Neuroleptic malignant syndrome

We report 37-year-old man admitted to the psychiatric ward with acute depression. Antidepressive medications were initiated including: promethazine hydrochloride, hydroxyzine hydrochloride, lorazepam and haloperidol. In an attempt to control his depression, doctors increased the dose of haloperidol. Five days later he developed fever, cough, confusion and he was unable to eat. Accordingly, he was transferred to the medical ward for further assessment. On examination he was febrile, confused, there was neck stiffness and generalized rigidity with flexor planters. Both serum myoglobin and creatine kinase level were elevated. The urine myoglobin test result was positive. He was diagnosed with neuroleptic malignant syndrome. Dantrolene was started for 3 days, followed by bromocriptine. The clinical syndrome resolved over the next couple of days.     

Methods and studies of tongue reconstruction

Total and even partial glossectomy could be a major event in the life of a patient. Tongue function is so complicated which makes maintaining normal functions of the tongue such as swallowing and speech and preserving larynx integrity after the surgery is a primary objective of the surgeon. This task is very difficult and the result is not predictable. Recent years, however, there has been interesting developments in microsurgical techniques, and these advancements enable oral and maxillofacial surgeons to achieve better results and improve the quality of their patient′s life. The results even with use of the new technology are still far from perfect. Several reasons may cause variation in the result. Some of them have to do with the patient such as general health and other reasons are due to the method that is used and nature of the defect after the removal of the tumor. This article was undertaken to summarize the various methods and techniques used over the years to restore oral tongue functions after defects.     

Dietary intervention versus metformin to improve the reproductive outcome in women with polycystic ovary syndrome. A prospective comparative study

OBJECTIVE: To compare the clinical results and reproductive outcome in obese women with polycystic ovary syndrome (PCOS) following dietary intervention or treatment with metformin. METHODS: Forty-six patients with PCOS were studied prospectively in Prince Rashed Hospital, Irbid, Jordan, between January 2003 and April 2005. The women were randomly divided into 2 groups: Group 1 (n=24) was prescribed with 1200-1400 kcal/day diet (25% proteins, 25% fat, and 50% carbohydrates plus 25-30 gm of fiber per week). Group 2 (n=22) was assigned to take 850 mg of metformin twice in a continuous manner. Both treatments continued for 6 months. Clinical and biochemical data, before and after both treatments along with the reproductive outcome were compared between the 2 groups. RESULTS: There were no significant differences between the 2 groups in terms of age, body mass index (BMI) and duration of infertility. Both groups had a significant improvement after treatment in the menstrual cyclicity (66.7% and 68.2% versus 12.5% and 18.2%) and significant reduction in BMI (mean of 27.4 and 27.8 versus 32.2 and 31.9), luteinizing hormone levels (7.9+/-1.7 and 6.9+/-1.8 versus 11.8+/-2.2 and 11.5+/-1.8), and androgen (testosterone, androstenedione, dehydroepiandrosterone sulfate) concentration. The clinical, biochemical, and reproductive outcome including menstrual cycle pattern, ovulation, and pregnancy rates were similar in both groups after treatment. CONCLUSION: Amelioration of hyperinsulinemia and hyperandrogenemia with dietary intervention or metformin treatment improves significantly the clinical features and reproductive function in overweight PCOS women.     

Chronic outpatient management of asthmatics attending the emergency department: a survey from a country with low income.

PURPOSE: Little is known about compliance with international guidelines of asthma management in developing countries where some medications are prohibitively expensive. METHODS: A survey was conducted in asthmatic patients attending the emergency department for acute asthma. Asthma severity was evaluated and conformity of chronic treatment with international guidelines was assessed. Additional features of asthmatic education were also evaluated. RESULTS: A total of 127 consecutive patients (mean age 34 +/- 14 years) answered the questionnaire. Mild asthma was present in 19.7% patients, 56.7% had moderate asthma and 23.6% had severe asthma. Of the 124 known asthmatic patients, 33% had no treatment for chronic asthma. In the remaining, treatment adhered to international guidelines in 44% patients. The major cause of treatment inadequacy was the lack of inhaled corticosteroids (64%) or suboptimal dosage of corticosteroids (13%). Conformity to guidelines according to favorable or unfavorable economic conditions was 59% and 33%, respectively (P = 0.036). Treating physicians provided an 'action plan' for managing acute symptoms to 19% patients. Forty percent of asthmatic patients performed correctly the five components of metered dose inhaler use. CONCLUSION: Our study reveals an important proportion of non-treated asthmatic patients. In most asthmatic patients, treatment did not conform with guidelines because of an underutilization of corticosteroids, mainly because of economic obstacles.     

Efficacy of fasting calorie restriction on quality of life among aging men

Calorie restriction (CR) has been promoted to increase longevity. Previous studies have indicated that CR can negatively affect mood and therefore the effect of CR on mood and quality of life (QOL) becomes crucial when considering the feasibility of CR in humans. We conducted a three month clinical trial on CR (reduction of 300 to 500 kcal/day) combined with two days/week of Muslim sunnah fasting (FCR) to determine the effectiveness of FCR on QOL among aging men in Klang Valley, Malaysia. A total of 25 healthy Malay men (age 58.8 ± 5.1 years), with no chronic diseases and a BMI of 23.0 to 29.9 kg/m² were randomized to FCR (n = 12) and control (n = 13) groups. Body composition measurements and QOL questionnaires were ascertained at baseline, week 6 and week 12. QOL was measured using the Short-Form 36, sleep quality was determined using the Pittsburgh Sleep Quality Index, the Beck Depression Inventory II was used to measure mood and the Perceived Stress Scale was used to measure depression. The FCR group had a significant reduction in body weight, BMI, body fat percentage and depression (P < 0.05). The energy component of QOL was significantly increased in FCR group (p < 0.05). There were no significant changes in sleep quality and stress level between the groups as a result of the intervention. In conclusion, FCR resulted in body weight and fat loss and alleviated depression with some improvement in the QOL in our study and has the potential to be implemented on a wider scale.     

A novel norovirus recombinant strain GII.4/GII.21 in Bangladesh, 2011

We identified a novel inter-genotype recombinant norovirus strain, Dhaka85/2011/BGD, collected from a stool specimen of a nine-month-old infant who was hospitalized with diarrhea. Molecular investigation and phylogenetic analysis classified its RNA polymerase gene as GII.4-like, which commonly circulates in humans. The capsid gene was classified as GII.21-like, most likely originated from water. The discovery of this novel strain is an illustration of the enormous diversity among the norovirus strains, especially in developing countries and has important implications for future vaccine strategies.     

Complete Genome Sequence and Phylogenetic Relatedness of Hepatitis B Virus Isolates in Papua,Indonesia

Each hepatitis B virus (HBV) genotype and subgenotype is associated with a particular geographic distribution, ethnicity, and anthropological history. Our previous study showed the novel HBV subgenotypes C6 (HBV/C6) and D6 (HBV/D6), based on the S gene sequences of isolates in Papua, Indonesia. The present study investigated the complete genome sequence of 22 strains from Papua and subjected them to molecular evolutionary analysis. A phylogenetic analysis revealed that 9 out of 22 strains were classified as HBV/C6, 3 strains as HBV/D6, and 9 strains as HBV/B3. A particular strain positioned between HBV/B3 and HBV/B5 remained unclassifiable into any known subgenotypes. This strain showed high homology with HBV/C5 from the Philippines in the core region and was thought to have undergone genetic recombination with HBV/C5. Further studies are needed to determine whether this strain belongs to a new subgenotype of HBV/B. Based on the amino acid alignment, HBV/C6 has subgenotype specific variations (G18V and V47M) in the S region. HBV/C6 strains were more closely related in terms of evolutionary distance to strains from the east Asia and Pacific regions than those found in southeast Asia. HBV/D6 strains were most closely related to strains from the Western countries (HBV/D3) rather than those from Asia and Papua New Guinea. In conclusion, we have confirmed by complete sequence analysis that two novel HBV subgenotypes, HBV/C6 and HBV/D6, are prevalent in Papua, Indonesia.Hepatitis B virus (HBV) is an etiological agent of chronic liver disease, including chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma, and this poses major health problems worldwide, especially in Asian Pacific countries (7, 10).HBV strains that infect humans show genetic and antigenic heterogeneity, and eight genotypes, designated A to H, have been identified so far by molecular evolutionary analysis (19). The HBV genotypes have distinct geographical distributions, which are associated with anthropological history (4, 13, 20, 31). Furthermore, previous studies have demonstrated the presence of several subgenotypes within the widely spread genotypes. HBV genotype B (HBV/B) is classified into six subgenotypes, B1 to B6, B1 dominating in Japan, B2 in China and Vietnam, B3 in Indonesia, B4 in Vietnam, B5 in the Philippines, and B6 in the Arctic (3, 16, 23, 24, 26, 27). As for HBV/C, C1 is common in southeast Asia, C2 in east Asia, C3 in Oceania, C4 in Aborigines, and C5 in the Philippines (15, 26). HBV/D has a worldwide distribution, with its highest prevalence in the Mediterranean region, and is classified as D1 to D5 (1, 15, 17). Our previous study revealed novel subgenotypes (HBV/C6 and HBV/D6) based on the S gene sequence of HBV isolates in Papua, Indonesia, where HBV infection is endemic (9).HBV genotyping with the S gene sequence is, in general, consistent with the genotyping of the full genomic sequence, and therefore, HBV genotypes can be assigned based upon S gene sequences (11, 16, 19). Subgenotype classification, however, may not be applicable to some HBV strains on the basis of the S region sequence alone (9, 14, 15). Accordingly, complete genome sequences are more reliable for the analysis of genotype and subgenotype classification for HBV (14). The data on the complete genome sequences of the HBV strains found in Papua are scant. The present study aimed to evaluate the HBV genotypes and subgenotypes present among the Papuan population using complete genome sequences. In addition, the phylogenetic relatedness of HBV strains isolated from Papua was assessed.     

Facile fabrication of a phosphonium-based ionic liquid impregnated chitosan adsorbent for the recovery of hexavalent chromium

Chitosan adsorbents impregnated with a phosphonium-based ionic liquid (Chi_IL), trioctyldodecyl phosphonium chloride, were prepared for the adsorption of hexavalent chromium and compared to the performance of native chitosan. The physical and chemical properties of the adsorbents were characterized by Fourier-transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Effects of various parameters, such as pH, adsorbent dosage, contact time, temperature, and multi-component systems, were systematically examined. Chi_IL showed a high adsorption capacity (282.6 mg g⁻¹) compared to native chitosan (238.1 mg g⁻¹). The adsorption kinetics of the metals followed a pseudo-second-order kinetic model, and the experimental data were a good fit for the Freundlich isotherm model. Following the isotherm and activation energy parameter, adsorption of Cr(vi) onto Chi_IL follows a chemisorption process, possibly through an anionic exchange with the anion of the IL. The thermodynamic parameters suggested that the adsorption of Cr(vi) is a spontaneous and exothermic reaction. In the column adsorption, Chi_IL exhibited a longer column exhaustion time than that of native chitosan owing to the enhanced adsorption capacity caused by the introduction of IL. Moreover, the column with the parameters of 6 cm bed depth, 5 mL min⁻¹ flow rate, and 50 mg L⁻¹ was able to achieve the best performance in Cr(vi) adsorption.

Trioctyldodecyl phosphonium chloride was impregnated onto chitosan and able to efficiently remove Cr(vi) in batch and continuous adsorption. The Cr(vi) was chemically adsorbed onto the adsorbent through anionic exchange with the ionic liquid moieties.