Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent Mortality in Rheumatoid Arthritis

OBJECTIVE

Morbidity and mortality in rheumatoid arthritis (RA) is partly mitigated by maintaining immune and hematologic homeostasis. Identification of those at risk is challenging. Red cell distribution width (RDW) and absolute lymphocyte count (ALC) associate with cardiovascular disease (CVD) and mortality in the general population, and with disease activity in RA. How these variables relate to inflammation and mortality in RA was investigated.

METHODS

In a retrospective single Veterans Affairs (VA) Rheumatology Clinic cohort of 327 patients with RA treated with methotrexate (MTX)+/- a tumor necrosis factor (TNF) inhibitor (TNFi), we evaluated RDW and ALC before and during therapy and in relation to subsequent mortality. Findings were validated in a national VA cohort (n = 13,914). In a subset of patients and controls, we evaluated inflammatory markers.

RESULTS

In the local cohort, high RDW and low ALC prior to MTX treatment was associated with subsequent mortality over 10 years (both P < 0.001). The highest mortality was observed in those with both high RDW and low ALC. This remained after adjusting for age and comorbidities and was validated in the national RA cohort. In the immunology cohort, soluble and cellular inflammatory markers were higher in patients with RA than in controls. ALC correlated with age, plasma TNF receptor II, natural killer HLA-DR mean fluorescence intensity, and CD4CM/CD8CM HLA-DR/CD38%, whereas RDW associated with age and ALC. MTX initiation was followed by an increase in RDW and a decrease in ALC. TNFi therapy added to MTX resulted in an increase in ALC.

CONCLUSION

RDW and ALC before disease-modifying antirheumatic drug therapy are associated with biomarkers of monocyte/macrophage inflammation and subsequent mortality. The mechanistic linkage between TNF signaling and lymphopenia found here warrants further investigation.

Use of remdesivir for COVID-19 pneumonia in patients with advanced kidney disease: A retrospective multicenter study

Background and objectives

Remdesivir, an antiviral drug routinely used in the treatment of COVID-19 has not yet received FDA approval for use in patients with advanced kidney disease defined as GFR < 30 mL/min/1.73 m². There is concern that an excipient in Veklury (Gilead's proprietary name for remdesivir) called sulfobutylether-beta-cyclodextrin (SBECD), which is renally cleared, may accumulate and reach toxic levels in patients with advanced kidney disease. The aim of this study was to summarize characteristics and incidence of adverse events of chronic kidney disease (CKD) patients who received remdesivir during hospitalization.Design, setting, participants, and measurements.We retrospectively studied patients admitted to one of several hospitals of the Mayo Clinic Foundation with the diagnosis of COVID-19 pneumonia and CKD. Laboratory values were also measured when remdesivir was first administered and stopped. All analyses were performed in the overall patient group and three separate subgroups of patients with a GFR ≥ 15, a GFR < 15 and dialysis, and a GFR < 15 and no dialysis.

Results

A total of 444 CKD patients who were admitted to the hospital with COVID-19 pneumonia between May 2020 and September 2021 were included. Information was collected on patient characteristics, hospitalization, and adverse events. In the overall cohort, median age was 72 years (Range: 21-100 years), 55.2 % of patients were male, and most (86.5 %) were Caucasian. CKD stage was 3 for 114 patients (25.7 %), 4 for 229 patients (51.6 %), and 5 for 101 patients (22.7 %). A total of 146 patients (32.9 %) were admitted to the ICU, 103 (23.2 %) died in the hospital, and 120 (27.0 %) were on dialysis. The proportion of patients with an adverse event did not differ dramatically between the GFR ≥ 15 (20.9 %), GFR < 15 and dialysis (30.2 %), and GFR < 15 and no dialysis (32.3 %) groups (P = 0.12).

Conclusion

Our results suggest that the use of remdesivir in patients with very severe CKD is safe, even in those who are not on renal replacement therapy.

Glucose-induced response on photosynthetic efficiency, ROS homeostasis, and antioxidative defense system in maintaining carbohydrate and ion metabolism in Indian mustard (Brassica juncea L.) under salt-mediated oxidative stress

In plants, glucose (Glc) acts as a crucial signaling molecule in mediating metabolism, growth, stress tolerance mechanism, etc. However, little is known about Glc supplementation in salinity tolerance. This experiment was designed to study the ameliorative effect of Glc in mustard under salt stress. The seeds were soaked in three concentrations of NaCl (0, 50, or 100 mM) for 8 h and then treated with four concentrations of Glc (0, 2, 4, or 8%) as foliar spray for 5 days at 25-day stage. The plants were harvested at three growth stages (30, 45, and 60) for examining morpho-physiological and proteomic studies. Glc application as foliar spray increases growth, photosynthesis, and antioxidative enzyme activities in NaCl-treated plants. Glc applied in plants also showed reduction in superoxide anion, hydrogen peroxide, and malondialdehyde content under salt stress. Amongst all doses of Glc, spray of 4% Glc proved best in alleviating the harmful effects of salinity.

Nanoparticles enhances the salinity toxicity tolerance in Linum usitatissimum L. by modulating the antioxidative enzymes, photosynthetic efficiency, redox status and cellular damage

The contribution of nanoparticles (NPs) in physiology of the plants became the new area of interest for the physiologists; as it is very much cost effective compared to the phytohormones. Our present investigation was also based on this interest in which the same doses (50 mg/L) of four different NPs were sprayed on stressed and non-stressed foliage. The experiment was conducted to assess the impact of four NPs viz., zinc oxide (ZnO), silicon dioxide (SiO₂), titanium dioxide (TiO₂), and ferric oxide (Fe₂O₃) on the morphology and physiology of linseed in the presence of sodium chloride (NaCl). Plants responded positively to all the treated NPs and improved the growth, carbon and nutrient assimilation, while salt stress increased the content of proline, hydrogen peroxide and superoxide anion. Application of NPs over the stressed plants further increased the antioxidant enzymatic system and other physiochemical reactions. Results indicate that application of NPs increased the growth and physiology of the plant and also increased the salt tolerance capacity of the plant.

Effect of sciatic nerve mobilisation on muscle flexibility among diabetic and non-diabetic sedentary individuals: a comparative study

The purpose of the present study was to compare the effect of sciatic nerve mobilisation on muscle flexibility among diabetic and non-diabetic sedentary individuals. The study was a pre-post experimental-group design. A sample of 40 sedentary subjects was assigned into two groups; Group A (diabetics: 10 males and 10 females) and Group B (non-diabetics: 10 males and 10 females). Both groups were tested for hamstring and calf flexibility following which sciatic nerve mobilisation was given to the most affected lower limb in terms of reduced hamstring and calf flexibility. Hamstring flexibility was checked by active knee extension test and calf flexibility was checked with the distance-to-wall technique using a tape measure. It was a two-week program in which subjects were given sciatic nerve mobilisation using sliders technique after which flexibility was checked. Three sessions per week were given for two weeks and muscle flexibility of hamstring and calf was measured after the intervention. The present study findings reveal that sciatic nerve mobilisation by sliders technique when given to diabetic and non-diabetic groups of sedentary individuals for two weeks, enhance patient outcomes in both the groups in terms of increase in hamstring and calf flexibility, but results were more significant in non-diabetic individuals as compared to diabetic individuals. In conclusion, sciatic nerve mobilisation resulted in an increase of muscle flexibility of hamstring and calf muscles in both groups.

Foliar spray of Auxin/IAA modulates photosynthesis, elemental composition, ROS localization and antioxidant machinery to promote growth of Brassica juncea

Auxins (Aux) are primary growth regulators that regulate almost every aspect of growth and development in plants. It plays a vital role in various plant processes besides controlling the key aspects of cell division, cell expansion, and cell differentiation. Considering the significance of Aux, and its potential applications, a study was conducted to observe the impact of indole acetic acid (IAA), a most active and abundant form of Aux on Brassica juncea plants growing under natural environmental conditions. Different concentrations (0, 10^-10, 10^-8, 10^-6 M) of IAA were applied once in a day at 25-day stage of growth for 5 days, consecutively. Various parameters (growth, photosynthetic, biochemical, oxidative biomarkers and nutrient composition) were assessed at different days after sowing (DAS). Scanning electron microscopy (SEM) of leaf stomata, reactive oxygen species (ROS) localization in leaf and roots, and confocal microscopy were also conducted. The results revealed that all the IAA concentrations were effective in growth promotion and ROS reduction, however, the 10^-8 M of IAA exhibited the maximum improvement in all the above mentioned parameters as compared to the control.

Salinity induced physiological and biochemical changes in plants: An omic approach towards salt stress tolerance

Salinity is one of the major threats to sustainable agriculture that globally decreases plant production by impairing various physiological, biochemical, and molecular function. In particular, salinity hampers germination, growth, photosynthesis, transpiration, and stomatal conductance. Salinity decreases leaf water potential and turgor pressure and generates osmotic stress. Salinity enhances reactive oxygen species (ROS) content in the plant cell as a result of ion toxicity and disturbs ion homeostasis. Thus, it imbalances nutrient uptake, disintegrates membrane, and various ultrastructure. Consequently, salinity leads to osmotic and ionic stress. Plants respond to salinity by modulating various morpho-physiological, anatomical, and biochemical traits by regulating ion homeostasis and compartmentalization, antioxidant machinery, and biosynthesis of osmoprotectants and phytohormones, i. e, auxins, abscisic acid, brassinosteroids, cytokinins, ethylene, gibberellins, salicylic acid, jasmonic acid, and polyamines. Thus, this further modulates plant osmoticum, decreases ion toxicity, and scavenges ROS. Plants upregulate various genes and proteins that participate in salinity tolerance. They also promote the production of various phytohormones and metabolites that mitigate the toxic effect of salinity. Based on recent papers, the deleterious effect of salinity on plant physiology is discussed. Furthermore, it evaluates the physiological and biochemical responses of the plant to salinity along with phytohormone response. This review paper also highlights omics (genomics, transcriptomics, proteomics, and metabolomics) approach to understand salt stress tolerance.

Melatonin modulates photosynthesis, redox status, and elemental composition to promote growth of Brassica juncea-a dose-dependent effect

Melatonin (MEL) is an antioxidant molecule, present throughout plant kingdom, animals, and microbes. It is a well-known free radical scavenger and modulates growth and development in plants against various abiotic and biotic stresses. The present study was done to investigate the role of MEL as a foliar spray on the morphological, physiological, and biochemical parameters in Brassica juncea cv. Varuna. Five different doses (10, 20, 30, 40, or 50 μM) of MEL were applied as foliar spray to the leaf of plant at 25 days after sowing (DAS) and continued up to 30 DAS once in a day. The plants were sampled at 30, 45, and 60 DAS to assess various parameters. The present results indicate that most of the parameters, i.e., growth, photosynthetic, nutrients, and enzyme activities increased in a concentration dependent manner. MEL application reduced the accumulation of reactive oxygen species (ROS) by enhancing the antioxidant enzyme activities. Microscopic examinations further revealed a significant increase in the size of the stomatal aperture in the presence of MEL. Out of the various concentrations tested, 40 μM of MEL proved best and can be used for further studies.

Phytoremediation of Cadmium Contaminated Soil Using Brassica juncea: Influence on PSII Activity, Leaf Gaseous Exchange, Carbohydrate Metabolism, Redox and Elemental Status

Phytoremediation is an ecologically and economically feasible technique to remove heavy metal from soil. The aim of the study was to examine cadmium (Cd) toxicity and phytoremediation aptitude of Brassica juncea. In the present study, plants survived when exposed to different levels of Cd (0, 25, 50 and 100 mg/kg soil) and accumulated a large amount of Cd in its root and shoot. Translocation factor (TF) of Cd from root to shoot was > 1 at both 45 and 60-day stage of growth suggesting that B. juncea is a hyperaccumulator and strong candidate for phytoextraction of Cd. Alongside, Cd impaired photolysis of water, PSII activity, nutrient uptake, photosynthesis and sugar accumulation in the plant. Cd-generated oxidative stress restricts the growth of B. juncea. The toxic effect of Cd was more pronounced at 45-day stage of growth signifying the drifting of plant towards acquirement of exclusion strategy.

Role of Strigolactones: Signalling and Crosstalk with Other Phytohormones

Plant hormones play important roles in controlling how plants grow and develop. While metabolism provides the energy needed for plant survival, hormones regulate the pace of plant growth. Strigolactones (SLs) were recently defined as new phytohormones that regulate plant metabolism and, in turn, plant growth and development. This group of phytohormones is derived from carotenoids and has been implicated in a wide range of physiological functions including regulation of plant architecture (inhibition of bud outgrowth and shoot branching), photomorphogenesis, seed germination, nodulation, and physiological reactions to abiotic factors. SLs also induce hyphal branching in germinating spores of arbuscular mycorrhizal fungi (AMF), a process that is important for initiating the connection between host plant roots and AMF. This review outlines the physiological roles of SLs and discusses the significance of interactions between SLs and other phytohormones to plant metabolic responses.

The surgical treatment of Balanitis Xerotica Obliterans

Background: Balanitis Xerotica Obliterans (BXO) is a chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. Steroid creams are usually the first-line treatment but have a limited role and surgical intervention is frequently necessary. Conservative surgical procedures (circumcision) are often preferred in the first instance with the premise that recurrence of disease will require a more definitive reconstruction. This study looked at patients with pathologically proven BXO referred to the Plastic Surgery Unit at James Cook University Hospital between 2005 and 2009. The aim was to look at their management in the past and subsequent management by us. We also looked at whether early referral of progressive and recurrent BXO patients to reconstructive surgery could have prevented unnecessary delay in resolving symptoms at an earlier stage. Materials and Methods: Data was collected retrospectively and information regarding the exact anatomical location affected, the extent of the disease, the referring specialty and any previous surgical interventions was obtained. Alterations in urinary and sexual function and relief of symptoms following reconstructive surgery were analysed. Results: Of the 23 patients in the study, 43% had previous surgery and 60% of those had undergone two or more procedures. Twenty-one percent of patients had a history of BXO for over five years. Forty-seven percent of patients had alteration in their urinary function and 48% alteration in their sexual function due to the disease, prior to referral. Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group. Conclusions: Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases. Circumcision can be a curative procedure in early disease. Although there is conflicting evidence for treatment of recurring urethral strictures, repeated urethrotomy or urethral dilatation has poor long-term outcome. In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment.

Glucose: Sweet or bitter effects in plants-a review on current and future perspective

Sugars are metabolic substrates playing a part in modulating various processes in plants during different phases of development. Thus, modulating the sugar metabolism can have intense effects on the plant metabolism. Glucose is a soluble sugar, found throughout the plant kingdom. Apart from being a universal carbon source, glucose also operates as a signaling molecule modulating various metabolic processes in plants. From germination to senescence, wide range of processes in plants is regulated by glucose. The effect of glucose is found to be concentration dependent. Photosynthesis and its related attributes, respiration and nitrogen metabolism are influenced by glucose application. Endogenous content of glucose increases upon exposure of plant to various abiotic stresses and also when glucose is supplied exogenously. Glucose accumulation alleviates the damaging effects of stress by enhancing production of antioxidants and compounds similar to that of photosynthetic CO₂ fixation which act as an osmoticum by maintaining osmotic pressure inside the cell, pH homeostasis regulator and reduce membrane permeability during stress. Glucose interaction with various phytohormones has also been discussed in this review.

Nanoparticles: biosynthesis, translocation and role in plant metabolism

Nanotechnology is an emerging field of science that applies particles between 1 and 100 nm in size for a range of practical uses. Nano-technological discoveries have opened novel applications in biotechnology and agriculture. Many reactions involving nanoparticles (NPs) are more efficient compared to those of their respective bulk materials. NPs obtained from plant material, denoted as biogenic or phytosynthesised NPs, are preferred over chemically synthesised NPs due to their low toxicity, rapid reactions and cost-effective production. NPs impart both positive and negative impacts on plant growth and development. NPs exhibit their unique actions as a function of their size, reactivity, surface area and concentration. An insight into NP biosynthesis and translocation within the plant system will shed some light on the roles and mechanisms of NP-mediated regulation of plant metabolism. This review is a step towards that goal.

Interaction of glucose and phytohormone signaling in plants

Energy acts as a primary prerequisite for plant growth like all the other organisms. Soluble sugars function in providing enough supply of nutrients which further helps in building macromolecules and energy to carry out specific and coordinated development. Sugars functions as nutrient as well as signaling molecule to promote cell division and differentiation in plants. Intriguingly, glucose has emerged as a crucial signaling molecule where hexokinase1 acts as the conserved glucose sensor. On the molecular scale, an extensive crosstalk between glucose and phytohormone signaling has been observed where glucose signals trigger multiple hexokinase1-dependent as well as hexokinase1-independent pathways to mediate diverse developmental, physiological and molecular mechanisms. Taken together, these findings this review focused on the glucose crosstalk with several classical plant hormonal-signaling pathways and the crucial role of hexokinase1 in modulating plant physiological processes.

Comparative effect of 28-homobrassinolide and 24-epibrassinolide on the performance of different components influencing the photosynthetic machinery in Brassica juncea L

BRs are polyhydroxylated sterol derivatives, classified as phytohormones. Plants of Brassica juncea var. Varuna were grown in pots and an aqueous solution (10^-8 M) of two brassinosteroid isomers 28-homobrassinolide (HBL) and 24-epibrassinolide (EBL) of same concentration (10^-8 M) was applied to their leaves. The treatment up-regulated the photosynthetic machinery directly by enhancing water splitting activity, photochemical quenching, non-photochemical quenching, maximum PSII efficiency, actual PSII efficiency, electron transport rate, stomatal movement, stomatal conductance, internal CO₂ concentration, transpiration rate, net photosynthetic rate and carbohydrate synthesis. Moreover, the level of biochemical enzymes (carbonic anhydrase and nitrate reductase), reactive oxygen species (superoxide and hydrogen peroxide) generation, antioxidant enzyme activity and mineral status (C, N, Mg, P, S, K), which indirectly influence the rate of photosynthesis, also improved in the treated plants. Out of the two BR analogues tested, EBL excelled in its effects over HBL.

Nitric oxide-mediated integrative alterations in plant metabolism to confer abiotic stress tolerance, NO crosstalk with phytohormones and NO-mediated post translational modifications in modulating diverse plant stress

Nitric oxide (NO) is a major signaling biomolecule associated with signal transduction in plants. The beneficial role of NO in plants, exposed to several abiotic stresses shifted our understanding as it being not only free radical, released from the toxic byproducts of oxidative metabolism but also helps in plant sustenance. An explosion of research in plant NO biology during the last two decades has revealed that NO is a key signal associated with plant growth, germination, photosynthesis, leaf senescence, pollen growth and reorientation. NO is beneficial as well as harmful to plants in a dose-dependent manner. Exogenous application of NO at lower concentrations promotes seed germination, hypocotyl elongation, pollen development, flowering and delays senescence but at higher concentrations it causes nitrosative damage to plants. However, this review concentrates on the beneficial impact of NO in lower concentrations in the plants and also highlights the NO crosstalk of NO with other plant hormones, such as auxins, gibberellins, abscisic acid, cytokinins, ethylene, salicylic acid and jasmonic acid, under diverse stresses. While concentrating on the multidimensional role of NO, an attempt has been made to cover the role of NO-mediated genes associated with plant developmental processes, metal uptake, and plant defense responses as well as stress-related genes. More recently, several NO-mediated post translational modifications, such as S-nitrosylation, N-end rule pathway operates under hypoxia and tyrosine nitration also occurs to modulate plant physiology.

Multi-disciplinary management of complex pressure sore reconstruction: 5-year review of experience in a spinal injuries centre

INTRODUCTION In our regional spinal injuries unit, complex pressure ulcer reconstruction is facilitated by a monthly multidisciplinary team clinic. This study reviews a series of the more complex of these patients who underwent surgery as a joint case between plastics and other surgical specialties, aiming to provide descriptive data as well as share the experience of treating these complex wounds. MATERIALS AND METHODS Patients operated on as a joint case from 2010 to 2014 were identified through a locally held database and hospital records were then retrospectively reviewed for perioperative variables. Descriptive statistics were collected. RESULTS 12 patients underwent 15 procedures as a joint collaboration between plastic surgery and other surgical specialties: one with spinal surgery, 12 with orthopaedic and two with both orthopaedic and urology involvement. Ischial and trochanteric wounds accounted for 88% of cases with five Girdlestone procedures being performed and 12 requiring soft-tissue flap reconstruction. Mean operative time was 3.8hours. Four patients required high-dependency care and 13 patients received long-term antibiotics. Only three minor complications (20%) were seen with postoperative wound dehiscence. DISCUSSION The multidisciplinary team clinic allows careful assessment and selection of patients appropriate for surgical reconstruction and to help match expectations and limitations imposed by surgery, which are likely to influence their current lifestyle in this largely independent patient group. Collaboration with other specialties gives the best surgical outcome both for the present episode as well as leaving avenues open for potential future reconstruction.

Improving outcomes following reconstruction of pressure sores in spinal injury patients: A multidisciplinary approach

BACKGROUND AND AIM

Pressure sore treatment in spinal injury patients is challenging. A multidisciplinary approach with joint management by the plastic surgery and spinal injury teams was initiated at our institution in 2005 to improve patient care and surgical outcomes following reconstruction. This study assessed the surgical outcomes following reconstruction using the team approach and to compare inpatient stay and readmissions for complications before and after the multidisciplinary protocol was introduced.

METHODS

A retrospective review of consecutive patients in the multidisciplinary pressure sore clinic was performed. Data were collected on patient demographics, reconstructive techniques, surgical outcomes and readmission for any complications.

RESULTS

In total, 45 patients with 60 pressure sores (grade 3 or 4) were reviewed in the joint clinic between 2005 and 2011. The majority of patients were paraplegic (78%), while the remaining 22% were tetraplegic. Ischial sores were the most common (45%) followed by trochanteric (23%) and sacral (20%) sores. Multiple sores were noted in 44% of patients. Flap reconstruction was required in 32 patients (71%); after a mean follow-up time of 33 months (range 25-72 months), there were three (9%) major complications (two recurrences of pressure sores and one sinus) and seven (22%) minor complications. After introduction of patient care pathways through the multidisciplinary approach, the rate of readmission for complications decreased from 14% to 5.5% and inpatient stay upon readmission reduced from 65 to 45 days.

CONCLUSIONS

Implementation of a multidisciplinary approach was key to optimising surgical outcomes, achieving a low recurrence rate (6%) and reducing readmissions.

A kick in the shins: the financial impact of uncontrolled warfarin use in pre-tibial haematomas

Warfarin is increasingly prescribed in the elderly population for a number of medical conditions. Pre-tibial haematomas are a common cause of morbidity in this group. The aim of the study was to identify the proficiency of INR monitoring at a primary care level in correlation with their recommended INR range and to study the treatment outcome in this group. A retrospective single-centre study of patients diagnosed with pre-tibial haematomas was conducted over a two-year period. Length of hospital stay, time delay until operative intervention, blood transfusion and warfarin reversal requirements, social care input and cost to the NHS were considered. A total of 62 patients were admitted with pre-tibial haematomas of which 20 were on Warfarin. Females were predominantly more affected (5.6:1). The mechanism of injury was as a result of minor trauma. The mean INR level was 3.8 with a standard deviation of 3.1. Mean length of hospital stay was 11 days with a standard deviation of 13.6. Nine patients required skin grafting. Average cost for the acute episode was £3500 per patient. INR levels were significantly outwith the target range causing substantial patient morbidity and imposing a significant financial burden on the NHS. Tighter regulation at a primary care level should help reduce this risk.

The surgical treatment of Balanitis Xerotica Obliterans

BACKGROUND

Balanitis Xerotica Obliterans (BXO) is a chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. Steroid creams are usually the first-line treatment but have a limited role and surgical intervention is frequently necessary. Conservative surgical procedures (circumcision) are often preferred in the first instance with the premise that recurrence of disease will require a more definitive reconstruction. This study looked at patients with pathologically proven BXO referred to the Plastic Surgery Unit at James Cook University Hospital between 2005 and 2009. The aim was to look at their management in the past and subsequent management by us. We also looked at whether early referral of progressive and recurrent BXO patients to reconstructive surgery could have prevented unnecessary delay in resolving symptoms at an earlier stage.

MATERIALS AND METHODS

Data was collected retrospectively and information regarding the exact anatomical location affected, the extent of the disease, the referring specialty and any previous surgical interventions was obtained. Alterations in urinary and sexual function and relief of symptoms following reconstructive surgery were analysed.

RESULTS

Of the 23 patients in the study, 43% had previous surgery and 60% of those had undergone two or more procedures. Twenty-one percent of patients had a history of BXO for over five years. Forty-seven percent of patients had alteration in their urinary function and 48% alteration in their sexual function due to the disease, prior to referral. Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group.

CONCLUSIONS

Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases. Circumcision can be a curative procedure in early disease. Although there is conflicting evidence for treatment of recurring urethral strictures, repeated urethrotomy or urethral dilatation has poor long-term outcome. In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment.

Prevalence and correlates of HIV, syphilis, and hepatitis knowledge among intrapartum patients and health care providers in Kabul, Afghanistan

Little is known about blood-borne infection awareness and knowledge among obstetric populations and health care providers in Afghanistan. HIV and hepatitis B awareness and knowledge are described among 4452 intrapartum patients completing an interviewer-administered questionnaire and whole-blood rapid testing and 123 obstetric care providers completing a questionnaire between June 2006 and September 2006. Participants were enrolled from three Kabul public maternity hospitals. Most participants were aware of HIV (50.8% of patients and 95.9% of providers) and hepatitis (72.1% of patients and 91.1% of providers). Correct transmission knowledge (defined as naming three correct routes and no incorrect routes) was lower for both groups (HIV: 19.4% for patients and 59.7% for providers; hepatitis B: 1.90% for patients and 33.9% for providers). Correct HIV transmission knowledge among providers was independently associated with level of education (AOR=1.75, 95% CI: 1.20-2.55). While HIV and hepatitis B awareness is common, correct and comprehensive knowledge is not. Continuing education for providers and health communications strategies should address identified knowledge gaps.

Utilising field assignments in survey methodology course at Ziauddin Medical University, Karachi

OBJECTIVE

To describe the teaching-learning strategy employed in the module of Survey Methodology for undergraduate medical students at Ziauddin Medical University.

SETTING

Medical students of Ziauddin Medical University, Clifton, Karachi.

METHODS

The objectives of the Survey Methodology course were developed so that a student would be able to design and conduct a small survey independently. For this purpose the students were required to participate in a census survey of a squatter settlement. The questionnaire for the survey was developed with the students, which included the demographic information of the households. It was discussed and pretested with the medical students. The students edited and entered the data on computer using Epi-Info. They were trained in sampling methods, data collection, data editing and entry through lectures and small group sessions. At the end of the course, students filled the course evaluation form.

RESULTS

Out of 117 students who responded, 63% found the course to be useful. Small group sessions were regarded as the most helpful teaching strategy by 91% of the students. Majority (74%) of the students recommended that field visits should be a part of teaching strategy.

CONCLUSION

The Survey Methodology course reinforces the importance and practical application of research methods. The students appreciate the course especially the small group sessions and the field visits.

Cannula related suppurative thrombophlebitis in the burned patient

Suppurative thrombophlebitis is a well recognised and potentially fatal complication of intravenous cannulation in burns patients. We report a case of an Afro-Caribbean patient with noninsulin-dependent diabetes who developed signs of systemic sepsis two weeks after a 14% total body surface area flame burn. Despite an initial paucity of clinical signs at the cannulation site, exploratory venotomy revealed frank suppuration within the long saphenous vein from the ankle to the groin. This was treated successfully by total excision of the vein and its tributaries and delayed wound closure. Following this, a retrospective analysis of the measured clinical parameters and blood tests revealed no obvious, missed pointers to the impending sepsis other than a dramatic increase in the overall daily insulin requirement. This had doubled over a 48-h period, preceding the clinical diagnosis by three days. The relevant literature and guidelines for management are reviewed.

Systemic lupus erythematosus in Kuwait--hospital based study

The present study describes the clinical characteristics of patients with systemic lupus erythematosus (SLE), from the rheumatology service of the two main teaching hospitals in Kuwait. It was a retrospective-cum-prospective clinical study of 108 SLE patients. There were 98 females and 10 males, with a median age of 31.5y. Kuwaitis constituted 69%, while 31% were expatriates. The mean disease duration was 62 months. The main clinical features were: musculoskeletal involvement (87%), photosensitivity (48%), malar rash (43%), discoid lesions (10%), oral ulcers (33%), vasculitic skin lesions (10%), haematological features (53%), constitutional symptoms (51.4%), neuropsychiatric manifestations (23%), renal involvement (37%), serositis (29%), clinical manifestations of antiphospholipid syndrome (21%), cardiac involvement (10%) and pulmonary manifestations (19%). In conclusion, the clinical features of SLE in Kuwait were similar to most major studies from developed countries. Main differences included prominent haematological and mucocutaneous manifestations and possibly a low prevalence of anti-Sm antibodies. Whether these differences are due to the environment or genetic factors, remains to be studied.

Further observations concerning steroidal, β-lactones. Boron trifluoride catalysed rearrangements of β-lactones in the cholestane series

B-Nor-5β-cholestane-3,3,5-diol-6-carboxylic acid 5,6-lactone 3-acetate on treatment with BF3 etherate in ether or ether-acetic anhydride gave B-norcholest-5-en-3β-ol-6-carboxylic acid 3-acetate and 19-nor-5-methyl-B-nor-5β-cholest-9(10)-en-3,3-ol-6-carboxylic acid 3-acetate, a product of the Westphalen rearrangement. B-Nor-5β-cholestan-5-ol-6-carboxylic acid 5,6-lactone under similar reaction conditions provided the product of the Westphalen rearrangement, 19-nor-5-methyl-B-nor-5β-cholest-9(10)-ene-6-carboxylic acid.