Health effects associated with passenger vehicles: monetary values of air pollution

Air pollution is regarded as one of the highest priorities in environmental protection in both developed and developing countries. High levels of air pollution have adverse effects on human health that might cause premature death. This study presents the monetary value estimates for the adverse human health effects resulted from ambient air pollution. It aids decision makers to set priorities in the public health relevance of pollution abatement. The main driver of policymaker is the need to reduce the avoidable cardiopulmonary morbidity and mortality from pollutant exposures. The monetary valuation involves 2 steps: (i) relate levels of pollutants to mortality and morbidity (concentration-response relationships) and (ii) apply unit economic values. Cost of air pollution associated with passenger vehicles running over a major traffic bridge (6th of October Elevated Highway) is presented as a case study to demonstrate the use of monetary value of air pollution. The study proves that the cost of air pollution is extremely high and should not be overlooked.     

Low turnover bone disease in Egyptian children with acute leukemia

The aim of this work was to study bone turnover markers, calcium homeostasis and bone mineral density (BMD) in children with acute leukemia at diagnosis, after induction chemotherapy, and during maintenance therapy to delineate abnormalities present. After evaluation of L2-L4 BMD using dual-energy X-ray absorptiometry in patients with acute myeloid and lymphoid leukemia at presentation and after treatment, the results were compared to 352 healthy age- and sex-matched Egyptian controls. Calcium homeostasis parameters and bone turnover biochemical markers (serum osteocalcin and urinary deoxypyridinoline) were also assayed and the results were compared to 12 healthy age- and sex-matched controls. Osteopenia was observed at diagnosis and during treatment in patients with acute leukemia. At diagnosis osteopenia was observed in 27 patients (62.8%): 10 (23.3%) had non severe osteopenia and 17 (39.5%) had severe osteopenia. This low BMD persisted in those who were followed up. Parathyroid hormone (PTH) (pg/ml) levels demonstrated non significant differences between children with acute leukemia at different stages of therapy and controls, while, 25 (OH) D3 (ng/ml) was significantly lower in acute leukemia patients at different stages of therapy compared to controls (p<0.001). Osteocalcin (ng/ml) is significantly lower in patients at different stages of the disease compared to controls (p<0.001) but there was no significant difference between patients at different stages of therapy. Deoxy-pyridoline cross links showed non-significant difference between the different types of acute leukemia and with controls. Osteopenia is a significant problem in children with acute leukemia at presentation and after chemotherapy. Osteopenia in acute leukemia appears to be of the low turnover type (decreased osteoblastic activity and decreased bone mineralization).     

Mechanism of action of sacral nerve stimulation using a transdermal amplitude-modulated signal in a spinal cord injury rodent model

Introduction:

Sacral neuromodulation (SNM) is an effective treatment modality for several urological problems, including neurogenic bladder. However, the invasiveness of this technique makes it unsuitable for many patients. We present a novel transdermal amplitude-modulated signal (TAMS) that may provide a non-invasive alternative to implantable SNM to treat neurogenic detrusor overactivity (NDO).

Methods:

In this study, we investigated the mechanism of action of non-invasive SNM using TAMS on our established spinal cord injury (SCI) animal model. We demonstrated that spinally transected rats develop urinary bladder hyper-reflexia after 3 weeks of SCI, indicated by the presence of uninhibited contractions, increased resting pressure, increased threshold pressure and increased maximum voiding pressure.

Results:

Short-term neurostimulation affected urodynamics parameters by significantly reducing the threshold pressure (p = 0.02). Spinal transection also increased calcitonin gene-related protein (CGRP) concentration in the L6 dorsal root ganglia; whereas, neurostimulation significantly reduced CGRP concentration in L6 (p = 0.03).

Conclusion:

TAMS caused a reduction in NDO by inhibiting C-fibre activity.     

A randomized comparison of labetalol and nitroprusside for induced hypotension

In a randomized study, labetalol-induced hypotension and nitroprusside-induced hypotension were compared in 20 patients (10 in each group) scheduled for major orthopedic procedures. Each patient was subjected to an identical anesthetic protocol and similar drug-induced reductions in mean arterial blood pressure (BP) (50 to 55 mmHg). Nitroprusside infusion was associated with a significant (p < 0.05) increase in heart rate and cardiac output; rebound hypertension was observed in three patients after discontinuation of nitroprusside. Labetalol administration was not associated with any of these findings. Arterial PO₂ decreased in both groups. It was concluded that labetalol offers advantages over nitroprusside.     

Toxicity of high-dose intravitreal dexamethasone

The intravitreal toxicity of a high concentration of dexamethasone was studied in New Zealand white rabbits. No toxicity was observed after intravitreal injections of up to 4.8 mg/0.2 ml.     

Antral Endocrine Cells in Nonobese Diabetic Mice

The antral endocrine cells were investigated innonobese diabetic (NOD) mice by means ofimmunohistochemistry, image analysis, andradioimmunoassays (RIA). As controls BALB/CJ mice of thesame age and sex as the NOD mice were used. The number ofgastrin- and somatostatin-immunoreactive cells wassignificantly decreased in both prediabetic and diabeticmice. There was no statistical difference between the NOD mice and controls regarding theserotonin-immunoreactive cells. Somatostatin levels asrevealed by RIA in the antrum of both prediabetic anddiabetic NOD mice were lower than those of the controls. There was no statistical difference in thelevel of antral gastrin between NOD mice and thecontrols. It was concluded that the changes in antralcells are primary to the onset of diabetes, and that the abnormalities observed in the antral cells inan animal model for diabetes type I might have relevancefor the upper gastrointestinal dysfunction displayed inhuman diabetes.     

Carotid artery dissection

Opinion statement Dissection of the carotid artery in the neck is a relatively common condition. Most dissections are spontaneous, likely related to activities that cause sudden stretch of the pharyngeal portion of the carotid artery. Many patients do not develop brain ischemia but have a triad of neck and head pain, Horner’s syndrome, and pulsatile tinnitus. Others present with transient or persistent brain ischemia. Strokes are due to the embolization of thrombus material from the lumen of the dissected artery to the intracranial arteries, most often the middle cerebral artery. Although there have been no randomized therapeutic trials in patients with carotid artery dissection, experience shows that standard anticoagulants in the form of heparin followed by Coumadin (Du Pont Pharma, Wilmington, DE) are effective in preventing further artery-to-artery emboli.     

CT of hepatic schistosomiasis mansoni

Schistosomal periportal fibrosis produced a typical pattern on computed tomography in five patients. Low-density periportal tissue, present throughout the liver, enhanced strongly after the administration of contrast medium. While rounded in cross section, the thickened periportal tissue produced linear and branching patterns when imaged in longitudinal section. In all cases, the sonographic features were typical of schistosomal periportal fibrosis. A lack of awareness of the distinctive features of periportal fibrosis may result in a mistaken diagnosis of hepatic metastases.     

Neurourologic correlation in multiple sclerosis

Vesicourethral dysfunction is a common finding in patients with multiple sclerosis (MS). In a retrospective study of 70 patients with MS we correlated urologic, neurologic, and urodynamic data. We found that 67% of patients complained of voiding dysfunction: irritative bladder symptoms in 37.2%, obstructive bladder symptoms in 23.2%, and combination of both in 39.5%. Signs of bilateral pyramidal tract dysfunction were found in 58.5% of patients. Urodynamic studies revealed the presence of unstable (hyperreflexic) bladder in 70.2% and hypotonic bladder in 18.2%. There is a high statistical correlation (P = .0001) between the presence of signs of bilateral pyramidal tract dysfunction and bladder unstability. We suggest that in MS patients, a particular emphasis should be placed on pyramidal signs. A urodynamic study is very helpful, particularly in those showing bilateral signs of pyramidal tract dysfunction.     

Pessary use in advanced pelvic organ prolapse

The objective of this study was to review our experience with pessary use for advanced pelvic organ prolapse. Charts of patients treated for Stage III and IV prolapse were reviewed. Comparisons were made between patients who tried or refused pessary use. A successful trial of pessary was defined by continued use; a failed trial was defined by a patients discontinued use. Thirty-two patients tried a pessary; 45 refused. Patients who refused a pessary were younger, had lesser degree of prolapse, and more often had urinary incontinence. Most patients (62.5%) continued pessary use and avoided surgery. Unsuccessful trial of pessary resorting to surgery included four patients (33%) with unwillingness to maintain, three patients (25%) with inability to retain and two patients (17%) with vaginal erosion and/or discharge. Our findings suggest that pessary use is an acceptable first-line option for treatment of advanced pelvic organ prolapse.