Vocal cord dysfunction presenting as refractory asthma

Vocal cord dysfunction is a rare variety of upper airway obstruction characterized by typical laryngoscopic features and may mimic an acute asthma attack. The case presented in this report pertains to a 15-year-old girl who had repeated acute episodes of dyspnoea and wheezing and remained non-responsive to corticosteroids and inhaled bronchodilators requiring endotracheal intubations for adequate control. Laryngoscopic findings were consistent with vocal cord dysfunction. She was treated with a tracheostomy and psychological support.     

Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind,randomized controlled trial

BACKGROUND: Zinc deficiency, common in developing countries, is associated with decreased immunocompetence. Zinc supplementation benefits children with acute and persistent diarrhea and prevents pneumonia. Most deaths from vaccine-preventable diseases are from measles and whooping cough; pneumonia is the most common complication of measles and often the proximate cause of related deaths. OBJECTIVE: We evaluated the effect of zinc supplementation on episodes of illness in children with measles accompanied by pneumonia. DESIGN: In a double-blind, randomized controlled trial, children aged 9 mo-15 y who were admitted to the Infectious Diseases Hospital in Calcutta with clinically severe measles accompanied by pneumonia and who had been ill for 相似文献   

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata,India

Unaided visual inspection or "downstaging" has been suggested as a potential alternative method for cervical cancer screening in developing countries. Our study was designed to evaluate the accuracy of downstaging to detect cervical neoplasia in a low-resource setting. A total of 6,399 women aged 30-64 years were screened with downstaging by trained nonmedical health workers. Two thresholds were used to define positive downstaging: "low threshold" when any visible abnormality on the cervix was considered positive and "high threshold" when selected abnormalities such as bleeding on touch, bleeding erosion, hypertrophied oedematous cervix, congested stippled cervix and growth or ulcer constituted the positive test. All women underwent a colposcopy examination. Biopsies were directed when colposcopy revealed abnormal lesions. True disease status was defined as histologically proven moderate dysplasia and worse lesions. Since all the participants received a diagnostic (reference) investigation (biopsy and/or colposcopy), sensitivity, specificity and predictive values were estimated directly. Low- and high-threshold downstaging were positive in 1,585 (24.8%) and 460 (7.2%) women, respectively. The sensitivities of low- and high-threshold downstaging to detect high-grade precursors and invasive cancers were 48.9% and 31.9%, respectively. The specificities were 75.8% and 93.3%, respectively. These results indicate that downstaging is not suitable as an independent primary screening modality for cervical neoplasia.     

A molecular approach (multiplex polymerase chain reaction) for diagnosis of rhinosporidiosis

A New multiplex PCR have been developed in our laboratory using primer sets, aiming amplification of both D.N.A target fragments obtained in 18S RNA of commonly encountered fungi in human being and in Rhinosporidium seeberi using F1-fw/F2-rev (500 bp target) and Rhino-fw/ Rhino-rev (.177 bp target). This multiplex PCR has been found to be able to delect R. seeberi from clinical samples and differentiate it from other fungi. Furthermore, by this multiplex PCR, R. seeberi, phylogenitically appears to belong to a member of so called DRIPs clade of fish parasite not a cyanobacterium as claimed previously, by some workers.     

A molecular approach (multiplex polymerase chain reaction) for diagnosis of rhinosporidiosis

A New multiplex PCR have been developed in our laboratory using primer sets, aiming amplification of both D.N.A target fragments obtained in 18S RNA of commonly encountered fungi in human being and in Rhinosporidium seeberi using F1-fw/F2-rev (500 bp target) and Rhino-fw/ Rhino-rev (.177 bp target). This multiplex PCR has been found to be able to delect R. seeberi from clinical samples and differentiate it from other fungi. Furthermore, by this multiplex PCR, R. seeberi, phylogenitically appears to belong to a member of so called DRIPs clade of fish parasite not a cyanobacterium as claimed previously, by some workers.     

Vagally mediated sympathoexcitation and central depression by desflurane in rabbits

The effects of desflurane on renal sympathetic nerve activity(RSNA) were studied in intact or vagotomized anaesthetized rabbitswith initial concentrations of 4.5–18%, subsequently equilibratedto end-tidal concentrations from 3%, 6%, 9% and 12% each for20 min allowing sympathetic activity to stabilize. In intactanimals, immediate transient increases in mean sympathetic activityfrom 27% to 63% were closely related to initial concentrationsfrom 4.5% to 18%. During subsequent equilibration this remainedelevated by 25–30% up to 6%, returned to control at 9%and fell by 33% at 12%. Bilateral vagotomy abolished sympathoexcitationapart from small increases in sympathetic activity, for example14% at 4.5% (P<0.05). We conclude that increases in inspireddesflurane concentrations evoked rapid transient vagally mediatedreflex sympathoexcitation with a small extra-vagal contribution.Central depression of sympathetic activity started at 6% andwas 33% below baseline at 12%. Footnotes ² Present address: Department of Anaesthetics, Wycombe Hospital,Queen Alexandra Road, Buckinghamshire HP11 2TT, UK     

Intermittent high frequency ventilation: a new mode to measure changes in lung volume and alveolar gas concentration, enhance CO2 elimination and reduce intrapulmonary pressures

A new method of artificial ventilation, intermittent high frequency ventilation (IHFV), is described in which high frequency ventilation (HFV) is intermittently interrupted so that short periods of ventilation and pauses in ventilation occur in sequence several times a minute. During the pauses in ventilation the increase in lung volume, which occurs during the short periods of HFV, is either exhaled completely or to a predetermined level which prevents sustained hyperinflation of the lungs but allows the maintenance of PEEP if required. The volume of gas expired during the ventilation pauses, i.e. gas retained during the periods of HFV, is measured. When this trapped gas is exhaled completely, the mean airway and compliance pressures are reduced by up to 50% compared to continuous HFV at the same frequency, inspiration:expiration (I:E) ratio and low tidal volume (VT). The alveolar CO2 concentration was measured in gas expired towards the end of the pauses in ventilation. CO2 elimination was improved, especially at high frequencies of ventilation, which allowed a further reduction in inflation pressures while maintaining a constant PaCO2.     

Cardiac tamponade as a terminal event in the hemolytic uremic syndrome in childhood

The case of a 6-year-old Inuit female with the epidemic form of hemolytic uremic syndrome (HUS) with myocardial involvement and probable cardiac tamponade is presented. This case illustrates the multisystemic nature of the syndrome, and to our knowledge, cardiac tamponate as a probable terminal event in HUS has not been reported previously.     

Determination of 8-methoxypsoralen in plasma by scanning fluorometry after thin-layer chromatography

A rapid and sensitive method is described for determining 8-methoxypsoralen in plasma. Plasma samples are acidified with 6 mol/liter and heated in a boiling water bath to release the plasma-bound drug nondestructively. It then is extracted into a solvent mixture consisting of benzene/ethyl acetate (9/1 by vol). The solvent phase is separated, evaporated, and an aliquot of the dissolved residue is thin-layer chromatographed, with benzene/ethyl acetete (9/1) as developing solvent. The plate is dried and the spots, made visible under ultraviolet light (320-400 nm), are scanned. The smallest amount detectable is 20 ng; the overall analytical recovery from plasma is 84%. We used the method to determine the drug in the plasma of rabbits after intravenous and oral administration of 10 mg, and in one patient after an oral dose of 30 mg.