Chest discomfort in a patient with dengue - is it an acute myocardial infarction?

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a 56-year-old woman.

Real-world experiences of folic acid supplementation (5 versus 30 mg/week) with methotrexate in rheumatoid arthritis patients: a comparison study.

The objective of this study was to compare the tolerability of methotrexate in two different regimes of folic acid (FA) supplementation in rheumatoid arthritis (RA). We performed a multicenter, cross-sectional observational cohort study on 240 RA patients with 120 patients each in 5 mg of FA weekly and 30 mg of FA weekly supplementation. There were no significant differences for side effects (14.2 versus 22.5%, P=0.523) and discontinuation of methotrexate (3.6 versus 13.3%, P=0.085). RA patients given 5 mg of FA weekly supplementation had a lower disease activity score 28 compared to 30 mg of FA weekly supplementation [3.44 (1.10) versus 3.85 (1.40), P=0.014]. FA supplementation of 5 mg per week and 30 mg per week was associated with similar tolerability of methotrexate in RA patients.

Associations of Low Muscle Mass and the Metabolic Syndrome in Caucasian and Asian Middle-aged and Older Adults.

OBJECTIVE: Age-related declines in skeletal muscle mass may confer significant metabolic consequences for older adults. Associations of low muscle mass and metabolic syndrome (MetS) in Caucasians, and comparisons with associations observed in Asian populations, have not been reported. We examined associations of low muscle mass and metabolic syndrome (MetS) in Asian and Caucasian middle-aged and older men and women using criteria for low muscle mass. DESIGN, SETTING AND PARTICIPANTS: Two population-based studies of Australian (Tasmanian Older Adult Cohort Study; TASOAC; N=1005) and Korean (Korean Sarcopenic Obesity Study; KSOS; N=376) community-dwelling adults, mean age 62 and 58 years, respectively. MEASUREMENTS: Appendicular lean mass (aLM) determined by dual-energy X-ray absorptiometry and normalised to height squared (aLM/Ht2), weight (aLM/Wt) or body mass index (aLM/BMI). Participants in the lowest sex-specific 20% for aLM measures were defined as having low muscle mass. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Although Australians demonstrated generally unfavourable anthropometric and metabolic characteristics compared to Koreans, prevalence of MetS was similar (29.5% in Australians and 31.4% in Koreans, respectively). Low aLM/Ht2 was associated with significantly reduced likelihood of MetS in both Australians (OR: 0.30, 95% CI 0.19 - 0.46) and Koreans (OR: 0.31, 95% CI 0.16 - 0.62). Conversely, low aLM/BMI was associated with increased odds for MetS in Australians (OR: 1.78, 95% CI 1.12 - 2.84), but not Koreans (OR: 1.33, 95% CI = 0.67 - 2.64). CONCLUSION: Low aLM/BMI is associated with significantly increased likelihood of MetS in Australian adults, but not Koreans, suggesting potential differences in effects of low muscle mass relative to body mass on cardiometabolic health in Caucasian and Asian middle-aged and older adults. Low muscle mass relative to height is associated with reduced likelihood of MetS in both populations.

Association of glypican-4 with body fat distribution, insulin resistance, and nonalcoholic fatty liver disease.

CONTEXT AND OBJECTIVE: Glypican-4 was identified as a novel adipokine capable of enhancing insulin signaling and modulating adipocyte differentiation. We investigated associations between glypican-4 and body composition, insulin resistance, arterial stiffness, and nonalcoholic fatty liver disease (NAFLD) in nondiabetic Asian subjects. DESIGN AND PARTICIPANTS: We analyzed baseline cross-sectional data from the Korean Sarcopenic Obesity Study, an ongoing prospective cohort study. NAFLD was diagnosed by unenhanced computed tomography using the liver attenuation index. We also examined the effects of a 3-month combined aerobic and resistance exercise program on glypican-4 levels and cardiometabolic risk factors. RESULTS: Circulating glypican-4 levels were higher in men than in women (1.83 [1.19, 2.78] ng/mL vs 1.17 [0.66, 2.00] ng/mL, P < .001) and had a significant positive relationship with the waist-to-hip ratio (WHR) (r = 0.20, P = .014) and the ratio of visceral to sc fat area (r = 0.30, P < .001). Furthermore, glypican-4 levels in women were correlated with cardiometabolic risk factors, including insulin resistance and arterial stiffness, and were independently associated with NAFLD by multiple logistic regression analysis (P = .017, R² = 0.33). The 3-month combined exercise training program significantly improved several cardiometabolic parameters and reduced retinol binding protein-4 levels. Changes in glypican-4 levels after the exercise program were significantly different between subjects with an increased WHR compared with those with a decreased WHR (P = .034). CONCLUSION: A gender-based difference in circulating glypican-4 levels was apparent as these were increased in women with NAFLD and related to body fat distribution, insulin resistance, and arterial stiffness.

Fractionated algal organic materials as precursors of disinfection by-products and mutagens upon chlorination.

Cells and proteins of Chlamydomonas sp. (a common green alga in local reservoirs) were separated by ultrafiltration respectively into 3 fractions with variable molecular weights (MW: >100, 10-3 and <3 kDa). After chlorination (20°C, pH 7, Cl(2)/DOC ratio of 20 mg Cl(2)mg(-1), 120 h), levels of disinfection by-products (DBPs) and mutagenicity (via Salmonella T100 mutation assay, -S9) were analyzed. The highest yields of chloroform (2571 µmol mol C(-1)), DCAA (19,083 µmol mol C(-1)) and TCAA (4939 µmol mol C(-1)) were observed from the fraction of MW>100 kDa, while the fraction of 3-10 kDa was potent DCAN precursor. In contrast, the chlorinated MW 3-10 kDa cell fraction showed high mutagenicity (maximum level of 93 rev µL(-1) at 2 min), while the MW>100 kDa cell fraction showed low mutagenicity (maximum level of 16.6 rev µL(-1) at 7200 min) after chlorination. This indicated that unmeasured DBPs or possible interactions among the DBPs contributed to the mutagenicity. Comparing between the cell and protein fractions, the former was more potent in forming chloroform, DCAA, TCAA, DCAN and TCAN. This is the first study that fractionated algal cells and proteins were examined for DBP formation and mutagenicity.

Efficacy and safety of topical WBI-1001 in patients with mild to severe atopic dermatitis: results from a 12-week, multicentre, randomized, placebo-controlled double-blind trial.

BACKGROUND: There is a need for the development of novel nonsteroidal topical drugs for the treatment of atopic dermatitis (AD). OBJECTIVES: The primary objective was to evaluate the efficacy of WBI-1001 over 6 weeks of treatment of mild to severe AD. METHODS: Patients with AD affecting 3-20% of their body surface area and with an Investigator's Global Assessment (IGA) of 2-4 were randomized (1 : 1 : 1) to receive placebo, WBI-1001 0·5% or WBI-1001 1·0% in a cream formulation applied twice daily for 6 weeks. At the end of this phase, patients receiving WBI-1001 continued the same treatment for an additional 6 weeks. Patients receiving placebo entered into a 6-week double-blind phase with re-randomization (1 : 1) to WBI-1001 0·5% or 1·0% cream. The primary objective was to evaluate the efficacy of WBI-1001 over 6 weeks of treatment of mild to severe AD. The primary endpoint was the mean change from baseline in IGA at day 42 (week 6). RESULTS: In total, 148 patients were randomized and analysed in the placebo (51), WBI-1001 0·5% (50) and WBI-1001 1·0% (47) groups. There was a decrease of 1·3 [43%; P < 0·001; 95% confidence interval (CI) -1·2 to -0·5] and 1·8 (56·3%; P < 0·001; 95% CI -1·6 to -0·9) in IGA at day 42 in the WBI-1001 0·5% and 1·0% groups, respectively, as compared with a decrease of 0·5 (14·7%) in the placebo group. Adverse drug reactions included a few cases of folliculitis and contact dermatitis. CONCLUSIONS: WBI-1001 is an efficacious novel topical anti-inflammatory molecule for the treatment of AD.

Stretching and migration of DNA by solvent elasticity in an oscillatory flow.

A model with solution viscoelasticity is proposed to explain the ratchetlike stretching of DNA by a symmetric ac electric field in polymer solutions. In this model, DNA is stretched by the interaction between the fluid elasticity and the oscillatory flow induced by DNA. Predictions of the model are confirmed by DNA stretching experiments performed in various polymer solutions and the corresponding rheological measurements of the solutions. In particular, experiments have verified that a net migration of stretched DNA in polymer solutions can be induced by a zero-mean asymmetric ac electric field. This last finding cannot be explained by other existing models.

Pentachlorophenol induced physiological-biochemical changes in Chlorella pyrenoidosa culture.

Present study investigated physiological and biochemical changes in a green alga culture (Chlorella pyrenoidosa) upon exposure to varied concentrations of pentachlorophenol (PCP) (0, 0.4 mgL(-1), 2.5 mgL(-1) and 10 mgL(-1)). The results revealed that with the increase of PCP concentration, a decrease of the algal biomass, levels of photosynthetic pigments (chlorophyll a, b and carotenoid), soluble protein and an increase of nitrate reductase (NR) activity were observed. This suggests that the PCP may serve as an uncoupler, causing low ATP level within the algal cells and led most of the NR molecules to be in the dephosphoration state (i.e. active from). Moreover, it shows that photosynthetic pigments especially carotenoid were more sensitive indicators to indicate PCP toxicity as compared to the other parameters.

Amino acids as precursors of trihalomethane and haloacetic acid formation during chlorination.

Twenty amino acids were chlorinated and examined for the formation of trihalomethane (THM) and haloacetic acid (HAA). The amino acids exhibited a high Cl(2) demand (3.4-10 mg Cl(2) mg(-1) C) but low THM formation (<4.19 microg mg(-1) C) except for tryptophan and tyrosine (45.8 - 147 microg mg(-1) C). Large variation in HAA yield occurred among the amino acids (from not detectable to 106 microg mg(-1) C). One group of amino acids, possessing chain structures, exhibited a slow increase in HAA formation (<6.2 micromol mol(-1) amino acid or <11.3 microg mg(-1) C) as the chlorine demand increased (3.4-8.9 mol Cl(2) mol(-1) amino acids). The other group of amino acids, containing ring structures (including tryptophan, tyrosine, histidine, phenylalanine, and proline) and two amino acids with chain structures (aspartic acid and asparagine), showed a fast increase in HAA formation (16-96 micromol mol(-1) amino acid or 27-106 microg mg(-1) C) with the increase in chlorine demand (5.2-15.9 mol Cl(2) mol(-1) amino acid). The ratios of TCAA to DCAA (mol/mol), derived from the amino acids, ranged between 0.01 and 1.10.

Sources and properties of natural organic matter (NOM) in water along the Dongjiang River (the Source of Hong Kong's drinking water) and toxicological assay of its chlorination by-products.

The Dongjiang River is the major source of the drinking water supply for Hong Kong and also other parts of the Pearl River Delta in China, and the deterioration in the water quality of this river and the excessive levels of trihalomethanes (THMs) in the tap water of some districts in Hong Kong have become a matter of public concern. The main objective of the present study is to investigate the distribution patterns of natural organic matter (NOM) and their association with THM production in the Dongjiang River. We examined the physicochemical and biological properties of the river water and the corresponding sediment elutriate collected from four sampling sites along the Dongjiang River from upstream to downstream and chlorination experiments were conducted. Algal bioassays were performed in order to test the chlorination effects. The results showed that: (1) upstream NOM was derived from terrestrial input, while that at mid- and downstream was most likely derived from phytoplankton; (2) phytoplankton is a major contributor to NOM in the sediments, whereas sediments seem to be the site for major microbial degradation of NOM, biogeochemical recycling of nutrients and a potential NOM pool for the overlaying water during sediment resuspension; (3) dissolved organic carbon (DOC) in surface water is a good indicator for THM production, whereas ultraviolet (UV) absorbance at 254 nm (UV(254)) is a better predictor for THM formation in the elutriates; (4) the bioassay results showed that toxic compounds other than THMs in the chlorinated water are the major factors causing algal growth inhibition.

Modeling of trihalomethane (THM) formation via chlorination of the water from Dongjiang River (source water for Hong Kong's drinking water).

The Dongjiang River is the major source of drinking water supply for Hong Kong. The deterioration of the water quality of the Dongjiang River and excessive trihalomethanes (THMs) in the tap water of some districts in Hong Kong have become causes for public concern. The main objective of the present study is to investigate and model THM formation due to the chlorination of the Dongjiang River water under different chlorination conditions. The results showed that the total THM formation ranged between 11.7 and 91.8 mg L(-1) and that control of the levels was primarily due to the reaction time and the Br(-) level in the water. Bromide concentration was a key factor in determining bromine-containing THM formation and consequently the speciation of THMs. Higher concentrations of bromide shifted THM species to more-bromine-containing ones, while the kinetics reflected the competing halogenation reactions. As the two mixed-halogen THMs had high cancer potency, the cancer risk of total THMs appeared to reach a peak at a bromide concentration ranging between 218 and 262 mg L(-1) (with a bromide to dissolved organic carbon molar ratio (Br(-)/DOC) ranging between 15 and 18 mM/mM).

Residue of pentachlorophenol in freshwater sediments and human breast milk collected from the Pearl River Delta, China.

Pentachlorophenol (PCP) was investigated in freshwater sediments and human breast milk collected from the Pearl River Delta, China. The average level of PCP in river sediments was 7.93 ng/g based on dry weight, ranging from 1.44 to 34.4 ng/g. As to the sediments from fishponds, samples from Zhongshan had the highest PCP levels (37.5 ng/g on average), followed by Dongguan (21.1 ng/g on average) and the least in Shenzhen (3.69 ng/g on average) and Shunde (2.20 ng/g on average). Negative relationship was obtained between the PCP level and pH value in sediment (r=0.553, n=13, p<0.05), while positive relationship was found between the PCP levels and the total organic matter (TOM) levels in sediment (r=0.700, n=17, p<0.01). These results indicated that pH and TOM played important roles during the process of PCP settling down to the sediment. PCP was also detected in human breast milk with an average of 2.15 ng/g. The PCP concentration increased with the age increasing of donors. The estimated PCP body burden for mother, daily and yearly PCP intake of infants ranged from 0.16 to 4.17 mg/person, from 0.26 to 10.23 mug/infant.day and from 0.09 to 3.73 mg/infant.year, respectively.

Randomized trial of a hexachlorophene preparation and P-300 bacteriostatic soaps.

Twenty-six patients undergoing chemotherapy for acute leukemia on a protected environment-prophylactic antibiotic program were randomly assigned to bathe with either P-300 or a 3% hexachlorophene preparation. Both agents substantially reduced the microbial flora of the skin, but the latter preparation was slightly more effective. The bacteriostatic compounds in both preparations were absorbed through the skin but no toxic effects were observed.