Echocardiography and Management of Sick Neonates in the Intensive Care Unit

To evaluate the influence of echocardiographic examination in the clinical management of the sick neonate, 241 patients, admitted to the neonatal intensive care unit of a tertiary referral center that had echocardiograms with data available for review, were enrolled in a retrospective study. Asymptomatic murmurs (45%) followed by extracardiac anomalies/dysmorphic features (24%) were the most common clinical indications for requesting an echocardiogram. Congenital structural abnormalities (33%), hemodynamically significant patent arterial duct (3%), persistent pulmonary hypertension of the newborn (6%), and left ventricular dysfunction (3%) were the echocardiographic findings that subgrouped as structural or functional abnormalities. Patent oval foramen and hemodynamically nonsignificant patent arterial duct (20%) and physiologic pulmonary artery stenosis (1%) were categorized as normal structural group. Thirty‐four percent of neonates had normal heart anatomy. This investigation changed the clinical management in at least 66% of newborns scanned, including emergency surgical intervention for 7%, medical treatment for 22%, and routine cardiologic follow‐up for 37% of patients. Asymptomatic murmur in our critically ill neonates has been associated with a higher incidence of cardiac disease. Hence, echocardiography is an important tool for diagnosis of cardiac abnormalities that can influence the management and outcome of the sick newborn in the intensive care unit. A preliminary echocardiogram performed by the neonatologist under the supervision of a pediatric cardiologist for interpretation and review is an alternate when there is not a cardiologist “in house.”     

HLA-B35 association with nephritis in Henoch-Schönlein purpura

OBJECTIVE: To investigate the implications of the HLA-B locus in the susceptibility to Henoch-Sch?nlein purpura (HSP) and determine if there are associations with renal and gastrointestinal (GI) manifestations of the disease. METHODS: A retrospective study was performed on an unselected population of patients with HSP from Northwest Spain. Forty-eight Caucasian patients (24 women), 11 of them older than 20 years, were studied. Patients and ethnically matched controls were HLA-B genotyped from DNA using molecular based methods. RESULTS: When patients with HSP were compared with matched controls, no differences in HLA-B frequencies were observed. No HLA-B associations with GI manifestations were observed. In contrast, an increased frequency of HLA-B35 was observed in patients with renal manifestations (10 of 31) compared to those without (0 of 17). No significant distortions in frequency were seen for any other HLA-B alleles with HSP subgroups. CONCLUSION: Our results support a role of HLA-B35 in the susceptibility for nephritis in unselected patients with HSP.     

MCP-1 gene haplotype association in biopsy proven giant cell arteritis

OBJECTIVE: Giant cell arteritis (GCA) is the most frequent vasculitis in European and North American countries. Increased expression of monocyte chemoattractant protein 1 (MCP-1) has been observed within the inflammatory infiltrates of blood vessels and serum of patients with GCA and in other autoimmune and inflammatory conditions. MCP-1 gene polymorphisms have been reported to contribute to susceptibility to several immune and inflammatory conditions. To investigate the clinical implication of MCP-1 polymorphisms in GCA, we examined the association of 3 single nucleotide polymorphisms (SNP) in a series of patients with GCA from Northwest Spain. METHODS: Seventy-nine patients with biopsy proven GCA and 99 ethnically matched controls were studied. Patients and controls were genotyped for MCP-1 polymorphisms. SNP included in this study (rs2857657, rs4586, rs139000) were located in intron 1(G/C), exon 2(T/C), and 3'UTR(C/T) region of MCP-1 gene. RESULTS: The distribution of the alleles and genotypes for each MCP-1 polymorphism showed no significant differences between GCA patients and controls. When we compared the overall distribution of haplotype frequencies between GCA cases and controls a significant difference was observed (p = 0.005, by chi-square test from 4 2 contingency table). In addition, haplotype C-C was significantly increased in GCA patients compared with controls (p = 0.03, OR 2.09, 95% CI 1.09-4.02). Similarly, haplotype T-T was overrepresented in GCA patients (p = 0.005). CONCLUSION: Significant differences in haplotype frequencies between GCA patients and controls may indicate a role for MCP-1 gene in susceptibility to GCA.     

Acute methemoglobinemia following attempted suicide by Dapson

This report describes the case of an otherwise healthy young adult female, with oral ingestion of 40 unknown tablets. Her clinical course included progressive bluish discoloration of lips and limbs, hemolysis and jaundice. A high PaO2 in the presence of cyanosis and dark blood lead to suspicion of methemoglobinemia. Laboratory results showed methemoglobin level to be 3.8 g/dL (38%). The etiology was traced to dapsone according to patient history; after 3 days it became evident that she had ingested 2 g dapsone in suicidal intent. The therapeutic and diagnostic approach in such patients is discussed. In conclusion, acute methemoglobinemia is an uncommon but potentially treatable disorder.     

Modifiable Risk of Breast Cancer in Northeast Iran: Hope for the Future. A Case-Control Study

BACKGROUND: Breast cancer is the most common cancer in women. Its prevalence is increasing annually by 2%. The determination of modifiable risk factors has been the subject of various studies. The aim of this study was to determine risk factors of breast cancer in women in Golestan Province. PATIENTS AND METHODS: This case-control study was conducted among women with breast cancer recorded in the cancer registry system between 2004 and 2006 (n = 134), and their age-matched healthy neighbors (n = 133). Data were statistically analyzed. RESULTS: Age at marriage, menarche and pregnancy, breast feeding, positive family history, marital status, and educational level were not significantly correlated with risk of breast cancer, but age at menopause (< 46.6 years) was significantly correlated (95% confidence interval 1.15-7.37; p = 0.021). Live births, still births, and infant deaths were not significantly different between the 2 groups. For other variables, such as smoking history, no odds ratio was calculated. CONCLUSION: Results show that there is no significant correlation between variables and risk of breast cancer in our population, except for age at menopause. A large cohort study is recommended.     

Comparison of the sealing ability of mineral trioxide aggregate and Portland cement used as root-end filling materials

Inadequate apical seal is the major cause of surgical endodontic failure. The root-end filling material used should prevent egress of potential contaminants into periapical tissue. The purpose of this study was to compare the sealing ability of four root-end filling materials: white mineral trioxide aggregate (MTA), gray MTA, white Portland cement (PC) and gray PC by dye leakage test. Ninety-six human single-rooted teeth were instrumented, and obturated with gutta-percha. After resecting the apex, an apical cavity was prepared. The teeth were randomly divided into four experimental groups (A: white MTA, B: gray MTA, C: white PC and D: gray PC; n = 20) and two control groups (positive and negative control groups; n = 8). Root-end cavities in the experimental groups were filled with the experimental materials. The teeth were exposed to Indian ink for 72 hours. The extent of dye penetration was measured with a stereomicroscope at 16× magnification. The negative controls showed no dye penetration and dye penetration was seen in the entire root-end cavity of positive controls. However, there was no statistically significant difference among the four experimental groups (P > 0.05). All retrograde filling materials tested in this study showed the same microleakage in vitro. Given the low cost and apparently similar sealing ability of PC, PC could be considered as a substitute for MTA as a root-end filling material.