Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders.

Haemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. In children and young adults, the most commonly performed surgeries are tonsillectomies and/or adenoidectomies. Adequate haemostasis in these patients with bleeding disorders is centred on comprehensive perioperative haemostatic support and dexterous surgical technique. The aim of this study was to assess postoperative bleeding complications with tonsillectomy and/or adenoidectomy in children and young adults with known bleeding disorders. Retrospective review of all patients aged <25 years with known bleeding disorders who underwent tonsillectomy and/or adenoidectomy at Mayo Clinic, Rochester MN between July 1992 and July 2012. In contrast to reported literature, we observed a higher rate of bleeding complications (10/19, 53%) despite aggressive haemostatic support and appropriate surgical techniques. Delayed bleeding (>24 h postoperatively) was more common than early bleeding; and recurrent bleeding was associated with older age. Children and young adults with haemorrhagic diatheses undergoing adenotonsillectomy are at a higher risk of delayed bleeding and require close monitoring with haemostatic support for a prolonged duration in the postoperative period. A uniform approach is needed to manage these patients perioperatively by establishing standard practice guidelines and ultimately reduce postsurgical bleeding complications.

Control of Aedes aegypti and Ae. albopictus, the vectors of dengue and chikungunya, by using pheromone C21 with an insect growth regulator: Results of multicentric trials from 2007-12 in India.

BACKGROUND & OBJECTIVES: Aedes mosquito control has gained much importance nowadays in view of rise in number of reported cases of dengue and chikungunya in India and other countries. In the present study, C21 attracticide (containing a pheromone and an insect growth regulator­IGR, developed by Defence Research and Development Establishment (DRDE), Gwalior, India was tested for its feasibility for surveillance and control of Aedes mosquito in a multicentric mode from October 2007 to June 2012 in urban (Delhi, and Bengaluru district, Karnataka) and suburban (Alappuzha district, Kerala) settings of the country in three phases. METHODS: Across the randomly selected households in each study area, two to four containers treated with attracticide (experimental) and untreated (control) were placed and monitored by trained surveillance workers on weekly/ fortnightly basis for determining the presence of eggs, larvae and pupae. Container positivity, percent larvae, egg and pupae collected were determined during different phases and analyzed statistically using SPSS 18.0. RESULTS: Container positivity was found statistically significant at Bengaluru and Alappuzha, Kerala while in Delhi, it was found non-significant. Eggs collected from experimental containers were significantly higher in comparison to control at all the locations except Delhi. Also larvae collected from control containers were significantly higher at all the locations except Bengaluru. Pupae collected from control containers remained significantly higher at all the locations as no pupal formation was recorded from experimental containers. INTERPRETATION & CONCLUSION: The use of C21 attracticide hampered pupal formation, thus inhibiting adult population in the study areas. The study established that C21 attracticide was efficacious in the field conditions and has potential for use in surveillance and management of dengue and chikungunya mosquitoes.

Oviposition deterrent activity of three mosquito repellents diethyl phenyl acetamide (DEPA), diethyl m toluamide (DEET), and diethyl benzamide (DEB) on Aedes aegypti, Aedes albopictus, and Culex quinquefasciatus.

Oviposition deterrent activity of three mosquito repellents namely diethyl phenyl acetamide (DEPA), diethyl benzamide (DEB) along with diethyl toluamide (DEET) was studied in the laboratory against Aedes aegypti, A. albopictus, and Culex quinquefasciatus mosquitoes. All the repellents evaluated at three log concentrations 0.1, 0.01, and 0.001% in comparison with control by dual choice method. The oviposition response and oviposition activity index (OAI) was estimated by counting number of eggs laid in both the treatment and control. Mean OAI determined for A. aegypti was in the range of -0.23 to +0.22, -0.3 to +0.27, and +0.04 to +0.33 for DEPA, DEET, and DEB, respectively, whereas it was -0.77 to -0.035, -0.92 to +0.001, and -0.77 to -0.07 for A. albopictus and -0.927 to -0.251, -1 to -0.41, and -0.94 to -0.17 for C. quinquefasciatus. The oviposition deterrent activity was observed in the order of DEET > DEPA > DEB. Similarly, the response of species toward the repellents as oviposition deterrent was in the trend of C. quinquefasciatus > A. albopictus > A. aegypti. The finding suggests potential role of mosquito repellents as oviposition deterrent.

Local release of masitinib alters in vivo implantable continuous glucose sensor performance.

Continuous glucose monitoring (CGM) sensors are often advocated as a clinical solution to improve long-term glycemic control in the context of diabetes. Subcutaneous sensor inflammatory response, fouling and fibrous encapsulation resulting from the host foreign body response (FBR) reduce sensor sensitivity to glucose, eventually resulting in sensor performance compromise and device failure. Several combination device strategies load CGM sensors with drug payloads that release locally to tissue sites to mitigate FBR-mediated sensor failure. In this study, the mast cell-targeting tyrosine kinase inhibitor, masitinib, was released from degradable polymer microspheres delivered from the surfaces of FDA-approved human commercial CGM needle-type implanted sensors in a rodent subcutaneous test bed. By targeting the mast cell c-Kit receptor and inhibiting mast cell activation and degranulation, local masitinib penetration around the CGM to several hundred microns sought to reduce sensor fibrosis to extend CGM functional lifetimes in subcutaneous sites. Drug-releasing and control CGM implants were compared in murine percutaneous implant sites for 21 days using direct-wire continuous glucose reporting. Drug-releasing implants exhibited no significant difference in CGM fibrosis at implant sites but showed relatively stable continuous sensor responses over the study period compared to blank microsphere control CGM implants.

Low dose famotidine in the prevention of sleep disturbance caused by heartburn after an evening meal.

AIM: To determine whether, in a susceptible population, dosing with 10 mg famotidine 1 h before an evening meal could decrease the interference with sleep caused by heartburn. METHODS: Patients with a history of frequent heartburn (n = 309) were randomized to receive 10 mg famotidine or placebo 1 h before an evening meal likely to induce symptoms. Patients assessed the efficacy of the treatment in preventing heartburn after the meal, at bedtime and during the night. The number of awakenings due to heartburn and the consumption of antacid tablets taken to alleviate symptoms were also recorded. RESULTS: Treatment groups were well matched and data from 302 patients were available for analysis. Compared to placebo, famotidine treated patients had: less heartburn after the meal (P < 0.0001 mean global scores), less interference with getting to sleep (P = 0.0156 mean global scores), fewer awakenings (P = 0.0001 difference in mean number) and better control of heartburn during the night (P < 0.0001 mean global scores). They were also almost three times less likely to need antacid treatment than the placebo group during the night (relative odds for no antacid 2.78 (95% CI: 1.29-5.96). Only four patients in each group suffered adverse events. CONCLUSION: Taking a 10 mg dose of famotidine 1 h before an evening meal appears to be a successful and well tolerated strategy for preventing post-prandial heartburn and avoiding the associated interference with sleep.

Prevention of heartburn relapse by low-dose famotidine: a test meal model for duration of symptom control.

AIM: To establish whether patients taking famotidine 10 mg to treat an episode of heartburn were protected from a recurrence of symptoms after a subsequent test meal. METHODS: Frequent heartburn sufferers (n = 366) were randomized to receive double blind treatment with famotidine 10 mg or 2 x 250 mg chewable alginate tablets within 30 min of a spontaneous episode of heartburn. After 4 h, patients with no or slight residual symptoms consumed a meal likely to induce heartburn. Over the next 4 h patients recorded the severity of heartburn and any consumption of 'rescue' antacids. At the end of this time they rated the global efficacy of their treatment in controlling meal-induced symptoms. RESULTS: Study groups were well matched for all baseline characteristics. Of the 366 randomized patients, 276 took study medication and data from 269 patients (132 famotidine, 137 alginate) were analysed for efficacy. Compared to the alginate control group famotidine treated patients reported better global efficacy following the test meal (P < 0.001; relative odds for a more favourable response: 2.26 [95% CI: 1.45-3.53]). Fewer patients receiving famotidine resorted to antacid rescue (P = 0.038; relative odds for a more favourable response: 2.24 [95% CI: 1.04-4.79]) and peak heartburn was significantly less severe with famotidine treatment (P < 0.001: relative odds for a more favourable response: 2.90 [95% CI: 1.85-4.53]). Eleven famotidine-treated patients (8%) and 13 alginate patients (9%) reported adverse events. CONCLUSION: Compared to patients receiving an alginate preparation, patients self medicating with famotidine 10 mg for heartburn are better protected against a recurrence of their symptoms when they next eat. This suggests that the duration of acid control (9 h) previously demonstrated with this dose translates into a similar duration of measurable symptom control during the day.

Rapid donor liver procurement with only aortic perfusion.

AIM: To describe a rapid technique for procurement of donor liver with aortic perfusion only (APO). METHODS: Only the aorta is cannulated and perfused with chilled preservation solution. RESULTS: The quality of donor liver can ensure the grafted liver functions. CONCLUSION: The method of APO can simplify the operative procedure, compared with the dual cannulation. It also can minimize the danger of injuring vascular structures and involve less dissection.

Experience with a sliding screw in intertrochanteric fractures.

A retrospective study of our first year's experience with a sliding screw in intertrochanteric fractures was conducted. Forty-five patients with intertrochanteric fractures were admitted to St. Louis City Hospital in the year considered. All those who came to surgery were treated with a sliding screw. We were impressed by the ability of the sliding screw plate to adapt to the forces which, under other circumstances, cause the unstable I-T fractures to collapse or displace. The characteristics of unstable hip fractures are discussed.

Foreign body response to subcutaneous biomaterial implants in a mast cell-deficient Kit(w-Sh) murine model.

Mast cells (MCs)_are recognized for their functional role in wound-healing and allergic and inflammatory responses - host responses that are frequently detrimental to implanted biomaterials if extended beyond acute reactivity. These tissue reactions impact especially on the performance of sensing implants such as continuous glucose monitoring (CGM) devices. Our hypothesis that effective blockade of MC activity around implants could alter the host foreign body response (FBR) and enhance the in vivo lifetime of these implantable devices motivated this study. Stem cell factor and its ligand c-KIT receptor are critically important for MC survival, differentiation and degranulation. Therefore, an MC-deficient sash mouse model was used to assess MC relationships to the in vivo performance of CGM implants. Additionally, local delivery of a tyrosine kinase inhibitor (TKI) that inhibits c-KIT activity was also used to evaluate the role of MCs in modulating the FBR. Model sensor implants comprising polyester fibers coated with a rapidly dissolving polymer coating containing drug-releasing degradable microspheres were implanted subcutaneously in sash mice for various time points, and the FBR was evaluated for chronic inflammation and fibrous capsule formation around the implants. No significant differences were observed in the foreign body capsule formation between control and drug-releasing implant groups in MC-deficient mice. However, fibrous encapsulation was significantly greater around the drug-releasing implants in sash mice compared to drug-releasing implants in wild-type (e.g. MC-competent) mice. These results provide insights into the role of MCs in the FBR, suggesting that MC deficiency provides alternative pathways for host inflammatory responses to implanted biomaterials.

Mediation of oviposition responses in the malaria mosquito Anopheles stephensi Liston by certain fatty acid esters.

The chemical factors involved in oviposition site selection by mosquitoes have become the focus of interest in recent years, and considerable attention is paid to the chemical cues influencing mosquito oviposition. Studies on synthetic oviposition attractants/repellents of long-chain fatty acid esters against Anopheles stephensi are limited. Screening and identification of chemicals which potentially attract/repel the gravid females to/or from oviposition site could be exploited for eco-friendly mosquito management strategies. The ester compounds demonstrated their ability to repel and attract the gravid A. stephensi females in the treated substrates. Significant level of concentration-dependent negative oviposition response of mosquitoes to octadecyl propanoate, heptadecyl butanoate, hexadecyl pentanoate, and tetradecyl heptanoate were observed. In contrast, decyl undecanoate, nonyl dodecanoate, pentyl hexadecanoate, and propyl octadecanoate elicited concentration-dependent positive oviposition responses from the gravid mosquitoes. Forcing a female to retain her eggs due to unavailability of a suitable oviposition site and attracting them to lay the eggs in a baited ovitraps shall ensure effective control of mosquito breeding and population buildup because the oviposition bioassay target the most susceptible stage of an insect life cycle. Treating relatively smaller natural breeding sites with an effective repellent and placing ovitraps containing an attractant in combination with insect-growth regulator (IGR)/insecticide would be a promising method of mosquito management.

Oviposition responses of Aedes aegypti and Aedes albopictus to certain fatty acid esters.

Laboratory studies were carried out to observe the oviposition responses of Aedes aegypti (L.) and Aedes albopictus (Skuse) to several C21 fatty acid esters. The oviposition activity of these dengue and chikungunya vectors to the long-chain fatty acid esters of C21 length have not been reported earlier. From the multiple choice experiments on oviposition activity in standard mosquito cages, it was observed that compounds hexadecyl pentanoate, tetradecyl heptanoate and tridecyl octanoate presented significant oviposition repellent activity against the two mosquito species, while one compound propyl octadecanoate was found to attract A. aegypti to the treated oviposition substrate at 1- and 10-ppm concentrations. The possible utilization of these esters in integrated vector management is discussed.

Erythroid colony studies on sickle cell anemia in hypoproliferative crisis.

Bone marrow cells, peripheral blood lymphocytes, and sera from patients with sickle-cell anemia in hypoproliferative crisis were studied in the plasma clot culture system in the presence or absence of erythropoietin (Epo). Bone marrow cells from five patients demonstrated a marked ability to form erythroid colonies in the presence of Epo. These studies also suggested that bone marrow cells from some patients may have an increased sensitivity to Epo. The most outstanding observation in the present study was the marked erythroid colony inhibition by serum taken from one patient during crisis. Serum taken from the same patient two months after hypoproliferative crisis had no suppressive effect on erythroid colony formation. Lymphocytes taken from three patients in crisis had a stimulatory effect on erythroid colony formation when included in culture. The conclusion is that the defect of erythropoiesis in sickle-cell anemia during hypoproliferative crisis is not due to the absence of erythroid precursor cells or to the presence of suppressor lymphocytes, but may in some cases be associated with a circulating inhibitor of erythroid maturation.

Aplastic anemia with fetallike erythropoiesis following androgen therapy.

A 43/4-yr-old black girl with acquired aplastic anemia had an increase in total hemoglobin (Hb) from 4.5 to 16.8 g/dl and fetal hemoglobin (HbF) from 0.8 g/dl (18.8%) to 9.6 g/dl (60.2%) following combined androgen-adrenal steroid therapy. Discontinuation of the drugs was followed by a decline in both HbF and total Hb. Reinstitution of the combined steroids prompted a second rise in total and fetal hemoglobin. During these responses the subject's erythrocytes exhibited an increased i antigen score and a low level of red cell carbonic anhydrase. The glycine:alanine ratio at position 136 of the gamma chains of HbF was of the fetal type (proportion of chains with glycine residues, 0.74). Hemoglobin A2 was low (0.4%). The synthesis of alpha and non-alpha chains was balanced. These results indicate that the stimulation of red cell proliferation in this subject, in response to androgen therapy, resulted in the production of cells with several characteristics of "fetal" erythrocytes.