Preoperative Cell-Mediated Immune Status of Patients with Malignant Glial Tumors

The leukocyte adherence inhibition assay (LAI) was used to measure cell-mediated immunity in 26 patients with malignant glial neoplasms and in 41 control subjects. A significant inhibition of leukocyte adherence was observed in 21 out of 26 (80%) patients with malignant astrocytic gliomas in the presence of a 3M KC1 extract of glioma tissue compared to that of normal brain extract. Among the control group, no significant difference in the percentage of nonadherent leukocytes (NAL) was noted in the presence of either antigen. To study the specificity of the reaction, 3M KC1 extracts of meningioma, pituitary tumor, carcinoma of breast, carcinomas of lung, melanoma, brain, and heart tissues were employed as nonspecific antigens. Such studies revealed significantly lower values of NAL.

These data indicate that patients with malignant glial neoplasms manifest a cellular-immune response to glioma-associated antigens that can be measured by the tube LAI assay and that LAI assay may render additional useful information in the diagnostic and prognostic evaluation of malignant glial neoplasms.     

Association between occlusal force distribution in implant overdenture prostheses and residual ridge resorption

This study aimed to investigate residual ridge resorption (RRR) of anterior and posterior maxillary and mandibular edentulous ridges, in patients treated with mandibular implant overdentures (IOD) and compare with conventional complete denture (CD) wearers, and to determine at each location, the association of RRR with the occlusal forces distribution and other patients’ variables. The anterior and posterior RRR of IOD (six males, 17 females) and CD (12 males, 11 females) groups were determined using baseline and follow‐up dental panaromic radiographs (DPT) (mean intervals 4 ± 1·8 years). The bone ratios were calculated using proportional area: anatomic to fixed reference areas and mean difference of ratios between the intervals determined RRR. The ridge locations included anterior and posterior maxillary and posterior mandibular arches. The T‐Scan III digital occlusal system was used to record anterior and posterior percentage occlusal force (%OF) distributions. There were significant differences in anterior and posterior %OF between treatment groups. Two‐way anova showed RRR was significant for arch locations (P = 0·005), treatment group (IOD versus CD) (P = 0·001), however, no significant interaction (P = 0·799). Multivariate regression analyses showed significant association between RRR and %OF at anterior maxilla (P = 0·000) and posterior mandible (P = 0·023) and for treatment groups at posterior maxilla (P = 0·033) and mandibular areas (P = 0·021). Resorption was observed in IOD compared to CD groups, with 8·5% chance of less resorption in former and 7·8% in the latter location. Depending on arch location, ridge resorption at various locations was associated with occlusal force distribution and/or treatment groups (implant prostheses or conventional complete dentures).     

Complications in paediatric liver transplant from Kuwait when transplanted abroad

Background and study aimsSince the introduction of liver transplantation (LTx) in children suffering from liver failure in 1963, many centres around the world have offered this service to children that have no other alternative. The aim of this retrospective study is to analyse the results of paediatric liver transplant in Kuwait over the last decade.Patients and methodsA retrospective chart review was done involving paediatric patients during the time period of 1995–2004. The information collected included patient demographics, indications for liver transplantation, survival of both patient and allograft, and complications.ResultsA total of 16 cases were found and analysed. The mean age was 3.6 years (ranged 5 months–17 years). There were nine boys and seven girls. The most common indications for LTx were biliary atresia and metabolic liver disease. All the liver transplants were done abroad. There were totally nine deceased donor and seven living related cases. The complications were acute cellular rejection in five, hypertension in two, biliary complications in four, cytomegalovirus (CMV) infection in three and post lymphoproliferative disease in two cases. All but one patient are presently alive.ConclusionThe above information demonstrates that LTx in Kuwati children is safe and improves the quality of life for those that would otherwise have no other alternative.     

Best evidence continuous medical education

Health care professionals need to approach their profession with a view to life long learning. They need to develop a strategy to meet their learning needs in a reflective and effective manner. Continuous medical educational (CME) is the traditional tool for learning and updating knowledge. Most of them are in the forms of courses, conferences, journal clubs and workshops. They are mostly didactic sessions and evidence suggests that they are not effective to improve the clinical skills and attitude. Systematic review of teaching evidence-based medicine shows that interactive and clinically integrated learning is the most effective form of learning. It enhances knowledge and skills. Professionals should view CME in a holistic manner in the context of continuous professional development (CPD) and even in the wider concept of knowledge translation, which encompasses both CME and CPD. e Learning is one of the most important forms of non-traditional CME. It provides an efficient and increasingly interactive delivery system that can handle complex and layered information. More work needs to be done to see its effectiveness for practising clinicians.     

The DOTS strategy for treatment of paediatric pulmonary tuberculosis in South Delhi, India.

SETTING: Paediatric Pulmonology Department, TB Institute, New Delhi, India. OBJECTIVE: To evaluate the outcome of the DOTS strategy for paediatric pulmonary tuberculosis (TB). DESIGN: Retrospective analysis of 1098 children. RESULTS: The mean age of the children included in the study was 11.2 years, with more females (61.7%) than males (38.3%). In the 0-5, 6-10 and 11-14 year age groups, the percentage of patients was respectively 18.3%, 26.6% and 55.1%. Patients were registered as new cases (87.7%), relapses (1.9%), failures (1.0%), defaulters (5.0%), transferred in (0.9%) and others (3.5%). Of the total number of cases, 414 were smear-positive and 404 smear-negative, while sputum status was not known for 280 patients. Sputum positivity increased with age. Category I, II and III regimens were started by respectively 50.6%, 10.5% and 38.9% patients. The cure rate was 92.4% (302/327) for new and 92% (80/87) for retreatment cases (chi(2)(1) = 0.02, P = 0.901), but the treatment completion rate was significantly higher for new cases (97%, 636/656) than retreatment cases (53.6%, 15/28) (chi(2)(1) = 100.8, P < 0.001). The overall success rate was 95.4% and 82.6% for new and retreatment cases, respectively (chi(2)(1) = 30.35, P < 0.001). Overall, the rates for default, failure and death in the study were respectively 3%, 1.9% and 1%. CONCLUSION: DOTS appears to be a highly efficacious treatment strategy.     

CT findings in a child with reflux oesophagitis.

We report the case of a 7-month-old boy who presented with a history of vomiting since birth. A computed tomography study showed circumferential thickening of the lower oesophageal wall with enhancement of the mucosa. After a period of antireflux medication, the patient underwent simultaneous oesophageal dilatation and Nissen fundoplication. He is doing well at 2-year follow up.     

Post-transplant infections: single center experience from the developing world.

OBJECTIVE: To describe our experience of post-transplant infections in allogeneic stem cell transplants at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. METHODS: From July 2001 to September 2006, patients with malignant and non-malignant hematological disorders having human leukocyte antigen (HLA)-matched sibling donors were selected for transplant. Pre-transplant infection surveillance was carried out, and strict prophylaxis against infection was observed. After admission to the hospital, patients were kept in protective isolation rooms, equipped with a HEPA filter positive-pressure laminar airflow ventilation system. Bone marrow and/or peripheral blood stem cells were used as the stem cell source. Cyclosporin and prednisolone were used as prophylaxis against graft-versus-host disease (GVHD). The engraftment was monitored with cytogenetic/molecular analysis and change of blood group. Survival was calculated from the date of transplant to death or last follow-up. RESULTS: One hundred and fifty-four patients received allogeneic stem cell transplants from HLA-matched siblings for various hematological disorders at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan between July 2001 and September 2006. Indications for transplant included aplastic anemia (n=66), beta-thalassemia major (n=40), chronic myeloid leukemia (n=33), acute leukemia (n=8), and miscellaneous disorders (n=7). One hundred and twenty patients were male and 34 were female. The median age of the patient cohort was 14 years (range 1 1/4-54 years). One hundred and thirty-six patients and 135 donors were cytomegalovirus (CMV) IgG-positive. One hundred and forty patients (90.9%) developed febrile episodes in different phases of post-transplant recovery. Infective organisms were isolated in 150 microbiological culture specimens out of 651 specimens from different sites of infections (23.0% culture positivity). Post-transplant infections were confirmed in 120 patients (77.9%) on the basis of clinical assessment and microbiological, virological, and histopathological examination. Mortality related to infections was 13.0%. Fatal infections included CMV disease (100% mortality, 6/6), disseminated aspergillosis (66.7% mortality, 4/6), pseudomonas septicemia (42.9% mortality, 9/21), and tuberculosis (25% mortality, 1/4). CONCLUSIONS: More than 90% of our patients developed febrile episodes with relatively low culture yield. The majority of infections were treated effectively, however CMV, aspergillosis, and pseudomonas infections remained problematic with high mortality.