Assessment of asthma control in users of oral anti-asthma medications.

BACKGROUND: Despite guidelines recommending inhalation therapy as the preferred choice, oral therapy is still widely used in the treatment of asthma in India. However, data about the level of asthma control and healthcare use in patients on oral anti-asthma medications are scarce.METHODS: A retrospective study was conducted to assess the level of asthma control and healthcare use in patients taking oral anti-asthma medications.RESULTS: The study population consisted of 381 adults randomly selected from health screening programmes. All subjects were already receiving oral anti-asthma medications; however, up to 72% had not been diagnosed with asthma by their treating doctors prior to the screening programmes. The cohort had a mean age of 48.26 ± 13.83 years (70% males) and mean peak expiratory flow of 245 ± 78.93 mL/sec. The mean Asthma Control Questionnaire 5 (ACQ-5) score was 2.53 ± 1.15, with respectively 33%, 49.3% and 32.6% reporting at least one episode of breathlessness, one emergency doctor visit and one hospitalisation due to asthma or its symptoms in the past year.CONCLUSION: Underdiagnosis and inappropriate management, as indicated by the poor asthma control and increased hospitalisations seen in this study, is probably a key contributor to the increased burden of the disease in India.

Characterization of arrhythmias, evaluation of cardiac biomarkers and their association with survival in calves suffering from foot-and-mouth disease.

INTRODUCTION: Foot-and-mouth disease (FMD) causes mortality in calves due to myocarditis; however, the effects of FMD virus on cardiac arrhythmogenesis and Purkinje cells are unknown. Identifying diagnostic and prognostic markers in FMD-affected calves may be useful in disease management in the endemic countries. MATERIALS AND METHODS: A total of 81 FMD-affected calves were prospectively monitored till death or recovery. Foot-and-mouth disease was diagnosed by serology and reverse transcriptase-polymerase chain reaction (RT-PCR). Electrocardiography was recorded and serum cardiac biomarkers were measured. Histopathological examination of the ventricular myocardium was carried out in the calves that died of FMD (n = 33). Apparently healthy calves (n = 15) served as control. RESULTS: Serology and RT-PCR consistently revealed that the FMD was caused by serotype O virus. Arrhythmias occurred in 62 of 81 (76.5%) FMD-affected calves, of which, ventricular premature complexes (VPCs) were the most common type (22%). The combined mortality rate due to ventricular tachycardia, polymorphic VPCs, and atrial fibrillation was 27.6%. Receiver operating characteristic curve analysis revealed that cardiac troponin I (cTnI) concentrations of ≥1.3 ng/mL were diagnostic of myocarditis with a sensitivity and specificity of 90% and 100%, respectively. Similarly, serum cTnI concentrations of <6.4 ng/mL were a good predictor of survival [odds ratio of 263; 95% confidence interval: 29-2371]. Histopathology of the myocardium revealed hyaline degeneration, necrosis, edema, mononuclear cell infiltration, and disruption by fibroblasts. Atrophy of the Purkinje cells was also present. CONCLUSIONS: FMD induces cardiac arrhythmias and Purkinje cell pathology in the calf. Portable ECG coupled with assay of serum cTnI would help in predicting survival in FMD-affected calves.

Effects of periodontal disease on systemic health.

About one in two adults in the United States has periodontal disease. Chronic periodontitis is an oral disease affecting the supporting structures of the teeth leading to progressive loss of the attachment apparatus and bone around teeth. It is characterized by gingival pocket formation and/or gingival recession. The disease is initiated by bacteria and their components like lipopolysaccharide and causes a heightened host inflammatory response. This cascade of inflammatory response ultimately leads to an increased osteoclastic activity and bone loss. Individuals with periodontitis have increased systemic levels of acute phase proteins, plasma antibody levels, coagulation factor, total white blood cell count, neutrophils, C reactive protein (CRP), and cytokines such as INF- gamma (Interferon gamma), TNF-α (Tumor necrosis Factor- Alpha), IL (Interleukin)-1ß, IL-2 and IL-6. As periodontitis works on the same chronic inflammation model seen in systemic diseases, there is sufficient evidence to suggest a bi-directional link between the two. This article summarizes the established associations between periodontal disease and systemic health.

Dentigerous cyst in a young child: clinical insight and a case report.

A dentigerous cyst or follicular cyst is an odontogenic cyst - thought to be of developmental origin - associated with the crown of an unerupted tooth. Such cyst remain initially completely asymptomatic unless when infected. The purpose of this case report was to describe the diagnosis and management of dentigerous cyst in a 9-year-old boy. The chosen treatment was cyst enucleation and tooth extraction.

RURS' elbow guard: an innovative treatment of the thumb-sucking habit in a child with Hurler's syndrome.

Thumb sucking is the process of sucking on the thumb for oral pleasure. Thumb and finger sucking habits, or nonnutritive sucking, are considered to be the most prevalent of oral habits. Some parents are concerned by thumb sucking and may even try to restrain the infant or child. In most cases, this is not necessary. Most children stop thumb sucking on their own. When older children continue to suck their thumbs, it could mean they are bored, anxious, or have emotional problems such as depression. This article presents a case report of a child with Hurler's syndrome along with thumb sucking/biting habit. Hurler's syndrome, also known as mucopolysaccharidosis I, is a rare condition inherited as an autosomal-recessive trait. It represents the classical prototype of mucopolysaccharide disorder. A unique appliance to prevent thumb sucking/biting was developed and termed as "RURS' elbow guard," which was successfully used to break thumb sucking of the child with Hurler syndrome. The present report also describes the steps in fabrication of this new habit-breaking appliance, which is also designed to protect the finger from the effects of the sucking habit.

The Eyes Absent phosphatase-transactivator proteins promote proliferation, transformation, migration, and invasion of tumor cells.

The Eyes Absent (EYA) proteins combine transactivation, tyrosine phosphatase, and threonine phosphatase activities in their function as part of a conserved regulatory cascade involved in embryonic organ development. EYA tyrosine phosphatase activity contributes to fly eye development, and vertebrate EYA is involved in promoting DNA damage repair subsequent to genotoxic stress. EYAs are known to be expressed at elevated levels in ovarian and breast cancers. Here, we show that the tyrosine phosphatase activity of the EYAs promotes tumor cell migration, invasion, and transformation. These cellular effects are accompanied by alterations of the actin cytoskeleton and increased levels of active Rac and Cdc42. The invasiveness conferred by EYA is reflected in vivo by inhibition of metastasis seen when EYA3 expression is silenced in the invasive breast cancer cell line MDA-MB-231. Together, our data directly associate the tyrosine phosphatase activity of the EYAs with the oncogenesis-associated cellular properties of motility and invasiveness.

Pierre Robin sequence: report of two cases.

Pierre Robin sequence (PRS) or anomalad, a well-recognized presentation, is the association of the first brachial arch malformation. It presents with a classic triad of micrognathia, glossoptosis, and cleft palate. In a neonate with a complete cleft palate, problems with feeding are commonly encountered. Presented here are two cases with PRS in whom palatal obturators were constructed.

Inhibition of Eyes Absent Homolog 4 expression induces malignant peripheral nerve sheath tumor necrosis.

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas without effective therapeutics. Bioinformatics was used to identify potential therapeutic targets. Paired Box (PAX), Eyes Absent (EYA), Dachsund (DACH) and Sine Oculis (SIX) genes, which form a regulatory interactive network in Drosophila, were found to be dysregulated in human MPNST cell lines and solid tumors. We identified a decrease in DACH1 expression, and increases in the expressions of PAX6, EYA1, EYA2, EYA4, and SIX1-4 genes. Consistent with the observation that half of MPNSTs develop in neurofibromatosis type 1 (NF1) patients, subsequent to NF1 mutation, we found that exogenous expression of the NF1-GTPase activating protein-related domain normalized DACH1 expression. EYA4 mRNA was elevated more than 100-fold as estimated by quantitative real-time PCR in most MPNST cell lines. In vitro, suppression of EYA4 expression using short hairpin RNA reduced cell adhesion and migration and caused cellular necrosis without affecting cell proliferation or apoptotic cell death. MPNST cells expressing shEYA4 either failed to form tumors in nude mice or formed very small tumors, with extensive necrosis but similar levels of proliferation and apoptosis as control cells. Our findings identify a role of EYA4 and possibly interacting SIX and DACH proteins in MPNSTs and suggest the EYA4 pathway as a rational therapeutic target.

A short note on peste des petits ruminants in Karnataka, India.

Retrospective quantitative analysis of epidemiological data on peste des petits ruminants (PPR) from the Department of Animal Husbandry and Veterinary Sciences in Karnataka, southern India, revealed significant information about the disease in this area. In the nine years between April 1998 and March 2007 a total of 624 outbreaks were reported in the state. With the exception of the 12-month period between April 2001 and March 2002 the disease occurred every year. The study shows clearly that incidences were highest during the rainy season and in the dry agro-climatic zones. The density of the PPR-susceptible population in different districts of the state played a major role in disease incidences. Environmental factors also influenced disease occurrence. Vaccination programmes are slowly being taken up in the state. The disease data documented in this study provide information about the endemicity of the disease that can help to formulate an effective strategy for a PPR-control programme in the state.

The branching pattern and communications of the musculocutaneous nerve.

Anatomical variations of peripheral nerves are important and can help explain otherwise incomprehensible clinical findings. A study of 26 right and 18 left formalin-preserved upper limbs identified the fact that the musculocutaneous nerve is subject to considerable anatomical variation, including communication with the median nerve. A study of its branching pattern made us aware of why debility after trauma to the lateral aspect of the upper arm may be more than expected, and this study considers the clinical and surgical importance of these variations of the musculocutaneous nerve.

Autonomic dysfunction in tetanus - what lessons can be learnt with specific reference to alpha-2 agonists?

Severe tetanus is seen infrequently in the developed world, but often requires intensive care support. Mechanical ventilation with neuromuscular blockade and heavy sedation, good wound care and prompt administration of antitoxin are important. The management of autonomic dysfunction remains challenging. We measured serum catecholamine levels in a patient with severe tetanus in whom autonomic crises were a major and persistent feature, and investigated the impact of sedatives plus alpha(2)-agonists on these levels. Serum adrenaline levels were elevated up to 100-fold with clinically observed crises, although noradrenaline levels were much more difficult to interpret. There was no appreciable difference in catecholamine levels following administration of alpha(2)-agonists in the doses we used, although clonidine did allow easier control of crises with other agents. This case highlights some important lessons in the management of severe tetanus.

Highly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial.

Anaemia in critically ill patients is common and phlebotomy associated blood loss may contribute towards this anaemia. The aims of this study were twofold. Firstly, a survey was conducted to provide a summary of current phlebotomy practices within Australian intensive care units. A standardized telephone survey was aimed at Australian intensive care units registered with Australia and New Zealand Intensive Care Society (ANZICS) and questions regarding phlebotomy procedures directed at nursing staff. Secondly, a prospective randomized controlled trial aimed to assess the impact of a highly conservative phlebotomy procedure on haemoglobin concentration in intensive care patients. Patients admitted to our own intensive care unit were randomized using a sealed envelope technique to either a highly conservative phlebotomy group, or standardized controls. Blood was taken according to strict protocols and recorded along with haemoglobin concentration daily. The survey demonstrated that 16% of Australian units return deadspace volumes from in-line arterial sets and no unit routinely used paediatric-sized blood collection tubes. Using our highly conservative protocol, median phlebotomy-associated blood loss was reduced by over 80% (40 ml vs 8 ml P<0.001). Mean haemoglobin fell from 13.7 g/dl to 11.7 g/dl in controls (P=0.002) and from 12.7 g/dl to 11.5 g/dl (P=0.074) in our study group. We conclude that highly conservative phlebotomy is feasible in a critical care unit and is associated with a reduction in blood loss.

The Jehovah's Witness and dementia: who or what defines 'best interests'?

An elderly woman with dementia presented for repeat surgical management of fractured neck of femur. Although no advance directive had ever been generated, the patient was declared to be a strict Jehovah's Witness by her daughter, who vetoed the transfusion of any blood products. The fracture was managed conservatively but the patient suffered repeated chest infections, from which she died 4 months after admission. This case raised several clinical, ethical and legal issues and generated a spectrum of opinion as to the appropriateness of operative intervention, transfusion and provision of intensive care. We suggest that professional guidelines and the new Mental Capacity Act 2005 do not provide explicit and comprehensive guidance for practitioners. Further deliberation is required to bring about convergence between the law, ethical principles and professional guidelines.

Generation and propagation of a picosecond acoustic pulse at a buried interface: time-resolved x-ray diffraction measurements.

We report on the propagation of coherent acoustic wave packets in (001) surface oriented Al0.3Ga0.7As/GaAs heterostructure, generated through localized femtosecond photoexcitation of the GaAs. Transient structural changes in both the substrate and film are measured with picosecond time-resolved x-ray diffraction. The data indicate an elastic response consisting of unipolar compression pulses of a few hundred picosecond duration traveling along [001] and [001] directions that are produced by predominately impulsive stress. The transmission and reflection of the strain pulses are in agreement with an acoustic mismatch model of the heterostructure and free-space interfaces.

Sublingual traumatic ulceration due to neonatal teeth (Riga-Fede disease).

The term Riga-Fede disease has been used historically to describe traumatic ulceration that occurs on the ventral surface of tongue in neonates and infants. It is most often associated with natal and neonatal teeth in newborns. A case of Riga-Fede disease is presented.

Central giant cell granuloma in child: a case report.

The central giant cell granuloma or CGCG is a benign intraosseous lesion of the jaw. It is found predominantly in children and young adults. A case of 10 year old male child with CGCG in mandible is presented.

A classical live attenuated vaccine for sheep pox.

A classical live attenuated sheep pox vaccine was prepared using the Ranipet strain of sheep pox virus (SPV) at the 50th passage in a secondary lamb testicular cell system. The TCID50 and RD50 were 10(9.63)/ml and 10(9.51)/ml. respectively. The SID50 of SPV challenge virus was 10(5)/ml. The vaccine was found to have no adverse effects in laboratory animals, and was safe and effective in SPV seronegative lambs. In the field, 660 sheep were vaccinated with an immunizing dose containing 1 x 10(2) TCID50. Randomly selected vaccinated sheep mounted good cell-mediated immunity and humoral responses as measured by glucose utilization test and serum neutralization test, respectively, for the study period of 6 months.

Acute idiopathic thrombocytopenic purpura in childhood: a case report.

Acute thrombocytopenic purpura is the most common of thrombocytopenias of the childhood. Clinical features include petechial lesions on oral mucosa, gingival bleeding and occasionally hemorrhage. A case of acute thrombocytopenic purpura is presented.

Tooth fragment reattachment--an esthetic alternative: report of a case.

Trauma to the anterior teeth is relatively common among children and teenagers. Reattachment of a fractured fragment to the remaining tooth can provide better and long lasting esthetics, improved function, a positive psychological response and is a faster and less complicated procedure. This article discusses fragment reattachment technique and presents clinical case of coronal fracture involving enamel and dentin.