Severe invalidating pain syndrome associated with benznidazole therapy for Chagas’ disease

Chagas’ disease is an endemic parasitic disease and constitutes an important health problem in Latin American countries. The increasing number of immigrants from these countries has resulted in a rise in diagnosis and consequently in the treatment of this disease in developed countries not familiar with this condition. Currently, benznidazole is used for treatment of this condition. However, undesirable effects have been reported with this treatment, and there are few data about continuous long-term use of this drug. We describe a case of invalidating pain syndrome in a 31-year-old Bolivian woman with Chagas’ disease while receiving benznidazole therapy. Because of the number of cases with this condition will probably increase because of immigration, a better understanding of the side effects of the treatment of this disease is essential.     

Molecular insights into gastrointestinal neuroendocrine tumours: importance and recent advances

A subset of gastrointestinal neuroendocrine tumours (carcinoids and pancreatic endocrine tumours) show aggressive growth. Early identification of this subset is essential for management; however, clinical, laboratory and histologic features frequently fail to achieve this. Currently, there is an increased understanding of the molecular pathogenesis/changes in neuroendocrine tumours and this may identify important prognostic factors and possibly, new treatments. Recent findings and progress in this area are briefly reviewed in this article.     

Heart Failure in South Asia

South Asia (SA) is both the most populous and the most densely populated geographical region in the world. The countries in this region are undergoing epidemiological transition and are facing the double burden of infectious and non-communicable diseases. Heart failure (HF) is a major and increasing burden all over the world. In this review, we discuss the epidemiology of HF in SA today and its impact in the health system of the countries in the region. There are no reliable estimates of incidence and prevalence of HF (heart failure) from this region. The prevalence of HF which is predominantly a disease of the elderly is likely to rise in this region due to the growing age of the population. Patients admitted with HF in the SA region are relatively younger than their western counterparts. The etiology of HF in this region is also different from the western world. Untreated congenital heart disease and rheumatic heart disease still contribute significantly to the burden of HF in this region. Due to epidemiological transition, the prevalence of hypertension, diabetes mellitus, obesity and smoking is on the rise in this region. This is likely to escalate the prevalence of HF in South Asia. We also discuss potential developments in the field of HF management likely to occur in the nations in South Asia. Finally, we discuss the interventions for prevention of HF in this region     

Lessons learned from previous dengue outbreaks

Dengue is an important tropical infection caused by an arbovirus dengue. As a mosquito borne infection, this disease is widely spread in several tropical endemic countries. Millions of world populations are at risk for this arboviral infection. Each year, thousands of dengue infections are reported and there are several death cases. Each year, the outbreaks of dengue emerge in several countries and this implies the global importance of this infection. Fighting with dengue outbreak is important in public health. In this specific chapter, the author discussed lessons learned from previous dengue outbreaks.     

褐家鼠在新疆阿拉山口口岸居民区形成种群

为了解新疆阿拉山口口岸居民区褐家鼠的迁入现状，作者等于１９９３年６、１２月对该区域的鼠类进行了调查。结果表明：阿拉山口居民区的褐家鼠是通过铁路建设被迁移到当地的，进而定居，并逐渐形成了当地居民区的优势鼠种。其捕获率达１１．９％，占家栖鼠类的６２．５％。此外，就该鼠种的繁殖、危害等进行了调查。     

Interaction of haemoglobin E with alpha-thalassaemia and haemoglobin Constant Spring.

The combination of Hb E,alpha-thalassaemia and Hb CoSp was found in a 20-year-old female Malay who presented with a moderately severe haemolytic anaemia. The findings in the patient and her family from which this diagnosis was arrived at are discussed. Although this is the first report of this condition in this country it is pointed out that one may see more such cases in the future if one is aware of this condition since Hb E, alpha-thalassaemia and Hb CoSp all occur at significant frequencies in this country.     

Medical aspects of fitness to drive. What do public hospital doctors know and think?

Background: In Australia medical practitioners are often required to assume the responsibility for assessing fitness to drive. However the clinical practice, knowledge and attitudes of doctors with regards to this responsibility are unknown. The aim of this study was to determine the clinical practice, knowledge and attitudes of public hospital doctors in the area of fitness‐to‐drive decision‐making. Methods: A survey of public hospital doctors in Adelaide, South Australia was undertaken in 2003, shortly after the promulgation nationwide of guidelines to assist in the assessment of patients’ fitness to drive. The survey sought details on medical practitioners’ clinical practice in this regard, as well as their knowledge of the guidelines. In addition, it sought their attitudes to undertake this responsibility. Results: Eighty‐four per cent of respondents had at some time in their working career at least discussed the issue of fitness to drive with their patients. Seventy per cent acknowledged that they had received the recently published guidelines on fitness to drive. Despite this, knowledge of the contents of the guidelines was poor. Attitudes to the responsibility were equivocal with several significant reservations expressed. Conclusion: Public hospital doctors in Australia have poor knowledge of the content of published guidelines in the area of fitness to drive. If this situation is to be improved, alternative approaches to the education of this group with respect to this significant public health problem should be considered. Many doctors are uncomfortable with their responsibilities in this area and alternative models of decision‐making should be considered.     

Physiopathology of splanchnic vasodilation in portal hypertension

In liver cirrhosis, the circulatory hemodynamic alterations of portal hypertension significantly contribute to many of the clinical manifestations of the disease. In the physiopathology of this vascular alteration, mesenteric splanchnic vasodilation plays an essential role by initiating the hemodynamic process. Numerous studies performed in cirrhotic patients and animal models have shown that this splanchnic vasodilation is the result of an important increase in local and systemic vasodilators and the presence of a splanchnic vascular hyporesponsiveness to vasoconstrictors. Among the molecules and factors known to be potentially involved in this arterial vasodilation, nitric oxide seems to have a crucial role in the physiopathology of this vascular alteration. However, none of the wide variety of mediators can be described as solely responsible, since this phenomenon is multifactorial in origin. Moreover, angiogenesis and vascular remodeling processes also seem to play a role. Finally, the sympathetic nervous system is thought to be involved in the pathogenesis of the hyperdynamic circulation associated with portal hypertension, although the nature and extent of its role is not completely understood. In this review, we discuss the different mechanisms known to contribute to this complex phenomenon.     

人体结膜吸吮线虫病与犬的感染关系的研究

目的阐明五河地区人体结膜吸吮线虫病与犬的感染关系。方法调查结膜吸吮线虫病的传播媒介和采取控制养犬前后本病流行情况。结果通过调查,于1989年证明了结膜吸吮线虫病的传搔媒介为变色纵眼果蝇(Amita variegata);1985～1992年于五河县发现婴幼儿病例17例,其间家犬感染本虫阳性率为86.9%。而控制养犬后调查换代家犬31只未见感染,人体病例亦不再出现。结论流行区控制养犬后消灭了传染源,经7年跟踪观察,该地区达到了消灭结膜吸吮线虫病的目标。     

Brachial loop: transradial technique to overcome this rare anatomic variation.

A brachial loop is a rare anatomic variation and can result in the failure of transradial coronary procedures. We report a brachial loop encountered in a patient undergoing a coronary angiogram. During this angiogram, a 0.035' J-tipped Teflon-coated guidewire met with resistance in the brachial artery because of this rare vascular loop. In this case report, we discuss the technique we used to manage this rare condition. Interventional cardiologists should keep in mind that resistance of the guidewire can result in major vessel complications during the transradial approach.     

Ulcerative colitis and cytomegalovirus infection

Colitis ulcerous and citomegalovirus infection association have been reported in medical literature in sometimes, althougth this prevalence have lately increased. We report a case record of this association and do a review of this subject. It is not clear what factors are involved in this association, being necessary hore studies to know them.     

FLT3 Tyrosine Kinase Inhibitors

The receptor tyrosine kinase FLT3 is an important regulatory molecule in hematopoiesis and is expressed on the blasts in most cases of acute leukemia. Activating mutations of this receptor are present in roughly 30% of acute myeloid leukemia (AML) patients and are associated with a distinctly worse clinical outcome. Efforts to target this mutation and improve out-comes in this subgroup of AML patients have led to the investigation of several novel small-molecule FLT3 tyrosine kinase inhibitors. These compounds derive from a wide variety of chemical classes and differ significantly, both in their potency and in their selectivity. In this review, we discuss the results of preclinical, clinical, and correlative laboratory studies of FLT3 inhibitors in demonstrating how this field represents a truly translational enterprise with multiple ongoing interactions between the laboratory and the clinic.     

慢性丙型肝炎患者血清自身抗体检测及其临床意义研究现状*

经常发现慢性丙型肝炎病毒（HCV）携带者血清非器官特异性自身抗体（non-organ-specific autoantibodies,NOSA）和抗甲状腺自身抗体（anti-thyroid autoantibodies ATAB）阳性,伴有以自身免疫耐受性丧失为特征的一组自身免疫性疾病,本文将重点介绍这方面的研究进展。     

Diabetic ketoacidosis secondary to L‐asparaginase in acute lymphoblastic leukaemia

We describe a case of severe hyperglycaemia resulting in diabetic ketoacidosis secondary to L‐asparaginase. There are few reports of this potentially life‐threatening complication, particularly in the English literature. Awareness and recognition of this preventable and manageable problem will improve safe delivery of this anti‐leukaemic drug.     

Conservative excision and radiotherapy for early breast cancer--an acceptable alternative?

The Westminster Hospital treatment policy for operable breast cancer is presented in this paper and particular attention is paid to its technical aspects. The techniques of tumour lumpectomy, radical external beam irradiation and local boosting therapy with iridium implantation are described in detail. Our initial results with this approach are encouraging and will shortly be reported. In view of this and the obvious advantages of breast conservation we hope that techniques similar to this will be adopted by others working in this field.     

Increased expression of the G gamma and A gamma globin genes associated with a mutation in the A gamma enhancer

We have previously described a unique type of delta beta-thalassemia in a Chinese family characterized by increased expression of the G gamma and A gamma fetal globin genes in the absence of a large deletion in the beta-globlin gene cluster. Our earlier study of the beta-globin gene on this delta beta-thalassemia chromosome showed a promoter mutation in the TATA box. In this report, we describe the results of our study of the fetal globin domain of this delta beta-thalassemia chromosome. We have cloned a 13-kb DNA fragment that includes the G gamma and the A gamma genes and the 3' A gamma enhancer element of this delta beta-thalassemia chromosome. DNA sequence analysis of the G gamma and A gamma-globin genes including their promoters did not show any mutations, but analysis of the putative enhancer element downstream from the A gamma-globin gene showed a C to T substitution 2,401 nucleotides downstream from the A gamma cap site. We performed DNA linkage analysis to determine if this mutation is unique to this chromosome or represents a common polymorphism. Our linkage analysis showed that this mutation is not a common polymorphism and that it is also not an intrinsic part of the haplotype of the chromosome on which it was found. We also studied the interaction of nuclear proteins from erythroid and nonerythroid cells with the DNA sequences surrounding this mutation. We have shown by in vitro DNase I footprinting that this mutation falls within a region that is occupied by a novel DNA-binding protein that binds to this site in nuclear extracts from erythroid, but not nonerythroid cells. The binding of this nuclear protein to DNA appears to be dependent on GATA-1 binding to an adjacent GATA-1 site. We have also developed a new functional assay to compare the activity of the normal and mutant A gamma enhancer elements in erythroid cells. Analysis of the activity of the mutant enhancer shows that the mutation completely eliminates all enhancer activity in this assay. These findings suggest that this mutation of the A gamma enhancer on a chromosome that carries a partially inactivated beta-globin gene may be responsible for the increased expression of both gamma-globin genes seen in this condition.     

Mouse models in liver cancer research： A review of current literature

Primary liver cancer remains one of the most lethal malignancies worldwide. Due to differences in prevalence of etiological factors the incidence of primary liver cancer varies among the world, with a peak in East-Asia. As this disease is still lethal in most of the cases, research has to be done to improve our understanding of the disease, offering insights for possible treatment options. For this purpose, animal models are widely used, especially mouse models. In this review, we describe the different types of mouse models used in liver cancer research, with emphasis on genetically engineered mice used in this field. We focus on hepatocellular carcinoma （HCC）, as this is by far the most common type of primary liver cancer, accounting for 70%-85% of cases.     

Use of entecavir in hepatitis B virus reactivation of a patient with non-Hodgkin's lymphoma

We read with interest the case report by Liu et al and the correspondence by Tuna et al regarding this case. Liu et al described hepatitis B virus(HBV) reactivation in a patient with non-Hodgkin's lymphomaafter withdrawal of lamivudine prophylaxis. When HBV reactivation was observed three months after lamivudine withdrawal, entecavir 0.5 mg daily was started. HBV DNA level was moderately elevated(104 copies/m L) at that time. So, we could not understand why a potent antiviral like entecavir was required for this case. In addition to this, entecavir must be used at a dose of 1 mg in patients with prior prophylactic treatment with lamivudine. As stated by Tuna et al duration of lamivudine prophylaxis in this case might be insufficient and HBV reactivation might have occured for this reason. So, we suppose that resolution of HBV reactivation might also be achieved with lamivudine instead of entecavir in this case.     

Dynamic electrochemistry: a step in the right direction

Variation in hematocrit is a serious but underappreciated interference to accurate point-of-care glucose measurement. Using a meter employing new technology of dynamic electrochemistry, Musholt and colleagues present in vitro data in this issue of Journal of Diabetes Science and Technology demonstrating improved glucose accuracy over a wide range of hematocrits. Although this may have some importance for patients testing in the home environment, the essential application of this new technology will be in the critical care and perioperative environment, where wide swings in hematocrit are common. Because these meters are in use with great frequency in the hospital where accurate glucose measurement is vital, mitigating this interference is a welcome addition to our diagnostic armamentarium.