3 Symbol Version Test; IPCPTS), working memory (Spatial Capacity Delayed Response Test; SCAP), response inhibition (Stop Signal Reaction Time; SSRT), Emotional Recognition and Risk taking (Balloon Analogue Risk Task; BART). Test results were compared to a demographically matched US sample.

RESULTS

Overall test performance in the Kerala sample was comparable to that of the US sample and commensurate to that generally described in studies from western countries.

INTERPRETATION & CONCLUSIONS

Our results support the metric equivalence of currently available cognitive test batteries developed in western countries for use in India. However, the sample was restricted to individuals who were literate and had completed basic primary and secondary education.

Recurrent acute renal failure

While acute renal failure secondary to intravascular hemolysis is well described in hemolytic anemias, recurrent acute renal failure as the presenting manifestation of a hemolytic anemia is rare. We report a patient with recurrent acute renal failure who was found to have paroxysmal nocturnal hemoglobinuria (PNH), on evaluation.

Cryptococcal sepsis in small vessel vasculitis

While meningoencephalitis due to cryptococcus is well known in immunocompromised patients, disseminated cryptococcosis and cryptococcemia is rare outside the setting of advanced HIV infection. We report a case of disseminated cryptococcosis occurring in a patient with Wegener's granulomatosis on immunosuppressive medications.

Utility of QuantiFERON TB gold test in a south Indian patient population of ocular inflammation

Aim:

To study the utility of interferon-γ release assays (QuantiFERON TB gold test) in a south Indian patient population of intraocular inflammation.

Design:

Evaluation of a diagnostic test- a pilot study from January 2007 to October 2008.

Materials and Methods:

QuantiFERON TB gold test was performed on the following groups of patients following an informed consent. Group A included healthy volunteers without any exposure to tuberculosis (TB) or past history of TB (n=22). Group B included patients with active systemic TB diagnosed by the demonstration of acid-fast bacilli or by the histopathology finding of caseation with granuloma formation from the sputum, lymph node, skin or intestinal biopsies (n=26). Group C included patients with uveitis of known etiologies other than intraocular TB without any history of exposure to active TB (n=21). Group D included patients with a diagnosis of presumed intraocular TB, who responded to antitubercular therapy by decreased or no recurrences following treatment and with a minimum of nine months follow-up following initiation of antitubercular therapy (n=39).

Results:

The sensitivity and specificity of the QuantiFERON TB gold test to pick up active systemic TB was 58% and 77% respectively. The sensitivity and specificity of the QuantiFERON TB gold test to pickup intraocular TB was 82% and 76% respectively.

Conclusions:

QuantiFERON TB gold test alone may not be specific for intraocular TB. The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB.

Membranoproliferative glomerulonephritis with essential cryoglobulinemia

Cryoglobulinemia is an uncommon cause of renal disease and often occurs in patients with hepatitis C virus (HCV) infection. We report a case of membranoproliferative glomerulonephritis in a patient with cryoglobulinemia, which was not associated with HCV infection or any identifiable etiology.

Altered structure and expression of RB1 gene and increased phosphorylation of pRb in human vestibular schwannomas

Tumor-specific alterations at the RB1 gene locus in 30 human vestibular schwannomas including 10 NF2 and 20 sporadic cases were analysed. Southern blot analysis of DNA from these samples revealed loss of heterozygosity (LOH) at the RB1 locus in 6 of 24 informative cases (25%) compared to normal blood DNAs from the same patients. Northern blot analysis showed normal size RB1 mRNA in all the tumor samples. However, there was a 2-5-fold increase in the level of expression of the RB1 gene in all the tumor samples compared to the WI38 cell line which was used as control. Western blot analysis of the RB1 protein, pRb showed a 2.5-5-fold increase in the level of total pRb as compared to normal WI38 cell line. Sixty five to seventy five percent of the total pRb were in phosphorylated form in most tumors. The LOH at the RB1 gene locus suggests genetic instability in these patients. Further, increased levels of RB1 mRNA, total pRb and the phosphorylated form of pRb suggests that RB1 gene in these tumors may have anti-apoptotic function. These results suggest that the RB1 gene has a major role in the development of human vestibular schwannomas.

Purification of a Class B1 platelet aggregation inhibitor phospholipase A2 from Indian cobra (Naja Naja) venom

A platelet aggregation inhibitor phospholipase A(2) (NND-IV-PLA(2)) was isolated from Naja naja (Eastern India) venom by a combination of cation and anion exchange chromatography. NND-IV-PLA(2) is the most catalytically active enzyme isolated from the Indian cobra venom. The acidic PLA(2) profile of Eastern regional Indian cobra venom is distinctly different from that of the western regional venom. However the acidic PLA(2)s from both the regions follow the pattern of increasing catalytic activity with increase in acidic nature of the PLA(2) isoform. NND-IV-PLA(2) is a Class B1 platelet aggregation inhibitor and inhibits platelet aggregation induced by ADP, collagen and epinephrine. Modification of active site histidine abolishes both catalytic activity and platelet aggregation inhibition activities while aristolochic acid, a phospholipase A(2) inhibitor has only partial effect on the two activities.

Co-occurrence of Wilson's disease and glioblastoma multiforme--is it a chance association?

We report a patient with glioblastoma multiforme who was subsequently diagnosed to have Wilson's disease. Immunohistochemical studies of the tumor revealed high (> 60%) labeling index for p53 and Rb retinoblastoma protein. Whether this association is like the co-occurrence of retinoblastoma and Wilson's disease due to possible somatic mutation in chromosome 13 needs to be explored.

Stress-dependent expression of a polymorphic, charged antigen in the protozoan parasite Entamoeba histolytica

We have identified a novel stress inducible gene, Ehssp1 in Entamoeba histolytica, the causative agent of amebiasis. Ehssp1 belongs to a polymorphic, multigene family and is present on multiple chromosomes. No homologue of this gene was found in the NCBI database. Sequence alignment of the multiple copies, and genomic PCR data restricted the polymorphism to the central region of the gene. This region contains a polypurine stretch that encodes a domain rich in acidic and basic amino acids. Under normal culture conditions only one copy of this multigene family is expressed, as observed by Northern blot and RT-PCR analysis. The size of this copy of the gene is 1,077 nucleotides, encoding a protein of 359 amino acids. The polymorphic domain in this copy is 64 nucleotides long. However, on exposure of cells to stress conditions such as heat shock or oxidative stress, multiple polymorphic copies of the gene are expressed, suggesting a possible role of this gene in adaptation of cells to stress conditions. The gene copy expressed under normal conditions, and the expression profile of cells under heat stress was identical in two different strains of E. histolytica tested. Interestingly, the extent of polymorphism in this gene was very less in E. dispar, a nonpathogenic sibling species of E. histolytica. Ehssp1 was found to be antigenic in invasive amebiasis patients.

Differential use of multiple replication origins in the ribosomal DNA episome of the protozoan parasite Entamoeba histolytica

The factors that control the initiation of eukaryotic DNA replication from defined origins (oris) on the chromosome remain incompletely resolved. Here we show that the circular rDNA episome of the human pathogen Entamoeba histolytica contains multiple potential oris, which are utilized in a differential manner. The primary ori in exponentially growing cells was mapped close to the promoter of rRNA genes in the upstream intergenic spacer (IGS) by two-dimensional gel electrophoresis. Replication initiated predominantly from the upstream IGS and terminated in the downstream IGS. However, when serum-starved cells were allowed to resume growth, the early oris which became activated were located in other parts of the molecule. Later the ori in the upstream IGS became activated, with concomitant silencing of the early oris. When the upstream IGS was located ectopically in an artificial plasmid, it again lost ori activity, while other parts of the rDNA episome could function as oris in this system. Therefore, the activation or silencing of the ori in this episome is context dependent, as is also the case with many eukaryotic replicons. This is the first replication origin to be mapped in this primitive protozoan and will provide an opportunity to define the factors involved in differential ori activity, and their comparison with metazoans.

The Relationship Between Blood Pressure and Mortality in the Oldest Old

OBJECTIVES

To explore the relationship between systolic and diastolic blood pressure and risk of 6-year, all-cause mortality in men and women age 65 to 84 versus those 85 and older.

DESIGN

A population-based longitudinal study.

SETTING

This study was conducted at four different sites: East Boston, Massachusetts; New Haven, Connecticut; two rural counties in Iowa; and Piedmont, North Carolina.

PARTICIPANTS

12,802 community-dwelling persons age 65 and older.

MEASUREMENTS

Baseline measurements collected include demographics, self-reported chronic medical conditions, blood pressure measurements, medications, health habits, and hospitalizations.

RESULTS

Unadjusted actuarial survival analyses show that men age 65 to 84 years with systolic blood pressure < 130 mmHg have significantly lower mortality compared with those with systolic blood pressure > or = 180 mmHg (P < .0001). In contrast, men 85 and older with systolic blood pressure > or = 180 mmHg have significantly lower mortality compared with those with systolic blood pressure < 130 mmHg (P < .0001). In Cox proportional hazards analyses controlling for other predictors of survival, the hazard of death associated with each 10-mmHg increase in systolic blood pressure is positively associated among men age 65 to 84 years and negatively associated among men age 85 and older (Hazard ratio and 95% confidence interval (CI): 1.04 (1.01, 1.07) for younger men vs 0.92 (0.86, 0.99) for older men). Among women age 65 to 84, the hazard of death significantly increased with increase in systolic blood pressure (P < .0001), while there was no relationship between level of systolic blood pressure and survival in women 85 and older. Both men 65 to 84 years old and those 85 and older showed a negative relationship between diastolic blood pressure and all-cause mortality (Hazard ratio 0.93, 95% CI (0.88-0.97) for men age 65-84 years, and Hazard ratio 0.90, 95% CI 0.80-1.02 for men 85 and older).

CONCLUSION

In men age 85 and older, higher systolic blood pressure is associated with better survival.

Clinical significance of falling blood pressure among older adults

We assessed the prevalence of falling blood pressure among older adults and its relationship to subsequent outcomes, using public use data from four sites of the Established Populations for Epidemiologic Studies of the Elderly. Seventeen percent of subjects had a decrease in systolic blood pressure of 20 mm Hg or greater and 22% had a decrease in diastolic blood pressure of 10 mm Hg or greater between year 0 and year 3. Falling systolic and diastolic blood pressure was associated with increased all-cause mortality (OR 1.5, 95% CI 1.3, 1.7), cardiovascular mortality (OR 1.6, 95% CI 1.3, 1.9) and all cardiovascular events (OR 1.4, 95% CI 1.2, 1.6) in the subsequent 3 years (years 4 to 6). Increasing amount of fall in blood pressure was associated with increasing risk of mortality. The magnitude of effect of falling blood pressure on adverse outcomes declined and became nonsignificant after adjusting for comorbidity and functional status at baseline. Thus, falling blood pressure is common among older adults and is a marker for underlying poor health and subsequent mortality.

Chronic rheumatologic symptoms in a tri-ethnic sample of men and women aged 75 and older

BACKGROUND

The high prevalence of musculoskeletal symptoms in elderly persons tends to obscure the recognition of specific medical conditions. The purpose of this study is to describe the prevalence of chronic rheumatologic symptoms and the associated measures of health status in an older population.

METHODS

This is a cross-sectional study of 507 noninstitutionalized tri-ethnic men and women aged 75 and older living in Galveston County, Texas. A home interview collected data on demographics, chronic medical conditions, cognition, depression, and functional status. Site, severity, and duration of rheumatologic symptoms such as morning stiffness, body tenderness, and body aching in the past month were also collected.

RESULTS

There was a high prevalence of nonspecific rheumatologic symptoms such as morning stiffness (32% in the shoulder girdle, 31% in the hip girdle), tenderness to touch (9%), and generalized body aching (11%) in the study population. Twenty-one percent of the subjects reported either bilateral shoulder or hip girdle stiffness or tenderness lasting more than 30 minutes almost every day or every day or generalized body aching most of the time during the past month. Age-, gender-, and ethnicity-adjusted multivariate analyses showed that more than three self-reported chronic medical conditions, poor or fair self-reported health, impairment in instrumental activities of daily living (IADL), and the presence of depressive or anxiety symptoms were associated with the presence of these chronic rheumatologic symptoms.

CONCLUSION

Chronic rheumatologic symptoms are common in people aged 75 and older. Such symptoms are markers for underlying poor health and for anxiety and depression among older subjects.

Vertebral artery aneurysms

Vertebral artery (VA) aneurysms are rare. We present our experience with three cases of VA aneurysms. Two aneurysms were located close to the origin of basilar artery while the third patient had a giant posterior inferior cerebellar artery aneurysm. These aneurysms were operated by the far lateral inferior suboccipital approach with good results.

The genome of Entamoeba histolytica

Estimation of genome size of Entamoeba histolytica by different methods has failed to give comparable values due to the inherent complexities of the organism, such as the uncertain level of ploidy, presence of multinucleated cells and a poorly demarcated cell division cycle. The genome of E. histolytica has a low G+C content (22.4%), and is composed of both linear chromosomes and a number of circular plasmid-like molecules. The rRNA genes are located exclusively on some of the circular DNAs. Karyotype analysis by pulsed field gel electrophoresis suggests the presence of 14 conserved linkage groups and an extensive size variation between homologous chromosomes from different isolates. Several repeat families have been identified, some of which have been shown to be present in all the electrophoretically separated chromosomes. The typical nucleosomal structure has not been demonstrated, though most of the histone genes have been identified. Most Entamoeba genes lack introns, have short 3' and 5' untranslated regions, and are tightly packed. Promoter analysis revealed the presence of three conserved motifs and several upstream regulatory elements. Unlike typical eukaryotes, the transcription of protein coding genes is alpha-amanitin resistant. Expressed Sequence Tag analysis has identified a group of highly abundant polyadenylated RNAs which are unlikely to be translated. The Expressed Sequence Tag approach has also helped identify several important genes which encode proteins that may be involved in different biochemical pathways, signal transduction mechanisms and organellar functions.

Congenital retinal arterial loops and spontaneous vitreous haemorrhage: a case report

This report describes a case of unilateral spontaneous vitreous haemorrhage associated with congenital retinal arterial loops.

Aging versus disease: the opinions of older black, Hispanic, and non-Hispanic white Americans about the causes and treatment of common medical conditions

BACKGROUND

Little is known about how older people interpret disease and how those interpretations might relate to use of medical services.

OBJECTIVE

To assess opinions of older subjects about the cause and treatment of common diseases and how they are related to health behaviors.

DESIGN

In-home interview of a population-based sample (n = 601) of noninstitutionalized black, Hispanic, and non-Hispanic white American men and women aged 75 and older in Galveston County, Texas.

RESULTS

Substantial proportions of the subjects considered heart disease, arthritis, or difficulty sleeping to be a normal part of aging. In multivariate analyses including age, gender, education, marital status, living arrangement, global self-rating of health, and comorbidity, older black subjects were less likely to view heart disease (OR = 0.41; 95% CI, 0.26-0.64), arthritis (OR = 0.48; 95% CI, 0.31-0.73), or sleep problems (OR = 0.50; 95% CI, 0.32-0.77) as a normal part of aging than were non-Hispanic whites. Blacks were more than three times as likely to attribute heart disease to overwork or stress than were non-Hispanic whites. In multivariate analyses, subjects who considered all three of the medical conditions to be a normal part of aging ("fatalistic") were less likely to have received preventive medical services in the previous year (OR = 0.13; 95% CI, 0.02-0.96), and subjects who felt that nothing could be done to treat any of the conditions ("nihilistic") were less likely to have a regular physician (OR = 0.24; 95% CI, 0.08-0.74).

CONCLUSIONS

Substantial numbers of older subjects are fatalistic about the cause of disease and/or nihilistic about its treatment. These attitudes are associated with decreased utilization of health services. Attempts to improve the health of underserved groups should employ interventions that are sensitive to the health beliefs of the targeted group.

Undertreatment of hypertension in older Mexican Americans

OBJECTIVE

To identify the prevalence of hypertension and factors associated with nontreatment and poor control of hypertension in Mexican Americans aged 65 years and older.

DESIGN

A population-based survey of older Mexican Americans conducted in 1993-1994.

SETTING

Subjects residing in five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

An area probability sample of 3050 noninstitutionalized Mexican American men and women aged 65 and older took part in a 90-minute in-home interview, which included review of all medications taken and two sitting blood pressure measurements.

OUTCOME MEASURES

Measured were previous diagnoses of hypertension, current medication for hypertension, and current blood pressure

RESULTS

Sixty-one percent of older Mexican-Americans were hypertensive, and 51% of those with hypertension were taking antihypertensive medications. Only 25% of hypertensive subjects (18% of males and 30% of females) were in good blood pressure control (i.e., systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg). In multivariate analyses, factors associated with increased likelihood of treatment included female gender (OR = 1.9), history of heart disease (OR = 2.4), possessing a regular source of health care (OR = 2.7), and having seen a physician two or more times in the previous year (OR = 3.8). These were also independent predictors of good blood pressure control.

CONCLUSION

Nontreatment of hypertension is still a major public health concern in older Mexican Americans. We estimate that adequate blood pressure control in this population would prevent approximately 30,000 adverse cardiovascular events over 10 years, affecting approximately 6% of the entire Mexican American older population.

Factors influencing unawareness of hypertension among older Mexican Americans

BACKGROUND

The objective of the study was to identify factors associated with unawareness of hypertension among Mexican Americans age 65 years and older.

METHODS

This was a population-based survey of 3,050 older Mexican Americans conducted in five Southwestern states in 1993-1994. An in-home interview included sociodemographics, review of medications, and blood pressure measurements.

RESULTS

Sixty percent of all subjects were hypertensive, and 37% of these were unaware of their diagnosis. Unaware hypertensive had significantly higher mean blood pressures than did aware hypertensives (145.7/ 86.2 mm Hg vs 142.4/83.1 mm Hg). While 77% of aware hypertensives were treated, only 10% of unaware hypertensives were treated. In multivariate analyses, factors associated with unawareness included male gender (OR = 1.8), being married (OR = 1.6), having Medicaid (OR = 1.6), having made fewer than two visits to a doctor in the past year (OR = 2.8), having a history of heart disease (OR = 0.57) or stroke (OR = 0.37), and having poor self-reported health (OR = 0.43).

CONCLUSION

Despite 3 decades of hypertension detection and education programs, unawareness of hypertension remains high among older Mexican Americans. There is a continued need for community-based education programs for hypertensives who are unaware of their diagnosis, and also there is need for programs to increase access to primary care physicians.

Geriatric targeting criteria as predictors of survival and health care utilization

OBJECTIVE

To assess the utility of geriatric targeting criteria in predicting survival and health care utilization in a cohort of hospitalized older veterans.

DESIGN

A prospective cohort study assessing geriatric targeting criteria, e.g., polypharmacy, falls, or confusion, with respect to adverse outcomes at 12 months.

SETTING

A Tertiary Care VA Medical Center.

PATIENTS

507 acutely hospitalized male veterans aged 65 years or more.

MAIN OUTCOME MEASURES

Survival status, nursing home placement, and total hospital days during 12 months following hospital admission.

RESULTS

Patients who had a higher number of targeting criteria at admission showed a significantly increasing trend toward death (P < or = .001), nursing home placement (P < or = .01), and longer hospital stays (P < or = .01) at 12 months. In univariate analyses, weight loss (relative hazard 3.8, 95% CI 2.4, 5.9), appetite loss (relative hazard 3.3, 95% CI 1.9, 5.8), depression (relative hazard 2.5, 95% CI 1.4, 4.5), falls (relative hazard 2.2, 95% CI 1.2, 4.1), confusion (relative hazard 2.2, 95% CI 1.2, 4.0), and socioeconomic problems (relative hazard 1.6, 95% CI 1.0, 2.5) predicted death. Polypharmacy (OR 3.4, 95% CI 1.3, 8.8), confusion (OR 4.4, 95% CI 1.5, 13.0), and prolonged bedrest (OR 7.6, 95% CI 1.5, 39.3) predicted nursing home placement. Confusion (Beta 12.0, 95% CI 2.9, 21.3), falls (Beta 14.2, 95% CI 4.2, 24.3), and prolonged bedrest (Beta 22.4, 95% CI 3.9, 41.0) predicted total hospital days. In multivariate analyses, weight loss, depression, and socioeconomic problems predicted death; confusion and polypharmacy predicted nursing home placements; and falls predicted total hospital days.

CONCLUSION

This prospective cohort study of hospitalized older veterans demonstrated geriatric targeting criteria as predictors of adverse hospital outcomes. Our findings suggest screening acutely hospitalized patients using chart abstracted geriatric targeting criteria is useful in identifying patients at risk for adverse outcomes of hospitalization.