Thyroid function status evaluation in patient post-radiotherapy for nasopharyngeal carcinoma: A retrospective study.

INTRODUCTION: Nasopharyngeal carcinoma (NPC) is among the most common malignancy in Malaysia. Radiationinduced hypothyroidism has been reported in other countries. However, in Malaysia, no studies were ever done to determine the effect of radiation on hypothyroidism. The objective of this study is to evaluate the practice of taking thyroid function test (TFT) and determine hypothyroidism post-radiation in patients with NPC. MATERIALS AND METHODS: A retrospective study on the symptoms and results of TFT according to the dosage of intensity-modulated radiotherapy (IMRT) given to patients with NPC. Data were traced and analysed. RESULTS: A total of 78 patients were identified. All patients received IMRT with 33-35 fractions of radiotherapy (RT) with total dosage of 66-70 Gray given. Not all patients had their thyroid function status measured routinely. Twelve patients did have symptoms of hypothyroidism. TFT were obtained in this group but the results were normal. No correlation was found between RT and hypothyroidism. CONCLUSION: There was no correlation between IMRT and the development of hypothyroidism. A prospective study with better control of inclusion and exclusion criteria, and longer follow-up period with TFT, is needed to demonstrate the consistency of these findings.

Mysterious Case of Drooling Infant - Hidden Foreign Body over Hard Palate.

Foreign body over the hard palate is a rare clinical entity that happen almost exclusively in young pediatric age group with only about 40 odd cases ever reported. Most cases in the literature are described as incidental findings of hard palate mass causing heightened anxiety to parents and clinicians alike during routine oral cavity examination. Owing to its rarity and lackluster presenting symptoms, this simple condition are often overlooked but has high propensity to develop into life threatening condition if dislodged into the airway.

The reliability of a rapid molecular detection method in determining the prevalence of rifampicin-resistant Mycobacterium tuberculosis in an urban district health facility in Malaysia.

INTRODUCTION: Rifampicin is a key first-line antimycobacterial agent employed for the treatment of pulmonary tuberculosis (PTB). This study sought to obtain prevalence data on rifampicin-resistant Mycobacterium tuberculosis among smear-positive PTB patients in the Klang District of Malaysia. MATERIALS AND METHODS: A total of 103 patients from the Chest Clinic of Hospital Tengku Ampuan Rahimah with sputum smears positive for acid-fast bacilli were included in this cross-sectional study. All sputa were tested using Xpert MTB/RIF to confirm the presence of M. tuberculosis complex and detect rifampicin resistance. Sputa were also sent to a respiratory medicine institute for mycobacterial culture. Positive cultures were then submitted to a reference laboratory, where isolates identified as M. tuberculosis complex underwent drug susceptibility testing (DST). RESULTS: A total of 58 (56.3%) patients were newly diagnosed and 45 (43.7%) patients were previously treated. Xpert MTB/RIF was able to detect rifampicin resistance with a sensitivity and specificity of 87.5% and 98.9%, respectively. Assuming that a single resistant result from Xpert MTB/RIF or any DST method was sufficient to denote resistance, a total of 8/103 patients had rifampicinresistant M. tuberculosis. All eight patients were previously treated for PTB (p<0.05). The overall prevalence of rifampicin resistance among smear-positive PTB patients was 7.8%, although it was 17.8% among the previously treated ones. CONCLUSION: The local prevalence of rifampicin-resistant M. tuberculosis was particularly high among previously treated patients. Xpert MTB/RIF can be employed in urban district health facilities not only to diagnose PTB in smear-positive patients, but also to detect rifampicin resistance with good sensitivity and specificity.

A randomized phase 2 study of MK-2206 versus everolimus in refractory renal cell carcinoma.

Background: Activation of the phosphoinisitide-3 kinase (PI3K) pathway through mutation and constitutive upregulation has been described in renal cell carcinoma (RCC), making it an attractive target for therapeutic intervention. We performed a randomized phase II study in vascular endothelial growth factor (VEGF) therapy refractory patients to determine whether MK-2206, an allosteric inhibitor of AKT, was more efficacious than the mammalian target of rapamycin inhibitor everolimus. Patients and methods: A total of 43 patients were randomized in a 2:1 distribution, with 29 patients assigned to the MK-2206 arm and 14 to the everolimus arm. Progression-free survival (PFS) was the primary endpoint. Results: The trial was closed at the first futility analysis with an observed PFS of 3.68 months in the MK-2206 arm and 5.98 months in the everolimus arm. Dichotomous response rate profiles were seen in the MK-2206 arm with one complete response and three partial responses in the MK-2206 arm versus none in the everolimus arm. On the other hand, progressive disease was best response in 44.8% of MK2206 versus 14.3% of everolimus-treated patients. MK-2206 induced significantly more rash and pruritis than everolimus, and dose reduction occurred in 37.9% of MK-2206 versus 21.4% of everolimus-treated patients. Genomic analysis revealed that 57.1% of the patients in the PD group had either deleterious TP53 mutations or ATM mutations or deletions. In contrast, none of the patients in the non-PD group had TP53 or ATM defects. No predictive marker for response was observed in this small dataset. Conclusions: Dichotomous outcomes are observed when VEGF therapy refractory patients are treated with MK-2206, and MK-2206 does not demonstrate superiority to everolimus. Additionally, mutations in DNA repair genes are associated with early disease progression, indicating that dysregulation of DNA repair is associated with a more aggressive tumor phenotype in RCC.

A comprehensive review on Nepalese wild vegetable food ferns.

Ferns are used as traditional and fascinating foods in many countries. They are also considered to possess important ethnomedicinal values; however, ferns are one of the underutilized plant resources by both scientific and local communities. Pharmagonostical studies reveal that ferns and fern-allies possess several biological activities including antibacterial, antiviral, antifungal, antimalarial, antidiarrheal, anthelmintic, analgesic, anti-inflammatory, antidiabetic, anticancer, neuroprotective, nephroprotective, hepatoprotective, antifertility, etc. Flavonoids and terpenoids are major secondary metabolites present in ferns. Ugonins, particularly isolated from Helminthostachys zeylanica, have found diverse bioactivities. Ptaquiloside, a norsesquiterpene glucoside, found in Pteridium revolutum, Dryopteris cochleata and Polystichum squarrosum, is one of the hazardous metabolites of ferns which is responsible for the toxic effect. Alkaloids are reported to be present in the ferns; however, the qualitative data are uncertain. Some fern metabolites, such as cyanogenic glycosides and terpenoids, are considered to possess defensive activity against animal attacks. Some ferns are also used for manuring as biological alternative to pesticides. Nepalese have consumed at least 33 species of ferns and fern-allies belonging to 13 families, 20 genera as cooked vegetable foods. The aim of this review is compilation of information available on their distribution, ethnomecinal values, pharmcognosy, pharmacology and phytochemistry.

Fatty acid profile of yak milk from the Qinghai-Tibetan Plateau in different seasons and for different parities.

Yaks are the most important grazing livestock for milk production on the Qinghai-Tibetan plateau because these animals are adapted to the high elevations and extremes of cold and can graze throughout the year. In the present study, 30 yaks were selected and the fatty acid (FA) profile of yak milk at different seasons and parities was investigated using gas chromatography. The concentrations of cis-9 C18:1, cis-11 C18:1, cis-9,trans-11 C18:2, and C18:3 n-3 in yak milk were higher in summer (25.26, 1.50, 1.46, and 0.33 g/100 g of total FA, respectively) than in winter (22.17, 0.77, 1.27, and 0.28 g/100 g of total FA, respectively). The contents of monounsaturated and polyunsaturated FA in milk fat of multiparous (parities 2 to 5) yaks (31.61 and 4.20 g/100 g of total FA, respectively) were higher than those in primiparous yaks (29.61 and 3.80 g/100g of total FA, respectively). These results suggest (1) that the potential exists to improve the FA composition of yak milk by developing local supplement resources during the winter and (2) that multiparous yaks have a more favorable FA profile than primiparous yaks.

First Report of Corynespora Leaf Spot on Patchouli Caused by Corynespora cassiicola in China.

Patchouli (Pogostemon cablin (Blanco) Benth.) is mainly cultivated in Southeast Asia as a medicinal shrub and a source of patchouli oil used in perfumery. In 2008, a leaf spot disease was observed on patchouli plants grown on most farms (some farms had 99% incidence) in Wanning, the predominant cultivation location in the Hainan Province of China. The disease usually began at the tip of leaves, the main veins, or small veinlets. Severely irregular-shaped dark brown leaf spots expanded over 5 to 10 days, eventually causing infected leaves to abscise. The time from initial leaf lesions to abscission usually took 1 month. The disease was usually most severe in April and May, causing significant economic losses along with quality losses to patchouli oil extracted from leaves. To isolate the causal pathogen, diseased leaves were collected in August 2008 from a farm of the Hainan Branch Institute of Medicinal Plant Development in Wanning, surface sterilized in 75% ethanol for 1 min, transferred to potato dextrose agar (PDA), and incubated at 28°C for 14 days. Single-spore cultures of three isolates were obtained and identified as Corynespora cassiicola (Berk. & Curt.) Wei. on the basis of morphological and physiological features (1). Genomic DNA was extracted from all the cultures. The internal transcribed spacer (ITS) region of the rDNA was amplified using primers ITS1 (5'-TCCGATGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3'). Amplicons were 546 bp (GenBank Accession No. HM145960) and had 99% nucleotide identity with the corresponding sequence (GenBank Accession No. GU138988) of C. cassiicola isolated from cassava (Manihot esculenta Crantz). To satisfy Koch's postulates, 50-day-old potted plants in a tent were sprayed until runoff with a spore suspension (1 × 106 spores/ml) prepared from 10-day-old cultures. Using this spray method, one isolate was inoculated separately onto nine leaves of three potted plants. The potted plants were covered with plastic bags to maintain high humidity for 48 h and then placed outside under natural environmental conditions (temperature 20 to 28°C). Another nine leaves of three potted plants, sprayed only with sterile water, served as noninoculated control plants. Leaf spot symptoms similar to those on diseased field plants appeared after 7 days on all inoculated plants. C. cassiicola was reisolated from all inoculated test plants. No symptoms were observed on the control plants. To our knowledge, this is the first report of C. cassiicola causing a leaf spot disease on patchouli in China. Other previous reports of this disease were from Cuba (2). This pathogen has also been reported previously to be economically important on a number of other hosts. On patchouli plants, more attention should be given to prevention and control measures to help manage this disease. References: (1) M. B. Ellis. Dematiaceous Hyphomycetes. Commonwealth Mycological Institute: Kew, Surrey, England, 1971. (2) I. Sandoval et al. Cienc. Tec. Agric., Prot. Plant. 10:21, 1987.

Epidermal growth factor-urogastrone causes vasodilatation in the anesthetized dog.

Epidermal growth factor-urogastrone (EGF-URO) administered intraarterially was a potent dilator in dog femoral (FEM), superior (cephalic) mesenteric (SMA), celiac (CAC), coronary (COR), carotid (CAR), and renal (REN) vascular beds. The effects of EGF-URO, which exhibited tachyphylaxis, could not be attributed either to recirculating EGF-URO or to the secondary release of other agonists or products of the cyclooxygenase pathway. Two vascular beds (FEM, SMA) showed a high maximum responsiveness to EGF-URO (maximum effect [Emax] approximately equal to 70% increase in flow) whereas another group (CAC, COR, CAR, and REN) exhibited lower responsiveness (Emax approximately equal to 20%). The ED50 for this effect of EGF-URO was in the range of 0.4 micrograms (FEM, SMA, CAR, and COR) to 0.9 micrograms (CAC and REN). In isolated dog COR helical strips, EGF-URO did not exhibit either a direct relaxing or a contractile effect. However, preincubation of strips with EGF-URO caused up to a 66% inhibition of contraction in response to norepinephrine (1 microM), with an ED50 for EGF-URO of 1 nM. This action of EGF-URO also showed marked tachyphylaxis. Our data point to a potential role for EGF-URO (and possibly for the structurally related alpha-transforming growth factor) in the regulation of blood flow in vivo.

Antileishmanial diterpenoid alkaloids from Aconitum spicatum (Bruhl) Stapf.

The crude extracts of tubers of Aconitum spicatum (Bruhl) Stapf were investigated for in vitro antileishmanial activity against Leishmania major. The dichloromethane extract at pH 2.5 showed antileishmanial activity with IC50 value of 27.10 ± 0.0 µg/mL. Chromatographic purification of the dichloromethane extract led to isolation of three C-19 norditerpenoid alkaloids indaconitine (1), chasmaconitine (2) and ludaconitine (3). Compounds 3 and 2 showed antileishmanial activity with IC50 = 36.10 ± 3.4 and 56.30 ± 2.1 µg/mL, respectively. Compound 1 was less effective (IC50 > 100 µg/mL). The cytotoxicity of compounds 1, 2 and 3 studied against MCF7, HeLa and PC3 cancer cell lines and 3T3 normal fibroblast cell line did not show cytotoxicity at 30 µM.

Can bacterial interference prevent infection?

The concept that one bacterial species can interfere with the ability of another to colonize and infect the host has at its foundation the prerequisite that bacteria must attach to biological surfaces to cause infection. Although this is an over-simplification of pathogenesis, it has led to studies aimed at creating vaccines that block adhesion events. Arguably, the use of commensal bacteria (also referred to as "normal flora", "indigenous" or "autochthonous" microorganisms) to inhibit pathogens has even greater potential than vaccine use, because these bacteria are natural competitors of pathogens and their action does not require host immune stimulation. Exogenous application of commensal organisms (probiotics) has been shown to reduce the risk of infections in the gut, urogenital tract and wound sites. To manipulate and optimize these effects, further studies are required to understand cell signaling amongst commensals and pathogens within biofilms adherent to host tissues. The potential for new therapeutic regimens using probiotics is significant and worthy of further study.

Dural sinus thrombosis after minor head injury in a child.

INTRODUCTION: Dural sinus thrombosis following minor head injury is rare. We report such a case in a child after mild head injury. CLINICAL PICTURE: A 4-year-old child presented with giddiness and vomiting after a fall. Clinical examination was unremarkable. Magnetic resonance venogram revealed thrombosis of the right sigmoid and transverse sinuses. TREATMENT: The patient was managed conservatively. OUTCOME: Repeat scans 10 weeks after injury showed recanalisation of the thrombosis. CONCLUSION: Dural sinus thrombosis should be excluded in children presenting with persistent giddiness and vomiting after minor head injury.

Diversity, pharmacology and synthesis of bergenin and its derivatives: potential materials for therapeutic usages.

Bergenin, a natural secondary metabolite, has been isolated from different parts of a number of plants. It is one of active ingredients in herbal and Ayurvedic formulations. It exhibits antiviral, antifungal, antitussive, antiplasmodial, antiinflammatory, antihepatotoxic, antiarrhythmic, antitumor, antiulcerogenic, antidiabetic and wound healing properties. It has been analyzed and estimated in different plant extracts, blood and drug samples using chromatographic techniques, and pharmacokinetic studies have been made. Several bergenin derivatives were isolated and/or synthesized and were found to possess pharmacological activities. Total synthesis of bergenin and its derivatives were reported. This review article covers literature on bergenin and its derivatives until 2013. Ethnomedicinal value of bergenin containing plant materials is also highlighted. This comprehensive review provides information on the potentiality of bergenin and its derivatives for therapeutic usages.

Autoradiographic localization of binding sites for epidermal growth factor-urogastrone (EGF-URO) in coronary arteries.

Previously published data have indicated that epidermal growth factor-urogastrone (EGF-URO) can regulate blood flow in vivo and can modulate vascular smooth muscle contractility in vitro. However, the exact location of the receptors responsible for this vascular action of EGF-URO has not been previously determined. In this report, employing in vitro autoradiography with 125I-labeled EGF-URO, we have documented the presence of specific EGF-URO binding sites in the tunica media of bovine and porcine coronary arteries. Our observations support the indirect evidence pointing to presence of EGF-URO receptors on the smooth muscle elements of arterial tissue. Our data also support further the hypothesis that EGF-URO and related growth factors (like TGF-alpha or PDGF) may play a role in normal and pathophysiological vascular function.

Electrophysical properties of electrosurgery and capacitive induced current.

BACKGROUND: Although electrosurgery is one of the most commonly used technologies in the operating room, its electrophysical properties, including the potential for complications, are poorly understood by many surgeons. METHODS: We describe the experimental simulation of a highly unusual complication that occurred during a surgical procedure requiring concurrent use of monopolar and bipolar electrosurgery. RESULTS: Capacitive induced current from an activated monopolar electrode to the bipolar cord was reproduced and consistently led to full-thickness burns in our experiments. CONCLUSIONS: Surgeons should be familiar with the principles of electrosurgery, its electrophysical properties, and possible complications.

Correlations on radioimmunoassay, fluorescence polarization immunoassay, and enzyme immunoassay of cannabis metabolites with gas chromatography/mass spectrometry analysis of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in urine specimens.

Results obtained from three commercial immunoassay kits, Abuscreen, TDx, and EMIT, commonly used for the initial test of urine cannabinoids (and metabolites) were correlated with the 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid (9-THC-COOH) concentration as determined by GC/MS. Correlation coefficients obtained based on 26 (out of 1359 total sample population) highly relevant samples, are 0.601 and 0.438 for Abuscreen and TDx. Correlation coefficients obtained from a parallel study on a different set of 47 (out of 5070 total sample population) highly relevant specimens are 0.658 and 0.575 for Abuscreen and Emit. The immunoassay concentration levels, that correspond to the commonly used 15 ng/ml GC/MS cutoff value for 9-THC-COOH, as calculated from the regression equations are 82 ng/ml and 75 ng/ml for TDx and EMIT and 120 ng/ml and 72 ng/ml for Abuscreen manufactured at two different time periods. The difference of these calculated corresponding concentrations provides quantitative evidence of the reagent specificity differences.

Arthroscopic treatment of triangular fibrocartilage tears.

Lesions of the TFCC are more frequently implicated as a cause of ulnar-sided wrist pain. Accurate diagnosis of TFCC pathology must be based on a thorough history and physical examination. Imaging modalities of particular use include plain radiographs, triple compartment arthrography, and MR imaging. The most sensitive and accurate diagnosis of the extent as well as the clinical significance of intra-articular pathology on the ulnar side of the wrist is by means of the arthroscope. With the advent of smaller and more elaborate arthroscopic instrumentation, the ability to perform arthroscopic surgery on the TFCC has dramatically increased over the past decade. The present arthroscopic treatment of traumatic central and radial lesions consists of debridement of unstable flaps, whereas dorsal and ulnar-sided lesions can be directly repaired. Centrally located degenerative perforations can be debrided in conjunction with an arthroscopic wafer procedure on the distal ulna.

An unusual complication of appendectomy.

Intraabdominal abscess formation is a well-recognized complication of perforated appendicitis. Extraabdominal complications, however, are rare. The authors present the case of an 8-year-old boy who had an acute painful right-sided scrotal mass 2 days after an operation for perforated appendicitis. During exploration, an abscess within a previously undiagnosed patent processus vaginalis was found and successfully managed by drainage. This case demonstrates that a persistent patent processus vaginalis may predispose to scrotal pathology secondary to intraabdominal sepsis and represents a unique complication of perforated appendicitis.

Simultaneous analysis of amphetamine, methamphetamine, and 3, 4-methylenedioxymethamphetamine (MDMA) in urine samples by solid-phase extraction, derivatization, and gas chromatography/mass spectrometry.

A rapid and effective solid-phase extraction procedure using Bond Elute Certify bonded silica sorbent cartridges was adopted to extract amphetamine, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA or Ecstasy) from urine samples. The extract was derivatized with trichloroacetic anhydride prior to gas chromatography/mass spectrometry (GC/MS) analysis with selected ion monitoring of the following ions: 190, 91, 188; 204, 91, 202; 162, 135, 202; 194, 123; and 211, 209 for the derivatized amphetamine, methamphetamine, MDMA, d5-amphetamine, and d9-methamphetamine, respectively. The first of the ions listed for each compound was used for quantitation. The compound d5-amphetamine was used as the internal standard for amphetamine, and d9-methamphetamine was used for methamphetamine and MDMA. Results showed a higher than 65% recovery and a reproducibility with less than a 5% coefficient of variation. When a sample size of 2 mL was used, the lowest detectable concentration was about 50 ng/mL, and a near-perfect fit can be obtained (within the 250 to 4000-ng/mL concentration range studied) using a second-order polynomial model.

The effects of ultrasound treatment on flexor tendon healing in the chicken limb.

We report the effects of early and late ultrasound treatment protocols on healing of surgically lacerated zone 2 flexor tendons in a chicken model. Ultrasound was administered directly using a coupling gel. Treatment was shown to increase range of movement, to advance scar maturation and to decrease the amount of inflammatory infiltrate around the repair site. No adverse effects on tensile strength were noted in either group. Early (starting 7 days post-operatively) administration was more effective than late (starting 42 days post-operatively) administration in achieving these effects. These results suggest that ultrasound therapy may be of benefit in the early healing process of flexor tendon lacerations.

Outcome of moderate and severe traumatic brain injury amongst the elderly in Singapore.

INTRODUCTION: In line with other established protocols, our unit has instituted a standardised protocol for the management of moderate and severe traumatic brain injury since 1996 in our neurointensive care unit. MATERIALS AND METHODS: We reviewed the outcomes, at 6 months' post-injury, in an elderly group aged > or = 64 years (73.86 +/- 8.0 years) and compared them to a younger group aged 20 to 40 years (29.2 +/- 5.7 years) in a cohort of 324 patients. Outcome was dichotomised as favourable (mild and moderate disability but independent; Glasgow Outcome Score [GOS] 4 and 5), unfavourable (severe disability and persistent vegetative state; GOS 2 and 3) and death (GOS 1). RESULTS: In the elderly group, the mortality (55.4%) was slightly more than double that of the younger group (20.9%); 21.5% had an unfavourable outcome (14.2% in the younger group) and only 23% had a favourable outcome (compared to 64.9% in the younger group). The final outcomes were significantly worse in all levels in the elderly group. This was in spite of data showing that the mechanism of injury was of a higher impact in the younger group, with a higher incidence of polytrauma and cervical spine injury. On admission, the mean Glasgow Coma Score (GCS) was 8.3 +/- 3.91 for the elderly group and 8.59 +/- 4.05 for the younger group (P = 0.763). Computed tomography scan showed that the elderly had a higher incidence of mass lesions (extradural haematoma and subdural haematoma) and traumatic subarachnoid haemorrhage. A subgroup (29.2%) of elderly patients had no surgical intervention based on poor clinical/neurological status, premorbid functional status and pre-existing medical conditions, with their family's consent. The GCS of < or = 8, on admission, was significant (P <0.001) in predicting mortality in the elderly. In the elderly group, the female gender had a higher mortality rate (70.4%) than the males (44.7%) (P = 0.19). CONCLUSION: Age must be considered an independent factor in outcome prediction in the elderly with moderate and severe traumatic brain injury. A more conservative approach in the management of an elderly patient with severe head injury may be reasonable given its dismal outcomes after careful dialogue with the relatives.