Comparison of outpatient visits and hospitalisations, in patients with chronic obstructive pulmonary disease, before and after influenza vaccination

OBJECTIVE

To determine the effectiveness of influenza vaccination on acute respiratory illness (ARI) and on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) during a 2-year study conducted prior to and after influenza vaccination in patients with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

Eighty-seven male patients with COPD were stratified on the basis of their forced expiratory volume in 1 s (FEV(1)) as having mild, moderate and severe COPD. These patients were evaluated for a total duration of 2 years; 1 year prior to vaccination and for a period of 1 year following influenza vaccination. The vaccine (split virion, inactivated) composed of A/New Caledonia/20/99 (H1N1); A/California/7/2004(H3N2) and B/Shanghai/361/2002 strains all with 15 mug of haemagglutinin in each 0.5 ml dose.

MEASUREMENTS

The number of episodes and severity of ARI and AECOPD, classified as outpatient treatment, hospitalisation and requirement of mechanical ventilation, for a period of 1 year before and 1 year after influenza vaccination were recorded.

RESULTS

The incidence of ARI and AECOPD was 28.6 per 100 person-years prior to vaccination and 9.7 per 100 person-years postvaccination [relative risk (RR) 0.33; p = 0.005). Among the exacerbations because of natural infections prior to vaccination the incidences were 16.12, 42.1 and 33.14 per 100 person-years in the patients with mild, moderate and severe COPD respectively. These were significantly lower following vaccination with the incidences being 6.5, 18.5 and 8.42 per 100 person-years in the same subgroup of patients. Vaccine effectiveness in patients with mild COPD was 60% RR, 0.4 (p = 0.26); in patients with moderate COPD was 60% RR, 0.4 (p = 0.56); and in patients with severe COPD was 75% RR, 0.25 (p = 0.02). The total number of outpatient visits and hospitalisations before vaccination was eight and 14, respectively for a duration of 1 year in the total 87 patients with COPD being studied which decreased significantly to four outpatient visits and four hospitalisations postvaccination (p = 0.02). The overall effectiveness of influenza vaccination was 67%.

CONCLUSIONS

Influenza vaccination is highly effective in the prevention of ARI. Maximum protection was found to be in patients with severe COPD. Influenza vaccination in patients is associated with fewer outpatient visits and fewer hospitalisations.

Molecular regulation of gonadotropin receptor expression: relationship to sterol metabolism

We have identified a specific LHR mRNA binding protein that selectively binds to the polypyrimidine-rich bipartite sequence in the coding region of the LHR mRNA and accelerates its degradation. This process has been shown to be one of the mechanisms that is responsible for the loss of the steady-state levels of LHR mRNA following the preovulatory LH surge or the down regulation of the receptor in response to the administration of a pharmacological dose of LH or hCG. The trans factor, designated as the LHR mRNA binding protein (LRBP), was purified and its identity was established as being mevalonate kinase, an enzyme involved in cholesterol biosynthesis. When mevalonate kinase expression was abolished by treating cultured luteal cells with 25-hydroxycholesterol, the ability to undergo LH-induced down regulation of LHR mRNA was completely abrogated. Examination of the crystal structure of mevalonate kinase coupled with mutagenesis of the critical residues in the catalytic site revealed that the catalytic site is in close proximity to the LHR mRNA binding site. Further studies revealed that mevalonate kinase causes LHR mRNA degradation by acting as a translational suppressor by forming an untranslatable ribonucleoprotein (RNP) complex which is then targeted for degradation. These studies show that LHR expression in the ovary is regulated by a post-transcriptional mechanism mediated by mevalonate kinase thereby linking LHR expression with cholesterol metabolism.

Multimodal CT Imaging: Time to Treatment and Outcomes in the IMS III Trial

BACKGROUND AND PURPOSE

The importance of time in acute stroke is well-established. Using the Interventional Management of Stroke III trial data, we explored the effect of multimodal imaging (CT perfusion and/or CT angiography) versus noncontrast CT alone on time to treatment and outcomes.

MATERIALS AND METHODS

We examined 3 groups: 1) subjects with baseline CTP and CTA (CTP+CTA), 2) subjects with baseline CTA without CTP (CTA), and 3) subjects with noncontrast head CT alone. The demographics, treatment time intervals, and clinical outcomes in these groups were studied.

RESULTS

Of 656 subjects enrolled in the Interventional Management of Stroke III trial, 90 (13.7%) received CTP and CTA, 216 (32.9%) received CTA (without CTP), and 342 (52.1%) received NCCT alone. Median times for the CTP+CTA, CTA, and NCCT groups were as follows: stroke onset to IV tPA (120.5 versus 117.5 versus 120 minutes; P = .5762), IV tPA to groin puncture (77.5 versus 81 versus 91 minutes; P = .0043), groin puncture to endovascular therapy start (30 versus 38 versus 44 minutes; P = .0001), and endovascular therapy start to end (63 versus 46 versus 74 minutes; P < .0001). Compared with NCCT, the CTA group had better outcomes in the endovascular arm (OR, 2.12; 95% CI, 1.36-3.31; adjusted for age, NIHSS score, and time from onset to IV tPA). The CTP+CTA group did not have better outcomes compared with the NCCT group.

CONCLUSIONS

Use of CTA with or without CTP did not delay IV tPA or endovascular therapy compared with NCCT in the Interventional Management of Stroke III trial.

Combined pulmonary fibrosis and emphysema in a welder

Combined pulmonary fibrosis and emphysema (CPFE) syndrome is an uncommon entity characterised by emphysema of the upper lobes and diffuse fibrosis of the lower lobes and carries a bad prognosis with the onset of pulmonary hypertension. Lung involvement due to exposures suffered by welders is generally considered benign though, rarely, a diffuse interstitial fibrotic disease has been reported. CPFE syndrome has however never been reported in welders. A 65-year-old man, welder by occupation and an ex-smoker, presented with progressive exertional dyspnoea associated with dry cough noticed for the last four months. On examination, there was mild tachypnea, clubbing and bilateral basal velcro crepitations on chest auscultation. Lung function test revealed mild mixed ventilatory impairment with severe diffusion defect. HRCT chest showed bilateral upper lobe emphysema and diffuse interstitial fibrosis in the lower lobes. Transbronchial lung biopsy revealed interstitial fibrosis, chronic inflammation and iron deposits. A diagnosis of combined pulmonary fibrosis with emphysema (CPFE) with interstitial pulmonary siderofibrosis (IPS) was established. A review of literature did not show any other report of a similar nature.

India's first successful intestinal transplant: the road traveled and the lessons learnt

Intestinal transplant is a therapeutic challenge not just surgically but also logistically because of the multidisciplinary expertise and resources required. A large proportion of patients who undergo massive bowel resection and develop intestinal failure have poor outcome, because of inability to sustain long-term parenteral nutrition and limited availability of intestinal and multi-visceral transplantation facilities. We report the first successful isolated intestinal transplant from India.

Neuropharmacological studies of ethanolic extract of Vaccinium corymbosum on Alzheimer’s type dementia and catatonia in Swiss albino mice

Introduction: Neuroactive herbal drugs enriched with antioxidants are valuable in treating neurocognitive dysfunction and Vaccinium corymbosum, enriched with antioxidant phytochemicals, is used for treating memory disorders. Hence, the present study evaluated the neuroprotective effects of ethanolic extract of Vaccinium corymbosum (EEVC) on aluminium chloride(AlCl3)-induced Alzheimer’s type of dementia and haloperidol-induced catalepsy-associated behavioural changes. Methods:In vitro antioxidant potential was evaluated using 1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS). The total phenolic content (TPC) was quantified. For in vivo studies, AlCl3 (100 mg/kg) was orally administered for 42 days, whereas the EEVC was administered on the 21st day until the 42nd day in two doses (200 mg/kg and 400 mg/kg). In the haloperidol-induced group, EEVC was treated for 21 days, and haloperidol (1 mg/kg) was administered to induce behavioural changes. Open-field, Y-Maze and traction tests were performed, and the mice brain acetylcholinesterase (AChE) enzyme was determined. Results: IC50 values in DPPH and ABTS assays were 85.5 μg/mL and 80 μg/mL, respectively and the total phenolic content of EEVC was found to be 0.166 mg. In a behavioral study, animals treated with 200 mg/kg and 400 mg/kg of EEVC exhibited a neuroprotective impact on AlCl3-induced neurodegeneration and haloperidol-induced behavioral changes with significant inhibition (P < 0.05 and P < 0.01, respectively) in acetylcholinesterase enzyme. Conclusion: The neuroprotection by EEVC postulated that it is a promising therapeutic agent for treating behavioral and cognitive dysfunctions. Further investigations on pro-inflammatory cytokine and neuroendocrine regulation in transgenic Alzheimer’s disease (AD)models complement the therapeutic value of V. corymbosum.

Modulation of alpha1beta1 integrin mediated adhesion of hepatocytes to collagen IV and laminin by divalent cations

Cell matrix interactions play a critical role in hepatic development and regeneration after acute injury. These interactions are mediated by transmembrane receptors belonging mainly to the integrin family. We have tried to assess the role of divalent cations in mediating attachment of hepatocytes to matrix proteins like collagen IV (Col IV) and laminin (Ln). The three cations examined viz. Ca2+, Mg2+ and Mn2+ showed attachment promoting activity. Since alpha1beta1 integrin is a common receptor for col IV and LN in liver, the effect of cations in its binding to these matrix proteins was studied. Although cations in general enhanced the binding, different cations exhibited differential effect in promoting the binding for different ligands. Mg2+ ions were more effective in promoting the binding of alpha1beta1 integrin to col IV but Ca2+ proved to be more effective one for Ln. Kinetic analysis of binding in dot blot assays using different concentrations of cations showed that while Mg2+ was active at low concentrations Ca2+ and Mn2+ promoted the binding more at higher concentrations. Absence of competitive effect in binding studies showed that they bind at different sites on the receptor. Differential effects of cations in promoting the binding of alpha1beta1 integrin to Col IV and Ln suggest that changes in level of diffusible cations can modulate affinity of the common receptor alpha1beta1 integrin to its ligands and can influence adhesion of hepatic cells to different matrix proteins during hepatic development and regeneration.

Hypoglycemic hemiparesis as stroke mimic with transient splenial lesion and internal capsule involvement: A reversible clinico-radiological concurrence

Hypoglycemia presents with a spectrum of neurological manifestations ranging from lightheadedness to confusion and coma. We report here the case of a 61-year-old woman with right hemiparesis presenting within the window period for stroke thrombolysis. MRI brain showed diffusion restriction in posterior limb of left internal capsule and splenium. Patient had documented hypoglycemia of 38 mg/dL. Patient's hemiparesis resolved after glucose correction, and radiological findings completely resolved after 10 days. We present this case to highlight the rare radiological finding of simultaneous internal capsule and splenium involvement in hypoglycemic hemiparesis and the importance to rule out stroke mimics to avoid unwanted thrombolysis.

Actin binds to the cytoplasmic tail of alpha 1 subunit of integrin in hepatocytes

alpha 1 beta 1-Integrin is a common receptor for laminin and collagen IV on hepatocytes. The interactions of intracellular domain of integrins with cytoplasmic elements are critical in the initiation and transduction of signals. In order to understand the nature of cytoplasmic components that can interact with cytoplasmic domain of alpha 1 integrin, cytoplasmic extracts of monolayers of rat hepatocytes were subjected to chromatography over an affinity column prepared by coupling a 60-mer synthetic cytoplasmic tail of alpha 1 subunit. SDS-PAGE analysis of the eluate showed the presence of a 47 kDa protein. Dot-Blot assay using radio-iodinated 47 kDa protein showed the binding of the protein to 60-mer C tail in a concentration dependent manner. Immunoblot analysis using specific antibodies showed that the 47 kDa protein is actin.

Effects of exogenous vitamin C on ethanol toxicity in rats

The effect of a mega dose of ascorbic acid (200 mg/100 g body wt.) on alcohol-induced toxicity in rats was evaluated. In rats administered alcohol and ascorbic acid, malondialdehyde (MDA), hydroperoxide and conjugated dienes decreased in comparison with that given alcohol alone. The reduced activities of scavenging enzymes, e.g. superoxide dismutase (SOD) and catalase, in ethanol-administered rats were also enhanced by the co-administration of ascorbic acid and ethanol. Co-administration of ethanol and ascorbic acid reduced phospholipids and MDA levels of the erythrocyte membrane in comparison with that of the ethanol fed rats. The reduction in the activities of glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamaglutamyl transpeptidase (GGT) and the decrease in triglycerides levels also clearly showed the protective action of ascorbic acid in reducing ethanol induced toxicity.

Talc granulomatosis mimicking sarcoidosis

Pulmonary disease due to talc, a group of hydrous magnesium silicates, is almost exclusively encountered secondary to occupational exposure or intravenous drug abuse. Talcosis or talc pneumoconiosis is one of the rarer forms of silicate-induced lung disease. It is seen in workers exposed during its production, and occasionally, in users of cosmetic talc and in intravenous drug addicts. Very often, the history of exposure is not recognised by the patient, and it is only the finding of granulomatous cellular interstitial lesions containing birefringent crystals which indicates considerable talc exposure. We report a 38-year-old woman who was initially diagnosed with sarcoidosis, until a bronchoscopic biopsy revealed the presence of numerous foreign body giant cells and birefringent particles forming non-caseating granulomas. There was no history of occupational exposure to talc or intravenous drug abuse. The patient responded to oral corticosteroid treatment. Talcosis is generally considered to be relatively benign.

CT Perfusion Does Not Modify the Effect of Reperfusion in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment in the ESCAPE-NA1 Trial

BACKGROUND AND PURPOSE

Although reperfusion is associated with improved outcomes in patients with acute ischemic stroke undergoing endovascular treatment, many patients still do poorly. We investigated whether CTP modifies the effect of near-complete reperfusion on clinical outcomes, ie, whether poor clinical outcomes despite near-complete reperfusion can be partly or fully explained by CTP findings.

MATERIALS AND METHODS

Data are from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial. Admission CTP was processed using RAPID software, generating relative CBF and CBV volume maps at standard thresholds. CTP lesion volumes were compared in patients with-versus-without near-complete reperfusion. Associations between each CTP metric and clinical outcome (90-day mRS) were tested using multivariable logistic regression, adjusted for baseline imaging and clinical variables. Treatment-effect modification was assessed by introducing CTP lesion volume × reperfusion interaction terms in the models.

RESULTS

CTP lesion volumes and reperfusion status were available in 410/1105 patients. CTP lesion volumes were overall larger in patients without near-complete reperfusion, albeit not always statistically significant. Increased CBF <34%, CBV <34%, CBV <38%, and CBV <42% lesion volumes were associated with worse clinical outcome (ordinal mRS) at 90 days. CTP core lesion volumes did not modify the treatment effect of near-complete recanalization on clinical outcome.

CONCLUSIONS

CTP did not modify the effect of near-complete reperfusion on clinical outcomes. Thus, CTP cannot explain why some patients with near-complete reperfusion have poor clinical outcomes.