A fatal case of erythema necroticans

Erythema nodosum leprosum (ENL) classically presents as tender, erythematous nodules over the face, arms and legs. Severe ENL can become vesicular or bullous and break-down and is termed erythema necroticans (Jopling & McDougall, 1996) and is treated with corticosteroids. The causes of death in a majority of leprosy patients are the same as in the general population, with the exception of renal damage in lepromatous leprosy. There is possible increased mortality from side-effects of antileprosy drugs, steroids, or other drugs used in reactions, from toxaemia in severe reactions, and from asphyxia due to glottic oedema (Jopling & McDougall, 1996). We report here a case of erythema necroticans, the cause of death being septicaemia, secondary to skin ulcers and urinary tract infection, precipitated by corticosteroids.     

Cancer-related anemia in a rat model: alpha2-macroglobulin from Yoshida sarcoma shortens erythrocyte survival

Implantation of Yoshida ascites sarcoma in rats was found to lead to a reduction in the hemoglobin content, the erythrocyte count and the packed cell volume of blood to 30% of normal in 4 d; however, there was no decrease in the mean cell hemoglobin, the mean cell volume and the mean corpuscular hemoglobin concentration, or suppression of erythropoiesis. The red cells from the circulation of tumor-bearing animals, tagged with (51)Cr and injected intravenously in normal rats, showed significantly faster clearance than normal. The erythrocytes contaminating the tumor ascites exhibited extremely short survival, suggesting that one or more secreted tumor product(s) may be responsible for the effect. Incubation of red cells from normal rats in the cell-free ascites fluid, or with an isoform of alpha2-macroglobulin purified from it, also led to reduction in the survival; but the ascites fluid depleted specifically of alpha2-macroglobulin was without any effect. The erythrocytes exhibiting reduced survival showed a proportionate decrease in their cellular deformability. The study identifies a tumor product that is directly responsible for the causation of anemia in the host, and the mechanism by which it does so.     

Role of oxidative stress and antioxidants in neurodegenerative diseases

Neurodegenerative diseases (NDD) are a group of illness with diverse clinical importance and etiologies. NDD include motor neuron disease such as amyotrophic lateral sclerosis (ALS), cerebellar disorders, Parkinson's disease (PD), Huntington's disease (HD), cortical destructive Alzheimer's disease (AD) and Schizophrenia. Numerous epidemiological and experimental studies provide many risk factors such as advanced age, genetic defects, abnormalities of antioxidant enzymes, excitotoxicity, cytoskeletal abnormalities, autoimmunity, mineral deficiencies, oxidative stress, metabolic toxicity, hypertension and other vascular disorders. Growing body of evidence implicates free radical toxicity, radical induced mutations and oxidative enzyme impairment and mitochondrial dysfunction due to congenital genetic defects in clinical manifestations of NDD. Accumulation of oxidative damage in neurons either primarily or secondarily may account for the increased incidence of NDD such as AD, ALS and stroke in aged populations. The molecular mechanisms of neuronal degeneration remain largely unknown and effective therapies are not currently available. Recent interest has focused on antioxidants such as carotenoids and in particular lycopene, a potent antioxidant in tomatoes and tomato products, flavonoids and vitamins as potentially useful agents in the management of human NDD. The pathobiology of neurodegenerative disorders with emphasis on genetic origin and its correlation with oxidative stress of neurodegenerative disorders will be reviewed and the reasons as to why brain constitutes a vulnerable site of oxidative damage will be discussed. The article will also discuss the potential free radical scavenger, mechanism of antioxidant action of lycopene and the need for the use of antioxidants in the prevention of NDD.     

Chromium removal and reduction in COD of tannery effluents

Tannery effluents are highly polluting and contain chromium and high COD and BOD. Alkalotolerant/alkalophilic actinomycetes NCIM 5080 and NCIM 5109 have been shown earlier to tolerate and accumulate chromium during growth also produce alkaline protease in presence of chromium ions. These properties of the isolates are suitable for treatment of tannery effluents which are alkaline and contain chromium and proteinaceous matter. Both the actinomycetes are able to grow in undiluted tannery effluents and remove chromium almost completely and reduce the COD by 70-80% during growth as well as by pregrown biomass.     

Gastric thumbprinting: diffuse gastric wall mucosal and submucosal thickening in infants with ductal-dependent cyanotic congenital heart disease maintained on long-term prostaglandin therapy

Seven infants with ductal dependent cyanotic congenital heart disease are reported. All were on prostaglandin E1 therapy to maintain ductus patency. All showed chest radiographic evidence of multiple masses indenting the stomach lumen (gastric thumbprinting). Other than feeding intolerance in two patients, the findings were incidental and disappeared with cessation of PGE1 therapy. "Gastric thumbprinting" appears to be a more common consequence of PGE1 therapy than actual obstructing antral masses (antral foveolar hyperplasia).     

Anaesthesia for cardioversion: a comparison of sevoflurane and propofol

This study compared the induction time, haemodynamic changes, recovery characteristics and patient satisfaction for sevoflurane and propofol when used as the main anaesthetic agents for cardioversion. Sixty-one unpremedicated patients scheduled for elective cardioversion were anaesthetised with either inhaled sevoflurane 8% or an intravenous propofol target-controlled infusion set at 6 microg.ml(-1).There was no significant difference in induction time between the two groups: mean (SD) = 90.1(40) s in the sevoflurane group vs. 83.7(35) s in the propofol group. Mean (SD) time to recovery was significantly shorter in the sevoflurane group than in the propofol group: 318 (127) s vs.738 (355) s, respectively, p < 0.001. At recovery, the patients in the propofol group had significantly lower systolic and diastolic blood pressures than those in the sevoflurane group, p < 0.001. The incidence of complications was low in both groups, with similar patient satisfaction expressed after the procedure. We conclude that sevoflurane is a suitable choice for anaesthesia for cardioversion and may provide greater haemodynamic stability than a target-controlled infusion of propofol.     

Drug therapy of childhood asthma

Drug therapy is used to prevent and control asthma, and also to reduce the frequency and severity of its exacerbations, and reverse airflow obstruction. Asthma medications are thus categorized into two general classes--bronchodilators (relievers) and anti-inflammatory drugs (preventers). Short acting beta2-agonists is the therapy of choice for relief of acute symptoms and prevention of exercise induced bronchospasm (EIB). Corticosteroids are the most potent and effective anti-inflammatory medication currently available. Inhaled form is used in the long-term control of asthma. Systemic corticosteroids are used to gain prompt control of the disease when initiating long-term therapy. Long acting bronchodilator used concomitantly with anti-inflammatory medications for long-term control of symptoms, especially nocturnal symptoms. Ipratropium bromide may provide some additive benefit to inhaled beta2-agonists in severe exacerbations. Sustained release theophylline is a mild to moderate bronchodilator used principally as adjuvant to inhaled corticosteroids for prevention of nocturnal asthma. Leukotriene modifiers may be considered as an alternative therapy to inhaled corticosteroids or cromolyn or nedocromil.