Effect of topical nasal steroid spray in the treatment of non-specific recurrent / chronic pharyngitis - a trial study

Objective  Non-Specific Chronic/Recurrent Pharyngitis is a diagnosis with no definite effective treatment. An array of drugs and therapies has been tried from local applications like Mandl’s paint and throat gargles to anxiolytics. None have proved of therapeutic benefit. This trial study is a Pilot study of its kind in to the effectiveness of nasal steroid spray in the treatment of non-specific chronic pharyngitis. This is a prospective randomized study. Setting  Study done in medical college with ambulatory patients centre. Patients  53 patients were taken up for the study though only 42 could be followed up for a period of 1–2.5 years. Selection done on the basis of symptoms avoiding extreme age groups and subjective persistent relief was central to be considered proof of effectiveness of the treatment. Fluticasone Nasal Spray was used in the study. Results  35 patients (83.3%) reported some degree of relief in symptoms. 68% had >90% relief of symptoms with only a total of 1–2 sprays. There were 7 failures. Side effects were negligible. Conclusion  Nasal steroid spray is therefore recommended as a most cost-effective, safe treatment method for well-selected cases of Chronic Non-Specific Pharyngitis.     

Association of apolipoprotein E ε4 allele with cognitive impairment in patients with epilepsy and interaction with phenytoin monotherapy

Cognitive impairment implicates many factors beyond phenytoin monotherapy in patients with epilepsy. Apolipoprotein E ε4 allele has been reported to play a role in severe memory impairment that ultimately progresses to Alzheimer's disease (AD); however, knowledge about its role in cognitive impairment in patients with epilepsy is lacking. Our study proposes the possible involvement of the APOE ε4 allele in cognitive impairment in patients with epilepsy which is further worsened by phenytoin monotherapy. Assessment of the APOE ε4 allele in a population with epilepsy will help to identify the patients vulnerable to cognitive impairment and, therefore, the corrective therapy that needs to be addressed.     

Use of verbal autopsy to determine mortality patterns in an urban slum in Kolkata, India

Objective

To define mortality patterns in an urban slum in Kolkata, India, in the context of a cholera and typhoid fever project.

Methods

In a well-defined population that was under surveillance for 18 months, we followed a dynamic cohort of 63 788 residents whose households were visited monthly by community health workers to identify deaths. Trained physicians performed verbal autopsies and experienced senior physicians assigned the primary cause of death according to the International classification of diseases, 10th edition. We tabulated causes of death in accordance with Global Burden of Disease 2000 categories and assessed overall and cause-specific mortality rates per age group and gender.

Findings

During 87 921 person–years of follow-up, we recorded 544 deaths. This gave an overall mortality rate of 6.2 per 1000 person–years. We assigned a cause to 89% (482/544) of the deaths. The leading causes of death, in descending order, were cardiovascular diseases (especially among adults aged over 40 years), cancer, respiratory ailments and digestive disorders. Most deaths in children under 5 years of age were caused by tuberculosis, respiratory infections and diarrhoeal diseases.

Conclusion

Although the most common causes of death in children were infectious, non-communicable diseases were predominant among adults. There is a need for continuing interventions against infectious diseases in addition to new and innovative strategies to combat non-infectious conditions.     

Myeloablative 131I-tositumomab radioimmunotherapy in treating non-Hodgkin's lymphoma: comparison of dosimetry based on whole-body retention and dose to critical organ receiving the highest dose.

Myeloablative radioimmunotherapy using (131)I-tositumomab (anti-CD20) monoclonal antibodies is an effective therapy for B-cell non-Hodgkin's lymphoma. The amount of radioactivity for radioimmunotherapy may be determined by several methods, including those based on whole-body retention and on dose to a limiting normal organ. The goal of each approach is to deliver maximal myeloablative amounts of radioactivity within the tolerance of critical normal organs. METHODS: Records of 100 consecutive patients who underwent biodistribution and dosimetry evaluation after tracer infusion of (131)I-tositumomab before radioimmunotherapy were reviewed. We assessed organ and tissue activities over time by serial gamma-camera imaging to calculate radiation-absorbed doses. Organ volumes were determined from CT scans for organ-specific dosimetry. These dose estimates helped us to determine therapy on the basis of projected dose to the critical normal organ receiving a maximum tolerable radiation dose. We compared organ-specific dosimetry for treatment planning with the whole-body dose-assessment method by retrospectively analyzing the differences in projected organ-absorbed doses and their ratios. RESULTS: Mean organ doses per unit of administered activity (mGy/MBq) estimated by both methods were 0.33 for liver and 0.33 for lungs by the whole-body method and 1.52 for liver and 1.74 for lungs by the organ-specific method (P=0.0001). The median differences between methods were 0.92 mGy/MBq (range, 0.36-2.2 mGy/MBq) for lungs, 0.82 mGy/MBq (range, 0.28-1.67 mGy/MBq) for liver, and -0.01 mGy/MBq (range, -0.18-0.16 mGy/MBq) for whole body. The median ratios of the treatment activities based on limiting normal-organ dose were 5.12 (range, 2.33-10.01) for lungs, 4.14 (range, 2.16-6.67) for liver, and 0.94 (range, 0.79-1.22) for whole body. We found substantial differences between the dose estimated by the 2 methods for liver and lungs (P=0.0001). CONCLUSION: Dosimetry based on whole-body retention will underestimate the organ doses, and a preferable approach is to evaluate organ-specific doses by accounting for actual radionuclide biodistribution. Myeloablative treatments based on the latter approach allow administration of the maximum amount of radioactivity while minimizing toxicity.     

Selective serotonin depletion does not regulate hippocampal neurogenesis in the adult rat brain: differential effects of p-chlorophenylalanine and 5,7-dihydroxytryptamine

Serotonin is suggested to regulate adult hippocampal neurogenesis, and previous studies with serotonin depletion reported either a decrease or no change in adult hippocampal progenitor proliferation. We have addressed the effects of serotonin depletion on distinct aspects of adult hippocampal neurogenesis, namely the proliferation, survival and terminal differentiation of hippocampal progenitors. We used the serotonin synthesis inhibitor p-chlorophenylalanine (PCPA) or the serotonergic neurotoxin 5,7-dihydroxytryptamine (5,7-DHT) to deplete serotonin levels. 5,7-DHT selectively decreased hippocampal serotonin levels, while PCPA resulted in a significant decline in both serotonin and norepinephrine levels. We observed a robust decline in the proliferation and survival of adult hippocampal progenitors following PCPA treatment. This was supported by a decrease in the number of doublecortin-positive cells in the neurogenic niche in the hippocampus. In striking contrast, 5,7-DHT did not alter the proliferation or survival of adult hippocampal progenitors and did not alter the number of doublecortin-positive cells. The terminal differentiation of adult hippocampal progenitors was not altered by either PCPA or 5,7-DHT treatment. An acute increase in serotonin levels also did not influence adult hippocampal progenitor proliferation. These results suggest that selective serotonin depletion or an acute induction in serotonin levels does not regulate adult hippocampal neurogenesis, whereas treatment with PCPA that induces a decline in both serotonin and norepinephrine levels results in a significant decrease in adult hippocampal neurogenesis. Our results highlight the need for future studies to examine the role of other monoamines in both the effects of stress and antidepressants on adult hippocampal neurogenesis.     

Terahertz spectroscopy to identify the polymorphs in freeze-dried mannitol

We show how terahertz time-domain spectroscopy (THz-TDS) in the range from 0.1 to 7.5 THz can be used to identify the polymorphs of Mannitol, a frequently used excipient in the freeze drying industry. The results are subsequently used to study the effect that different freeze drying techniques have on the formation of these polymorphs. We find that, depending on the freeze-drying technique, the Mannitol either crystallizes in the δ form, or in a mixture of both the δ form and the β form. The results are in agreement with conventional X-ray diffraction measurements used to identify the polymorphs. © 2009 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 99:932–940, 2010     

Blunt traumatic rupture of the heart: case report and selected review.

Cardiac rupture is a common complication following blunt thoracic trauma. Blunt traumatic rupture of the heart is a frequent cause of death. Cardiac injuries are rarely diagnosed early in the preoperative period. Most of them die at the scene of the accident and only a few survive to make it to the hospital alive. Rapid evaluation and expeditious management may increase the number of survivors. We present here an illustrative case report and selected review of literature regarding clinical presentation, mechanism of injury, investigation and treatment.