IL-1α is a DNA damage sensor linking genotoxic stress signaling to sterile inflammation and innate immunity.

Environmental signals can be translated into chromatin changes, which alter gene expression. Here we report a novel concept that cells can signal chromatin damage from the nucleus back to the surrounding tissue through the cytokine interleukin-1alpha (IL-1α). Thus, in addition to its role as a danger signal, which occurs when the cytokine is passively released by cell necrosis, IL-1α could directly sense DNA damage and act as signal for genotoxic stress without loss of cell integrity. Here we demonstrate localization of the cytokine to DNA-damage sites and its subsequent secretion. Interestingly, its nucleo-cytosolic shuttling after DNA damage sensing is regulated by histone deacetylases (HDAC) and IL-1α acetylation. To demonstrate the physiological significance of this newly discovered mechanism, we used IL-1α knockout mice and show that IL-1α signaling after UV skin irradiation and DNA damage is important for triggering a sterile inflammatory cascade in vivo that contributes to efficient tissue repair and wound healing.

Prevention of E.N.T. diseases.

World Health Organization has announced 'HEALTH FOR ALL BY YEAR 2000'. Unfortunately the emphasis at present is only on early diagnosis of a disease and its treatment. The modern investigations and treatment has become very costly which a poor man cannot afford. Preventive medicine is less costly. The developing countries have many socio-economic problems of population explosion, poverty, ignorance, illiteracy, shifting of population from rural to urban areas for employment and traffic jams in cities. Rapid industrialization has resulted in indiscriminate cutting of trees and forests and increasing pollution. Under the present circumstances one wonders whether it would be possible to achieve the WHO's object of health for all or will it remain a dream! The role of 'Yoga and Meditation' and vegetarian diet has been recognised world over for maintenance of normal physical and mental health; these help to lessen mental tension in the present competitive world full of stress and strain for all of us. 3-4% of people in the world avail the beneficial effects of alternative system of medicine is complete as each has its own merits and limitations. Hence our aim should be to choose an integrated system of medicine which would help in preventing diseases and treat them early by a safe and effective procedure. In the present political situation in our country none of the parties have announced any definite programme for population control, through it is a grave problem. We will not be able to fulfil our object of reaching our target of Health for all without strict population control major. Unless this programme is undertaken seriously as a priority in a co-ordinated disciplined manner by all of us and completed in a given period of time, the younger generation will not forgive us. We hope that as true citizens of India we will not spare any efforts on our part in attaining this objective for a bright future.

Short report: the spatula test: a simple bedside test to diagnose tetanus.

Four hundred patients with suspected tetanus were studied to determine the value of the spatula test to diagnose tetanus. A positive test result (reflex spasm of the masseters on touching the posterior pharyngeal wall) was seen in 359 (94%) of 380 patients with tetanus and in no patient without tetanus. Thirty-three of 400 patients (13 with tetanus and 20 with other diagnoses) had a negative test result (a gag reflex with attempted expulsion of the spatula). Thus, the test performed on presentation had a high specificity (100%) and sensitivity (94%) for diagnosing tetanus.

Health care delivery system and surgical education in India.

In India health care delivery and medical education are largely governmental functions. India cannot afford a national health service. However, it has a national health policy based on the primary health care approach, with emphasis on rural health in order to achieve the World Health Organization's goal of "Health for All" by 2000 AD. Health care delivery is represented by the public sector as well as the private sector. Nearly 80% of the health facilities, both public and private, are concentrated in the urban areas. Hence despite its best efforts, the government has not been able to make medical education need-based. The postgraduate surgical trainees are not exposed to rural work owing to inadequate facilities and resources in rural areas. Surgical residents get their training in teaching hospitals located in urban areas. Most of the public sector teaching hospitals as well equipped to impact training to the residents according to the guidelines of the Medical Council of India (MCI), the apex governing body. However, the rapid advancement in medical technology over the last decade, the government is finding it increasingly difficult to keep these teaching hospitals up-to-date. Of late, some of the sophisticated private sector hospitals are therefore sharing the onus of surgical education, especially at the subspeciality level. Thus despite the good intentions of government planning a two class system of health care delivery has come into being and a two class system of medical education is foreseeable.

Facial nerve involvement in pseudotumor cerebri.

A woman with history of bifrontal headache, vomiting and loss of vision was diagnosed as a case of pseudotumor cerebri based on clinical and MRI findings. Bilateral abducens and facial nerve palsies were detected. Pseudotumor cerebri in this patient was not associated with any other illness or related to drug therapy. Treatment was given to lower the raised intracranial pressure to which the patient responded.

Poncet's disease.

Tuberculous rheumatism is not generally accepted as a specific disease entity in Great Britain or the U.S.A. We are reporting a adult male whom we believe suffered from this disease, to open the controversy surrounding its existence with a review of the literature.

Gastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized, controlled trial.

OBJECTIVE: To study the effects of pharmacologically increasing gastric pH on gastric colonization and the development of pneumonia in intubated critically ill patients. DESIGN: Randomized, controlled trial. SETTING: Medical ICU in a university hospital. PATIENTS: Thirty-four tracheotomized patients with tetanus. INTERVENTIONS: Sixteen patients received iv ranitidine to increase gastric pH greater than 4 (ranitidine group), while 18 patients received no prophylaxis for upper gastrointestinal bleeding (control group). MEASUREMENTS AND MAIN RESULTS: Mean gastric pH was higher in the ranitidine group (median 4.7, range 3.6 to 6.1) than in the control group (median 2.1, range 1.2 to 4.9; p less than .05). Gastric colonization occurred in 15 (94%) of 16 patients who received ranitidine, 2 days (median; range 1 to 5) after intubation; gastric colonization also occurred in all control patients (median 4 days, range 1 to 9; p less than .05). Pneumonia occurred in 13 (81%) of 16 patients who received ranitidine, 3 days (median, range 1 to 5) after intubation and in nine (50%) of 18 control patients (p less than .01) 5 days after tracheal intubation (median, range 3 to 14; p less than .01). Prior gastric colonization by the pathogen that caused pneumonia was demonstrable in nine (56%) of 16 patients who received ranitidine vs. eight (44%) of 18 control patients (p greater than .05). The risk for developing pneumonia in the ranitidine-treated group was highest in the first 4 days after tracheal intubation. There was no difference in the frequency of upper gastrointestinal hemorrhage in the two groups. CONCLUSIONS: Pharmacologically increasing gastric pH increases the risk for developing pneumonia in intubated critically ill patients. The pneumonia occurs earlier than in untreated control patients.

Tricuspid valve endocarditis following septic abortion.

PIP: The characteristics features of right-sided endocarditis are summarized in this case report of a 30-year-old female admitted with a history of high grade, continuous, fever, breathlessness, and dry cough over a 10-day period. The patient had had an incomplete abortion 15 days earlier for which dilatation and curettage was performed. On examination, the patient was toxic, febrile with a pulse of 118/minute and respiration 36/minute. Her blood pressure was 110/70 mm Hg. There was soft, tender hepatomegaly and soft splenomegely. There also were scattered coarse crepitations over both lungs. The vaginal examination revealed posterior fornicial bogginess and tenderness. Urine and cervical pus swab showed growth of klebsiella. The blood culture was negative. A plan chest X-ray revealed multiple, small, basal, pulmonary infiltrates. Posterior colopuncture revealed a small quantity of clear, yellowish fluid. Abdominopelvic ultrasonography revealed an ill-defined haziness in the parauterine region. The patient was treated with ampicillin, gentamycin, and metronidazole, but she continued to deteriorate. An urgent exploratory laparotomy was performed. The patient died on the 2nd postoperative day. The autopsy findings revealed that the heart was normal in size and shape. The tricuspid valve showed a large vegetation projecting into the ventricle. Microscopic examination revealed polymorphonuclear infiltration with clumps of gram-negative bacillifocal areas of myocarditis also were seen. In lungs the right lower lobe showed a small, hemorrhagic infarct. Both the liver and spleen were congested. Kidneys showed multiple petechiae on the external surface and on the cut section. Endocarditis during pregnancy may be because of perinatal infections, urinary tract infection, or septic thrombophlebitis of pelvi veins. Septic abortion of pelvic infection secondary to IUD also can provide portal of entry for bacteria. The common organisms are streptococcus, staphylococci, and occasionally bacteroides and gram negative bacilli. Clinical suspicion of right-sided endocarditis is justified in any patient with prolonged fever, cough, pleuritic pain, tachycardia, and multiple pulmonary infiltrates. Heart murmurs are usually absent and if present are soft and may be heard at atypical sites.^ieng

Evolution of nasal mucosal lesions in leprosy (histological study).

Four stages of nasal pathology in tuberculoid leprosy is described. In every atrophic rhinitis case nasal biopsy is advocated. Rhinoscopic examination should be done in family contacts and early cases of leprosy.

Evolution of nasal mucosal lesions in leprosy (histological study)

Four stages of nasal pathology in tuberculoid leprosy is described. In every atrophic rhinitis case nasal biopsy is advocated. Rhinoscopic examination should be done in family contacts and early cases of leprosy.