Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria

BACKGROUND

This study sought to describe and quantify microcirculatory changes in the mucosal surfaces of patients with severe malaria, by direct in vivo observation using orthogonal polarization spectral (OPS) imaging.

METHODS

The microcirculation in the rectal mucosa of adult patients with severe malaria was assessed by use of OPS imaging, at admission and then daily. Comparison groups comprised patients with uncomplicated falciparum malaria, patients with bacterial sepsis, and healthy individuals.

RESULTS

Erythrocyte velocities were measured directly in 43 adult patients with severe falciparum malaria, of whom 20 died. Microcirculatory blood flow was markedly disturbed, with heterogeneous obstruction that was proportional to severity of disease. Blocked capillaries were found in 29 patients (67%) and were associated with concurrent hyperdynamic blood flow (erythrocyte velocity, >750 mm/s) in adjacent vessels in 27 patients (93%). The proportion of blocked capillaries correlated with the base deficit in plasma and with the concentration of lactate. Abnormalities disappeared when the patients recovered. In healthy individuals and in patients with uncomplicated malaria or sepsis, no stagnant erythrocytes were detected, and, in patients with sepsis, hyperdynamic blood flow was prominent.

CONCLUSION

Patients with severe falciparum malaria show extensive microvascular obstruction that is proportional to the severity of the disease. This finding underscores the prominent role that microvascular obstruction plays in the pathophysiology of severe malaria and illustrates the fundamental difference between the microvascular pathophysiology of malaria and that of bacterial sepsis.

Liposome encapsulation of curcumin: physico-chemical characterizations and effects on MCF7 cancer cell proliferation

The role of curcumin (diferuloylmethane), for cancer treatment has been an area of growing interest. However, due to its low absorption, the poor bioavailability of curcumin limits its clinical use. In this study, we reported an approach of encapsulation a curcumin by nanoliposome to achieve an improved bioavailability of a poorly absorbed hydrophobic compound. We demonstrated that liposomal preparations to deliver curcumin increase its bioavailability. Liposomes composed of salmon's lecithin also improved curcumin bioavailability compared to those constituted of rapeseed and soya lecithins. A real-time label-free cell analysis system based on real-time cell impedance monitoring was used to investigate the in vitro cytotoxicity of liposomal preparations.

Chitosan-coated liposomes encapsulating curcumin: study of lipid–polysaccharide interactions and nanovesicle behavior

Despite various spectacular therapeutic properties, curcumin has low bioavailability mainly due to its poor solubility in water.

Comparison of maximal acid output and gastrin response to meals in Chinese and Scottish normal and duodenal ulcer subjects

Maximal acid output (MAO) after pentagastrin stimulation and gastrin response to a standard meal was studied in 100 control and 200 duodenal ulcer subjects from each of two ethnic groups, Scots and Chinese. The acid output was significantly higher in the Scots than in the Chinese for both controls and duodenal ulcer patients. Despite correction for differences in body stature by expressing MAO as a function of the body weight, these differences persisted. In 45 pairs of closely matched patients with duodenal ulcer, the differences between the two ethnic groups remained significant, irrespective of whether MAO was expressed in absolute or weight corrected values. This indicates that differences in age, sex, family history, or duration of illness did not account for differences in acid output. In 20 pairs of normal control and 45 pairs of duodenal ulcer patients the fasting and post-prandial serum gastrin levels did not differ, significantly between the two ethnic groups. The proportion of acid normosecretors was significantly higher in the Chinese duodenal ulcer patients than in the Scottish. The reason for these differences in the gastric acid output between the two ethnic groups is not known and needs to be studied further.

N,N'-dialkylimidazolium chloroplatinate(II), chloroplatinate(IV), and chloroiridate(IV) salts and an N-heterocyclic carbene complex of platinum(II): synthesis in ionic liquids and crystal structures

The first imidazole-type carbene complex of platinum(II), cis-(C2H4)(1-ethyl-3-methylimidazol-2-ylidene)PtCl2, has been obtained by reacting PtCl2 and PtCl4 with ethylene in the basic [EMIM]Cl/AlCl3 (1.3:1) ionic liquid (where [EMIM]+ = 1-ethyl-3-methylimidazolium) at 200 degrees C and structurally characterized (monoclinic P21/c space group, a = 10.416(2) A, b = 7.3421(9) A, c = 15.613(2) A, beta = 101.53(2) degrees, Z = 4). This complex can be regarded as a stable analogue of the pi-alkene-Pd(II)-carbene intermediate in the Heck reaction. In addition, a series of new N,N'-dialkylimidazolium salts of platinum group metals of the type [RMIM]2[MCln], where [RMIM+] = 1-alkyl-3-methylimidazolium and M = Pt(II), Pt(IV), or Ir(IV), have been prepared and characterized. The salts [EMIM]2[PtCl6] (1) and [EMIM]2[PtCl4] (2) were prepared in the ionic liquid [EMIM]Cl/AlCl3 and the salts [BMIM]2[PtCl4] (3) and [BMIM]2[PtCl6] (4) (where [BMIM]+ = 1-n-butyl-3-methylimidazolium) and [EMIM]2-[IrCl6] (5) in aqueous or acetonitrile media. From TGA measurements, salts 1-5 decompose in air in several steps eventually to form the corresponding metal, the onset of decomposition being observed at (degree C) 260 (1), 220 (2), 200 (3), 215 (4), and 210 (5). The structures of 1, 2, and 5 were determined by single-crystal X-ray analysis. The three salts crystallize in the monoclinic P21/n space group (1, a = 7.6433(9) A, b = 16.353(2) A, c = 9.213(1) A, beta = 113.56(1) degrees, Z = 2; 2, a = 8.601(1) A, b = 8.095(2) A, c = 13.977(2) A, beta = 91.75(2) degrees, Z = 2; 5, a = 10.353(2) A, b = 9.759(2) A, c = 10.371(2) A, beta = 92.98(3) degrees, Z = 2).

Irritable bowel syndrome in a rural community in Bangladesh: prevalence, symptoms pattern, and health care seeking behavior

OBJECTIVE

The aim of this study was to investigate the prevalence of irritable bowel syndrome (IBS) and the pattern of symptoms and health care seeking behavior of IBS subjects in the rural population in Bangladesh.

METHODS

This was an observational study to do a positive diagnosis of IBS. A total of 2426 persons > or =15 yr old were interviewed by a predesigned questionnaire based on the Rome criteria. Two villages of a northern district in Bangladesh were included.

RESULTS

A response of 95.4% yielded 2426 questionnaires for analysis. Mean age of the surveyed sample was 32.3+/-14.2 yr. In total, 1113 (45.9%) were men, and 1313 (54.1%) were women. Farmers and housewives comprised 2058 (84.8%) persons. The apparent prevalence of IBS was 24.4% with a prevalence of 20.6% in men and 27.7% in women. With strict Rome criteria, the overall prevalence was 8.5% (10.7% in women and 5.8% in men). Age was not found to influence the prevalence in either sex. Other than abdominal pain, the most common IBS symptom was altered stool passage (81.1%). Others in order of frequency were passage of mucus with stool (56.8%), abdominal distension (46.2%), altered stool form (46%), and altered stool frequency (18.2%). Spastic colon pain was noted in 339 (57.2%). IBS subjects with more prevalence of colonic symptoms in the nonspastic group. Drinking milk was found to have a little impact on IBS. A total of 35% IBS subjects consulted doctors for symptoms. Age, sex, and number of symptoms did not influence health care seeking behavior.

CONCLUSIONS

IBS is also a problem in rural people in Bangladesh with a prevalence almost identical to most other countries, and only a minority of them seeks health care. Positive diagnosis of IBS can be done by precisely enquiring colonic symptoms in apparently healthy people.

Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults

BACKGROUND & AIMS

In developing countries where Helicobacter pylori infection is widespread, posttherapeutic recurrence rates may be high. Many of the limited studies available have methodological problems and show varied recurrence rates. We determined late recrudescence rates, true reinfection, and ulcer recurrence.

METHODS

One hundred five Bangladeshi patients with H. pylori infection and duodenal ulcer disease were treated with a triple therapy. Follow-up included 13C-urea breath tests, endoscopy, and biopsy-based tests. In reinfected patients, genomic typing compared pretherapeutic and posttherapeutic strains.

RESULTS

Recrudescence, associated with nitroimidazole-based treatment, occurred in 15 of 105 patients (14%) within the first 3 months, but only 8 of 105 patients tested positive 4 weeks after therapy ended. True reinfection was diagnosed in 11 of 105 patients between 3 and 18 months after therapy. The annual reinfection rate was 13%, based on a total follow-up of 84.7 patient years. Ulcer relapse occurred in 2 of 15 (13%) recrudescence cases and in 6 of 11 (55%) reinfection cases, but also in 4 of 73 (5%) H. pylori-negative patients.

CONCLUSIONS

In Bangladesh, late recrudescence of H. pylori after eradication therapy occurs within the first 3 months. The reinfection rate is high and might influence cost-benefit analyses for determining diagnostic and therapeutic procedures.

The occipital sinus

✓ Fresh dural preparations and dried occipital bones from 200 adult cadavers were examined to define the characteristics of the occipital sinus. The occipital sinus was found to be present in 64.5% cases. Different morphological types are classified into the following: median occipital sinus (35%), double occipital sinus (22.5%), left occipital sinus (4%), and right occipital sinus (3%). Communications with the confluence, superior sagittal, straight, transverse, and sigmoid sinuses are described. The normal findings and some notable anomalies are discussed in the light of the available literature.

Safety and efficacy of cytology brushings versus standard fine-needle aspiration in evaluating cystic pancreatic lesions: a controlled study

BACKGROUND AND STUDY AIMS

Cystic pancreatic lesions (CPLs) are increasingly detected by various imaging studies. Mucinous CPLs carry a risk of malignant transformation but this is often difficult to diagnose preoperatively. In a previous report of 10 suspected mucinous CPLs, the cellular yield of endoscopic ultrasonography (EUS)-guided cytology brushings was found to be superior to the yield from standard fine-needle aspiration (FNA). The aim of this prospective and blinded study was to compare the cytology yield of mucinous epithelium from brushing with FNA in suspected mucinous CPLs.

PATIENTS AND METHODS

In total, 37 patients with 39 CPLs measuring at least 20 mm were enrolled between June 2006 and July 2008 for EUS-cytobrushing and EUS-FNA of CPLs. Demographic, clinical, EUS, cytopathologic, and surgical data were recorded whenever available. Yield of cytology brushings was compared with that of FNA. Procedure morbidity was evaluated after 30 days. The main outcome assessed was yield of intracellular mucin (ICM) on cytobrushing specimens compared with EUS-FNA for the diagnosis of suspected mucinous CPL.

RESULTS

Cytobrushings were more likely to detect ICM than the EUS-FNA method ( P = 0.001). In three patients with hypocellular FNA, dysplasia was found on cytology brushing and later confirmed by surgical pathology. Significant complications occurred in three patients (8 %): one postbrushing bleeding and two acute pancreatitis.

CONCLUSIONS

Cytology brushings are more likely to provide an adequate mucinous epithelium specimen than standard FNA and could aid the diagnosis of CPLs in a selective group of patients.

Age-related elevation of lipid peroxidation products: diminution of superoxide dismutase activity in the central nervous system of rats

Alteration in lipid peroxidation products such as lipid peroxides, lipid hydroperoxides were studied in different regions of CNS of ageing rats (13, 26, 52, 78 and 104 weeks). The levels of lipid peroxide and lipid hydroperoxide were increased in various regions of brain and spinal cord. However, the activity of superoxide dismutase was decreased in cerebrum, hypothalamus, hippocampus, cerebellum, brain stem and spinal cord. The present communication demonstrates that the different parts of CNS at 13 and 26 weeks of age have lipid peroxidation products different from that of 104-week-old rats.

Association of gene-linked SSR markers to seed glucosinolate content in oilseed rape (Brassica napus ssp. napus)

Breeding of oilseed rape (Brassica napus ssp. napus) has evoked a strong bottleneck selection towards double-low (00) seed quality with zero erucic acid and low seed glucosinolate content. The resulting reduction of genetic variability in elite 00-quality oilseed rape is particularly relevant with regard to the development of genetically diverse heterotic pools for hybrid breeding. In contrast, B. napus genotypes containing high levels of erucic acid and seed glucosinolates (++ quality) represent a comparatively genetically divergent source of germplasm. Seed glucosinolate content is a complex quantitative trait, however, meaning that the introgression of novel germplasm from this gene pool requires recurrent backcrossing to avoid linkage drag for high glucosinolate content. Molecular markers for key low-glucosinolate alleles could potentially improve the selection process. The aim of this study was to identify potentially gene-linked markers for important seed glucosinolate loci via structure-based allele-trait association studies in genetically diverse B. napus genotypes. The analyses included a set of new simple-sequence repeat (SSR) markers whose orthologs in Arabidopsis thaliana are physically closely linked to promising candidate genes for glucosinolate biosynthesis. We found evidence that four genes involved in the biosynthesis of indole, aliphatic and aromatic glucosinolates might be associated with known quantitative trait loci for total seed glucosinolate content in B. napus. Markers linked to homoeologous loci of these genes in the paleopolyploid B. napus genome were found to be associated with a significant effect on the seed glucosinolate content. This example shows the potential of Arabidopsis-Brassica comparative genome analysis for synteny-based identification of gene-linked SSR markers that can potentially be used in marker-assisted selection for an important trait in oilseed rape.

Posterolateral tunnels and ponticuli in human atlas vertebrae

The posterolateral tunnel on the superior surface of the first cervical (atlas) vertebra is of normal occurrence in monkeys and other lower animals, but its presence in the form of a tunnel-like canal, for the passage of the third part of the vertebral artery over the posterior arch of the human atlas vertebra is not reported. The aim of the present study was to detect the presence of such a canal, in addition to other types of ponticuli (little bridges) reported by earlier investigators, in macerated atlas vertebrae and routine cadaveric dissections. The posterolateral tunnel was detected in 1.14%, and the posterior and lateral ponticuli in 6.57 and 2% of vertebrae. Probably the bony roof of the posterolateral tunnel serves the purpose of additional lateral extension for the attachment of the posterior atlanto-occipital membrane in quadrupeds, where the load of the head is supported by the extensor muscles of the neck, ligaments and posterior atlanto-occipital membrane. In man, where the weight of the head is borne by the vertical loading of the superior articular process of the atlas, the roof of the tunnel has disappeared.

Duplex Ultrasound Evaluation for Dialysis access Selection and Maintenance: A Practical Guide

Detailed case directed history and examination is the mainstay of dialysis access modality selection, ie site and type of access, as well as for maintenance of dialysis access for longevity. As a logical step following history and physical examination, duplex ultrasound evaluation (DUE) is the most cost effective and non-invasive screening tool for evaluation for access placement and for assessment of an established access. Pre-operative vascular mapping allows selection of the optimal dialysis access modality and site. In established accesses, duplex ultrasound testing will diagnose the majority of vascular access complications and direct proper surgical or interventional radiology management. This review outlines a practical decision-making algorithm using DUE for choosing and managing the dialysis access.

Immune responses and cytokine induction in the development of severe hepatitis during acute infections with murine cytomegalovirus

Salivary gland-derived murine cytomegalovirus (SGV) infections of mice have been widely used as models of human cytomegalovirus infections and in the study of CMV biology. Still, many aspects of SGV pathogenesis are not clearly defined. Fatal and non-fatal SGV infections were investigated to characterize pathogenetic correlates of mortality and to assess the role of the immune response in disease progression. Suppression of immune responses was observed in both lethal and sublethal infections. Depletion of immune cell populations in spleen, however, correlated with severe CMV-induced hepatitis and mortality. In addition, T cell depletion studies indicated a requirement for this immune cell subset in control of liver damage and survival of infected mice. Examination of cytokine responses revealed a previously undescribed shock-like syndrome in lethally-infected mice characterized by high levels of tumor necrosis factor alpha and interferon gamma. Furthermore, the sites of tumor necrosis factor alpha gene induction did not strictly correlate with either viral load or the sites of tissue damage during infection. Taken together, these findings define the pathogenetic progression of disease as it relates to disease outcome and suggests that organ-specific differences in cytokine induction play a significant role in the late stages of acute lethal MCMV infections.

Genesis and possible dissolution of neuronal lipofuscin

The studies reviewed here reflect a marked difference of opinion among investigators on some fundamental aspects of lipo-fuscin research, such as its correlation to ageing, different type(s) and origin(s) of pigment granules, role of trauma and diseases, and the effect of drugs. An attempt has been made to present a unified concept of origin of lipofuscin and to point out the lacunae in our knowledge with a view to stimulate further research.

Prevalence of Helicobacter pylori in asymptomatic population--a pilot serological study in Bangladesh

Epidemiological reports reveal that H. pylori is distributed among all population in the world. The present cross-sectional study was undertaken to see the H. pylori seroprevalence rates among the asymptomatic adults, as yet reportedly no such data available in Bangladesh. Serum samples were collected from 181 consecutive subjects who attended at the health check-up centre of Bangladesh Institute of Diabeties, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, during the period of August to November 1995 for medical check up. The mean age of these subjects was 30.33 years (range 20-44 yrs). Incidentally all were male and belonged to average socioeconomic class. H. pylori specific IgG antibody level was assayed by an enzyme immunoassay kit ElAgen (Clone system). Among the 181 subjects, 166 (92%) had H. pylori specific antibodies and 15 (8%) were seronegative. No significant difference (p < 0.90) in seroprevalence rates was observed among different age groups. However, the results of higher seroprevalence rates of H. pylori infection in these asymptomatic adult population of Bangladesh are consistent with that of Africa and India.

Speed of onset of regional analgesia in labour: a comparison of the epidural and spinal routes

This study compares the speed of onset of effective analgesia in two randomly assigned groups of patients requesting analgesia in labour. Patients in the combined spinal-epidural group (n = 69) were given a subarachnoid injection of 1.5 ml containing bupivacaine 2.5 mg and fentanyl 25 microg for initiation of analgesia. Patients in the epidural group (n = 73) were given an epidural injection of 10 ml containing bupivacaine 12.5 mg and fentanyl 50 microg. Mean (SD) onset times to the first pain-free contraction were 10.0 (5.7) min in the combined spinal-epidural group and 12.1 (6.5) min in the epidural group (p = 0.054). Patients in the combined spinal-epidural group suffered a higher incidence of motor weakness and proprioceptive deficit than those in the epidural group (p = 0.01). The incidence of technique failure and side-effects was similar in the two groups. It is our contention that the statistically nonsignificant difference in onset times does not justify the additional potential for side-effects and the extra cost of the equipment involved in the combined spinal-epidural technique.

Duodenal mucosal architecture in non-specific and ulcer-associated duodenitis

This study was done to determine the severity and extent of abnormalities of duodenal mucosal architecture in non-specific (non-ulcerative) and ulcer-associated duodenitis. The effect of successful treatment with cimetidine on these changes has also been assessed. A method of microdissection and measurement of villus height, crypt depth, and mitotic figure count per crypt was applied to endoscopic biopsies from the duodenum. Five groups of patients were studied: untreated ulcer-associated duodenitis, untreated non-specific duodenitis, healed ulcer-associated and non-specific duodenitis after cimetidine treatment, and controls. Significant reduction in villus height, increase in crypt length, and increase in mitotic figure count per crypt were all found in both ulcer-associated and severe non-specific duodenitis as compared with controls. These changes were localised to visually inflamed areas and regressed after healing of these lesions with cimetidine. This is the first quantitative comparison of the architectural features between diseased states in the duodenum and control in the same study. Identical morphological changes in the form of crypt hyperplasia and villus atrophy were demonstrated in areas of non-specific and ulcer-associated duodenitis. No evidence could be found from this study that non-specific duodenitis constitutes a different disease from ulcer-associated duodenitis.