Evaluation of patient-related factors associated with causality, preventability, predictability and severity of hepatotoxicity during antituberculosis [correction of antituberclosis] treatment.

For evaluation the extent of antituberculosis drug-induced hepatotoxicity and also to determine the patient-related factors associated with causality, preventability, predictability and severity of hepatotoxicity induced by antituberculosis medications, a prospective study was conducted on 112 patients in a tertiary care university teaching hospital for three years. Causality, preventability, predictability and severity of hepatotoxicity were determined based on the available standard algorithms. Of 112 patients, 31 (27.7%) demonstrated hepatotoxicity. Two patients died from complications of liver-related illness. The mean duration of treatment before the onset of hepatotoxicity was 16.7+/-3.2 days. Malnutrition was present in 17 of 112 patients. Most of hepatotoxicity (25/31 or 80.6%) occurred within the first month of treatment. Reintroduction of antituberculosis drugs was possible in 29 of 31 patients. Univariate and multivariate analysis did not show significant relationships between the rate of hepatotoxicity with age, sex, nutrition and nationality. Our results showed that hepatotoxicity induced by antituberculosis drugs is a nonpreventable and unpredictable reaction. The causality of this reaction is classified as category A based on European grading of causality. This study noted that the frequency of hepatotoxicity induced by antituberculosis drugs in Iranian patients is higher than other studied populations.     

Effect of acetyl salicylic acid on production and action of leukocyte-derived interferons.

Although acetylsalicylic acid does not itself induce interferon, acetylsalicylic acid was found to significantly enhance the production of both human alpha interferon and human gamma interferon when added with the appropriate inducers to cultures of human peripheral blood mononuclear cells. The mechanisms associated with this effect were investigated.     

Severe malaria in children in Papua New Guinea

The clinical features of severe falciparum malaria and risk factors for mortality were studied in 489 children admitted with malaria to Madang Hospital, Papua New Guinea. The most common severe manifestations of malaria were severe anaemia (22%) and coma (16%). Children with severe anaemia were younger than those with coma (median age 2.2 vs. 3.7 years) and had been ill for longer before admission (median 7 vs. 4 days, respectively). Although the clinical features of coma in Madang children with malaria resembled closely those reported in African children, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%) children died, most within 12 h of admission. A high level of plasma lactate (> or = 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independent predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and death in many children, emphasis must be placed on the prevention or early recognition and treatment of acidosis in the district health clinic as well as the central hospital.      

Lactate dehydrogenase isoenzyme composition of human platelets

The LDH isoenzyme composition of 12 platelet preparations was determined by electrophoresis. The mean (+/- SD) percentages of LDH-1, LDH-2, LDH-3, LDH-4, and LDH-5 were 16.6 +/- 1.7, 30.1 +/- 1.0, 34.2 +/- 1.3, 18.2 +/- 1.3, and 0.9 +/- 1.1, respectively. In comparison with previous data, these data show identical ranking of the prevalence of each isoenzyme but significantly different percentages, particularly of LDH-1 and LDH-4. The release of platelet LDH by freezing and thawing differed little from that by homogenization.     

Patterns of Depressive Symptoms in Children

PROBLEM: Depressive symptoms in children have been linked to recurrent problems with depression, school problems, and risky health behaviors. Adolescent girls report depressive symptoms three to four times more frequently than adolescent boys. Few studies, however, have examined gender-related depressive symptoms in younger, school-aged children. METHODS: In the present study, gender differences in depressive symptoms in children ages 10-12 years were explored using the Children's Depression Inventory (CDI) with a convenience sample of 122 suburban middle-class public school fifth and sixth graders. FINDINGS: A distinct pattern of depressive symptom expression was found with girls reporting more internalizing and more negative self-esteem, and boys reporting more externalizing and more school problems. CONCLUSION: These findings suggest that despite similarities on a total depressive symptom score, there are distinct gender differences in depressive symptom expression that are identifiable before adolescence and may be associated with normative development.     

Pressure ulcer, fibronectin, and related proteins in spinal cord injured patients.

Pressure ulcer is a common occurrence in spinal cord injured (SCI) patients and can lead to serious complications. With proper management, some patients exhibit satisfactory healing whereas others show slow or nonhealing ulcers. Fibronectin has been shown to accumulate in wound, opsonize macroaggregate debris for phagocytosis, promote revascularization, and facilitate fibroblast migration and proliferation. We explored the relationship of plasma fibronectin with healing potential in 21 SCI men with pressure ulcer. They received standard wound care and were observed for eight weeks. Ten otherwise healthy SCI men without pressure ulcer (SCI-controls) and 32 able-bodied normal individuals (normal controls) were also studied. Plasma fibronectin and related proteins, ie, fibrinogen, plasminogen, alpha 2-antiplasmin and Factor XIII, were measured. Ten of 21 SCI patients with pressure ulcer showed rapid healing within four weeks and had significantly higher fibronectin levels as compared with the 11 patients with poor healing ulcers, SCI controls, and normal controls. Factor XIII and alpha 2-antiplasmin were mildly reduced and fibrinogen values were significantly increased in all SCI groups. Plasminogen concentrations were comparable in all groups studied. It thus appears that plasma fibronectin rises in patients with fast healing ulcers but fails to do so in those with poor healing ulcers and as such may be predictive of the course of pressure ulcers.     

Acute effects of dialysis on T lymphocytes in patients with end-stage renal disease

The acute effect of dialysis on T-lymphocyte responses was studied in 11 patients with end-stage renal disease (ESRD). The in-vitro mitogenic response to concanavalin A and pokeweed mitogen was decreased (p less than 0.05) after single passage of blood through the dialyzer, accompanied by a reduction in the proportion of monoclonal antibody-defined total T lymphocytes (Leu 1+ cells) (p less than 0.01), an increase in the percentage of monoclonal antibody-defined monocytes (M 2+ cells), and a decrease in interleukin 2 (IL-2) production (p less than 0.05). Depletion of adherent cells from mononuclear cells isolated from blood after single passage through the dialyzer restored the mitogenic responses to normal levels. Post dialysis mitogenic responses were comparable to pre-dialysis mitogenic responses although IL-2 production (p less than 0.05), and the proportion of T lymphocyte (Leu 1+ cells) remained depressed (p less than 0.01). Cumulative effects of long-term intermittent hemodialysis may contribute to the impaired immunity and the increased frequency of infections and neoplasms in patients with end-stage renal disease.     

Renal transplantation in the elderly

Elderly patients are increasingly being considered for kidney transplantation due to a global explosion of the aging population with end-stage renal disease (ESRD). However, mounting scarcity of available organs for transplant has led to a wider disparity between organ supply and demand. Consequently, the criteria for accepting kidneys for transplantation have been extended in an attempt to allow the use of organs from elderly donors or those with significant co-morbidities, so-called “expanded criteria donor” (ECD) kidneys. Excellent outcomes have been achieved from ECD kidneys with appropriate donor and recipient profiling and selection. With increasing recovery efforts directed at older donors, the concept of age-matching is becoming more accepted as a method of optimizing utilization of organs in elderly donors and recipients. Utilization of pulsatile perfusion has further improved ECD outcomes and helped the decision-making process for the UNOS (United Network for Organ Sharing) offer. However, age-related immune dysfunction and associated co-morbidities make the elderly transplant recipients ever more susceptible to complications associated with immunosuppressive agents. Consequently, the elderly population is at a higher risk to develop infections and malignancy in the post-transplant period notwithstanding improved transplant outcomes. Appropriate immunosuppressive agents and dosages should be selected to minimize adverse events while reducing the risk of acute rejections and maximizing patient and renal allograft survival.     

Laparoscopic Treatment of Celiac Artery Compression Syndrome: Case Series and Review of Current Treatment Modalities

Introduction  Compression of the celiac artery by the diaphragmatic crura, the median arcuate ligament, or the fibrous periaortic ganglionic tissue results in a rare constellation of symptoms known as celiac artery compression syndrome (CACS). Anatomy  First described in 1963 by Harjola in a patient with symptoms of mesenteric ischemia, it remains an elusive diagnosis. Clinical Presentation  Patients commonly present with a wide variety of symptoms resulting in multiple diagnostic tests. Diagnosis  A firm diagnosis is difficult to establish, and treatment is equally challenging. These challenges are illustrated by the following case series, and evidence supporting current treatment modalities is reviewed. Treatment  We describe a laparoscopic approach to decompression of the celiac artery facilitated by intraoperative ultrasound.