Prolonged non-invasive ventilation in extremely low birth weight preterm infants is associated with bronchopulmonary dysplasia.

AIM: To evaluate the association between the use of nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) with the development of bronchopulmonary dysplasia (BPD). METHODS: This is a single center retrospective cohort analysis of infants born at ≤1000 grams and ≤28 weeks gestation with respiratory distress treated with nCPAP or NIPPV. Groups were compared using Student's t test or chi-square, and associations estimated by logistic regression. RESULTS: Compared to nCPAP, infants who received NIPPV had a higher incidence of moderate to severe (M-S) BPD (84.2 vs 65.5%, p = 0.044) and death or severe BPD (75.0 vs 47.6%, p = 0.003). Each day on NIPPV was associated with an increased risk of M-S BPD (OR 1.08, p < 0.001) and an increased risk of death or severe BPD (OR 1.03, p = 0.006). After adjusting for days on oxygen, ventilator days, and days on all respiratory support, the odds of developing M-S BPD increased by 4.9% for each additional week on NIPPV (CI 2.1-7.7%, p = .0001). CONCLUSION: In this cohort, use of NIPPV was associated with an increased risk for developing BPD when compared to infants receiving nCPAP, and each additional day on NIPPV carried significant increased risk for developing BPD.

Solid lipid nanoparticles regulate functional assortment of mouse mesenchymal stem cells.

A rapid decline in self-renewability, viability and function, of isolated stem cells are major hurdles in developing cell based therapies. There has been an increasing interest towards identifying a support material for maintaining stem cell features of the isolated cells. Pioneering observations of the present paper, demonstrate functionally diverse potential of Solid Lipid Nanoparticles (SLNs) in deciding the fate & behavior of mouse mesenchymal stem cell. The evidences are provided to show the dual nature of the SLNs for being a scaffold for the stem cell attachment, to retain stemness, and as reagent for inducing stem cell differentiation. Scanning electron microscopic examinations together with expression analysis were used to conform to such observations. Results of the study thus suggest that Solid lipid nanoparticles can be used as a good support material when functionalized to achieve adhesive properties and as a molecular paradigm for studying the adipocytic differentiation. We envisage a new role of SLNs towards regulating stem cell character by orchestrating the structural alignment during preparation of Solid lipid nanoparticles.

The use of the Female Intervention Efficacy Index (FIEI) as an immediate outcome measure of medical intervention to treat female sexual dysfunction.

Many medications used in the treatment of male erectile dysfunction are still in the experimental phases for use in women. Numerous pharmacological options for women presently under testing include the EROS-CTD clitoral therapy device (Berman et al., 1999b; Billups et al., 2001). In addition to the new medical developments for treating female sexual dysfunction, methods for evaluating sexual responses and efficacy of intervention are evolving as well.

Lymphocyte subsets in cord blood of preterm infants: effect of antenatal steroids.

The objective of this study was to evaluate prospectively the influence of gestational age (GA) and short-term antenatal steroids on total lymphocyte count and lymphocyte subsets in cord blood from preterm infants. Two-color flow cytometric analyses of lymphocyte subsets were performed on cord blood collected from 67 infants. These infants were grouped according to GA: group I (term, n = 19); group II (GA 33-37 weeks, n = 25); group III (GA <33 weeks, n = 23). The mean absolute lymphocyte counts (ALC) in groups I, II and III were 5.6 +/- 2.5 x 10(3)/ microl, 4.3 +/- 1.5 x 10(3)/ microl and 3. 5 +/- 1.8 x 10(3)/ microl respectively. The mean values for CD4+ lymphocytes in groups I, II and III were 2.7 +/- 0.8 x 10(3)/ microl, 2.0 +/- 0.8 x 10(3)/ microl and 1.6 +/- 0.9 x 10(3)/ microl respectively. Mean values for CD8+ lymphocytes were 0.9 +/- 0.3 x 10(3)/ microl, 0.6 +/- 0.3 x 10(3)/ microl and 0.5 +/- 0.3 x 10(3)/ microl respectively. With decreasing GA, there was a statistically significant decrease in ALC (p = 0.0035), CD4+ lymphocytes (p = 0. 0013) and CD8+ lymphocytes (p = 0.0064). We then evaluated the effect of antenatal steroids, now routinely administered to women with preterm onset of labor to facilitate fetal lung maturation, and found that after adjusting for GA, infants of women on antenatal steroids had significantly fewer ALC (p = 0.0001), CD4+ lymphocytes (p = 0.02) and CD25+ lymphocytes (p = 0.03). In this population of infants, the decreased number of lymphocytes seen at younger GAs is associated with antenatal steroid use.

Cervical cancer with paraaortic metastases: significance of residual paraaortic disease after surgical staging.

Cervical carcinoma frequently metastasizes to the paraaortic region, necessitating extended field radiotherapy to effect a cure. As imaging modalities are unreliable in identifying all cases of paraaortic nodal metastases (PAN), surgical staging is often utilized prior to radiotherapy. This study was aimed at identifying factors predictive of survival in women with cervical carcinoma and paraaortic metastases. In particular, survival based on extent of paraaortic disease was examined. The study group consisted of 43 women (stages IB-IVB) identified between 1982 and 1993 who were treated with extended field radiation for cervical carcinoma with histologically confirmed paraaortic metastases. The estimated 5-year survival for the study population was 24% with a median survival of 18 months. Pelvic tumor size had a significant impact on survival with the median survival being 34 months if the primary lesion was < 6 cm compared to 14 months if > or = 6 cm (P = 0.01). Eight of the 26 (31%) women without residual PAN disease after surgical staging remain alive and disease free (mean follow-up, 74 months). In contrast, only 1 of the 17 (6%) women with gross residual PAN is alive 71 months after treatment (P = 0.05). However, a comparison of Kaplan-Meier survival curves did not show a statistically significant advantage to the surgical excision of grossly involved PAN (P = 0.98). Although long-term survival among women with grossly involved, unresected paraaortic metastases is uncommon, further study is necessary to elucidate the role of surgical excision of bulky aortic disease in women with cervical cancer.

Neurosonographic diagnosis of thalamic/basal ganglia vasculopathy in trisomy 13--an important diagnostic aid.

We performed a retrospective review of all the infants diagnosed with trisomy 13 in our institution from 1982 to 1995 and evaluated the neurosonographic findings along with their clinical information and cytogenetic analysis. Nine babies were admitted with trisomy 13. Sonography of the head was performed on 4 patients, and demonstrated in all of them a linear, branching, echogenic pattern in the thalamus/basal ganglia. Doppler evaluation of the thalamus/basal ganglia was performed in 3 of the 4 cases and confirmed these linear echogenicities to be of vascular origin. This is the first study to evaluated the occurrence of this finding in a specific syndrome, namely trisomy 13.

Vitamin A status in preterm neonates with and without chronic lung disease.

It has been proposed that there is an association between vitamin A (VA) deficiency and the development of chronic lung disease (CLD) in preterm infants. This study was designed to measure the VA status in preterm infants and to compare the results in the group of babies who developed CLD with the group who did not. Vitamin A status was assessed by measuring plasma VA, retinol binding protein (RBP) and the plasma VA:RBP molar ratio in 25 infants of less than 31 weeks gestation during the first 28 days of life. Eleven babies developed CLD and 14 did not. There was no significant difference in plasma VA levels between the CLD and non CLD groups during the first 28 days. The majority of infants had adequate VA status, with a subgroup being deficient.

Synergistic spermicidal activity of neem seed extract, reetha saponins and quinine hydrochloride.

In order to identify potent spermicidal agents which are free from the side effects of currently available agents, spermicidal activity of purified neem seeds extract (Praneem), reetha saponins and quinine hydrochloride was studied individually and in combination. Sander-Cramer test was used to assess the activity on human sperm. Under the test conditions, minimum effective spermicidal concentrations for Praneem, reetha saponins and quinine hydrochloride were 25%, 0.05% and 0.346%, respectively. At these concentrations, 100% of the sperm were immobilised within 20 seconds. A positive synergistic effect in the spermicidal activity of these components, if used in combination, was observed which implies the use of reduced concentrations of each to bring about the desired action. The selected combination formulated into a suitable dosage form is likely to offer dual benefit of a potent contraceptive and an antimicrobial preparation.

PIP: Contraceptive researchers in India and the United States used a modified version of the Sander-Cramer test to measure the minimum concentration of purified neem seeds extract, reetha saponins (pericarp of Sapindus fruits), and quinine hydrochloride to kill all sperm within 20 seconds. They wanted to determine the individual and combined action of these potential spermicidal agents on sperm motility and survival. The concentrations needed to effect the death of 100% of human sperm within 20 seconds were 25% for neem oil, 0.05% for reetha saponins, and 0.346% for quinine hydrochloride. A mixture of 25% neem extract, 1% reetha saponins, and 0.75% quinine hydrochloride was spermicidal up to a dilution of 72 times. This dilution was much higher (p = .0004) than the highest spermicidal dilution attained by reetha saponins, the most potent component of the mixture. The positive synergistic effect in the spermicidal activity of these components indicates reduced concentrations of each to achieve effective spermicidal activity (0.39% neem oil, 0.015% reetha saponins, and 0.0012% quinine hydrochloride). Reetha saponins contains considerable oleanolic acid or hederagenin, which have a mild detergent effect, inactivating sperm. Quinine chloride strengthens spermicidal activity and antimicrobial activity. Neem extract induces local cell-mediated immunity. Contraceptive developers can formulate the combination of these 3 components either as a cream or pessary.

A fatal neonatal case of medium-chain acyl-coenzyme A dehydrogenase deficiency with homozygous A-->G985 transition.

A term neonate became lethargic and hypotonic at 46 hours of age and died 10 hours later despite supportive therapy. Urinary organic acids indicated medium-chain acyl-coenzyme A dehydrogenase deficiency, and DNA studies confirmed this disorder. Neonatal symptoms in this enzyme deficiency have rarely been reported, and recent reviews have ignored or discounted this presentation.

Dermoid tumours occurring at the site of previous meningocele repair.

Two cases of dermoid tumours following meningocele repair have been reported because of the rarity of the condition and paucity of literature. It should be stressed that a dermoid tumour should be considered in the differential diagnosis of neurological deterioration in patients with a repaired meningocele.

Gingivitis and periodontal disease in pregnancy.

Forty pregnant women in each of three trimesters of pregnancy and forty nonpregnant women of comparable age, socioeconomic status and dietary habit have been examined to evaluate the gingival condition and the calculus and debris deposits. The study has shown that: There is a significant increase in the severity of gingivitis during pregnancy; The gingival changes progressively increase during the course of pregnancy; The gingival changes are more marked than the periodontal changes seen during pregnancy (increase in periodontal disease was seen in only a limited number of cases); There was an appreciable increase in the calculus and debris deposits in the pregnant as compared to the nonpregnant women; Increase in the calculus and debris deposits was apparent in all the trimesters of pregnancy; Gingival changes showed a greater correlation with the calculus and the debris index in the pregnant than in the nonpregnant women; The role of the irritant oral deposits either as a precipitating or perpetuating factor in the genesis of gingivitis during pregnancy can not be excluded.