Success of integrated methods of control of mosquitoes in India--a review

The integrated methodology for the control of vectors of diseases as well as mosquitoes has become an accepted concept amongst the public health experts. The feasibility of adopting this approach in different situations for mosquito control as per field trials by various institutions has been reviewed in this article. This concept, to some extent, has been in vogue under National Malaria Eradication Programme since long in a practicable way. Satisfactory results have been obtained wherever this approach has been applied carefully. The applicability of the integrated control methodology is not difficult provided various methods to be integrated are chosen and utilized in a rational way. Thorough health education is a prerequisite to awaken the community to accept the methods as part and parcel of routine life.     

Experience with Doppler investigations in vibration syndrome

The aim of this study was to examine the possibility of applying Doppler flowmetry in diagnosing vascular changes in workers exposed to vibration. Polish, directional, continuous-wave Doppler apparatus UDP-10, has been used for evaluation of multisegmental blood pressure, velocity flow tracing and for making an ultrasonic "map" of the upper limbs. The thermal test used in this investigation allowed us to distinguish functional and organic alterations in the hand arteries. The present study has been performed in 113 workers, employed in an iron casting company and exposed to vibration. The control group comprised 62 healthy men. Raynaud's phenomenon has been found in 34 workers. It has been confirmed that Doppler equipment is a safe, noninvasive technique, with a high percentage of diagnostic accuracy and is a great aid in establishing the severity of symptoms in patients with vasospastic disease. As a result of our study the diagram for diagnosing patients with vasospastic disease has been elaborated and presented in this work.     

Gastric Secretion Stimulated by Meat Extract in Man

The acid secretory response of the stomach has been studied after stimulation with meat extract, and compared with basal secretion and the response to histamine. The mechanism of the response has been considered, in studies performed before and after vagotomy. It has been shown that the antrum may act independently of the vagus nerve, and there is some support for the view that in certain patients secretion is dominated by the antral phase. It has also been shown that recurrent ulceration may be observed in these circumstances, and this may be the explanation of this complication in patients after apparent complete vagotomy.     

Rate-responsive pacing using electrographic parameters as sensors.

The use of evoked QT-interval and ventricular depolarization gradient as sensors for rate-responsive pacing is described in this article. The QT interval has been used as a biosensor in implantable pacemakers since 1981, and recent refinements have improved the rate response characteristics and simplified the programming of this pacemaker. Recently, QT and activity sensing have been combined to produce a dual-sensor rate-responsive pacemaker that may offer advantages over single-sensor devices. The ventricular depolarization gradient has been incorporated into a closed-loop rate-responsive pacing system and is undergoing clinical evaluation.     

The role of lasers in the management of peripheral vascular disease

Although it has been almost twenty-five years since the first studies of McGuff et al, who employed the laser for atheroablation, problems still require resolution. The various laser wavelengths from ultraviolet through visible to infrared have been employed for atheroablation. The laser's greatest appeal and the most spectacular results have been in reopening channels in totally occluded vessels. The laser's greatest problem has been damage of the arterial wall and even perforation. The purpose of this presentation is to clarify the present status of available lasers for the treatment of peripheral vascular disease of the lower extremities. To this end, the initial experience with angioscopically guided laser-assisted angioplasty with a new hybrid laser probe is reported.     

The SAPHO syndrome--are microbes involved?

The syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) includes a rare group of chronic, relapsing, inflammatory osteoarticular disorders that is conventionally associated with manifestations in the skin. Diagnostic dilemmas can arise due to incomplete manifestations or confusion generated through mimicking of other conditions, such as osteomyelitis. The aetiology of this syndrome remains unclear, but probably involves genetic, immunological and infectious mechanisms. The possible pathogenetic role of infectious agents in genetically predisposed individuals, resulting in a 'reactive osteitis', has been suggested because microbes such as Propionibacterium acnes have been recovered from bone biopsy samples. However, this hypothesis has not been demonstrated as yet. Current knowledge with regard to treatment of this syndrome is based on results reported from small case studies and, thus, is still empiric. The use of antibiotics, instituted based on the isolation of Propionibacterium acnes, has been reported to show conflicting results. Promising results for potential future application have recently been reported for treatment of SAPHO with bisphosphonates and antagonists of tumour necrosis factor-α. This review aims to evaluate the existing knowledge on the SAPHO syndrome and to provide information on symptoms, diagnosis and treatment options for this disease.     

The difference in gastric cancer between Japan, USA and Europe: what are the facts? what are the suggestions?

In Japan the survival rate for gastric cancer has steadily improved over the last 30 years whilst that in the West has remained static and inferior. In this review three hypotheses are examined to explain the difference. There is little evidence to suggest genetic differences, which might result in a less aggressive cancer in Japan. Recently there has been a rise in the proportion of cancers of the gastro-oesophageal junction in the West and this has not been seen in Japan. The comparison of survival data from these two regions is problematic with different staging systems and a stage migration effect. The established surgical treatment of gastric cancer in Japan is radical gastrectomy and regional lymphadenectomy and this has been proposed as a superior treatment to the standard gastrectomy common in the West. The results for survival benefit however, have not been reproduced in randomized clinical trials. The heterogeneity of adjuvant and neoadjuvant treatment regimens in Japan and the West has led to difficulties in the interpretation of their effects. There is considerable scope for future collaboration between clinicians in the West and Japan.     

When a Placebo is not a Placebo: the value of effect size measures in assessing the validity of deception used in the balanced placebo design

Although the use of the balanced placebo design has been invaluable in untangling alcohol's pharmacological and expectancy effects, only recently has the validity of the design been evaluated. The critical importance of checking the effectiveness of the expectancy manipulation has been singled out as a key methodological issue in assessing the validity of the balanced placebo design. It has been suggested by other researchers that a variety of credibility checks be used for this purpose. In this article it is recommended that a measure of effect size, such as omega squared, be utilized for each of the credibility checks as a measure of the strength of the experimental manipulation. The value of this information is illustrated by presentation of the data from a study utilizing the balanced placebo design.     

Using a tilt table to evaluate syncope

Upright tilt testing is commonly used in the evaluation of patients with syncope to provoke hypotension and/or bradycardia in the laboratory. The most common type of response is provocation of neurally mediated syndrome (vasovagal syncope). The American College of Cardiology Expert Consensus has proposed indications for tilt testing. The most common indication is recurrent syncope of unexplained cause. Upright tilt testing methods have not been standardized. The most common protocols in this country use a tilt angle of 60-80 degrees and use isoproterenol infusion after a period of drug-free tilt testing. The sensitivity of upright tilt testing is estimated to be 67-83%, and the specificity is between 75 and 100%. The reproducibility of the test has been variable. In patients with unexplained syncope, positive responses are found to be 50% without the use of isoproterenol and 64% with the use of isoproterenol. Many different treatments have been used. At this time, there is no consensus regarding the most effective treatment. Beta-blockers and fludrocortisone plus salt are the most commonly used drugs. Pacemakers have been used, but their role is ill-defined at this time.     

Long QT syndrome

In conclusion, much has been learned in the past several years regarding the molecular biology of LQTS, and this information has been directly applicable to the clinical care of patients with this syndrome. The knowledge also has been of considerable importance for understanding the molecular basis of arrhythmias in general and is providing insights into potential molecular-based therapies for arrhythmias.     

What next after infliximab?

The use of infliximab (Remicade) has revolutionized the care of Crohn's disease (CD) patients who have proved refractory to standard treatment. The use of infliximab is very well tolerated in the majority of patients but in a small subset of patients may lead to the production of antibodies (termed "antibodies to infliximab"-ATI). The production of these antibodies has been associated with the development of both acute and delayed infusion reactions, although even in patients who develop ATIs, these reactions are relatively uncommon. Nonetheless, these reactions may occasionally be severe enough to lead to intolerance to infliximab. Another group of patients, after initially having excellent responses to infliximab, experience an attenuated response or loss of response over time. What is the cause of this loss of efficacy? ATIs may play a role in some patients but other potential reasons for this phenomenon have provoked much debate. The importance of other cytokines after TNF-alpha has been neutralized may be relevant as (this has been shown to be the case in rheumatoid arthritis (RA) is the idea of beneficial autoimmunity production to TNF-alpha. (Wildbaum G, Nahir MA, Karin N. Beneficial autoimmunity to proinflammatory mediators restrains the consequences of self-destructive immunity. Immunity 2003;19:679-88.) It has been shown that during the course of an autoimmune condition, the immune system mounts a beneficial autoantibody response to proinflammatory mediators. This response counteracts, to a certain degree, the autoimmune pathology. This natural counteraction has been illustrated in animal models of autoimmunity, and there has been evidence demonstrated that this occurs in human RA. Whether this occurs in Crohn's is unknown; infliximab is a chimeric monoclonal antibody containing an approximately 25% murine region. It had been hoped that the development of humanized or fully human monoclonal antibodies would provide therapeutic antibodies that did not induce an immune response. While this has unfortunately not proven to be the case-these products still have significant immunogenicity-these products do present an alternative therapy when infliximab cannot be used. In light of this, adalimumab (Humira) a human monoclonal antibody used for treating rheumatologic conditions has been investigated as an alternate treatment for patients with CD who after initially responding to infliximab experience intolerance or loss of efficacy. Is this a viable alternative?     

Tear me down: role of calpain in the development of cardiac ventricular hypertrophy

Cardiac hypertrophy develops most commonly in response to hypertension and is an independent risk factor for the development of heart failure. The mechanisms by which cardiac hypertrophy may be reversed to reduce this risk have not been fully determined to the point where mechanism-specific therapies have been developed. Recently, proteases in the calpain family have been implicated in the regulation of the development of cardiac hypertrophy in preclinical animal models. In this review, we summarize the molecular mechanisms by which calpain inhibition has been shown to modulate the development of cardiac (specifically ventricular) hypertrophy. The context within which calpain inhibition might be developed for therapeutic intervention of cardiac hypertrophy is then discussed.     

Gastroenteritis eosinophilic presenting as colitis with acute abdomen

Eosinophilic gastroenteritis is rare. Fewer than 30 cases have been published in the Spanish literature, although Kaijser first described this entity in 1937. Its etiology is still unknown and it has frequently been reported to involve the stomach and small bowel, with characteristic eosinophilic infiltration of the bowel wall. The colon has rarely been reported as a site of this condition, which manifests as acute abdominal pain due to intestinal obstruction. We report the case of a 38-year-old woman who presented eosinophilic gastroenteritis. Onset was acute colitis causing acute abdomen. The patient received conservative treatment and responded well to steroids. To our knowledge, such a case has not previously been reported.     

Bronchoalveolar lavage to diagnose respiratory infections

Respiratory samples obtained by bronchoalveolar lavage (BAL) in infectious processes provide important microbiological and cytological information to manage this type of patient. Most of the clinical and experimental BAL investigations have been done in ventilator-associated pneumonia (VAP) and in immunosuppressed conditions. The impact of quantitative BAL bacterial cultures for managing VAP is still controversial. However, there is no doubt that this method provides sensitive and specific information on bacterial, viral, fungal, and noninfectious etiologies. The conclusion is that BAL has to be used in VAP depending on the clinical situation of the patient and taking into account the local expertise and laboratory facilities. In immunosuppressed patients with pulmonary infiltrates its utility has been clearly demonstrated. In this specific population the early use of the information provided by this method is related to a better outcome. In community-acquired pneumonia there is no strong information supporting its use. This technique has some side effects and contraindications that have been weighted individually in each patient.     

Onset of sucrase-isomaltase deficiency in late adulthood

Sucrase-isomaltase deficiency is a rare disorder usually manifested as diarrhea in infancy. The presentation of such a deficiency in adulthood is even more rare, particularly when the individual has no history of childhood diarrhea. After a literature search, the 59-yr-old patient we report is the oldest to have been identified with this condition. The difficulties encountered in diagnosis when such a case occurs at this age that have not previously been reported are highlighted.     

Sex hormones and liver cancer

Hepatocellular carcinoma (HCC) is one of the most common malignancy in the world and it usually occurs in individuals with chronic liver disease. The neoplasm is predominant in the male gender, where it is characterized also by a worst prognosis than in females. The pathogenesis of HCC is obscure. Because of its striking male predominance, androgens have been investigated as potential factors able to induce or at least promote hepatic carcinogenesis; this hypothesis has been also supported by the ability of androgens of inducing liver neoplasms in experimental models. On the other hand, due to the fact that HCC occurs predominantly in male cirrhotics who present a characteristic hormone imbalance with a relative hyperestrogenic state, the potential role of estrogen in liver cancer has been studied as well. In this paper, the potential role of sex hormones in liver carcinogenesis has been reviewed.     

Treatment of the bradycardia-tachycardia syndrome with permanent demand pacing.

The bradycardia-tachycardia syndrome (paroxysmal supraventricular tachycardia alternating with sinus bradycardia and episodes of sinus node arrest) has previously presented a complicated therapeutic dilemma when excitatory and suppressive drugs have been utilized. A patient with this syndrome successfully treated with a permanent ventricular transvenous demand pacemaker is presented. Various aspects of this syndrome as well as facets of diagnosis and treatment have been reviewed and discussed. Significant underlying cardiac disease was ruled out in this patient by the usual diagnostic methods including left heart catheterization and coronary angiography. An interesting possibility of the relationship of vagal stimulation secondary to hiatus hernia as an etiologic factor in this syndrome has been discussed. The opinion is expressed that the currently preferred method of treatment is the insertion of a permanent transvenous pacemaker alone or in conjunction with antiarrhythmic drugs, preferably digitalis and propranolol.     

关于慢性心力衰竭患者合并认知功能障碍的管理措施

慢性心衰患者合并认知功能障碍的发生率越来越高,且与不良预后相关。研究表明较差的自理能力与该类患者的不良预后密切相关。然而目前关于心衰患者因合并认知功能障碍而出现的自理能力受损尚未清楚。因此,迫切需要临床工作者重视该类患者的自我管理,采取一系列措施进而提高该类患者的生存率。     

Benign cystic mesothelioma in a male

We present a case of a male with benign cystic mesothelioma of the peritoneum. The literature is reviewed for previous case reports of this rare lesion in males. Benign cystic mesotheliomas occur predominantly in females. Despite a marked tendency to recur, no malignant degeneration has ever been demonstrated, and only one mortality has ever been attributed directly to this lesion. The diagnosis of this entity is made by confirming the benign mesothelial nature of the cells lining the cysts with electron microscopy or immunohistochemical staining. No significant difference in the clinicopathologic presentation of cystic mesotheliomas in men and women is found.