Comparative Efficacy of Anti-asthma Therapy in Non-asthmatic Cough: A Cross-Sectional Study in Dubai, United Arab Emirates

Background Cough is one of the most common presenting complaints for physicians across the world, with the potential to result in a significant influence on one's daily life. It is typically categorized into acute cough (<3 weeks), subacute cough (three to eight weeks), and chronic cough (>8 weeks). The lack of specific treatment guidelines and evidence-based recommendations for resolving cough creates reasonable controversy in the medical field. This retrospective study aims to identify the clinical features of cough and evaluate the comparative efficacy between different anti-asthmatic treatment modalities in the urban city of Dubai, United Arab Emirates. Methods A retrospective cross-sectional study was performed on patients presenting to pulmonology or respiratory outpatient clinics with complaints of cough in the absence of any known history of chronic respiratory illness (e.g., asthma). Analysis was conducted via chi-squared and analysis of variance (ANOVA) testing. Results A total of 308 patients were eligible for inclusion, with 273 patients presenting for follow-up. Overall, patients with acute, subacute, and chronic coughs had similar clinical presentations, with no statistically significant differences noted. However, patients with pets were more likely to develop an acute cough (p = 0.04). Moreover, the follow-up outcomes of acute, subacute, and chronic cough were similar, with no significant statistical difference noted. Furthermore, patients receiving dual therapy using budesonide and montelukast, and patients receiving triple therapy using budesonide, montelukast, and tiotropium/ipratropium were most likely to gain complete relief of their symptoms, although triple therapy treatment was also associated with the highest rate of null improvement (p = 0.012). Additionally, chronic cough patients were more likely to be subject to higher C-reactive protein (CRP) levels in comparison to other cohorts (p = 0.26). Conclusion The comparative superiority of dual therapy using budesonide and montelukast, and triple therapy using budesonide, montelukast, and tiotropium/ipratropium were highlighted in this study. In the sparseness of specific treatment guidelines and evidence-based recommendations for cough, the use of anti-asthmatic therapy for cough patients has shown favorable results. Moreover, the lack of clinical differences between acute, subacute, and chronic cough may result in difficulties with the treatment of cough patients. To arrive at a valid conclusion, further comprehensive studies with larger and more diversified sample populations are encouraged.

Review of hygiene adaptations among UK doctors in controlling the spread of SARS-CoV-2 infection

BACKGROUND

A significant number of healthcare workers around the world have contracted COVID-19 from their workplace, thus there is a need to investigate common hygiene practices.

AIM

We aimed to describe the common hygiene adaptations of doctors in the hospital and at home.

METHODS

A survey of 110 doctors in UK was carried out to determine their hygiene adaptations and practices. Data were collected on demographics and personal protective equipment compliance.

RESULTS

The key findings were frequent hand washing (51%), change of clothing entering and leaving hospital (88% and 92%, respectively), taking a shower upon returning home (85%) and washing work attire at temperatures of 60-80°C (50%). A higher proportion of junior doctors washed their scrubs (p=0.004) and stethoscopes (p=0.014) compared with consultants and seniors. Female doctors cleaned their mobile phones (p=0.022) and work belongings (p=0.01) more frequently.

CONCLUSION

This study signified that junior doctors were more meticulous in hygiene adaptations and female doctors were more fastidious in personal hygiene. The observations of this study may be beneficial in preventing transmission of infection to families of healthcare professionals and are important to implement in the case of a second wave of COVID-19.

Risk factors for vertical transmission of hepatitis E virus infection

Hepatitis E virus (HEV) infection can be vertically transmitted, but the factors that transmit the disease to foetuses are still unclear. We studied a total of 144 pregnant women with HEV infection. Cord blood and newborn samples were taken for analysis. Nutritional factors were evaluated on the basis of anthropometric parameters and biochemical factors, and HEV viral load was quantified by real-time PCR. Sequencing of HEV-positive samples was performed. Approximately 14.63% (6/41) of pregnant patients with acute liver failure (ALF) died before delivery. Vertical transmission was observed in 46.09% (59/128) of HEV-IgM-positive mothers. Approximately 23.80% (10/42) of newborns in the acute viral hepatitis group and 29.41% (5/17) in the ALF group were positive for HEV-RNA. No significant difference was observed in the occurrence of vertical transmission in HEV groups. Viral load was found to be a significant predictor for vertical transmission of HEV infection adjusted with haemoglobin and folate in derivation cohort group. Incorporating these variables, a new score predicting vertical transmission of HEV was derived. Using these significant predictors, the probability for vertical transmission of HEV was well stratified in the validation group (P>.05). In conclusion, viral load was associated with vertical transmission of HEV infection. A valid prediction score model was generated that was verified in a validation cohort group.

Favourable Prognosis when Lung-Cancer Patients with Superior Vena Cava Obstruction (SVCO) are Referred Promptly to EBUS-TBNA Prior to Medical or Surgical Management

BACKGROUND

Primary care patients with superior vena cava obstruction (SVCO) syndrome are usually referred to emergency departments for urgent medical management (high-dose corticosteroids to reduce inflammation), pre-biopsy radiotherapy and/or stent placements to restore patency to the vessel. Biopsy, diagnosis and staging of the mediastinal mass is often postponed until resolution of SVCO symptoms. However, lung cancers metastasise rapidly and delays can influence the eventual outcome of patients. An additional merit in treating SVCO symptoms post-biopsy is that high-dose corticosteroids and pre-biopsy radiotherapy will degrade the quality of biopsy specimens, complicating diagnosis and subsequent management.

AIMS

To determine if direct referrals of SVCO patients from primary care to the respiratory department for Endobronchial ultrasound (EBUS)-transbronchial needle-aspiration (TBNA) resulted in better outcomes.

METHODS

Direct referrals to the respiratory department from primary care physicians were sought. A total of 8 patients with symptoms of SVCO were rapidly diagnosed via EBUS-TBNA and ROSE, radiotherapy and specific chemotherapy was initiated following communication with oncology colleagues. High-dose corticosteroids were administered post-EBUS.

RESULTS

Rapid resolution of symptoms for SVCO were noted, without need for surgical intervention. In particular, one patient with small-cell lung cancer (the most aggressive type of lung cancer) remains well and cancer-free 14 months from diagnosis.

DISCUSSION

EBUS-TBNA is a safe modality for biopsy in SVCO as there is no risk of further compression of the vessel. We need a paradigm shift in referral and a guideline of SVCO patients in primary care, an urgent biopsy is important in mediastinal cancers which have high metastatic potentials.

Trauma, resiliency and recovery in children: lessons from the field

War atrocities, natural disasters, community violence, physical abuse and catastrophic illnesses are many faces of trauma and are endemic and the children are the most vulnerable victims. Since 1994, this author has visited war zones and disaster areas 80 times in 18 different countries and has collected data on children's reactions across cultures. Most children around the world show similar responses to the exposure to traumatic experience. Sleep disturbance, nightmares, flashbacks and re-enactment of traumatic events are common. Most children recover from these symptoms in couple of weeks depending on the resiliency and vulnerability factors that they may or may not possess. This author also studied resiliency in children across cultures. In this presentation, the author will present the current understanding of PTSD including the role of amygdala, medial prefrontal cortex and hippocampus in symptom formation. Drawing from the lessons learned during his work with children around the world, the author will discuss the role of resiliency in recovery from trauma.

Genetic polymorphism of glutathione S transferases M1 and T1 in Indian patients with hepatocellular carcinoma

Objective: Our aim was to evaluate whether the association of GSTM1/T1 gene polymorphisms modifies the risk of Hepatocellular carcinoma (HCC) and what is its correlation with other predisposing risk factors like alcohol intake, cigarette smoking and hepatitis B and C infections.

Study design/setting: It was a case-control study, included 254 HCC cases compared with 525 hospital-based age and sex matched cases of chronic liver disease without HCC as controls from Indian population. The GSTM1 and GSTT1 genotypes were detected using conventional multiplex PCR method.

Results: In this case-control study, we observed a positive correlation between age, HBV and HCV infection, smoking habit of > 20 packs/year, alcohol consumption of > 100 g/day and risk of liver cancer. We found significantly increased risk associated with GSTM1 null genotype (OR = 3.49; 95% CI = 2.52–4.84) as well as GSTT1 null genotype (OR = 3.12; 95% CI = 2.19–4.45), respectively. However, an increased risk of HCC was observed among heavy drinkers with GSTM1 (OR = 2.01; 95% CI = 1.11–3.66). Further, cigarette smoking showed a non-significant association with GSTT1 (OR = 1.49; CI = 0.69–3.25).

Conclusion: Our results suggest that the variants in low penetrance gene such as GSTM1 and GSTT1 are associated with an increased liver cancer risk. Further, an influence of GSTM1/T1 null genotypes may contribute in the etiology of HCC in patients with higher cigarette and alcohol consumption.

Hepatitis B virus BCP, Precore/core, X gene mutations/genotypes and the risk of hepatocellular carcinoma in India

The study aims to characterize mutations of the HBV genome involving BCP, Precore/core and X regions and also defines HBV genotypes in patients of hepatocellular carcinoma (HCC). The study involved 150 HBV-related HCC cases and 136 HBV-related chronic liver disease patients without HCC as controls. HBV DNA was subjected to mutational analysis using SSCP technique, genotyping by RFLP, and direct nucleotide sequencing. HBV DNA was found in 58.7% (88/150) of the HCC cases and 74.3% (101/136) of controls. HBV mutants were observed in 44.3% of HCC cases and 43.2% of controls. HBV/D was prevalent amongst the patients and controls, followed by HBV/A. The prevalence of the TT1504 mutation in the X gene, the V1753 and T1762/A1764 mutations in the BCP region, and G1914 mutation in the core gene were significantly higher in the HCC group than in the non-HCC group. Multivariate analyses showed that the TT1504, V1753, A1762T/G1764A, and the G1914 mutations and the patient's age, sex, and HBeAg status increased the risk of HCC development significantly. Also, patients with HCC had lower levels of serum albumin, viral load, and platelet counts but higher values of alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, and Alpha feto-protein than those of controls (P < 0.001 for all comparisons). HBV/D was the predominant genotype associated with HCC cases seen in India. The presence of different types of HBV mutations, age, sex, HBeAg status, and viral load was found to increase significantly the risk of HCC development in India.

Significance of anti-HBc screening of blood donors and its association with occult hepatitis B virus infection: Implications for blood transfusion

BACKGROUND & OBJECTIVES

Expansions of blood donor screening and improved laboratory detection of viral markers have remarkably reduced the risk for infection with transfusion-transmitted viruses. This study was aimed to evaluate the presence of anti-HBc and to determine the presence or absence of HBV DNA in the serum samples from HBsAg negative, anti-HBc positive blood donors in a tertiary care hospital blood bank from Delhi.

METHODS

A total of 2175 HBsAg negative, first time volunteer blood donors were included in the study from blood bank, Lok Nayak Hospital, New Delhi. The blood specimens from all these subjects were evaluated for anti-HBV-core antigen (anti-HBc) serology, anti-HBV-surface antigen (anti-HBs) titres and HBeAg. The presence of HBV DNA was evaluated by testing, through polymerase chain reaction (PCR) techniques.

RESULTS

Of the 2175 HBsAg negative voluntary blood donors, 413 (19.8%) were tested to be positive for anti-HBc alone. Of these, 153 (group-I) were anti-HBs negative whereas group-II comprises a total of 260 anti-HBs positive cases i.e. 89 out of 413 had anti-HBs titres of 10-99 IU/l and the remaining 171 had anti-HBs titres of 100-500 IU/l. HBV DNA was detected in 7.5 per cent anti-HBc positive samples irrespective of anti-HBs status.

INTERPRETATION & CONCLUSION

Our results showed that 18.9 per cent of our donor population was anti-HBc reactive, and hence inclusion of anti-HBc testing will lead to a high discard rate. The presence of HBV DNA in fairly high percentage of anti-HBc positive samples highlighted the need for a stringent and better screening system to prevent occult HBV infection.

Imaging of implants on chest radiographs: a radiological perspective

Endovascular and percutaneous techniques have emerged as alternatives to surgical management in the treatment for a wide range of congenital and acquired cardiac, non-vascular and vascular conditions. Consequently, there has been an increasing use of implants such as closure devices, vascular stents (coronary, aortic, pulmonary and superior vena cava) and non-vascular stents like oesophageal and tracheo-bronchial stents. A large number of percutaneously sited implants are used for treating congenital cardiac anomalies such as atrial septal defects (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA). These implants take many shapes and forms. The aim of this review is to demonstrate the radiographic appearances of the various types of cardiovascular, bronchial and oesophageal implants that are visible on plain films. A brief outline of the aims and indications of various implant procedures, the general appearance of the commonest types of implants, and the radiological procedures are discussed. All radiologists are likely to come across implanted devices in plain film reporting. Imaging can be useful in identifying the device, assessing the position, integrity, and for the identification of complications related directly to the implant.

Three new novel point mutations localized within and downstream of high-mobility group-box region in SRY gene in three Indian females with Turner syndrome

Point mutations and deletions in the SRY gene result in XY sex reversal in pure gonadal dysgenesis. To date, a majority of these affect the high-mobility group (HMG) domain of SRY, which plays a key role in its DNA binding activity. We carried out molecular genetics studies in three Turner syndrome patients all presenting with 45,X/46,XY mosaic karyotype. Case 1 demonstrated an insertion of T (thymine) within helix I of HMG box leading to frame shift mutation (N82X). In case 2, insertion of A (adenine) downstream of HMG box resulted in a nonsense frame shift mutation (L159fsX167). These mutations resulted in truncated and altered proteins. In case 3, G>C missense mutation is found at codon 74 within helix I of HMG box (Q74H). No other mutations were found in the SRY gene of these patients. An allele-specific oligonucleotide study further confirmed that these variants are not common polymorphisms. To our knowledge, this is the first time these mutations are described at these codons resulting in mutated SRY proteins. Lack of a second sex chromosome in a majority of cells [mosaic karyotype and mutation(s) in the SRY gene] in these patients may have triggered the short stature.

Two new novel point mutations localized upstream and downstream of the HMG box region of the SRY gene in three Indian 46,XY females with sex reversal and gonadal tumour formation

The Y chromosome-specific gene SRY is one of the key genes involved in human sex determination. The SRY gene encodes a testis-specific transcription factor that plays a key role in sexual differentiation and development in males and is located on the distal region of the short arm of the Y chromosome. Mutations in SRY gene result in XY sex reversal and pure gonadal dysgenesis. SRY expression initiates a network of gene activity that transforms the undifferentiated gonad, genital ridge into testis. Mutations in the SRY gene have been considered to account for only 10-15% of 46,XY gonadal dysgenesis cases, whereas the majority of the remaining cases may have mutation(s) in the SRY regulatory elements or other genes involved in the sex differentiation pathway. Patients both with gonadal dysgenesis and Y-chromosome presence are at high risk of developing gonadoblastoma. Using PCR, single strand conformational polymorphism (SSCP) and automated DNA sequencing, we analysed the mutations in the SRY gene in three 46,XY sex reversal patients. Two patients demonstrated nucleotide substitution (A-->G) within the open reading frame just outside and upstream of the conserved DNA-binding motif called the high-mobility group (HMG) box, replacing glutamine at codon 57 with arginine. Altered SSCP patterns were also observed in these patients. Histological examination of gonads in patient 1 revealed the formation of gonadoblastoma. Patient 3 demonstrated A-->T substitution which replaces serine at codon 143 with cysteine, just outside but downstream of the HMG box. Results suggest the involvement of SRY gene in sex reversal which further supports the relationship between SRY alterations, gonadal dysgenesis and/or primary infertility.

Promoter hypermethylation of MGMT, CDH1, RAR-beta and SYK tumour suppressor genes in granulosa cell tumours (GCTs) of ovarian origin

Ovarian carcinoma (OC) is a leading cause of death among women throughout the world. A number of cancer-associated genes have been shown to be inactivated by hypermethylation of CpG islands during tumorigenesis. We tested the hypothesis that methylation status of MGMT, CDH1, RAR-β and SYK could be important in the ovarian tumorigenic process and can lead to the gene(s) inactivation. Therefore, we assessed the promoter hypermethylation of MGMT, CDH1, RAR-β and SYK in 43 ovarian granulosa cell tumours (GCTs) (adult type) using methylation-specific PCR. These tumours are relatively rare, accounting for approximately 3% of all ovarian cancers. Hypermethylation of MGMT (in 14 tumours), CDH1 (in nine tumours), RAR-β (in eight tumours) and SYK (in seven tumours) have been found. Selective loss of RAR-β and RAR-β2 mRNA has been found in seven patients, while that of MGMT and SYK in three patients who also show aberrant methylation in promoter region of RAR-β in addition to MGMT, SYK and CDH1 genes. Promoter CpG hypermethylation may be an alternative to mutation(s) to inactivate tumour suppressor genes such as MGMT, CDH1, RAR-β and SYK, and this can also be an early event in the pathogenesis of OCs. Moreover, hypermethylation of the MGMT and CDH1, MGMT and RAR-β and CDH1 and RAR-β promoters occurred concordantly (P< 0.001, 0.0421 and 0.0005 respectively; Fischer's exact test). In addition to this, monosomy 22 and trisomy 14 have also been found in 10 tumours. It is clear from the results that hypermethylation of the promoter region of these tumour suppressor genes, monosomy 22 and trisomy 14, may be critical steps in the tumorigenesis, which consequently play a permissive role for tumour aggressiveness. All these events might play an important role in the early clinical diagnosis of the disease. Our results, therefore, suggest a potential role for epigenetic modification of these critical tumour suppressor genes in pathways relevant to the transformation and differentiation of rare type of ovarian cancer (GCTs).

Antituberculosis drug-induced hepatitis: risk factors, prevention and management

Apart from infectious or viral hepatitis, other most common non-infectious causes of hepatitis are alcohol, cholestatic, drugs and toxic materials. The most common mode that leads to liver injuries is antituberculosis drug-induced hepatitis. The severity of drug-induced liver injury varies from minor nonspecific changes in hepatic structure to fulminant hepatic failure, cirrhosis and liver cancer. Patients receiving antitubercular drug frequently develop acute or chronic hepatitis. The time required for the metabolites to reach hepatotoxic levels is much earlier with isoniazid plus rifampicin treatment than isoniazid alone and this has been shown to be synergistic rather than additive. Antituberculosis drug (ATT)-inducible cytochrome P-4502E1 (CYP2E1) is constitutively expressed in the liver. Recent studies show that polymorphism of the N-acetyltransferase 2 (NAT2) genes and glutathione-S-transferase (GST) are the major susceptibility risk factors for ATT-induced hepatitis. The hepatic NAT and GST are involved in the metabolism of several carcinogenic arylamines and drugs. The NAT2 enzyme has a genetic polymorphism in human. N-acetyltransferase 2 genes (NAT2) have been identified to be responsible for genetic polymorphism of slow and rapid acetylation in humans. Slow acetylators of NAT2 prove to develop more severe hepatotoxicity than rapid acetylators making it a significant risk factor. Deficiency of GST activity, because of homozygous null mutations at GSTM1 and GSTT1 loci, may modulate susceptibility to drug and xenobiotic-induced hepatotoxicity. Polymorphisms at GSTM1, GSTT1 and NAT2 loci had been linked to various forms of liver injury, including hepatocellular carcinoma.

Moalejat-e-hindi: a compilation of ăyurvĕdic formulations tested by Nizam--III of Hyderabad

This Indian Institute of History of Medicine possesses more than 100 medical manuscripts (paper) in Arabic, Persian and Urdu languages. One of the rare manuscripts is known as "Moalejat-e-Hindi", its specialty is that it is on ăyurvĕda in Persian. It contains shlokas in transliterated form. It contains three sections. It has been compiled by the order of Nizam-III of Hyderabad.

Ayurvedic literature in Urdu part-III

The present article is the continuation of the second part of the previous work published with the same title in the Bulletin of Indian Institute of History of medicine, Vol. XXIX. No. 2 in 1999. This work has ben initiated to introduce the books written in recent past, the period in which Urdu language had a prominent role in preserving the knowledge of old arts and sciences.

Children's trauma and adjustment reactions to violent and nonviolent war experiences

OBJECTIVE

According to most studies, more than half of children exposed to war meet criteria for posttraumatic stress disorder (PTSD). Although we know that children are adversely affected by atrocities of war, we do not know which specific war events are associated with children's stress reactions. For example, it is unclear whether differences exist in response to violent versus nonviolent war-trauma experiences. This study examined the relationship of violent and nonviolent war experiences to children's trauma reactions and adjustment in a group of children from Bosnia.

METHOD

During the 1994 siege in Sarajevo, 791 children aged 6 to 16 years participated in a study of trauma experience and response, in which assessment questionnaires (Impact of Event Scale, PTSD Reaction Index, Children's Depression Inventory, Child Behavior Checklist, and War Experience Questionnaire) were completed by children and their teachers.

RESULTS

In this sample 41% had clinically significant PTSD symptoms. Children were adversely affected by exposure to both violent and nonviolent war-traumas. An additive effect of trauma exposure on trauma reactions was also found. However, many war experiences were not associated with children's adjustment and trauma reactions.

CONCLUSIONS

Additive effects of violence and deprivations during war may overwhelm the coping skills of children and leave them vulnerable to externalizing and internalizing adjustment difficulties and symptoms of PTSD.

Lessor known ayurvedic physicians from an Urdu book Rumoozul Atibba: part II

Rumoozul Atibba, a rare Urdu book compiled by Hakim Fairozuddin is in two Volumes. It is published by Darul Kutub Rafiqul Atibba, printed in "Rifah-e-Aam press in 1913 at Lahore which contains short biographies of Ayurvedic and Unani physicians. It has been compiled to disclose the tested formulae hidden in the minds of eminent scholars of Ayurveda and Unani with their life sketches. The selection of this work has been aimed to enlight the Ayurvedic History prevailed in different languages. Twenty biographies of Ayurvedic Physicians were in first volume of 'Rumuzul Atibba', which were published prior to this article (Bulletin of Indian Institute of History of Medicine. Vol XXVI (1996). This article contains only three biographies of Ayurvedic physicians.

Abul Fatah - a commentator of "Al-Qanoon"

The Commentator of "Al-Qanoon" (Canon of Avicenna) Abul Fatah known as "Maseehuddin" also was a native of Gilan. He migrated to India during Akbar's period (1556-1605 A.D.). The emperor honoured him by confering Sadarat of Delhi, Malwa and Gujarat and bestowed upon him the title of Hasht Sadi. His commentary on the Canon is known as "Fatahi", in which he explained various problems elaborately. He was well versed in anatomy and connoisseur of Prose and Poetry. He had made a good change in Huble-Buble and he was the first who had made the inhailing of smoke less harmful. He died on 20th June, 1580 A.D.

Moalejat-E-Hindi

It is an introductory note on a rare and important medical manuscript, which were compiled in Persian language by the order of the 3rd Nizam of Hyderabad. It contains a number of Ayurvedic formulations, found very effective by him. These preparations were prepared and preserved by the Nizam in his royal store-house. The Sanskrit shiokas found in it are in transliterated form, written in beautiful script.

Status of chromosome breaks and gaps in breast cancer. a follow-up study

Genetic susceptibility and environmental factors are believed to be responsible for chromosomal instabilities and higher incidence of breast cancer. We conducted a follow-up study to find the levels of chromosome breaks and gaps in 20 premenopausal women with breast cancer before surgery, 1 month after surgery, and 3 years after surgery with respect to 20 age- and gender-matched controls. The mean level of chromosome breaks and gaps was found to be significantly higher (P<0.001) in breast cancer patients (before surgery) as compared with the controls. The chromosome breaks and gaps after 1 month of surgery were observed significantly decreased (P<0.005) when compared with that of patients before the surgery. Further significant increase in chromosome breaks and gaps was found after 3 years of surgery as compared with both the patients after 1 month of surgery (P<0.05) and controls (P<0.005). The significant increase in chromosome breaks and gaps in breast cancer patients (before surgery) may be due to the effects of genetic susceptibility to environmental carcinogens and endogenous factors. However, the decrease in this level after 1 month of surgery may be due to the removal of cancerous tissues, which in turn removes the effect of mutagens and clastogenic factors. Further increase in chromosome breaks and gaps after 3 years of surgery may be due to the long-term effects of therapeutic agents and genetic susceptibility to environmental carcinogens in the patients. The study furthermore suggests that the high level of chromosome breaks and gaps after 3 years of surgery may be a risk factor for the development of secondary tumor in patients.

Effect of nitric oxide and malondialdehyde on sister-chromatid exchanges in breast cancer

Nitric oxide (NO) and malondialdehyde (MDA) play a significant role in DNA damage, sister-chromatid exchanges (SCEs) and carcinogenesis. Here, we determine plasma NO and MDA to evaluate their role in carcinogenesis and their effect on the frequency of SCEs in 45 female breast cancer patients and in 35 age- and sex-matched controls. Plasma NO (P<0.01) and MDA (P<0.001) was significantly higher in the breast cancer group, and a direct correlation were found between plasma NO and MDA concentration and tumour grade. Patients with stage II disease showed the highest levels of both NO and MDA, compared with controls. Simultaneously, SCE frequency per lymphocyte in the breast cancer group was found to be significantly (P<0.001) higher; the greatest increase being found in patients with stage IV disease. Positive correlation was found between SCEs and both NO and MDA in the breast cancer group; however, both NO and MDA production decreased with increasing severity of the disease. Lower NO production in stage IV disease may be due to lower expression of nitric oxide synthase (NOS), further facilitating the production of superoxide anions (O2*-). The reaction between NO and O2*- results in peroxynitrite (OONO-) formation, which works efficiently at the molecular level and may induce higher SCE frequency. This work suggests that further cytogenetic and molecular study is required to provide definite answers for the therapeutic use of NO in breast cancer.

Role of lipids, lipoproteins and vitamins in women with breast cancer

OBJECTIVES

Improper balance between the production of reactive oxygen metabolites (ROMs), and antioxidative defense system have been defined as oxidative stress in various pathologic conditions. Lipids, lipoproteins and antioxidative vitamins have been associated with the risk of breast cancer. The present case-control study was conducted to investigate the status of antioxidative vitamins (A, C and E), lipids (total cholesterol; TC and triglycerides; TG), lipoproteins (high-density lipoprotein cholesterol; HDL-C and low-density lipoprotein cholesterol; LDL-C) and retinol-binding protein (RBP) in breast cancer patients. The aim of the study was to find out oxidative stress in breast cancer.

DESIGN AND METHODS

Plasma lipids, lipoproteins and vitamins were estimated in 54 untreated breast cancer patients of different clinical stages and in 42 age- and sex-matched controls.

RESULTS

Plasma TC (p < 0.05), and LDL-C and TG (p < 0.01) were found to be significantly elevated among breast cancer patients as compared to the controls. On the other hand, plasma HDL-C concentration (p < 0.001) and vitamin C and E (p < 0.01) were observed significantly decreased in breast cancer patients than in the controls. The maximum changes in plasma TC, and vitamin C and E concentrations were observed in breast cancer patients with stage IV when compared with controls.

CONCLUSION

The study suggests that higher levels of TC and TG may play important role in carcinogenesis. Furthermore, the elevated plasma LDL-C concentration, which is more susceptible to oxidation, may result in higher lipid peroxidation in breast cancer patients. However, decreased concentrations of HDL-C and vitamin C and E are not likely to be sufficient enough to counter higher ROMs production reported earlier in breast cancer patients that may cause oxidative stress leading to cellular and molecular damage thereby resulting in cell proliferation and malignant conversions.

Translation of the twelfth chapter of "Uyoonul Anba Fi Tabaqatil Atibba"

This is a translation of an Arabic book "Uyoonul Anba Fi Tabaqatil Atibba" compiled by Ibn-e-Abi Useibia, the famous writer of Abbaside's period of Baghdad in 13th century A.D. This book is in two volumes comprising of 15 chapters dealing with 388 biographies of world known physicians. Looking into the authenticity and importance of this work, the translation of its 12th chapter which is on Indian physicians is being submitted here in this article form. This portion provides information with regard to the Indian physicians, the way of their approach to Baghdad, their miraculous treatments and the literary works etc.

Alauddin Qarshi: a commentator of many classical treatises

This article deals with the life and work of a commentator of six authentic works. He was a discoverer of pulmonary circulation of blood. He described it more or less accurately, almost three centuries before Harvey (1578-1657). The views of medical historians about this scholar have been given in this article.

Lipid peroxidation, free radical production and antioxidant status in breast cancer

Reactive oxygen metabolites (ROMs), including superoxide anion (O2*-), hydrogen peroxide (H2O2) and hydroxyl radical (*OH), play an important role in carcinogenesis. There are some primary antioxidants such as superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) which protect against cellular and molecular damage caused by the ROMs. We conducted the present study to determine the rate of O2*- and H2O2 production, and concentration of malondialdehyde (MDA), as an index of lipid peroxidation, along with the SOD, GPx and CAT activities in 54 breast cancer (BC) patients. Forty-two age- and sex-matched patients with minor surgical problems, who had no history of any neoplastic or breast disorders, were taken as controls. The rate of O2*- production was significantly higher (p < 0.001) in BC patients than controls, irrespective of clinical stages and menopausal status. Similarly, H2O2 production was significantly higher in BC patients, especially in stage III and postmenopausal groups, as compared to the respective controls. MDA concentration was also observed significantly elevated in stage II (p < 0.001), stage III (p < 0.01), postmenopausal (p < 0.005), and premenopausal (p < 0.02) group as compared to their corresponding controls. SOD and GPx activities were found significantly raised in all the groups (p < 0.001), except the GPx activity was found a smaller alteration in stage IV (p < 0.02). On the contrary, CAT activity was found significantly depressed in all the study groups. The maximum depression was observed in stage II (-61.8%). Lower CAT activity in our study may be the effect of higher production of ROMs, particularly O2*- and *OH. SOD and GPx, however, were less effected by these higher ROMs production. The results of our study have shown a higher ROMs production and decreased CAT activity, which support the oxidative stress hypothesis in carcinogenesis. The relatively higher SOD and GPx may be due to the response of increased ROMs production in the blood. However, the higher SOD and GPx activities may be inadequate to detoxify high levels of H2O2 into H2O leading to the formation of the most dangerous *OH radical followed by MDA. Therefore, administration of CAT may be helpful in the management of BC patients. However, further elaborate clinical studies are required to evaluate the role of such antioxidant enzymes in BC management.

Ayurveda during Abbasid's period

This is a historical paper which deals with a brief account of Abbasid's period. In this article the existence of Ayurveda in Arab countries, arrival of Ayurvedic physicians to Baghdad, their eminence, authenticity and literary additions in medical field has been studied and presented.

Ayurvedic literature in Urdu (Part-II)

This article is a second part of previous work published with the same title in this Bulletin Vol. 28, 1998, P. nos. 151-158. It contains brief notes on six rare Ayurvedic books in Urdu. It provides two types of information, i.e. (i) Introduction to the books studied and (2) Literary history of Ayurveda of that period in which Urdu language had a prominent role in propagation of Arts and Science. It gives an idea for seeking information on these lines regarding the Ayurvedic works in Arabic and Persian also.

Stress reactions of children and adolescents in war and siege conditions

OBJECTIVE

This was a study of posttraumatic stress symptoms in children and adolescents during siege conditions in Sarajevo.

METHOD

Seven hundred ninety-one students aged 7-15 years were surveyed to assess symptoms of posttraumatic stress and level of deprivation.

RESULTS

Girls reported more stress than boys. Loss of family members and deprivation of basic needs were associated with more symptoms.

CONCLUSIONS

Personal experiences of siege are related to increased stress.

Ayurvedic literature in Urdu

Urdu is a distinct literary language began to develop in India during Mughal empire. Lots of people read, write and speak, this language in Indian subcontinent. This brief article will shed light on the seven rare books in Urdu compiled and published in the period from 19th century to the first half of the current century. Some books may not have high value but the struggle of the scholars, is appreciable.

The clamshell incision provides adequate exposure for aortic valve replacement and coronary revascularization

The standard median sternotomy provides ready access to all surfaces of the heart and the ascending aorta. When cosmetic considerations, associated medical conditions, such as an esophageal stoma, or tracheostomy preclude use of the median sternotomy, a bilateral transverse sternotomy will provide excellent exposure of the entire ascending aorta and the lateral and inferior walls of the heart.

A rare report of Nizam Ayurvedic Mobile Clinic

This article is a brief account of a rare Urdu booklet entitled 'Report Nizam Ayurvedic Safari Dawakhana'. It is a report of a mobile clinic sent by Nizam VII of Hyderabad to Kumbh Mela at Allahabad on a religious occasion in the year 1942, which was printed in the same year. This report sheds light on the history of the sacred place Prayag, its importance and the activities of the mobile clinic with the remarks of eminent personalities who visited the clinic on the occasion.

Hakeem Ali Gilani: a commentator of canon of Avicenna

Hakim Ali Gilani was a native of Gilan. He was a distinguished physician and medical writer. He wrote commentary on canon of Avicenna. He came to India during Akbar's time and served two Mughal rulers, Akbar and Jahangir. He was praised very much by the medical historians for his vast knowledge, curiosity and intelligence. A brief account of his achievements has been given in this article.

Lesser known Ayurvedic physicians of India from an Urdu book- "Rumoozul Atibba"

In early 20th century some Urdu scholars tried to enrich urdu literature with medical history. They started compiling and publishing the biographies of the contemporary physicians along with their achievements. One of such works "Rumoozul Atibba" a rare book compiled by Hakim Fairozuddin in Urdu, published by 'Darul Kutub Rafiqul Atibba' and printed in 'Rifah-e-Aam Press' at Lahore in the year 1913 A.D. has been taken here. It contains about 150 short biographies of Ayurvedic and Unani physicians, out of which all the twenty biographies of Ayurvedic physicians given in it, have been presented in this article.

Sister chromatid exchange (SCE) studies in breast cancer patients: a follow-up study

Sister chromatid exchanges (SCEs) were studied in 20 patients with breast cancer (stage II) before surgery, one month after surgery, and after three years as a follow-up study. Data from 50 age-matched, normal healthy females, preferably from the affected families, served as controls. In each patient, 50 well-spread metaphases were scored for SCEs. The mean values of SCEs per metaphase were 5.80, 4.69, and 5.98 in breast cancer patients before surgery, one month after surgery, and after a gap of three years as a follow-up, respectively. The one-way analysis of variance was applied and it was found that there was a highly significant difference in the frequency of sister chromatid exchanges in these patients before surgery, one month after surgical removal of cancerous tissue, and after three years as a follow-up study. The elevated level of SCEs three years after surgical removal of cancerous tissue predict the chances of development of another type of cancer.

Sister chromatid exchange frequency in breast cancer cases

Sister chromatid exchange (SCE) were studied in 22 patients with breast cancer (i.e., four stage II; 12 stage III, six stage IV) and 10 normal healthy females as age-matched controls. The data obtained in these cases followed a Poisson distribution. An apparent increase in the average rate of SCE/cell was observed with the advancing stage of breast cancer.

Chromatid association in acrocentric chromosomes of abnormal sexual development (ASD) cases

Concordant/discordant associations at chromatid level were compared and found significant (P less than 0.05) in females with primary amenorrhea. This probably suggested that the acrocentric association pattern in this group of ASD and infertility did not follow a random segregation in subsequent cell divisions and that the concordant acrocentric chromosomes have regularly established physical connections with one another, held together for several cell cycles. It could only be speculated that the association of acrocentric chromosome anomalies in some females with abnormal sex chromosomes are due to this reason. In the event that chromosome association has a bearing on chromosome aberrations, the non-random pattern of acrocentric association probably would increase the choice for translocation and non disjunction in the somatic cells in females with primary amenorrhea during ontogenesis.

Frequency of acrocentric association in abnormal sexual development in males and females

A significant difference (P less than 0.05) was observed in a chi 2 comparison of DD, GG and DG-DI associations between male hypogonads and females with primary amenorrhea. This difference increased still further (P less than 0.01) when only DD and GG associations were compared between males and females with abnormal sexual development (ASD). Similarly, when normal males and females were compared for DI, TRI, TETRA, DD vs GG and DG vs GG acrocentric chromosome associations, a significant difference (P less than 0.05) was again observed. The sex difference was also apparent in TRI and TETRA acrocentric associations both in abnormal and normal sexual development males and females. These results suggested that probably sex difference (may be hormonal) influences the number and/or type of acrocentric chromosomes involved in association between males and females with ASD and also between normal males and females.

Sister-chromatid exchange (SCE) rate in normal and abnormal sexual development in males and females

Thirty-three patients with abnormal sexual development (9 male hypogonads, 20 females with primary amenorrhea and 4 cases of ambiguous genitalia), 10 normal males and 8 normal females (below the age of 30 years) were evaluated for SCE/cell and for SCE distribution according to chromosome groups (A to G). Smokers and alcoholics and subjects under medication were excluded from the study. The average rates of SCE/cell in male hypogonads, primary amenorrhea and ambiguous genitalia were 4.23 +/- 1.51, 4.02 +/- 0.90 and 4.33 +/- 1.34, respectively, whereas in normal males and females the average rates were 4.27 +/- 0.69 and 4.49 +/- 0.87, respectively. The SCE data followed a Poisson distribution. Chi-square testing showed a statistically significant difference only in B-group chromosomes when male hypogonads were compared with normal males (p less than 0.02) and females with primary amenorrhea were compared with normal females (p less than 0.02), suggesting the importance of the study of SCE frequency distribution at chromosome group level to bring out the differences otherwise concealed in average rates.

Cerebellar ataxia and total albinism

In this report a family is described where cerebellar ataxia occurred along with total albinism. A possibility of syntenic condition of the two genes responsible for the traits could explain the occurrence of the two conditions. The presence of two traits singly in the sibs reflects a recombinant event and suggests that the linkage is not absolute. Chromosomal study did not show any structural or numerical anomalies except in 1/50 metaphase plates scored in the proband (with cerebellar ataxia) where in chromosome No. 14 proximal intense band (21) seemed to be shifted, inv. (14) (q13q23?). The affected sibs with ataxia and albinism or ataxia alone depicted relatively a lower sister chromatid exchange (SCE) rate than their parents and age matched controls.

Differences between midlife female offenders and those younger than 40

The authors studied 66 women referred for forensic evaluation and classified them into two age groups: 48 women 17-39 years old composed a young adult group and 18 women 40-54 years old composed a midlife group. The midlife group included a significantly larger number of first-time offenders with a higher frequency of medical as well as psychiatric disorders. None of the women in the midlife group was diagnosed as having antisocial personality disorder, but this was the most common diagnosis among the younger women. The authors note the implications of these findings for treatment of older female offenders, especially those in midlife.