Potent in vitro cytotoxic and antioxidant activity of Careya arborea bark extracts

Careya arborea is used in traditional medicine for the treatment of tumors and other ailments. The successive chloroform and ethyl acetate extracts and crude 50% methanol extract exhibited potent cytotoxicity against cancerous RD, HEp-2 and HeLa cell lines. They were found to be safe against the normal Vero cell line. The methanol and aqueous extracts possessed strong antioxidant activity against many oxidants in the in vitro antioxidant screening. The total phenol content of these extracts was found to be high. The results suggest strong cytotoxic and antioxidant properties and support the ethnomedical claims for the plant.     

Effectiveness, safety and acceptability of 'see and treat' with cryotherapy by nurses in a cervical screening study in India

We evaluated a 'see and treat' procedure involving screening, colposcopy, biopsy and cryotherapy by trained nurses in one-visit in field clinics in a cervical screening study in South India for its acceptability, safety and effectiveness in curing cervical intraepithelial neoplasia (CIN). Women positive on visual inspection with acetic acid (VIA) were advised colposcopy, directed biopsies and cryotherapy if they had colposcopic impression of CIN in one visit by nurses in field clinics supervised by a doctor. Side effects and complications were assessed and cure rates were evaluated with VIA, colposcopy and biopsy if colposcopic abnormalities were suspected. Cure was defined as no clinical or histological evidence of CIN at > or =6 months from treatment. Of the 2513 women offered 'see and treat' procedure, 1879 (74.8%) accepted. Of the 1397 women with histologically proved CIN treated with cryotherapy, 1026 reported for follow-up evaluation. Cure rates were 81.4% (752 out of 924) for women with CIN 1; 71.4% (55 out of 77) for CIN 2 and 68.0% (17 out of 25) for CIN 3. Minor side effects and complications were documented in less than 3% of women. 'See and treat' with cryotherapy by nurses under medical supervision is acceptable, safe and effective for cervical cancer prevention in low-resource settings.     

The prevalence and determinants of health care-seeking behavior for fecal incontinence in multiparous United Arab Emirates females

PURPOSE: This study was designed to determine the prevalence and sociodemographics of fecal incontinence in United Arab Emirates females. METHODS: A representative sample of multiparous United Arab Emirates females aged 20 years or older (N=450) were randomly selected from the community (n=225) and health care centers (n=225). Patients were interviewed about inappropriate stool loss in the past year using a structured and pretested questionnaire. RESULTS: Fifty-one participants (11.3 percent) admitted fecal incontinence; 26 (5.8 percent) were incontinent to liquid stool and 25 (5.5 percent) to solid stool. Thirty-eight patients (8.4 percent) had double (urinary and fecal) incontinence. Sixty-five patients (14.4 percent) were incontinent to flatus only but not to stools. The association between having fecal incontinence and chronic constipation was significant (P<0.0001), but there was no significant association with other known risk factors such as age, parity, and previous instrumental delivery, episiotomy, perineal tears, or anorectal operations. Only 21 incontinent patients (41 percent) had sought medical advice. Patients did not seek medical advice because they were embarrassed to consult their physician (64.7 percent), they preferred to discuss the difficulty with friends, assuming that fecal incontinence would resolve spontaneously (47.1 percent) or was normal (31.3 percent), and they chose self-treatment as a result of low expectations for medical care (23.5 percent). Sufferers were bothered by the inability to pray (92.2 percent) and to have sexual intercourse (43.1 percent). Perceived causes of fecal incontinence were paralysis (90.2 percent), old age (80.4 percent), childbirth (23.5 percent), or menopause (19.6 percent). CONCLUSIONS: Fecal incontinence is common yet underreported by multiparous United Arab Emirates females because of cultural attitudes and inadequate public knowledge.Poster presentation accepted at the XIX Biennial Congress of the International Society of University Colon and Rectal Surgeons, Osaka, Japan, April 14–18, 2002.     

Predictors of neck node control in radically irradiated squamous cell carcinoma of the oropharynx and laryngopharynx

Cases of squamous cell carcinoma (171) of the oropharynx and laryngopharynx with clinically positive neck nodes, treated primarily by radiotherapy, were used for a multivariate analysis of the factors related to the regional outcome. All patients were staged according to the UICC-TNM (1982) classification. Lymph node size (P < 0.01), TNM nodal category (P < 0.05), and stage of the disease (P < 0.05) were significant in univariate analysis. Patient- and disease-related factors (age, sex, and histology) and treatment related factors (radiation dose (5000–6000 rads), radiation schedule, and concurrent chemotherapy) did not reach statistical significance. The stepwise logistic regression resulted in a final model with node size as the most important predictor of neck node control (P < 0.01). Patients with neck nodes up to 1 cm can receive radical radiotherapeutic management for treating the primary as well as nodal disease.     

Comparison of bronchopulmonary collaterals and collateral blood flow in patients with chronic thromboembolic and primary pulmonary hypertension.

OBJECTIVE: To compare the visualisation of bronchopulmonary collaterals and bronchopulmonary collateral blood flow in patients with chronic thromboembolic pulmonary hypertension 2nd primary pulmonary hypertension. SETTING: Referral centre for cardiology at an academic hospital. PATIENTS: Nine patients with chronic thromboembolic pulmonary hypertension and 17 with primary pulmonary hypertension. INTERVENTIONS: Bronchopulmonary collaterals were visualised by selective bronchial arteriography or thoracic aortography. Bronchopulmonary collateral blood flow was estimated by injecting indocyanine green into the ascending aorta and sampling below the mitral valve from the left ventricle. RESULTS: The degree of pulmonary hypertension was comparable in the two groups. Large bronchopulmonary collaterals were visualised in all the patients with thromboembolic pulmonary hypertension who had bronchial arteriography or aortography or both. None of the primary pulmonary hypertension group studied by aortography had bronchopulmonary collaterals (P < < 0.001). All the patients with chronic thromboembolic pulmonary hypertension had significant bronchopulmonary collateral blood flow, which was (mean (SD)) 29.8 (18.6)% of the systemic blood flow. There was no recordable collateral blood flow in 11 of 15 patients with primary pulmonary hypertension. In the remaining four patients the mean value was 1.1 (1.8)% of the systemic blood flow (P < < 0.001). CONCLUSIONS: Visualisation of bronchopulmonary collaterals by thoracic aortography or by bronchial arteriography, or the demonstration of an increased bronchopulmonary collateral flow, helps to distinguish patients with chronic thromboembolic pulmonary hypertension from those with primary pulmonary hypertension.     

Protective roles of metallothionein and glutathione in hepatotoxicity of cadmium.

The protective roles of metallothionein (MT) and glutathione (GSH) in acute hepatotoxicity of cadmium (Cd) were investigated in an in vitro system. Liver slices were incubated in a buffer containing cadmium chloride (20-50 ppm) at 37 degrees C for 3 h. Viability of the slices was monitored by measuring intra-cellular potassium (K) content and GSH concentrations. A dose-dependent decrease of intracellular K content of GSH concentrations was observed. Pre-induction of MT (100-fold increase) by injection of zinc sulphate (30 mg Zn/kg body weight) showed protection against decrease in both intracellular K and GSH concentrations in liver slices. Decrease of hepatic GSH (90%) by an injection of buthionine sulfoximine (BSO)(4 mmol/kg body weight) to the rats further enhanced the Cd toxicity in the liver slices. This enhanced toxicity resulting from BSO treatment can be totally overvome by induction of MT by Zn pre-treatment. The cellular uptake of Cd remained unaltered in all experiments. These results demonstrate that hepatic toxicity of Cd may be due to its binding to intracellular sulfhydryl groups and both intracellular GSH and MT levels may provide protection against cytotoxicity of Cd in liver. Moreover, even at low GSH levels, MT could partially protect the hepatic cells from Cd cytotoxicity.     

Mycobacterium fortuitum sternal wound infection following mitral valve replacement

Mycobacterium fortuitum infection of the sternum following cardiac surgery is a rare occurrence.It is usually diagnosed late and has a considerable mortality. We present a female patient with mycobacterium fortuitum sternal wound infection following mitral valve replacement, who was successfully managed with radical surgical debridement combined with multidrug antibiotics. Multidrug antibiotic therapy is essential because of the emergence of resistant strains.     

Renal tubular function in protein energy malnutrition

Renal tubular handling of sodium, potassium, calcium, magnesium, phosphate and aminoacids in children suffering from marasmus and kwashiorkor revealed wastage of phosphate and aminoacids. In the malnourished children aminoaciduria could contribute significantly to the negative nitrogen balance. Exact cause of this tubular functional defect is not known.     

Surgical Correction of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) Is a rare congenital anomaly seen in 0.26% of all congenital heart defects. From 1978 to the present, we have encountered 11 such cases in patients ranging from 3 months to 60 years of age. A variety of procedures have been performed, such as ligation of the anomalous left coronary artery (n = 1), saphenous vein bypass (n = 2), subclavian to left coronary artery anastomosis (n = 4), Takeuchl repair (n = 1), and revascularizatlon using a 6-mm Gore-Tex tube (n = 1). No of these patients were children who also had prosthetic mitral valve replacements with a #1 M Starr-Edwards valve and left subclavian to left coronary artery anastomosis. Three patients died postoperatively, one Immediately after surgery due to low cardiac output, another on the eighth postoperative day due to renal failure, and the third was a child who died 3 months later due to bacterial endocarditis of the prosthetic valve. The surviving patients have been and are in NYHA Class I after a mean follow-up of 9 years. One patient, revascularized with a prosthetic graft, was lost for follow-up after 3 years. A two-coronary system appears more physiological and Is reported to be favored by most surgeons. Left subclavian to left coronary artery anastomosis has also been observed to give excellent results, with which we also agree. The mitral valve replacement In addition to this procedure, reported here, has not been described before in the literature.     

Diagnostic yield of early morning urine samples in the diagnosis of tuberculosis

Sir, Early morning urine (EMU) samples are sent in significant numbersfrom patients suspected of having tuberculosis (TB), despiteevidence that the diagnostic yield is very low.¹ We assessedthe diagnostic yield of EMUs and calculated the associated workload,by retrospectively analysing data from our institution fromJanuary 2000 to June 2004. All patients with