Hidradenitis suppurativa in Black and White patients - a clinical study.

OBJECTIVE: It is suggested that hidradenitis suppurativa (HS) is more prevalent and causes greater morbidity in Black patients than in White. Clinical data are however lacking. PATIENTS AND METHODS: We therefore describe HS risk factors, disease severity and clinical phenotypes in the Blacks and Whites. Patients referred for HS between 1984 and 2019 at the Johns Hopkins Hospital were identified using the Pathology Data System (PDS). Clinical and sociodemographic characteristics were extracted and the van der Zee & Jemec HS clinical phenotypes were recovered. RESULTS: A total of 278 patients were identified. Ethnically, 108 (38.8%) were White, and 170 (61.2%) Black. The following HS phenotypes were found: Regular (n=193, 69.4%), scarring folliculitis (n=40, 1.4%) frictional furuncle (11.2%), conglobata (n=9, 3.2%), syndromic (n=3, 1.1%) and ectopic (n=2, 0.7%). No statistically significant ethnic differences in clinical presentation were found. Blacks however had more severe diseases than Whites (p= 0.024 for trend). With multivariate logistic regression analysis, we found that male sex, disease duration, and smoking were independent predictors of regular HS phenotype. Major limitations are the limited number of cases studied and the lack of data regarding response to therapies. CONCLUSIONS: Demographics and phenotypical presentation of HS patients do not seem to be associated with Black ethnicity. However, there is a significant trend for Blacks to present with more Hurley stage 2 and 3 disease compared to White patients. It is speculated that ethnic differences are epiphenomena to social factors, highlighting the broader importance of ethnicity.

Regression-based technique for improved optical rangefinding using tunable focus lenses.

In this paper, we present a novel method of target range estimation by tuning the spot size of a Gaussian beam at the plane of a reflective target. The beam spot size tuning is achieved through the use of a tunable focus lens (TFL). Using a carefully aligned sensor assembly, the diameter of the reflected beam is recorded at the plane of an imaging detector for different TFL focal length settings. This dataset is then used to estimate the distance of the target from the TFL. The proposed rangefinder is compact and requires minimal post-data-acquisition signal processing resulting in a fast response time compared to other spatial signal processing-based sensor designs. The estimation of target distance through a multiple data-point measurement dataset also ensures that the proposed method is robust to errors associated with obtaining range estimates from a single measurement data point. Experimental results demonstrate an excellent agreement with theory. With our proposed estimation method, we show a significant improvement in the measurement dynamic range of the sensor as well as its resolution compared to similar sensing schemes in prior art. We also experimentally demonstrate the possibility to extend the measurement dynamic range by incorporating a bias lens of a fixed focal length with the sensor module. The proposed sensor module is electronically controlled and consequently can be fully automated and compactly packaged with the use of commercially available miniature optical components.

Insulin resistance and androgen levels in eugonadic and hypogonadic women with prolactinoma.

BACKGROUND: Hyperprolactinemia is the most common endocrinologic disorder in causing menstrual irregularities. Although the correlation between hyperprolactinemia and menstrual dysfunction is widely known, the etiology of menstrual cycle disorders is not profoundly understood in patients with prolactinoma. We aimed to investigate the correlation between prolactin levels and insulin resistance and hyperandrogenism in patients with prolactinoma. METHODS: Sixty-four patients with microprolactinoma and 33 healthy women were enrolled. Thirty-six of these patients with prolactinoma (group 1) had an estradiol (E2) level under 30 pg/mL, and 28 (group 2) had an E2 level greater than 30 pg/mL. Blood samples were drawn to measure the levels of the following hormones: Follicle stimulating hormone (FSH), luteinizing hormone (LH), E2, prolactin (PRL), total testosterone (TT), androstenedione (AS) and dehydroepiandrostenedione sulphate (DHEAS). Body Mass Index (BMI of ≥30 kg/m2) was excluded from the study. Insulin resistance (IR) was calculated by the HOMA-IR. RESULTS: BMI was higher in patients with prolactinoma than the control group (P=0.02, P=0.025, respectively). IR and glucose intolerance existence were higher in patients with prolactinoma (P=0.007, P=0.097, respectively) than the healthy women, but these differences did not exist between eugonadic and hypogonadic women with prolactinoma (P=0.020, P=0.032, respectively, Bonferroni correction). TT and AS were higher in eugonadic women with prolactinoma than the control group (P=0.004, P=0.003, Bonferroni correction, respectively). CONCLUSIONS: Our study revealed that the relationship between hyperprolactinemia and IR/glucose intolerance is irrespective of gonadal status in women with prolactinoma. Also, the study concluded that hyperandrogenism may be a cause of menstrual dysfunction in eugonadic women with prolactinoma.

Impaired endothelial function in patients with mild primary hyperparathyroidism improves after parathyroidectomy.

BACKGROUND: Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity; however, data on the reversibility of cardiovascular disease in mild primary hyperparathyroidism are conflicting. The aim of this study was to assess endothelial function in patients with mild PHPT before and after parathyroidectomy (Ptx). METHODS: We prospectively evaluated 53 patients with mild PHPT (Group 1; 45 women, eight men; aged 52 ± 3·1 years) and 46 healthy control subjects (Group 2; 38 women, eight men; aged 46 ± 9·5 years). Endothelial function was measured as flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) using Doppler ultrasonography. Patients with diabetes mellitus, coronary heart disease, impaired renal function, hyperthyroidism, hypothyroidism and a history of smoking were excluded from the study. Patients were studied at baseline and 6-12 months after the first evaluation. RESULTS: There were no differences with respect to age, gender and BMI between the two groups. Hypertension prevalence was three times higher in group 1 than in controls. % FMD was lower in group 1 than in group 2 (2·6 ± 1·2 vs 14·8 ± 9·6, P < 0·001). CIMT was higher in patients with PHPT than controls (0·69 ± 0·18 vs 0·61 ± 0·12, P = 0·045). This significance remained when hypertensive patients were excluded from the analysis. While FMD and CIMT improved significantly after Ptx, there were no differences in mild PHPT patients who followed without parathyroidectomy. CONCLUSION: FMD and CIMT are impaired in patients with mild PHPT compared to controls and improved significantly after a successful Ptx. Ptx improves endothelial function in patients with mild PHPT that may lead to decreased cardiovascular morbidity and mortality.

[Preclinical study of anxiolytic activity and safety of Racium phytomedicine].

Results of a preclinical study of the anxiolytic activity and safety of original Racium phytomedicine are presented. The preparation possessed high anxiolytic activity, exhibits a wide range of therapeutic effects, produces no lethality in male and female rats and mice upon single intragastric and intraperitoneal introduction in doses up to 5 g/kg (VI class of toxicity according to OECD), induces no pathologic effects upon prolonged (120 days) administration in these rodents, and has no local irritant and/or allergen action.

Risperidone induced ventricular tachycardia.

This is a case report of ventricular tachycardia in a 35 years old African American male being treated with risperidone for schizophrenia. Patient had no other cardiovascular risk factors. His physical examination and laboratory test results were essentially normal. Episodes of non-sustained ventricular tachycardia resolved after discontinuation of risperidone. Above case report is likely to add to the limited evidence for risperidone associated cardiotoxicity.

Effects of dietary chromium chloride, nicotinic acid and copper sulphate on meat of broilers.

1. Combinations of chromium and copper were added to the diet to assess their effects on broiler meat characteristics. 2. For this purpose 175 one-day-old broiler chicks were divided into 7 equal groups and were given treatment feeds containing copper sulphate, chromium chloride and nicotinic acid in different combinations. 3. The study was carried out for 5 weeks and samples were collected at the end of 15, 29 and 35 d of treatment and at 42 d after a withdrawal period of one week. 4. Cholesterol content had decreased significantly in breast meat at d 29 in all treatment groups. In thigh meat, it decreased significantly at d 29 in groups receiving two concentrations of chromium + two concentrations of copper. Cholesterol content remained lower even after withholding the treatment for one week. 5. Crude fat content decreased significantly in breast meat in all treatment groups. In thigh meat, at d 29, a significant reduction in crude fat was observed only in birds receiving low chromium and high copper. 6. Crude protein at d 29 increased significantly in breast meat of birds receiving low chromium and high copper, and low or high chromium, while it decreased significantly in treatment groups after withholding the treatment. In thigh meat, at d 29, it increased significantly in treatment groups but decreased significantly after withholding the treatment. 7. It was concluded that chromium and copper, along with nicotinic acid, have modulating effects on broiler meat under tropical conditions.

Trimetallic supported catalyst for renewable source of energy and environmental control through CO2 conversion.

A supported catalyst and a catalytic process have been developed for the conversion of carbgas (CO2 + (100 ppm) H2O + 1% H2) as a renewable source of energy and as a measure for the control of carbon dioxide -- a greenhouse gas. The carbgas was passed over a trimetallic supported catalyst consisting of ruthenium (Ru), manganese (Mn) and cobalt (Co) dispersed on a high surface area titanium dioxide support at 673 K and at atmospheric pressure with a gas space velocity of 6000-7200/h. The catalytic reaction produces methanol and propyne in a fixed bed reactor system. The catalyst simultaneously splits water into hydrogen and oxygen, and carbon dioxide into carbon and oxygen under very mild reaction conditions and at atmospheric pressure. The oxygen generated during the reaction and the addition of hydrogen during the catalytic reaction not only generates a considerable amount of energy for the reaction to proceed but also sustains the oxidation states of Ru, Mn and Co. This process maintains the specific active oxidation states of the metals during the catalytic run -- a key step in the process.

In-hospital percutaneous coronary intervention improves in-hospital survival in patients with acute inferior myocardial infarction particularly with right ventricular involvement.

OBJECTIVE: Assess the interaction between fibrinolysis and in-hospital percutaneous coronary intervention (PCI) in patients with inferior myocardial infarction (MI), particularly those with electrocardiographic evidence of right ventricular infarction (RVI). DESIGN: Retrospective observational study. PATIENTS: Consecutive patients with inferior MI identified from an MI registry between January 1998 and January 2004. INTERVENTIONS: Propensity analyses and multiple regression analysis were used to determine the mortality benefit of PCI. MAIN OUTCOME MEASURES: In-hospital morbidity and mortality. RESULTS: In total, 465 patients with inferior MI received fibrinolytic therapy (median pain-to-needle time of 167 minutes; IQR 100-311 minutes). The main predictors of PCI were recurrent chest pain, peak creatine kinase, age, reinfarction, presence of heart failure and male gender. Significant independent predictors of in-hospital mortality were age > or = 75 years, RVI, initial systolic blood pressure < or = 80 mmHg, female gender and no in-hospital PCI. In-hospital PCI was performed in 184/465 (40%) patients; 55 (30%) had rescue PCI performed < or = 6 hours post fibrinolysis, 45 (24%) within 6-24 hours and 84 (46%) > or = 24 hours. In-hospital PCI was associated with reduced in-hospital mortality (PCI: 9 [5%] vs. no PCI: 40 [14%]; p < 0.001) mainly in those with RVI (PCI: 8 [8%] vs. no PCI 33 [23%]; p = 0.002) compared with no RVI (PCI: 1 [1%] vs. no PCI 7 [5%]; p = 0.1). CONCLUSION: A strategy of timely fibrinolysis combined with in-hospital PCI including rescue PCI may result in a significant reduction in in-hospital mortality and morbidity in patients with inferior MI, particularly those with RVI.

In vitro anti-leishmanial activities of germatranyl and Silicon incorporated diorganotin derivatives: synthesis and spectroscopic properties.

A series of germanium and silicon incorporated diorganotin derivatives of general formula [N(OCH2CH2)3GeCH(R(1)CH2CO2]2 SnR2(2) where R1 = H3C, C6H5, p-CH3C6H4, p-FC6H4; R2 = H2CSi(CH3)2C6H5, H2CC6H5, p-CH3C7H7 were synthesized by the reaction of appropriate diorganotin dichlorides and germatranyl (substituted) propionic acid in 1:2 mole ratio, respectively. The evidence regarding their structure is mainly based on spectroscopic data obtained by multinuclear (1H, 13C, 29Si, 119Sn) NMR and 119mSn Mössbauer, IR and mass spectral studies in combination with melting points and elemental analyses. The compounds have been screened for in vitro anti-leishmanial activity against promastigotes of Leishmania major and the results offer potent activities which are better than the standard drug, pentamidine, for one compound.

Germatranyl substituted organotin (IV) carboxylates: synthesis spectroscopic characterization and biological activities.

Eight new organotin (IV) derivatives of general formula [N(CH2CH2O)3GeCH(R1)CH2COO](4-n)SnR(2)n, where n= 2, R(2) = C2H5 (1-5); R(1) = CH3 (1); C6H5 (2); p-CH3C6H4 (3); p-FC6H4(4); p-CH3OC6H4 (5) and n = 3, R(2) = CH2C6H5 (6-8), R(1) = CH3 (6); C6H5 (7); p-CH3C6H4 (8) have been synthesized by the reaction of di- or tri-organotin chloride with the corresponding germatranyl (substituted) propionic acid in the appropriate mole ratios using triethylamine as a base. The synthesized compounds were characterized by various spectroscopic techniques such as IR, multi-nuclear (1H, 13C, 119Sn) NMR, 119mSn Mössbauer, along with elemental analyses. They were also screened for in vitro anti-leishmanial activity against promastigotes of leishmania donovani and found some encouraging results.

Lower homologues (methyl, ethyl) of diorganotin derivatives of germyl (substituted) propanoic acids: spectroscopic elucidations and biological studies.

Some novel lower homologues of diorganotin derivatives of germyl substituted propanoic acids with general formula [Ar(3)GeCH(R(1))CH(R(2))COO](2)SnR(2)(3), where Ar = p-CH(3)C(6)H(4), C(6)H(5), R(1) = p-CH(3)C(6)H(4), p-CH(3)OC(6)H(4), o-CH(3)OC(6)H(4), C(6)H(5), R(2) = H, CH(3), R(3) = CH(3), C(2)H(5) have been prepared by the condensation reaction of dialkyltin oxide and triarylgermyl(substituted) propanoic acid in 1 : 2 M ratio, respectively, and were characterized by IR, multinuclear ((1)H, (13)C, (119)Sn) NMR, (119 m)Sn Mössbauer spectroscopy. The synthesized compounds were also screened for their toxicity and possible antibacterial, antifungal activities and found some encouraging results.

Giant true saphenous vein graft aneurysm causing cardiac compression: a rare cause of atrial flutter.

A 67 year old man presented with new-onset atrial flutter. He had a history of coronary artery bypass graft (CABG) surgery on two occasions. Subsequent investigation revealed the presence of a large saphenous vein graft (SVG) aneurysm compressing the right heart. We postulate that the SVG aneurysm was the precipitating cause for the atrial flutter. This case is the first in the literature to document an atrial arrhythmia as the presenting feature of a SVG aneurysm.

Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction.

AIMS: To assess the predictors of 1 year mortality in patients treated with fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI) and to determine whether a strategy of early percutaneous coronary intervention (PCI) improves outcome. METHODS AND RESULTS: Consecutive patients (n = 474) admitted to our unit (1998-2001) with STEMI were treated with fibrinolytic therapy. For each patient, age, gender, admission via mobile coronary care unit (MCCU), infarct location, initial systolic blood pressure and Killip class, prior history of ischaemic heart disease, hypertension, diabetes mellitus, smoking status, family history, hyperlipidaemia, and in-hospital PCI (n = 154) were recorded. Mortality at 1 year was obtained from medical records (n = 473). Binary logistic regression analysis was performed to determine independent predictors of 1 year mortality. Mortality in the non-PCI group was 21 vs. 7% in the PCI group. Independent predictors of 1 year mortality were age (risk ratio 1.12, 95% CI 1.08-1.15, P < 0.0001), initial SBP < or = 80 mmHg (risk ratio 4.34, 95% CI 1.68-11.2, P = 0.002), initial Killip class > or = 3 (risk ratio 2.97, 95% CI 1.42-6.2, P = 0.004), and lack of in-hospital PCI (risk ratio 0.39, 95% CI 0.19-0.81, P = 0.012). Although the PCI group were younger (P = 0.007), more likely to be admitted via the MCCU (P = 0.008), with a shorter pain to needle time (P = 0.04), multivariable analysis adjusted for these differences. CONCLUSION: In-hospital PCI in patients treated with fibrinolytic therapy for STEMI is associated with a substantial reduction in 1 year mortality.

Body surface potential mapping improves detection of ST segment alteration during percutaneous coronary intervention.

BACKGROUND: The 12-lead electrocardiogram underestimates ST segment alteration in acute coronary syndromes compared with multi-lead body surface mapping. We assessed whether 80-lead mapping would improve detection of ST alteration during percutaneous coronary intervention. METHODS: Simultaneous maps and 12-lead electrocardiograms were recorded pre-procedure, during balloon inflation and post-procedure from patients undergoing elective intervention to native coronary arteries. Recordings were obtained from 39 inflations (19 patients). All arteries were successfully stented. RESULTS: Mean 'lead specific' ST alteration (the difference in ST elevation/depression between pre-procedure and inflation recordings in the lead showing maximal ST alteration) was greater on the map than on electrocardiogram, both for ST elevation (0.16+/-0.02 vs. 0.06+/-0.01 mV; p<0.001) and ST depression (0.11+/-0.017 vs. -0.03+/-0.006 mV; p<0.001). During first inflations (n=19), mean lead specific ST elevation and depression on map were greater than on electrocardiogram (0.20+/-0.034 vs. 0.07+/-0.015 mV; p<0.001 and 0.11+/-0.029 vs. 0.03+/-0.009 mV; p=0.001, respectively). Mapping detected greater summated ST elevation and depression during inflation than electrocardiogram (0.04+/-0.005 vs. 0.021+/-0.003 mV; p<0.001 and 0.026+/-0.004 vs. 0.011+/-0.002 mV; p<0.001, respectively). Qualitative analysis of maps and electrocardiograms showed that 21/39 (53.8%) maps recorded during inflation met criteria for myocardial ischaemia compared with 7/39 (17.9%) electrocardiograms (p<0.001). CONCLUSION: Body surface mapping compared with the 12-lead electrocardiogram improves detection of myocardial ischaemia during intervention.

Clopidogrel as an antiplatelet agent in transplant heart coronary stenting.

Clopidogrel is increasingly used as an antiplatelet agent along with aspirin in coronary stenting due to its safety profile and clinical efficacy. This report describes a case of successful direct coronary stenting in a transplanted heart with the use of clopidogrel and aspirin therapy. Vessel patency was preserved with no evidence of in stent restenosis on 4-month follow-up angiography.

Synthesis, characterization and biological activity of dimethyltin dicarboxylates containing germanium.

A series of diorganotin dicarboxylates of the general formula (CH(3))(2)Sn(OCOCHR(3)CHR(2)GeR(1))(2) where R(1)=(C(6)H(5))(3), (P-CH(3)C(6)H(4))3, N(CH(2)CH(2)O)(3), R(2)=C(6)H(5), H, CH(3), P-CH(3)OC(6)H(4), P-ClC(6)H(4), P-CH(3)C(6)H(4), R(3)=CH(3) and H, have been synthesized by the reaction of dimethyltin oxide with germanium substituted propionic acid in 1:2 molar ratio in toluene. The H(2)O formed was removed azeotropically using a Dean and Stark apparatus. All the compounds have been characterized by IR, multinuclear ((1)H, (13)C, (119)Sn) NMR, mass and Mössbauer spectroscopies. All compounds were found to have potential activity against bacteria.

Use of Rtrade mark stent in the percutaneous coronary intervention of coronary bifurcation lesions.

BACKGROUND: Percutaneous Coronary Intervention (PCI) of coronary bifurcation lesion is technically quite demanding. It has been associated with a lower procedural success, higher rates of complication and restenosis. Side-branch occlusion and plaque shifting or 'snow plow' effect are not uncommon. Stenting of the main vessel may cause 'stent jail' of the side-branch. Modern stent design may allow passage of a balloon or stent into the side-branch through the struts of the stent placed in the main vessel. A newly developed 316 stainless steel tubular stent, the Rtrade mark stent is uniquely designed to provide flexibility, radial strength on deployment and conformability. Its large cell size facilitates PCI of bifurcation lesion. AIM: To assess the feasibility of R(trade mark) stent in the treatment of symptomatic patients with bifurcation coronary lesions. The main objective was to assess the ease of deployment, side-branch access and overall success of the R(trade mark) stent in this group of patients without any major adverse events. METHODS: Between December 1998 and September 2000 the R(trade mark) stent was used as a main stent in 28 consecutive patients with coronary bifurcation lesions, 46% of which had unstable angina. The mean age was 59 +/- 10 and 89% were male. Adjunctive medical therapy included clopidrogel, aspirin and intraprocedure heparin. Abciximab (ReoPro) was given to 9 patients. RESULTS: Successful stent deployment was achieved in all patients. Thirty-four R Stents and 16 other stents were used. Two patients had post-procedure rise in cardiac enzymes. There were no major adverse events at 30 days. LAD/D1 with LAD/diagonal was the target lesion in the majority of patients. Stenting of the side-branch was done in 18 and balloon dilatation in 9 patients. At 3-23 months (mean 11.8) follow-up, repeat angiography was done in 18 patients with restenosis in 4, two of them had repeat PCI and one had coronary artery bypass graft (CABG). CONCLUSION: Coronary bifurcation lesions are not uncommon. Current advances in stent technology offer a safe and effective revascularisation strategy for such complex lesions. The R(trade mark) stent appears to be a suitable device that provides good wall coverage, radial strength, conformability and easy side-branch access.