Clinical Presentation, Management and In-Hospital Outcome of COVID-19 among Non-Healthcare Personnel and Healthcare Personnel in a Tertiary Cardiac Care Hospital

The huge numbers of non-healthcare personnel (non-HCP) who get infected by corona virus disease 2019 (COVID-19) not only paralyze health care systems but also put health care personnel (HCP) at potential risk globally. Objective of the study was to compare the Healthcare personnel (HCP) and non-HCP COVID-19 cases. This prospective observational study was carried out in National Heart Foundation Hospital and Research Institute of Bangladesh from March 08, 2020 to July 20, 2020. During this study period all admitted non-HCP who subsequently was diagnosed as COVID-19 positive by rRT-PCR and HCP of this hospital, who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace and become COVID-19 positive, were included. Out of 320 infected patients, 181(56.6%) patients were non-HCP and 139(43.4%) were HCP. Non-HCP were older than HCP (Mean age: 52.95±13.82 years vs. 34.08±11.11 years; p=0.001). Non-HCP were predominantly male and HCP were predominantly female (73.5% vs. 41% & 26.5% vs. 59%; p=0.001). Non-HCP had more risk factors and co-morbidities than HCP (p=0.001). Typical symptoms of COVID-19 such as fever and cough were prevalent in HCP. More aggressive treatment was required for non-HCP. Non-HCP had more severe disease and higher case fatality rate (9.4% vs. 0.7%; p=0.001) than HCP. Disease severity (OR 0.03, 95% CI 0.01-0.15) and DM (OR 0.09, 95% CI 0.01-0.94) were the independent predictor of mortality. Non-HCP was older in age, predominantly male and had more co-morbidities than HCP. Typical symptoms of COVID-19 were prevalent in HCP. Non-HCP had more severe disease and higher case fatality rate than HCP.

Ruptured Liver Abscess in Neonates: Report of Two Cases

Neonatal hepatic abscess is a rare disease seen mainly in preterm following umbilical catheterisation. Liver abscess in term neonates without any predisposing factor is still rarer and only few cases have been reported in the literature. Here we report two cases of liver abscess in term neonates presenting with abdominal mass due to rupture.

Pattern of sexually transmitted infections: a profile from a sexually transmitted infections clinic of a tertiary care hospital of eastern India

BACKGROUND

Sexually transmitted infections (STIs) are public health problems, which significantly increase the risk of HIV transmission. A proper understanding of the pattern of STIs in different geographical regions is important for proper planning of STI control.

AIMS

To determine the pattern of sexually transmitted diseases in a tertiary care hospital in Eastern India.

SUBJECTS AND METHODS

This is a hospital-based, cross-sectional study done in a tertiary care hospital of Eastern India. All the consecutive patients attending the STI clinic of a tertiary care hospital from January 2011 to December 2011 were included in the study, irrespective of age and sex. Thorough history was taken; proper clinical examination and relevant laboratory investigations were done. STIs were categorized in different syndromes as depicted by National AIDS Control Organization(NACO) in the syndromic management of STIs. The STIs, which were not included in the syndromic management, were also identified by clinical features and investigations. Partner notification and condom promotion was done. The statistical analysis used was Chi-square test using Medcalc(R) statistical software Version 9.3 (Belgium).

RESULTS

The commonest STI was genital herpes. Viral STIs like genital herpes, condyloma acuminata, molluscum contagiosum were more prevalent than the non-viral ones like genital ulcer disease non-herpetic, syphilis. STIs which were not included in the syndromic management like molluscum contagiosum, condyloma acuminata, genital scabies were common. HIV seropositivity in the study population (4.2%) was more than the NACO estimate. Condom promotion, partner notification, and partner management was not adequate. Occurrence of venereophobia was found to be significantly higher in male than in female attendees of STI clinic.

CONCLUSIONS

The trend for viral STIs is increasing while that for bacterial STIs is decreasing. Proper training of the health care providers regarding minor STIs, condom promotion, partner notification and partner management, counseling regarding venereophobia should be undertaken to make STI control programs successful.

Collagen cross-linking with riboflavin and ultraviolet-A light in keratoconus: One-year results

Background:

The aim of this study is to evaluate the safety and effectiveness of riboflavin-ultraviolet type A (UV-A) light rays induced cross-linking of corneal collagen in improving visual acuity and in stabilizing the progression of keratoconic eyes. The method of corneal cross-linking using riboflavin and UV-A light is technically simple and less invasive than all other therapies proposed for keratoconus. It is the only treatment that treats not only the refractive effects of the condition but the underlying pathophysiology.

Materials and Methods:

In this prospective, nonrandomized clinical study, 20 eyes of 19 patients with keratoconus were treated by combined riboflavin UV-A collagen cross linking. The eyes were saturated with riboflavin solution and were subjected for 30 min under UV-A light with a dose parameter of 3 mW/cm². Safety and effectiveness of the treatment was assessed by measuring the uncorrected visual acuity, best corrected visual acuity, manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations from Pentacam and corneal aberrations at 6 months and 1 year post-treatment.

Results:

Comparative analysis of the pre-operative and 1 year post-operative evaluation showed a mean gain of 4.15 lines of UCVA (P= 0.001) and 1.65 lines of BCVA (P= 0.002). The reduction in the average keratometry reading was 1.36 D (P= 0.0004) and 1.4 D (P= 0.001) at the apex. Manifest refraction sphere showed a mean reduction of 1.26 D (P= 0.033) and 1.25 D (0.0003) for manifest cylinder. Topo-aberrometric analysis showed improvement in corneal symmetry.

Conclusion:

Cross-linking was safe and an effective therapeutical option for progressive keratoconus.

Light microscopic study of cervical smear in a tertiary hospital at Dhaka

This light microscopic retrospective study of 798 cervical smear were done to see the pattern of cervical lesions and main presenting complaints of the women who attended the Gynae & Obstetrics department of BIRDEM hospital for medical and surgical advice. Out of these 798 smears examined light microscopically 274(34.34%) was normal, 453(54.26%) were inflammatory smear, 49(6.14%) showed Gardrenella, 9(1.13%) revealed the presence of Candida, 3(0.38%) showed Trichomonial infection, 6(0.76%) showed the presence of atypical cells (5ASCUS, 1 CIN) and 2(0.26%) were positive for malignancy, (1 adenocarcinoma, 1 squamous cell carcinoma). The mean age+/-SE of the women were 43.12+/-9.18 years, mean+/-SE age of the last child was 14.19+/-7.99 years; mean+/-SE of para was 3.5+/-7.34 pregnancies. The common presenting complains of these women Menorrhagia (17.92%), Menopausal Symptoms (17.42%), Lower Abdominal pain (15.78%), White PV discharge (15.78%), Dysmenorrhoea (7.52%), Pruritus/Itching vulva (7.14%), Prolapse (4.39%), Fibroid (2.01%), Infertility (1.13%), Post coital bleeding (0.75%) respectively. Pap's smear is reconfirmed as an established major screening tool for diagnosis of different cervical lesions.

Relative and absolute contributions of postprandial and fasting plasma glucose to daytime hyperglycaemia and HbA(1c) in subjects with Type 2 diabetes

AIMS

To determine the relative and absolute contributions of postprandial glucose (PPG) and fasting or preprandial plasma glucose (FPG) to daytime hyperglycaemia and HbA(1c) respectively, in persons with type 2 diabetes (T2DM).

METHODS

Subjects (n = 52; 37 men) had 12hr plasma glucose (PG) profiles determined in response to three serial identical test meals. PPG exposure was calculated for each meal. Excess hyperglycaemia was calculated above a PG concentration of 5.5 mmol/l. Fasting hyperglycaemia was the difference between excess hyperglycaemia and PPG exposure. Subjects were divided into three groups according to HbA(1c)-(Gp1:<7.3%;Gp2:7.3%-8.0%;Gp3:>8.0%) and the relative contribution of PPG exposure and fasting hyperglycaemia to excess hyperglycaemia calculated for each meal. The absolute contribution of PPG and fasting hyperglycaemia to excess HbA(1c) (mean HbA(1c)-5.1%) was also calculated.

RESULTS

The relative contributions of PPG exposure to excess hyperglycaemia for the three groups were: 58.3%, 54.3% and 35.4% (P = 0.483-Group 1 vs. Group 2; P = 0.002-Group 2 vs. Group 3) for meal 1; 69.8%, 54.7% and 23.7% (P = 0.163-Group 1 vs. Group 2; P = 0.005-Group 2 vs. Group 3) for meal 2; 85.8%, 70.2% and 48.6% (P = 0.153-Group 1 vs. Group 2; P = 0.046-Group 2 vs. Group 3) for meal 3. Absolute contributions of PPG to excess HbA(1c) in the three groups were 1.4%, 1.6% and 1.3% (P = NS).

CONCLUSION

The relative contribution of postprandial glucose to excess hyperglycaemia decreases as glycaemic control deteriorates, being dominant with HbA(1c)</= 7.3%, irrespective of the timing of the meal during the day. However, the absolute contribution of postprandial glucose to excess HbA(1c) does not differ significantly ( approximately 1.5%) with varying glycaemic control.

Inter-rater and intra-rater reliability of the Bahasa Melayu version of Rose Angina Questionnaire

The objective of the study is to translate the Rose Questionnaire (RQ) into a Bahasa Melayu version and adapt it cross-culturally, and to measure its inter-rater and intrarater reliability. This cross sectional study was conducted in the respondents' homes or workplaces in Kelantan, Malaysia. One hundred respondents aged 30 and above with different socio-demographic status were interviewed for face validity. For each inter-rater and intra-rater reliability, a sample of 150 respondents was interviewed. Inter-rater and intra-rater reliabilities were assessed by Cohen's kappa. The overall inter-rater agreements by the five pair of interviewers at point one and two were 0.86, and intrarater reliability by the five interviewers on the seven-item questionnaire at poinone and two was 0.88, as measured by kappa coefficient. The translated Malay version of RQ demonstrated an almost perfect inter-rater and intra-rater reliability and further validation such as sensitivity and specificity analysis of this translated questionnaire is highly recommended.

Blood pressure in acute intracerebral haemorrhage

Stroke is one of the leading causes of death worldwide, and spontaneous bleeding into the brain parenchyma, intracerebral haemorrhage (ICH), is a stroke subtype associated with high morbidity and mortality. Overall, it comprises about 15% of all stroke in Caucasians, this figure being much higher in Asians and black people. Blood pressure (BP) appears to play an important role in this disease. We have reviewed available literature on the relationship of BP to the occurrence of primary and secondary ICH, the association of BP levels measured early after stroke with prognosis and complications, and evidence about the effects of early BP lowering treatments on post-stroke outcomes. BP appears to be an important risk factor for primary and secondary ICH. In addition, high BP early after ICH may be detrimental to outcome, possibly contributing to complications such as rebleeding and haematoma enlargement. Few data are available about the effects of early lowering of BP on outcome after ICH with no reliable trial yet conducted. Proper randomised trials are required to establish the effect of early lowering of BP on outcome after ICH.

Differences in cardiovascular disease risk factors between Japanese in Japan and Japanese-Americans in Hawaii: the INTERLIPID study

Despite increase in serum total cholesterol, high smoking rate, and frequency of adverse blood pressure levels in Japan, coronary heart disease (CHD) incidence and mortality apparently remain substantially lower at all ages in Japan than in the US and other Western societies. To better understand these differences, we compared CHD biomedical risk factors and dietary variables in Japanese living in Japan and 3rd and 4th generation Japanese emigrants living a primarily Western lifestyle in Hawaii, in an ancillary study of the INTERMAP. Men and women aged 40-59 years were examined by common standardized methods-four samples in Japan (574 men, 571 women) and a Japanese-American sample in Hawaii (136 men, 131 women). Average systolic (SBP) and diastolic (DBP) blood pressures were significantly higher in men in Japan than in Hawaii; there were no significant differences in women. The treatment rate of hypertension was much lower in Japan than Hawaii. Smoking prevalence was higher, markedly so for men, in Japan than Hawaii. Body mass index, serum total and low-density lipoprotein cholesterol, HbA1c, and fibrinogen were significantly lower in Japan than in Hawaii; high-density lipoprotein cholesterol was higher in Japan. Total fat, saturated fatty acid intake, and Keys dietary lipid score were lower in Japan than in Hawaii. Polyunsaturated/saturated fatty acid ratio and omega-3 fatty acid intake were higher in Japan than in Hawaii. In conclusion, levels of several, especially lipid, CHD risk factors were generally lower in Japanese in Japan than in Japanese in Hawaii. These differences were smaller for women than men between Japan and Hawaii. They may partly explain lower CHD incidence and mortality in Japan than Western industrialized countries.

A cheap and convenient modification of arsine generator used for arsenic estimation

In a study observing the effect of spirulina in the treatment of chronic arsenic poisoning quantitative estimation of arsenic in the urine of the patients was necessary. It was decided to try a modification of the arsine generator in the process. An alternative apparatus was designed following the structure of arsine generator by White (1976) using a 50-ml conical flask with rubber cork, 4-ml injection vial, two 3" long glass tubes and a glass test tube. An experiment was carried out with solutions containing known amounts of arsenic. The alternative arsine generator was tried in the estimation of arsenic content in those solutions. The results revealed that the apparatus permitted correct measurement of arsenic concentration. The alternative arsine generator was cheap easy to use and provided authentic results in estimation of arsenic concentration in the urine of patients with chronic arsenic poisoning.

Generational and regional differences in trends of mortality from ischemic heart disease in Japan from 1969 to 1992

The authors compared generational and regional trends of premature mortality from ischemic heart disease (IHD) from 1969 to 1992 for persons aged 30-69 years. They selected Tokyo and Osaka prefectures as the most urbanized and compared them with the rest of Japan. The data were divided into two periods: period I (1969-1978, International Classification of Diseases, Eight Revision) and period II (1979-1992, International Classification of Diseases, Ninth Revision). In both populations, IHD mortality decreased for both sexes, but mortality from nonspecific heart disease remained constant in men and decreased in women. In Tokyo and Osaka prefectures, the percentage decline per year in IHD mortality for both sexes was significantly smaller in period II than in period I. However, in the rest of Japan, it did not decrease for either sex. Age-specific analysis showed that the percentage decline per year in period II was smallest for the group aged 30-49 years (men, 0.05%; women, 0.76%) in Tokyo and Osaka prefectures, while it was similar for all age groups in the rest of Japan. For men, the IHD mortality rate in 1991-1992 for those aged 30-49 years was higher in Tokyo and Osaka prefectures (9.4/100,000) than in the rest of Japan (5.4/100,000).

Postoperative management of transtibial amputations in VA hospitals

Rigid plaster dressings and immediate postoperative prostheses (IPOP) in patients undergoing transtibial amputations have been reported to reduce pain and healing time, prevent knee flexion contractures, and expedite early ambulation compared to soft dressings. Yet, despite the reported benefits, surgical adoption of (conventional) rigid dressings and IPOP has been inconsistent. The purpose of this study was to determine the current postoperative transtibial amputation dressing practices in VA hospitals. A six-item questionnaire was sent to 134 surgeons at the 117 VA hospitals where transtibial amputations were performed in fiscal year 1999. Responses were received from 83% of the surgeons. During the 1999 study year, surgeons performing transtibial amputations used soft dressings on 67% of patients, conventional rigid dressings with no intent to apply a foot attachment on 14% of patients, removable rigid dressings on 14% of patients, and IPOP (almost exclusively without a foot) on 5% of patients. The application of a rigid dressing or IPOP did not correlate well with the total number of transtibial amputations performed by the surgeon, hospital bed size, or academic affiliation.

Human reproductive failure I: immunological factors

Human reproductive failure may be a consequence of aberrant expression of immunological factors during pregnancy. Although the relative importance of immunological factors in human reproduction remains controversial, substantial evidence suggests that human leukocyte antigens (HLA), antisperm antibodies, integrins, the leukaemia inhibitory factor (LIF), cytokines, antiphospholipid antibodies, endometrial adhesion factors, mucins (MUC1) and uterine natural killer cells contribute to reproductive failure. In contrast, fewer data support the roles of anti-trophoblast antibodies, anti-endometrial antibodies, T-cells, peripheral natural killer cells, anti-HLA antibodies, blocking antibodies and suppressor cells in reproductive failure. Although immunological factors involved in reproductive failure have been studied traditionally using assays for antibodies and/or antigens, detailed research on these factors demonstrates conflicting results in humans. Maternal and fetal immunology is also difficult to investigate in humans. For these reasons, molecular assays may serve as a valuable alternative to investigate how the immune system affects reproductive outcome. In Part I of this review, immunological factors involved in human reproductive failure are summarized and critically evaluated. Immunogenetic and interacting factors in human reproductive failure will be summarized and evaluated in Part II.

Human reproductive failure II: immunogenetic and interacting factors

Studies in humans suggest that reproductive failure may be influenced by immunological factors or by genes encoding immunological factors and regulatory mechanisms controlling immunological expression. Using molecular methods, immunological factors can be clearly studied in an immunogenetic context. One example, the major histocompatibility complex (MHC), known as the human leukocyte antigens (HLA) in humans and MHC in other mammals, affects many different stages of reproduction. Studies in some outbred, and in closely related, human populations indicate that HLA, or HLA-linked, genes and HLA regulatory factors affect gamete development, embryo cleavage, blastocyst and trophoblast formation, implantation, fetal development and survival. Studies in non-human mammals indicate that MHC, or MHC-linked, genes such as the grc complex, Ped/Qa-2, t haplotypes and MHC regulatory factors, have similar reproductive effects. Human reproductive failure may also be a consequence of disruption of interacting factors, including interactions between HLA antigens, cytokines and natural killer (NK) cells. In this review, we highlight the importance of immunogenetic and interacting factors in human reproductive failure. We argue that studies in closely related human populations and animal models may contribute to a better understanding of the ways in which immunogenetic and interacting factors are involved in human reproduction.

Epidemiology of hypertension in China and Japan

Hypertension is a major risk factor for cardiovascular disease in Chinese and Japanese with a low to moderate serum cholesterol level. The prevalence of hypertension is diverse in Chinese populations with different geographic region, lifestyles and cultures. The same diversity was observed in Japan in the past, but recently the regional difference has become smaller. The large decline in stroke mortality in Japan was followed by a reduction in the prevalence of hypertension and the lowering level of blood pressure. This is partly explained by various community-based hypertension control programmes. Chinese populations are now showing similar patterns as those observed in Japan. These populations still have high proportions of undetected hypertensives and untreated patients in China. In both Chinese and Japanese, high salt consumption is one of the most important risk factors for hypertension. In addition to this, the increase in body weight, smoking and alcohol consumption in Chinese people seems to be the major factors for the increasing trends in hypertension. Control of hypertension and lowering blood pressure in the population level should be the important strategies for the prevention of cardiovascular disease in Chinese and Japanese.

Stroke incidence and case fatality in Shiga, Japan 1989-1993

BACKGROUND

This paper describes incidence rates and case-fatality for sub-types of stroke using data collected in Takashima, Shiga, Japan, from 1989 to 1993 and compares these with similar registers in other parts of Japan.

METHODS

Registered patients included all residents of the county who experienced a first-ever stroke. Stroke was defined as sudden onset of neurological symptoms which continued for a minimum of 24 hours or led to death. Almost all such patients are hospitalized in this country. Early case fatality was defined as patients who died within 28 days of stroke onset. Diagnosis of stroke type was based on clinical symptoms as well as computed tomography (CT) scans.

RESULTS

Age-adjusted incidence rates for stroke per 100,000 population aged 35 years and older were 268.7 for men and 167.5 for women. The age-specific incidence rate of both cerebral infarction and cerebral haemorrhage increased with advancing age. The occurrence of cerebral infarction in men was twice as high as in women. The 28-day case fatality for all sub-types of stroke was 16.1% in men and 15.8% in women. Case fatality for cerebral infarction, cerebral haemorrhage, and subarachnoid haemorrhage was 10.7%, 22.4% and 28.6% respectively.

CONCLUSIONS

Takashima County has a moderately high stroke incidence rate and case fatality compared with other similar studies in Japan. The incidence rate of cerebral infarction in men is twice that in women, while other sub-types of stroke showed smaller differences. In order to decrease the incidence of stroke in Japan, greater efforts at primary prevention will be necessary, in particular, it is important to prevent cerebral infarction in men.

Changes in body mass index and its relationships to other cardiovascular risk factors among Japanese population: results from the 1980 and 1990 national cardiovascular surveys in Japan

Few studies have attempted to investigate the changes in body mass index (BMI) and its relationship to other cardiovascular factors in Asian populations, including Japanese. Data from two national cross-sectional surveys on circulatory disorders in 1980 and 1990 in Japan were used in this study. The sample consisted of 10,556 participants in the 1980 survey and 8,385 in the 1990 survey, aged > or = 30 years. The results show that after adjusting for age, smoking, alcohol consumption (ALC) and daily life physical activity (PA), mean BMI increased 0.49 kg/m2 (95% confidence interval: 0.34-0.65) in men aged 30-59 and 0.61 kg/m2 (0.37-0.86) in those aged > or = 60 from 1980 to 1990. In women, however, mean BMI decreased 0.24 kg/m2 (-0.39 0.09) in those aged 30-59 and increased 0.38 kg/m2 (0.12-0.64) in those aged > or = 60. BMI was significantly associated with hypertension, diabetes and hypercholesterolaemia. In both genders, cu-smokers had lower mean BMI than never smokers, while among the cu-smokers, mean BMI was positively associated with the number of cigarettes smoked per day. In men, BMI was positively associated with ALC and negatively associated with PA, while in women, BMI was negatively associated with ALC and positively associated with PA. The results suggest that BMI has significantly increased in men and in elderly women. BMI, even in the Japanese population who are characterized by relative low BMI, is significantly associated with several cardiovascular risk factors.

[Randomized controlled trial for smoking cessation among city office employees]

To evaluate the effect of a smoking cessation program by health professionals, a randomized intervention study was carried out in the Omihachiman city office in 1993. Participants (n = 53), volunteers from current smokers in the city office, were randomly divided into intervention and control groups. The intervention group received intensive education for five months (i.e., the effect of smoking on health, the beneficial aspects of quitting smoking, how to stop smoking and how to deal with the withdrawal symptoms). Group lectures (two times) and individual counseling (three times) were used for health education. After five months, the control group was also given the same advice on smoking cessation. Comparison of smoking cessation rates between the two groups was performed at the end of the intervention period. Follow-up of all participants occurred at six and 12 months post intervention. After the five months of intervention, smoking cessation rate in the intervention group (19.2%) tended to be higher than that in the control group (7.4%), but was not significant (chi 2 = 1.62). Over all smoking cessation rates of all participants (n = 53) at the end of the 10 month intervention was 32.1% and at six months and 1 year after the end of the 10 month intervention were 24.5% and 13.2%, respectively. Comparison of participants who successfully stopped smoking and those who did not, it was revealed that younger age, lower expired air CO concentration (p < 0.01), and attitude for smoking cessation at the beginning were significantly related to smoking cessation. In our study, after five months, smoking cessation rate in the intervention group was about two times that of the control group, although the effectiveness of our smoking cessation program could not be validated due to small sample size. Taking into account the rate of smoking cessation after one year, We believe that programs by health professionals are effective for smoking cessation.

Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications

PURPOSE

The aim of this study was to determine the influence of various prognostic factors on the outcome of esophageal atresia patients.

METHODS

The authors reviewed 240 charts of patients admitted with esophageal atresia or tracheoesophageal fistula (EA-TEF) in a single institution. A logistic regression model was used with survival as the dependent variable and era of repair, birth weight, and cardiac anomaly as independent variables.

RESULTS

Era was statistically significant (P = .011); 87% (117 of 134) of patients survived in the era from 1980 through 1997 compared with 78% (83 of 106) from 1960 through 1979. Cardiac anomaly (CHD) was a significant risk factor (P = .001); 88% (176 of 199) survived without cardiac anomaly, whereas only 59% (24 of 41) survived with cardiac disease. Eighty-four percent (185 of 219) of infants with a birth weight (BW) of more than 1,500 g survived, compared with 71% (15 of 21) of infants with a birth weight of less than 1,500 g. This was not statistically significant (P = .59). Early hospital deaths were primarily cardiac and chromosomal (61%). Late deaths were primarily respiratory (59%; two-tailed Fisher's Exact test, P = .004).

CONCLUSIONS

(1) Survival of patients with esophageal atresia has significantly improved in the recent years. (2) Low birth weight (<1,500 g) does not seem to affect survival. (3) Associated cardiac and chromosomal anomalies are significant causes of death, particularly for early demise. (4) Late death from respiratory disease (tracheomalacia, reactive airway disease, reflux, and aspiration) warrants attention, and a close follow-up of postoperative patients is suggested.

Relationship between blood pressure and alcohol consumption on the previous day in Japanese men

An association has been found between high blood pressure (BP) and the regular consumption of alcohol in epidemiological studies, and a repeated withdrawal reaction to alcohol is considered one of the mechanisms of high BP in drinkers. In this study, we investigated the association between BP and alcohol consumption on the previous day in regular male drinkers. The study participants were 551 men aged 20 to 59 yr who drank alcohol regularly. BP was measured and information on daily alcohol intake was obtained from each participant by a questionnaire, which also asked whether alcohol had been consumed on the day before BP measurement. Age-adjusted BP was compared between participants who had (n=504, 91.6%) and those who had not (n=47, 8.4%) consumed alcohol on the previous day. There were no significant differences between the two groups with regard to BP or body mass index. Even after excluding subjects who were receiving anti-hypertensive drugs, there was still no significant difference in age-adjusted BP between the two groups. Our study found no association between BP and alcohol consumption on the previous day in regular male drinkers, which implies that alcohol withdrawal after 1 d of abstinence cannot explain the high blood pressure found in regular drinkers in this Japanese middle-aged population.

Cisapride reduces neonatal postoperative ileus: randomised placebo controlled trial

AIM

To assess the efficacy of cisapride in reducing ileus persisting to the tenth postoperative day after neonatal abdominal surgery.

METHODS

A prospective, randomised, double blind trial comparing rectal cisapride (1.4-2.3 mg/kg/day) with placebo over seven days was undertaken in 33 neonates.

RESULTS

Seven of 12 (58%) patients receiving placebo and eight of 11 (73%) receiving cisapride achieved a first sustained feed during treatment. Of those receiving cisapride, the first sustained feed occurred at 2.3 days (SEM 0.6) compared with 4.7 days (SEM 0.8) with placebo. By the seventh day the mean daily net enteral balance was 69 (SEM 18) ml/kg in the cisapride subgroup and 17 (SEM 8) ml/kg for those receiving placebo. Stool was passed on 6.3 (SEM 0.4) treatment days in the cisapride subgroup compared with 4.1 (SEM 1.0) treatment days in the placebo subgroup.

CONCLUSION

Cisapride is effective in neonates with a prolonged ileus after abdominal surgery.

[Current epidemiology of hypertension in Japan]

In 1960, stroke mortality in Japan was the highest among industrialized countries, while CHD mortality was the lowest. Stroke mortality for men and women aged 30-69 years, however, declined by 80% during the 1965-90 years and CHD mortality also declined during the same period. Among risk factors, trends in blood pressure level and the prevalence of hypertension were very compatible with those in stroke mortality. Serum total cholesterol level has increased remarkably, however, CHD mortality has not increased. This may be explained by the decline in population blood pressure level and the prevalence of hypertension, and decreased smoking rate.

Fetiform teratoma arising from a tubular intestinal duplication. A probable cause of ruptured exomphalos

A neonate who had a ruptured exomphalos with a fetiform teratoma arising from the end of a long intestinal tubular duplication and a short gut is presented. The management is discussed and the literature is reviewed.

Association between electrocardiographic ischemic abnormalities and ischemic heart disease risk factors in a Japanese population

This cross-sectional study was undertaken to investigate the association of electrocardiographic (ECG) ischemic abnormalities with ischemic heart disease (IHD) risk factors in a Japanese population. Resting ECGs of 1201 subjects (572 men and 629 women, aged 30 to 89 years), were coded independently by two coders according to the Minnesota Code. Blood pressure (BP) was recorded using a standard sphygmomanometer, and non-fasting serum total cholesterol and high-density lipoprotein cholesterol were measured. Codes 1.1 and 1.2 were classified as myocardial infarction and codes 1.3, 4.1-4.4, 5.1-5.3 and 7.1 were classified as ischemia. Prevalence of ECG with evidence of IHD (IHD ECG) was defined as myocardial infarction and ischemia together. Levels of risk factors were compared between subjects with IHD ECGs and those without IHD ECGs. Multiple logistic regression analysis was used to ascertain the associations between IHD ECG and risk factors. The prevalence of myocardial infarction in the total population was 1.5% and 0.7% in men and women, respectively and the prevalence of IHD ECGs was 10% and 11.3% in men and women, respectively. Systolic blood pressure (SBP) was consistently higher in subjects with IHD ECGs in the total population of both sexes (P < 0.001, P = 0.001 for men and women respectively). Diastolic blood pressure (DBP) was higher only in men with IHD ECGs (P = 0.002). In middle-aged men (aged 30-59 years), total cholesterol was considerably higher in subjects with IHD ECGs, although this relationship was statistically not significant. In multiple logistic regression analysis, SBP was independently associated with IHD ECGs in both sexes (P = 0.001). Associations between IHD ECGs with total cholesterol, alcohol intake and smoking were not statistically significant. This study showed that electro-cardiographic IHD evidences in Japanese are predominantly associated with blood pressure level in both sexes.

The associations between alcohol drinking and dietary habits and blood pressure in Japanese men

OBJECTIVE

To clarify the relationships between blood pressure and alcohol, nutrients and electrolytes intakes in Japanese men.

DESIGN AND METHOD

A dietary survey was conducted in a rural population of Japan by the 2-day dietary record method, and blood pressure was measured with a standard sphygmomanometer. Blood pressure levels, nutrients and electrolytes intakes were compared among the non-drinkers and the tertiles of the alcohol-drinking subjects. The relationships between blood pressure and nutrients, electrolytes and alcohol intakes were also determined by multiple regression analysis.

RESULTS

Age and systolic blood pressure (SBP) were positively, and percentage of energy from fat and carbohydrates was negatively, related to the drinking categories. Univariate analysis showed that SBP was significantly related to age, body mass index (BMI) and alcohol intake, and diastolic blood pressure (DBP) was also significantly related to age, BMI and alcohol intake. Both SBP and DBP had a significant inverse relationship with the percentage of energy from fat (P < 0.01). Both SBP and DBP were significantly related to drinking categories when the effects of age, BMI and percentage energy from fat intake on blood pressure were adjusted for (P < 0.001). Multiple regression analysis revealed SBP to be significantly and positively associated with age, BMI and alcohol intake, and negatively associated with potassium intake, whereas DBP was significantly and positively associated with BMI and total energy intake, and was negatively associated with potassium and the percentage of energy intake from fat and carbohydrates.

CONCLUSION

The positive association between alcohol drinking and blood pressure persisted even after consideration of the effects of age, BMI and other macronutrient and electrolytes intakes. The reduction of alcohol intake should be an important public health strategy in the primary prevention of hypertension in this population.

Alcohol intake and serum lipids in a Japanese population

BACKGROUND

Previous epidemiological and clinical studies have shown that alcohol, which increases high density lipoprotein (HDL) cholesterol levels, has an anti-atherogenic effect. But data on the effects of alcohol on low density lipoprotein (LDL) cholesterol are scarce. In this paper a cross-sectional study on the associations of alcohol in graded doses with serum lipids in a Japanese population is presented.

METHODS

The daily alcohol intake of 832 Japanese men aged 35-59 was determined and the subjects were divided into five categories according to their daily alcohol consumption. The associations of alcohol intake and the kind of alcoholic beverage with serum lipids were determined by multiple regression analyses taking into consideration the differences of other confounding factors, i.e. age, body mass index (BMI) and smoking.

RESULTS

Serum triglycerides and HDL-cholesterol were higher (P < 0.001) with higher alcohol intake while LDL-cholesterol was lower (P < 0.01). In multiple regression analysis, after adjusting for age, BMI and number of cigarettes smoked per day, HDL-cholesterol and the ratio of HDL-cholesterol to LDL-cholesterol were found to have a significant positive relationship with daily alcohol consumption (P < 0.001) and LDL-cholesterol to have a significant negative relationship (P < 0.001). The kind of alcoholic beverage had no significant relationship with serum HDL-cholesterol and LDL-cholesterol; however, serum triglycerides were found to be significantly lower in those who drank beer (P < 0.05).

CONCLUSIONS

Alcohol drinkers have a higher HDL-cholesterol level and lower LDL-cholesterol level than non-drinkers. This anti-atherogenic lipid profile in alcohol drinkers may be explained by the effect of alcohol on serum lipids independent of age, BMI and smoking.

4-Methyl-7,11-heptadecadienal and 4-methyl-7,11-heptadecadienoic acid: new antibiotics from Sporothrix flocculosa and Sporothrix rugulosa

4-Methyl-7,11-heptadecadienal [1] and 4-methyl-7,11-heptadecadienoic acid [2] were isolated as new compounds from liquid cultures of Sporothrix flocculosa and Sporothrix rugulosa. Compounds 1 and 2 inhibited the growth of Fusarium oxysporum f. sp. lycospersici, Trichoderma viride, and Bacillus subtilis.

Genome size and restriction fragment length polymorphism analysis of Vibrio cholerae strains belonging to different serovars and biotypes

The genome size of Vibrio cholerae has been determined by pulsed field gel electrophoresis following digestion of chromosomal DNA with endonucleases. The genome size of all the classical strains examined was about 3000 kb and that of El Tor biotype was 2500 kb. The NotI and SfiI digestion patterns of the genomes of several V. cholerae strains belonging to different serovars and biotypes showed distinct restriction fragment length polymorphism (RFLP). RFLP analysis together with the genome size can be used to differentiate strains of different serovars and biotypes of V. cholerae.

Penile agenesis: an unusual variant

An unusual variant of penile agenesis with a high rectal termination of the urethra is reported. The difficulties faced in the management of this case and the possible aetiology of this rare anomaly are discussed.

Positron annihilation studies in lysozyme and catalase

Positron annihilation studies have been carried out in two enzymes, lysozyme and catalase. Temperature dependence of the positron lifetimes in these two enzymes has been investigated. The results explained in terms of the free volume model and fluctuations between different conformational microstates of enzyme structures provide a new insight into the mechanism of bio-activity of these enzymes.

Intestinal endometriosis

Two cases with intestinal endometriosis, one with a right iliac fossa mass and the other with subacute intestinal obstruction, are presented. In both the cases, the diagnosis was not suspected clinically and was reached only on histological examination of the resected specimens.

Acute abdomen: an unusual presentation of a blind-ending bifid ureter

This case report features the unusual presentation of a blind-ending ureteric duplication (BEUD) as acute abdomen. The partially obstructed BEUD had mimicked acute appendicitis, leading to previous errors in the diagnosis and management of the case. A high index of suspicion is necessary to diagnose such a rare congenital anomaly when it presents as acute abdomen.

Vasopressinergic neurons in periependymal and periventricular areas of the rostral third ventricle of the rat

On the lateral wall of the rostral third ventricle, an area separates the ependyma from the neurosecretory PVN neurons. Since VP from the latter discharges into the vasculature, the above area may be regarded as constituting an interface between the ventricular and vascular compartments of the CNS. As VP release into the two compartments is integrated, the interface region has been explored for possible existence of a neural infrastructure that would allow such an integration. Immunohistochemical staining for VP following colchicine treatment reveals the presence of an elaborate vasopressinergic network in the interface region that is divisible into a medial periependymal and a lateral periventricular area. A closer examination indicates that the ependymal, periependymal, periventricular and PVN areas (in that order medio-laterally) are all interconnected through this network. The medial area appears to be receptive in nature, while the connectivity of the lateral area points to an effector function. All in all, such a neural network would provide a sound morphological basis for integration of neuroendocrine mechanisms modulating VP release into the ventricular and vascular compartments of the CNS.

Penile nodule in a young adult

A 20 year old male presented with a nodule, 1.25 cm x 1 cm, on the ventral aspect of the foreskin of his penis. The nodule was excised by circumcision. On histology it was found to be a multiloculated cyst located in the dermis of the prepuce. It contained eosinophilic material and was lined by pseudostratified columnar epithelium. There was no evidence of inflammation or malignancy in any of the sections of this median raphe cyst. The aetiology of such cysts is discussed in addition to a review of the literature.

Vasopressinergic neurons and the associated blood vessels in the rat anterior hypothalamus: an immunohistochemical study

The paraventricular (PVN) and supraoptic (SON) nuclei of the hypothalamic neurosecretory system have been extensively investigated by many workers. The functional aspects of vasopressin secretion (elaborated by the PVN and SON neurons) in relation to the vasculature of the anterior hypothalamus are also well documented. However, the available data concerning vasopressin (VP) functions are largely based on physiological studies. Corroborative morphological correlation with regard to this has received little attention. The present report elucidates the intricate anatomical relationships between the VP-neurons and the adjoining capillaries in the rat anterior hypothalamus. A peroxidase-antiperoxidase (PAP) immunocytochemical study, using a commercial VP antibody, was carried out for this purpose. The observations are interpreted from a functional standpoint. VP-immunostained elements, i.e. the somata and the processes (mainly dendrites), were localized (i) close to the wall, (ii) on the endothelium, and (iii) occasionally, in the lumen of the hypothalamic capillaries. The findings provide immunocytochemical evidence that the vasopressinergic elements are in direct relationship with the hypothalamic vasculature. This raises some interesting possibilities for the former to be involved in: (i) affecting the permeability of the blood-brain barrier for transport of various nutrient substances (important in aging and Alzheimer's disease), (ii) inducing an alteration in the water permeability of the brain vessels on which depends the precise adjustment of brain water content and of brain volume (fundamental to normal functioning of the brain), and (iii) serving as osmoreceptors of the blood flowing through the capillaries and thus providing a feedback mechanism for VP modulation.

Vasopressinergic axon collaterals and axon terminals in the magnocellular neurosecretory nuclei of the rat hypothalamus

Axon collaterals emerging from the vasopressinergic neurons of the supraoptic (SON) and paraventricular (PVN) nuclei and recurving back towards their respective nuclei have been previously reported. Since such axon collaterals can play a role in the neuromodulation of SON and PVN, these nuclei have been further investigated immunohistochemically under the light and electron microscope. The PAP technique, using a commercial antibody, was employed. Vasopressin-positive axon collaterals were seen to recurve towards their nuclei of origin. In the latter, vasopressinergic intrinsic neurons were also observed. Under the electron microscope, axon terminals containing vasopressin-immunoreactive neurosecretory granules were noted. Such terminals presumably arise from the vasopressin-positive recurrent axon collaterals or from the intrinsic neurons for the purpose of neuromodulation within the SON and PVN.

Ultrastructural features of presumptive vasopressinergic synapses in the hypothalamic magnocellular secretory nuclei of the rat

Despite convincing physiological evidences for vasopressin (VP) autoregulation in the supraoptic (SON) and paraventricular (PVN) nuclei, the morphological demonstration of VP synapses has lagged behind. The present work investigates the possible existence of such synapses in the SON and PVN of the rat. Electron microscopy of sections immunostained with VP antibody (1:5,000) and conjugated with avidin-biotin demonstrated presynaptic terminals containing neurosecretory granule (NSG)-like bodies, 80-100 nm in diameter. The terminals formed axodendritic, axosomatic and axoaxonic synapses, though the postsynaptic elements remained largely unidentified. Other ultrastructural features of synaptic specialization were evident. The NSG-like bodies exhibited a varying and dynamic relationship to the presynaptic membrane, suggesting their involvement in synaptic mechanisms.

Dst in the course of post stroke depression

The dexamethasone suppression test was administered to five patients with post-stroke depression, at initial evaluation and also in follow-up. It showed parallel results to clinical course of depression in four out of five patients.

Congenital glanular sinus: possible variant of blind accessory urethral channel

We report a case of congenital sinus opening at an unusual position on the glans penis of an asymptomatic subject. The differential diagnosis and embryological implications of this rare anomaly are discussed. We believe that our case represents an uncommon location for a blind accessory urethral channel.

Ultrastructural observation on the rat supraoptic neurons following acute operative stress

The response of the SON to various forms of stress is well documented. However, the effect of operative stress, which is a common and important clinical event requiring the mediation of vasopressin, has largely escaped attention. The present report describes the ultrastructural changes in the neurons of the caudal (retrochiasmatic) part of the SON following a deepseated linear incision on the dorsum of the rat. The observations were confirmed to the first forty-eight hours after trauma. At 24-hours post-operatively, a marked depletion of the neurosecretory granules was observed. This was associated with a proliferation of the granular and smooth endoplasmic reticulum, Golgi cisternae and ribosomes. A few of the neurosecretory granules were seen to lie in the close vicinity of the Golgi complexes. At 48-hours after trauma, these features persisted. In addition, an accumulation of neurosecretory granules was conspicuous in some axon pre-terminals. From the above findings, it is suggested that an increased demand for vasopressin during the early postoperative period is met by the supraoptic neurons by a liberation of their neurosecretory contents. An attempt at replenishment of the latter is evidenced by a proliferation in the membrane components and ribosomes. The pooling of neurosecretory granules in occasional axon pre-terminals may indicate an imbalance in the synthesis-secretion coupling of vasopressin.