Hernandulcin: an intensely sweet compound discovered by review of ancient literature.

Ancient Mexican botanical literature was systematically searched for new plant sources of intensely sweet substances. Lippia dulcis Trev., a sweet plant, emerged as a candidate for fractionation studies, and hernandulcin, a sesquiterpene, was isolated and judged by a human taste panel as more than 1000 times sweeter than sucrose. The structure of the sesquiterpene was determined spectroscopically and confirmed by chemical synthesis. Hernandulcin was nontoxic when administered orally to mice, and it did not induce bacterial mutation.

Cardiovascular disease risk factors in 2 distinct ethnic groups: Indian and Pakistani compared with American premenopausal women.

BACKGROUND: Although people from the Indian subcontinent have high rates of cardiovascular disease (CVD), studies of such in Indian and Pakistani women living in the United States are lacking. OBJECTIVE: This study accounted for variability in serum lipid (total cholesterol and triacylglycerol) and lipoprotein [LDL cholesterol, lipoprotein(a), and HDL cholesterol] concentrations in Indian and Pakistani compared with American premenopausal women in the United States. Body composition, regional fat distribution, dietary intake, and energy expenditure were compared between groups. DESIGN: The 2 groups were 47 Indian and Pakistani and 47 American women. Health was assessed via medical history, physical activity, body composition (via anthropometry and dual-energy X-ray absorptiometry), dietary intake (via 7-d food records), and serum lipids. RESULTS: Serum total cholesterol, triacylglycerol, LDL cholesterol, lipoprotein(a), the ratio of total to HDL cholesterol, and the ratio of LDL to HDL cholesterol were greater (P <0.03), whereas HDL-cholesterol values were lower (P = 0.011) in Indians and Pakistanis than in Americans. Multiple regression analysis indicated that approximately 18% of the variance in total cholesterol (P = 0.0010) and LDL cholesterol (P = 0.0009) was accounted for by ethnicity, energy expenditure, and the ratio of the sum of central to the sum of peripheral skinfold thicknesses. Ethnicity, sum of central skinfold thicknesses, ratio of polyunsaturated to saturated fat, and monounsaturated fat intake accounted for approximately 43% of the variance in triacylglycerol concentration (P < 0.0001). Monounsaturated fat, percentage body fat, and alcohol intake accounted for approximately 26% of variance in HDL cholesterol. Ethnicity contributed approximately 22% of the 25% overall variance in lipoprotein(a). CONCLUSIONS: Results suggest that these Indian and Pakistani women are at higher CVD risk than their American counterparts, but that increasing their physical activity is likely to decrease overall and regional adiposity, thereby improving their serum lipid profiles.

Perceived control of nutrition behavior: a study of the locus of control theory among healthy subjects.

This study was conducted to gain insight into individuals' perceptions of their willingness and ability to change their nutrition behavior. As eating habits are primarily socially learned, the locus of control theory, a social learning theory, was applied to the understanding of nutrition behavior. Responses from 105 young male and female subjects to a questionnaire devised to examine individuals' beliefs about the internal and external factors which control, or determine, dietary habits and health were analyzed. Individual values and assessment of personal health and diet were measured, and demographic data were collected. Two major findings were obtained. First, the locus of control theory was too narrow a construct to explain the subjects' responses and beliefs. The data suggested six categories which differentiated between individuals' expectations about factors controlling outcomes of behavior and those controlling actual personal behaviors. Second, there were significant differences in responses to locus of control statements on the basis of certain demographic variables, especially religious affiliation. Religious/traditional Jewish subjects tended to be more internally oriented than nonreligious/nontraditional Jewish subjects, independent of other demographic variables. Subjects with greater willingness and perceived ability to change their nutrition behavior appeared to take responsibility for choosing what is "right" or "better" and had firmly established personal guidelines for what is, or is not, acceptable.

Inpatient and post-discharge course of the malnourished patient.

A retrospective review of the medical records of 114 malnourished and 106 non-malnourished male veterans assessed the inpatient and 1 year post-discharge dietetic care given for the treatment of malnutrition. The malnourished sample consisted of subjects discharged with a protein-energy or protein malnutrition comorbidity. Subjects in the diagnosis-matched and age-matched control sample were discharged without a malnutrition comorbidity during the same period. Data collected from progress notes included diagnoses, inpatient dietetic feedings and services provided, discharge dietetic care, intervening clinic visits, and rehospitalizations. On initial admission, 79% of the diagnoses for the malnourished group fell into five diagnosis categories: neoplasms; respiratory system diseases; digestive system diseases; endocrine, nutritional, and metabolic diseases; and mental disorders (including alcohol-related disorders). Malnourished subjects received more specialized feedings and dietetic services than did the controls on initial admission. However, the discharge and post-discharge care received by surviving members of both groups was similar. Fewer than half the members of either group received post-discharge care. Fifty-four malnourished and 54 control patients were hospitalized more than once. The findings indicate that levels of inpatient and outpatient dietetic care need to be coordinated to alleviate malnutrition.

Hospital malnutrition: a 33-hospital screening study.

A collaborative study involving nutrition screening of 3,047 patients (excluding 125 pregnant women) at admission to 33 hospitals in and around the greater Chicago area was carried out to identify patients at nutritional risk. Information on sex, age, admitting diagnosis, serum albumin, hemoglobin, total lymphocyte count, and height and weight was collected from the medical chart within 48 hours of admission. Nutrition screening could not be completed for a larger number of patients (60%) because data at admission were not available. Of the remaining 40% of patients, more than 50% had below normal values for one or more of the variables studied: serum albumin, hemoglobin, and total lymphocyte count. A large number of the patients (40%) also were considered at nutritional risk as judged by the criteria of weight/height (measured only). Early nutrition intervention for high-risk patients cannot be implemented, nor can the efficacy of nutrition services be evaluated, unless nutrition screening is carried out on patients at admission.

Efficacy of prenatal nutrition counseling: weight gain, infant birth weight, and cost-effectiveness.

A retrospective study on the effect of intensive nutrition counseling on weight gain of pregnant women and birth weight of their infants was conducted at an outpatient clinic by comparing one group of 86 women who attended only a nutrition class with another group of 114 women who attended the class plus multiple counseling sessions on appropriate weight gain and nutrient intake. The women receiving the counseling on an average gained 2.5 kg more weight, had fewer low-birth-weight infants (4% vs. 13%), and had infants weighing 100 gm more at birth. That indicates that intensive nutrition counseling results in a superior outcome of pregnancy. When the cost of intensive neonatal care for six infants was compared with the cost of nutrition counseling, a benefit-to-cost ratio of 1:5 was found.

Taste perception of children with chronic renal failure.

Taste sensitivity and preference in the suprathreshold ranges were compared for 20 pediatric patients with renal disease and 15 children with normal renal function. Nine patients had chronic renal insufficiency, and 11 had endstage renal disease. Subjects were also evaluated for various dietary, anthropometric, and biochemical parameters. All subjects were asked to pull out a tape measure to rate the strength of five varying concentrations of aqueous solutions of sucrose, sodium chloride, and quinine sulfate. The subjects' abilities to judge increasing concentrations with greater perceived intensity were measured by calculating individual and group slopes. No significant differences in the values were found between the groups. Similarly, no significant differences in mean peak preference concentrations were found between the groups. The patients with renal disease were found to be considerably growth retarded (height and weight less than 5th percentile), with a mean caloric intake less than 65% of the RDA even after an adjustment had been made for height. Serum zinc levels were all normal.

Total hepatic vascular exclusion for major hepatic resection.

Use of vascular occlusion techniques during hepatic resection has besides decreasing blood loss improved the feasibility of surgical extirpation of large hepatic tumors. We report successful use of this technique to resect a large hepatoma in the right lobe of the liver. The hemodynamic and biochemical changes in the perioperative period are documented.

Anaesthetic management of a patient with organophosphorus poisoning (a case report).

Anaesthesiologist may encounter problems while anaesthetising a patient following organophosphorus poisoning. These problems and the necessary precaution are described.

Preventing distortion of quick couplers of hoses of central pipe lines--a cheap and simple method.

A cheap and practical approach of steel chains attached to the station outlet quick couplers helps in maintaining the shape of the quick couplers and ensures their effective functioning over a long period of time and avoids mishap of connection due to damage of these couplers.

Difficult intubation--when can we predict it?

Anaesthetists at times encounter difficult intubation in an apparently normal individual in spite of using the best possible positioning and most profound relaxation. This study was carried out to find out the most simple and easy measurement that may predict a difficult intubation. The study was conducted in three groups of patients of twenty each. The first group consisted of patients in whom intubation was easy. Second group consisted of anticipated difficult intubation. Cases in whom very difficult intubation was encountered were analyzed retrospectively and were included in third group. An attempt has been made to predict difficult intubation with the roentgenographic study of lateral view of mandible along with the measurement of distance from chin to thyroid cartilage. Of all the parameters, ratio of effective mandibular length to posterior mandibular depth and distance from chin to thyroid cartilage were found to be important to predict difficult intubation.

The palm print as a sensitive predictor of difficult laryngoscopy in diabetics: a comparison with other airway evaluation indices.

AIMS: To evaluate the ink impression made by the palm of the dominant hand as a screening tool for difficult laryngoscopy in diabetic patients. SUBJECTS AND METHODS: In this prospective study, airway of 50 adult diabetic patients, undergoing elective surgery under general anaesthesia, was assessed preoperatively using the common clinical indices such as Modified Mallampati test, thyromental distance, degree of head extension and a specific index- the palm print test. Following induction of anaesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index were calculated. RESULTS: The incidence of difficult laryngoscopy was 16%. The palm print test had the highest sensitivity (75%) of all the indices. The thyromental distance less than six cm had the highest specificity (95.2%) but was least sensitive (25%). 87% of patients with difficult laryngoscopy had two or more indices abnormal. CONCLUSION: Though the palm print test was the most sensitive index of the four indices studied, a better prediction of difficult laryngoscopy can be achieved by evaluating all the four airway indices preoperatively.

Blood utilisation in elective general surgery cases: requirements, ordering and transfusion practices.

AIMS: For elective surgeries, over ordering of blood is a common practice. This can be decreased by simple means of changing the blood cross matching and ordering schedule depending upon the type of surgery performed. The principle aim of the study was to improve the efficacy of ordering system for maximum utilisation of blood and formulation of maximum surgical blood order schedule (MSBOS) for procedures where a complete cross-match appears mandatory. MATERIAL AND METHODS: We evaluated blood ordering and transfusion practices in 500 elective general surgical procedures at our institute. With the help of different indices such as cross-match to transfusion ratio (C/T ratio), transfusion probability (% T) and transfusion index (TI), blood ordering pattern was changed in the next 150 patients. RESULTS: Out of 1145 units of blood crossmatched for the first 500 patients only 265 were transfused with non-utilisation of 76.86% of ordered blood. With the help of the indices the wastage was reduced in next 150 patients, i.e. from 76.86% to 25.26% and improved the utilisation of blood, i.e. from 23.14% to 74.74%. CONCLUSIONS: Change of blood ordering patterns with use of MSBOS can avoid the over ordering of blood.

Comparative study of oral and intramuscular atropine sulphate as a premedicant in paediatric age group.

The use of atropine sulphate in the paediatric age group as a premedicant orally in a dosage of 0.02 mg/kg body weight 70 minutes prior to surgery was found to be as effective as atropine sulphate given intramuscularly 35 minutes prior to surgery in a dosage of 0.01 mg/kg body weight. This avoids the unpleasant memory of needle prick; The duration of effect as studied in the normal healthy children not subjected to surgery was found to be 2 1/2-3 hours.

Amino acid-restricted diets in the treatment of mammary adenocarcinoma in mice.

The effect of a diet moderately restricted in tryptophan on the tumor and the nutritional status of C3H mice bearing mammary adenocarcinoma was examined. Five groups of female tumor-bearing mice were fed ad libitum a diet containing 1) 15% casein, 2) 15% amino acid mixture, 3) 15% amino acid mixture restricted in tryptophan 4) 15% zein supplemented with lysine and tryptophan or 5) 15% zein supplemented with lysine and restricted in tryptophan. Another group of tumor-free mice of similar age fed 15% casein served as a control for the tumor-bearing group fed the 15% casein diet. Moderate restriction of tryptophan in the diet appeared to have no effect on the tumor status of the animal. Tumor burden usually induced malnutrition in the animal. However, tryptophan restriction did not further aggravate this malnutrition. The source of protein, whether casein, amino acid mixture or zein, appeared to make a difference in nutritional status of tumor-bearing animals though not in tumor status. Casein-fed animals generally tended to have higher values for all the nutritional markers studied than did animals fed the amino acid mixture or zein.

Comparative study of intrathecal pethidine versus lignocaine as an anaesthetic and a postoperative analgesic for perianal surgery.

100 patients with ASA risk I & II and undergoing perianal surgery were studied for anaesthetic effects and postoperative analgesia following either intrathecal pethidine or lignocaine. Saddle block was performed either with intrathecal pethidine 5% (50 mg/ml) 0.5 mg/kg or 1 ml of 5% lignocaine. Sensory and motor block postoperative analgesia, need for additional analgesia were studied. The onset of sensory and motor blockade with lignocaine was faster than pethidine. However the sensory and motor blockade lasted longer with pethidine. The duration of postoperative analgesia was 15.39 +/- 5.14 hours as against duration of postoperative analgesia with lignocaine which was 1.3 +/- 0.53 hours. Only 10% of patients in the pethidine group required intramuscular analgesic supplementation whereas 30% of patients in the lignocaine group required intramuscular analgesic supplementation.

Acute dietary tryptophan depletion: effects on schizophrenic positive and negative symptoms.

Because brain serotonin levels depend directly on the amounts of exogenous tryptophan (TRP) available for its synthesis, amounts of TRP in the diet may be manipulated to alter the corresponding levels of serotonin. This technique has been used for probing the role of serotonin in mediating various forms of pyschopathology. In this study, 16 patients meeting DSM III-R criteria for schizophrenia (n = 14) or schizoaffective disorder (n = 2) were assessed for the effects of acute dietary TRP depletion under controlled conditions. The hypothesis was that lowering of serotonin would result in a diminution of 'positive' and/or 'negative' symptoms of psychotic disorders. No clinically or statistically significant improvement compared to baseline occurred when TRP depletion was imposed. Indeed, there was a statistically significant deterioration on measures of negative symptoms. The results are discussed in the context of the methodological issues.

A phytochemical screening procedure for sweet ent-kaurene glycosides in the genus Stevia.

Altogether, 110 species of the genus Stevia, comprising both herbarium and fresh leaf samples, were screened for the presence of sweet ent-kaurene glycosides, using a combination of tlc and hplc, followed by gc/ms. Stevioside and rebaudiosides A and C were detected in a Stevia rebaudiana herbarium specimen collected in Paraguay in 1919, and stevioside was observed as a constituent of a Stevia phlebophylla herbarium specimen collected in Mexico in 1889. Steviol glycosides were not detected in any of the other 108 Stevia species studied. The phytochemical results obtained in this study are correlated with those of preliminary organoleptic tests on the sweetness of these Stevia samples, and the chemotaxonomic implications of the present findings are discussed.