Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India.

BACKGROUND: Hepatitis is an inflammatory disease of the liver. In sever cases, it may lead to permanent liver damage including liver cirrhosis or hepato-cellular carcinoma and may ultimately lead to death. Health-care workers (HCWs), due to their regular contact with patients are at a high-risk of acquiring this disease. AIM: The aim of this study was to assess the knowledge and attitude toward hepatitis B and C infection among the health-care interns and correlate the level of awareness to the attitude they behold toward the disease. SUBJECTS AND METHODS: A closed ended questionnaire consisting of questions to evaluate the knowledge regarding hepatitis B and C infection and attitude of the (HCWs/interns) was duly filled by 255 participants including, 100 dental, 100 medical, and 55 nursing interns. Statistical analysis was carried out using the Chi-square test, ANOVA test, post-hoc test and Pearson's correlation. RESULTS: Although most of the interns were aware of the existence of hepatitis B and C infection, the level of awareness regarding the modes of transmission and vaccination was found to be dissatisfactory. Awareness level regarding the infection among nursing interns was statistically significantly lower than the dental and medical interns. A direct positive correlation as found between awareness score and behavior score, which reveals that interns with better awareness level had better attitudes toward the infection and prevention of its transmission. CONCLUSION: There is an urgent need to increase the level and quality of training among HCWs to prevent the spread of hepatitis B virus and hepatitis C virus.

Angiostatic role of the selective cyclooxygenase-2 inhibitor etoricoxib (MK0663) in experimental lung cancer.

Lung cancer was induced in Sprague-Dawley rats by a single intra-tracheal instillation of 9,10-dimethybenz(a)anthracene (DMBA) and evaluated the anti-angiogenic action of etoricoxib, which is a selective cyclooxygenase-2 (COX-2) inhibitor. The animals were divided into four groups. Group 1 (Control) received 0.9% (w/v) normal saline intra-tracheal and 0.5% (w/v) carboxymethyl cellulose per oral daily as the vehicle of the drug, Group 2 received DMBA (20 mg/kg) intra-tracheal once, Group 3 received a daily oral dose of etoricoxib (0.6 mg/kg bw) in addition to the DMBA while Group 4 received etoricoxib alone. Morphological and histological analysis confirmed the presence of lung tumors 20 weeks after the administration of DMBA. Expressions of COX-2, MMP-2, MMP-9, MCP-1, MIP-1ß and VEGF were studied by immunofluorescence, Western immunoblot and mRNA studies, which showed a higher expression of these proteins in the DMBA-treated animals but much lower in DMBA+etoricoxib. Gelatin zymography as applied for the detection of the extracellular protein degrading enzymes, matrix metalloproteinases showed more intense activity in DMBA-treated rats as compared to the other groups. Also, the isolated alveolar macrophages were stained with Merocyanine540 (MC540) to study the membrane fluidity and lipid packing effect. DMBA treatment resulted in a significant increase in the number of lung cells exhibiting a high intensity of MC540 staining, which was reduced by the co-administration of etoricoxib. Thus the effects of etoricoxib on the expression of the angiogenic proteins have been observed, which clearly shows an anti-angiogenic mechanism of action of etoricoxib in lung cancer chemoprevention.

Changes in GH/IGF-1 axis in intrauterine growth retardation: consequences of fetal programming?

Fetal growth is a complex process that depends on the genotype and epigenotype of the fetus, maternal nutrition, the availability of nutrients and oxygen to the fetus, intrauterine insults, and a variety of growth factors and proteins of maternal and fetal/placental origin. In the fetus, growth hormone (GH) plays little or no role in regulating fetal growth, and insulin-like growth factors (IGFs) control growth directly independent of fetal GH secretion. Placental growth hormone (PGH) is the prime regulator of maternal serum IGF-1 during pregnancy. Total as well as free PGH and IGFs are significantly lower in pregnancies with intrauterine growth retardation (IUGR). The GH/IGF axis is significantly affected by intrauterine growth retardation and some of these alterations may lead to permanent pathological programming of the IGF axis. Alterations in the IGF axis may play a role in the future occurrence of insulin resistance and hypertension. In this review we focus on the regulation of fetal growth and the role of fetal programming in the late consequences of a poor fetal environment reflected in IUGR.

Uveitis following dengue fever.

OBJECTIVE: To report the occurrence of uveitis in patients with prior history of dengue fever. METHODS: A case series of patients with uveitis, presenting with ocular symptoms 3-5 months after contracting dengue fever during the dengue epidemic without any other attributable cause for uveitis. The dengue fever had subsided without any complication. None of the patients had any ocular complication during the acute dengue infection. They were treated on the lines of uveitis with local steroids, cycloplegic, and ocular hypotensive medications, when required, and oral steroid in case of posterior segment involvement. Patients' follow-up varied from 3-5 months. RESULTS: Six patients with serological evidence of prior dengue fever had presented with uveitis not attributable to any other disease. Seven eyes of six patients were affected. Anterior uveitis without any evidence of posterior segment involvement was present in six eyes of five patients whereas one patient had severe vitritis also. The most common symptom was progressive decrease in vision and only three out of seven eyes had evidence of ciliary congestion. All patients promptly responded to the treatment and visual acuity returned to 6/9 or better in five eyes, while 6/24 and 6/18 in other two eyes due to the presence of cataract. None of these patients had recurrence during the follow-up period. CONCLUSION: Uveitis in dengue infection is rare and ophthalmologists should be aware of these delayed ophthalmic complications. The prognosis of post-dengue uveitis is good.

Fetal birthweight and diastolic blood pressure: association with retinopathy in severe preeclampsia.

PURPOSE: To find the association of retinopathy in preeclampsia with fetal birthweight and systolic and diastolic blood pressure (BP) in patients with mild and severe preeclampsia. METHODS: Medical records of patients with preeclampsia who delivered at term between January 2002 and December 2006 were included in the study. Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic BP, and fetal birthweight. Multivariable linear regression was used for statistical analysis. p value < or =0.05 was considered significant. RESULTS: The patients were divided into two groups: mild preeclampsia (MP) and severe preeclampsia (SP). The MP had 156 patients and SP had 104 patients. The mean systolic BP in MP and SP was 147.2 mmHg and 164.6 mmHg, while the mean diastolic BP in MP and SP was 98.6 mmHg and 112.7 mmHg. Severity of retinopathy was inversely associated with fetal birthweight (p=0.022) in SP, while it was insignificant in the MP (p=0.082). Low birthweight was due to intrauterine growth retardation of the fetus. Diastolic BP in the SPshowed significant correlation with retinopathy (p=0.041). The systolic (p=0.55) and diastolic BP (p=0.248) in MP and systolic BP (p=0.803) in SP were insignificantly correlated with the retinopathy. CONCLUSIONS: Retinopathy in preeclampsia may indirectly indicate the level of placental insufficiencyand intrauterine growth retardation. The severity of retinopathy is more closely related with diastolic BP rather than systolic BP and the significance of this correlation increases in severe preeclampsia.

Evaluation of a mixture of zinc oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for primary teeth.

Endodontic treatment was performed on 25 pulpally involved mandibular primary molars in 4 to 9-year-old children; the root canals were obturated with a new root canal filling material consisting of a mixture of calcium hydroxide, zinc oxide, and 10% sodium fluoride solution, using hand-operated lentulo-spirals. All cases were evaluated clinically every 3 months and also radiographically every 6 months to assess the success of the treatment; we also examined the resorption of the root canal filling material from the root canals and the status of overpushed material, if any, as the tooth resorbed with the passage of time. At 6 months, endodontic treatment in 2 of the 25 teeth had failed and one tooth had exfoliated; the remaining 22 teeth were without any signs or symptoms. At the end of 2 years, 14 teeth could be evaluated; out of these 12 had physiologically exfoliated. It was observed that the rate of resorption of this new root canal obturating mixture was quite similar to the rate of physiologic root resorption in primary teeth. In three cases, where there was an overpush of the mixture, a gradual partial resorption was noted.

Efficient synthesis of (+/-)-7-isopropyl-2,10-dimethyl-8(E),10-undecadien-4-one and 3,7-dimethyl-11-oxo-2(E),6(E)-dodecadienol (oxocrinol) under ultrasound.

A simple and convergent synthesis of the title compounds has been achieved involving Zn-Cu couple catalysed conjugate addition of allylic halides to alpha,beta-unsaturated carbonyl compounds promoted by ultrasonic waves in aqueous medium as a key step in good overall yields.

Intussusception among infants given an oral rotavirus vaccine.

BACKGROUND: Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. Our investigation began on May 27, 1999, after nine cases of infants who had intussusception after receiving the tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV) were reported to the Vaccine Adverse Event Reporting System. METHODS: In 19 states, we assessed the potential association between RRV-TV and intussusception among infants at least 1 but less than 12 months old. Infants hospitalized between November 1, 1998, and June 30, 1999, were identified by systematic reviews of medical and radiologic records. Each infant with intussusception was matched according to age with four healthy control infants who had been born at the same hospital as the infant with intussusception. Information on vaccinations was verified by the provider. RESULTS: Data were analyzed for 429 infants with intussusception and 1763 matched controls in a case-control analysis as well as for 432 infants with intussusception in a case-series analysis. Seventy-four of the 429 infants with intussusception (17.2 percent) and 226 of the 1763 controls (12.8 percent) had received RRV-TV (P=0.02). An increased risk of intussusception 3 to 14 days after the first dose of RRV-TV was found in the case-control analysis (adjusted odds ratio, 21.7; 95 percent confidence interval, 9.6 to 48.9). In the case-series analysis, the incidence-rate ratio was 29.4 (95 percent confidence interval, 16.1 to 53.6) for days 3 through 14 after a first dose. There was also an increase in the risk of intussusception after the second dose of the vaccine, but it was smaller than the increase in risk after the first dose. Assuming full implementation of a national program of vaccination with RRV-TV, we estimated that 1 case of intussusception attributable to the vaccine would occur for every 4670 to 9474 infants vaccinated. CONCLUSIONS: The strong association between vaccination with RRV-TV and intussusception among otherwise healthy infants supports the existence of a causal relation. Rotavirus vaccines with an improved safety profile are urgently needed.

Immunization pockets of need: science and practice.

Despite high overall immunization coverage levels among U.S. preschool children, areas of underimmunization, called pockets of need, remain. These areas, which pose both a personal health and a public health risk, are typically poor, crowded, urban areas in which barriers to immunization are difficult to overcome and health care resources are limited. The purpose of this report is to review barriers to immunization of preschool children living in pockets of need and to discuss current issues in the identification of and implementation of interventions within these areas. The Centers for Disease Control and Prevention administers a federal grants program that funds state and metropolitan immunization programs. This program promotes a three-pronged approach for addressing pockets of need: (1) identification of target areas, (2) selection and implementation of programmatic strategies to improve immunization coverage, and (3) evaluation of progress or impact. At each step, scientific evidence can guide programmatic efforts. While there is evidence that state and metropolitan immunization programs are currently making efforts to address pockets of need, much work remains to be done to improve immunization coverage levels in pockets of need. Public health agencies must take on a broadened role of accountability, new partnerships must be forged, and it may be necessary to strengthen the oversight authority of public health. These tasks will require a concentration and redirection of resources to support the development of an immunization delivery infrastructure capable of ensuring the timely delivery of immunizations to the most vulnerable of America's children.