Plasmodium falciparum isolates in India exhibit a progressive increase in mutations associated with sulfadoxine-pyrimethamine resistance

The combination of sulfadoxine-pyrimethamine (SP) is used as a second line of therapy for the treatment of uncomplicated chloroquine-resistant Plasmodium falciparum malaria. Resistance to SP arises due to certain point mutations in the genes for the dihydrofolate reductase (DHFR) and dihydropteroate synthetase (DHPS) enzymes of the parasite. We have analyzed these mutations in 312 field isolates of P. falciparum collected from different parts of India to assess the effects of drug pressure. The rate of mutation in the gene for DHFR was found to be higher than that in the gene for DHPS, although the latter had mutations in more alleles. There was a temporal rise in the number of isolates with double dhfr mutations and single dhps mutations, resulting in an increased total number of mutations in the loci for DHFR and DHPS combined over a 5-year period. During these 5 years, the number of isolates with drug-sensitive genotypes decreased and the number of isolates with drug-resistant genotypes (double DHFR mutations and a single DHPS mutation) increased significantly. The number of isolates with the triple mutations in each of the genes for the two enzymes (for a total of six mutations), however, remained very low, coinciding with the very low rate of SP treatment failure in the country. There was a regional bias in the mutation rate, as isolates from the northeastern region (the state of Assam) showed higher rates of mutation and more complex genotypes than isolates from the other regions. It was concluded that even though SP is prescribed as a second line of treatment in India, the mutations associated with SP resistance continue to be progressively increasing.     

Intestinal protein supply alters amino acid, but not glucose, metabolism by the sheep gastrointestinal tract

This study was intended to establish the extent which amino acids (AAs) and glucose are net metabolized by the gastrointestinal tract (GIT) of ruminant sheep when intestinal protein supply is varied. Wether sheep (n = 4, 33 +/- 2.0 kg) were fitted with catheters for measurement of net absorption by the mesenteric (MDV) and portal-drained (PDV) viscera and a catheter inserted into the duodenum for casein infusions. Sheep received a fixed amount of a basal diet that provided adequate metabolizable energy (10.9 MJ/d) but inadequate metabolizable protein (75 g/d) to support 300-g gain per day. Four levels of casein infusion [0 (water), 35, 70, and 105 g/d], each infused for 5.5 d, were assigned to sheep according to a 4 x 4 Latin square design. [methyl-(2)H(3)]leucine was infused (8 h) into the duodenum while [1-(13)C]leucine plus [6-(2)H(2)]glucose were infused (8 h) into a jugular vein. With the exception of glutamate and glutamine, net absorption of AAs increased linearly (P < 0.05, R(2) = 0.46-1.79 for MDV; P < 0.05, R(2) = 0.6-1.58 for PDV) with casein infusion rate. Net absorption by the PDV accounted for <100% of the additional supplies of leucine, valine, and isoleucine (0.6-0.66, P < 0.05) from casein infusion, whereas net absorption by the MDV accounted for 100% of the additional essential AA supply. Glucose absorption (negative) and utilization of arterial glucose supply by the GIT remained unchanged. There was a positive linear (P < 0.05) relation between transfer of plasma urea to the GIT and arterial urea concentration (MDV, P < 0.05, r = 0.90; PDV, P < 0.05, r = 0.93). The ruminant GIT appears to metabolize increasing amounts of the branched-chain AAs and certain nonessential AAs when the intestinal supply of protein is increased.     

The challenging role of radiation therapy for very young children with rhabdomyosarcoma

PURPOSE: To evaluate local control and toxicity for very young children treated with multimodality therapy for rhabdomyosarcoma (RMS). METHODS AND MATERIALS: From 1990 to 2004, 20 patientsor=1 year after diagnosis (15) in terms of mild, moderate, or severe deficits. RESULTS: Median follow-up was 33 months for survivors and 23 months for all patients. Two-year actuarial local control, event-free survival, disease-specific survival, and overall survival were 84%, 52%, 74%, and 62%, respectively. All patients who began EBRT相似文献   

Fibrous histiocytoma in primary pterygium

Fibrous histiocytoma, a mesenchymal tumor, although reported to develop in various ocular structures with a variable frequency, has never been found within a pterygium. We report the case of a 50-year-old female who had had a pterygium for the last six years and had developed a tumor within it one and a half years ago. The tumor was excised along with the pterygium. On histopathological examination the tumor was found to be a benign fibrous histiocytoma arising from within the pterygium.     

Economic impact of asthma therapy with fluticasone propionate, montelukast, or zafirlukast in a managed care population

STUDY OBJECTIVE: To compare asthma-related health care expenditures among patients newly prescribed fluticasone propionate 44 or 110 microg, montelukast 5 or 10 mg, or zafirlukast 20 mg. DESIGN: Retrospective cohort analysis of medical and pharmacy claims. SETTING: University-affiliated health outcomes research center. PATIENTS: Seven hundred eighty-one patients (aged > or = 4 yrs) with asthma treated with controller therapy for 9 months (postindex period), with no claim for an inhaled corticosteroid or leukotriene modifier in the previous 9 months (preindex period). INTERVENTION: Asthma-related medical and pharmacy data from insurance claims of four managed care plans (two Northeastern, one Midwestern, and one Western) were tabulated over the pre- and postindex periods. MEASUREMENTS AND MAIN RESULTS: Numbers of patients identified were 284 beginning fluticasone propionate; 302, montelukast; and 195, zafirlukast. Fluticasone propionate treatment was associated with significantly (p<0.001) lower risk-adjusted asthma-related charges compared with montelukast and zafirlukast treatment: $528, $967, and $1359, respectively In this cohort, fluticasone propionate also was associated with fewer hospitalizations, less need for additional controller agents, and longer maintenance on the index drug compared with montelukast and zafirlukast. CONCLUSIONS: Based on these real-world data, as well as established national and international asthma guidelines, consideration should be given to inhaled corticosteroid therapy, particularly fluticasone propionate, for first-line, long-term effective management of asthma.     

Surgical management of lesions of the internal carotid artery using a modified Fisch type A infratemporal approach.

OBJECTIVE: To report seven cases of vascular repair of the internal carotid artery (ICA) using a modified Fisch type A infratemporal approach and a venous grafting. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care center. PATIENTS: We have analyzed the clinical presentation, paraclinical assessment, and postoperative results regarding the vascular repair and the facial and auditory function from seven consecutive patients. All patients have been operated on by a multidisciplinary team of ENT and vascular surgeons. RESULTS: The study includes four men and three women, aged from 21 to 62 years old. Six patients suffered from vascular traumatic injury after motor vehicle accident (n = 5) or cervical manipulation (n = 1) and one patient presented an atheromatous stenosis. All benefited from a vascular repair with a venous grafting through a modified Fisch Type A infratemporal approach. No death and no new stroke were noted (mean follow-up, 34 mo). The postoperative angiographies showed six functional grafts and one asymptomatic thrombosis. Six immediate postoperative facial palsy occurred but recovered to Grade I or II within 6 months. There was one traumatic injury of the facial nerve and one postoperative anacusis. For the six other patients, the reconstitution of the external auditory canal and ossicular chain allowed to limit the hearing loss to a mean air-bone gap of 22.5 dB (range, 15-35 dB). CONCLUSION: The lesions of the intrapetrous aspects of the ICA remain the subject of debates regarding the indication for a vascular repair. For young or in good health patients, the infratemporal approach provides a safe and reliable access to the horizontal segment of the ICA, offering to the vascular surgeons optimal conditions for the vascular repair.     

Gastric emptying scintigraphy in carcinoma of the pancreas

Objective: In patients with unresectable carcinoma of the pancreas, the role of prophylactic gastroenterostomy is debatable. Many workers still recommend combined biliary and enteric bypass at the initial surgery despite known complications of gastroenterostomy. Method: We conducted a prospective study in 17 patients with carcinoma of the pancreas without mechanical obstruction, to evaluate the presence of functional gastroparesis by doing a radionuclide, solid‐phase scintigraphy. We tried to correlate delayed gastric emptying (DGE) with symptoms of gastric outlet obstruction, serum bilirubin level, stage of disease and intraoperative assessment. Results: Of the 17 patients, seven (41.2%) had DGE. No correlation was found between delayed emptying and symptoms, serum bilirubin level, stage of disease or intraoperative assessment for gastric outlet obstruction. Conclusion: Solid‐phase gastric emptying scintigraphy may help to detect DGE in patients with carcinoma of the pancreas preoperatively. Patients with DGE may be chosen for prophylactic gastrojejunostomy during the initial biliary bypass.      

Chronic epididymitis (epididymal nodule) mimicking an adenomatoid tumor-case report with review of literature

Aim: To describe and review the differential diagnosis of epididymal nodules and chronic epididymitis so as to have a broad view of this pathology. We have suggested a possible diagnostic algorithm for the workup of an epididymal nodule.Methods/results: We have reported a case of a 35-year-old patient with a symptomatic palpable nodular mass in the tail of the left epididymis. Fine needle aspiration suggested an adenomatoid tumor while the surgical excision histology was reported as chronic epididymitis.Conclusions: Epididymal nodules are frequently encountered in the epididymis. Their differential diagnosis includes chronic granulomatous epididymitis, adenomatoid tumor and benign paratesticular neoplasms. We consider that it is important to distinguish epididymal nodules from benign inflammatory lesions and the threshold for a surgical excision should be low as it is therapeutic and provides a definite diagnosis. Whilst the FNAC alone may not be always adequate to confirm diagnosis, an epididymectomy may be curative as well as diagnostic in selected cases.     

Simulated Medical Learning Environments on the Internet

Learning anatomy and surgical procedures requires both a conceptual understanding of three-dimensional anatomy and a hands-on manipulation of tools and tissue. Such virtual resources are not available widely, are expensive, and may be culturally disallowed. Simulation technology, using high-performance computers and graphics, permits realistic real-time display of anatomy. Haptics technology supports the ability to probe and feel this virtual anatomy through the use of virtual tools. The Internet permits world-wide access to resources. We have brought together high-performance servers and high-bandwidth communication using the Next Generation Internet and complex bimanual haptics to simulate a tool-based learning environment for wide use. This article presents the technologic basis of this environment and some evaluation of its use in the gross anatomy course at Stanford University.Media-rich learning experiences are widely available on the web. Medical schools and other health care organizations maintain extensive websites for learning, reference, and assessment. Continuing medical education on the Internet is one of the most commonly available and widely used services for health care practitioners. These media-based learning environments, though widely available, represent a passive medium of information retrieval by clicking a mouse.We have been investigating the next generation of Internet-based learning technologies: simulation-oriented learning environments that support interaction, collaboration, and active learning. The topics of learning are anatomy and basic surgical manipulations. To support these topics, we have developed three-dimensional visualizations of anatomy and have enriched these anatomical models with biomechanical tissue properties of elasticity and viscosity such that the learner can use appropriate force-feedback tools to feel tissues at the same time that they visualize them. Access to and interaction with these simulation environments have required that we push the envelope of current Internet capabilities, and that we investigate the role of network bandwidth and latency in the performance of these applications. A preliminary version of this work was presented at MedInfo, 2001.¹