Paracetamol use in pregnancy and wheezing in early childhood

BACKGROUND: We recently reported links between frequent paracetamol (acetaminophen) use and wheezing and asthma in adults and children, but data are lacking on possible effects of prenatal exposure on wheezing in early childhood. METHODS: In the population based Avon Longitudinal Study of Parents and Children (ALSPAC) women were asked twice during pregnancy (at 18-20 weeks and 32 weeks) about their usage of paracetamol and aspirin. Six months after birth, and at yearly intervals thereafter, mothers were asked about wheezing and eczema symptoms in their child. The effects of paracetamol and aspirin use in pregnancy on the risk in the offspring of wheezing at 30-42 months (n=9,400) and eczema at 18-30 months (n=10,216) and on their risk of different wheezing patterns (defined by presence or absence of wheezing at <6 months and at 30-42 months) were examined. RESULTS: Paracetamol was taken frequently (most days/daily) by only 1% of women. After controlling for potential confounders, frequent paracetamol use in late pregnancy (20-32 weeks), but not in early pregnancy (<18-20 weeks), was associated with an increased risk of wheezing in the offspring at 30-42 months (adjusted odds ratio (OR) compared with no use 2.10 (95% CI 1.30 to 3.41); p=0.003), particularly if wheezing started before 6 months (OR 2.34 (95% CI 1.24 to 4.40); p=0.008). Assuming a causal relation, only about 1% of wheezing at 30-42 months was attributable to this exposure. Frequent paracetamol use in pregnancy was not associated with an increased risk of eczema. Frequent aspirin use in pregnancy was associated with an increased risk of wheezing only at <6 months. CONCLUSIONS: Frequent use of paracetamol in late pregnancy may increase the risk of wheezing in the offspring, although such an effect could explain only about 1% of the population prevalence of wheezing in early childhood.     

Two new triterpenoids from Azadirachta indica and their insecticidal activity

Two new triterpenoids, 22,23-dihydronimocinol (1) and desfurano-6alpha-hydroxyazadiradione (2), were isolated from a methanolic extract of the fresh leaves of Azadirachta indica (neem) along with a known meliacin, 7alpha-senecioyl-(7-deacetyl)-23-O-methylnimocinolide. The structures of 1 and 2 were elucidated through spectral and chemical studies. Compounds 1 and 2 showed mortality for fourth instar larvae of the mosquito (Anopheles stephensi), with LC(50) values of 60 and 43 ppm, respectively.     

Demographic and epidemiologic transition in the developing world: role of albuminuria in the early diagnosis and prevention of renal and cardiovascular disease

The developing world is facing a real pandemic of renal and cardiovascular disease. With the decrease of infectious disease morbidity and mortality, and the exposure to more westernized life style, signs of increasing renal and cardiovascular disease is particularly shown in the tremendous rise in type 2 diabetes and its sequelae. A group of doctors and scientists from all over the world have convened in Bellagio to halt this dramatic disease change and burden to the developing countries. They came to the conclusion that screening and treatment should clearly focus on cost-beneficial strategies, among which blood pressure and urinary albumin measurement, as well as effective and affordable treatment strategies to lower blood pressure and albuminuria, are essential.     

Epilepsy in children with cerebral palsy

This was a prospective analytical study done from October'99 through December 2000 to observe the clinical profile of epilepsy in children with cerebral palsy. Sixty epileptic children with cerebral palsy were studied and their results were compared with the results of epilepsy in 30 developmentally normal children. Ages of all children studied were 1-15 years. Majority were below five years of age and male out numbered female. Spastic quadriplegia (60%) was the commonest type of cerebral palsy. Generalized tonic-clonic seizure (66%) was the commonest seizure type in both groups. Second most common type of seizure was partial (13%) and myoclonic (29%) in developmentally normal and cerebral palsy children respectively. Mental retardation (63%) and speech delay (58%) were the two common associated problems in cerebral palsy patients. Ventriculomegaly (55%) was the commonest computed tomographic findings in cerebral palsy patients. In electro encephalography generalized epileptiform activity was the commonest finding in both groups. Clinical pattern is different in many ways when epilepsy is associated with cerebral palsy.     

Feasibility of open simple prostatectomy with early vascular control

OBJECTIVE: To determine the feasibility of open simple prostatectomy with early vascular control in the treatment of benign prostate hyperplasia (BPH), and thus reduce blood loss. PATIENTS AND METHODS: Thirty-seven patients were reviewed from 1991 to 2002; 34 had a Millin's and three a Freyer's prostatectomy performed by one surgeon, with early vascular control. RESULTS: The mean operative duration was 1.3 h and the mean blood loss 841 mL, with a mean decrease in haemoglobin level of 22 g/L. Six (16%) of the patients received a blood transfusion. The mean weight of the prostate removed was 97.8 g; the duration of catheterization and the hospital stay after surgery were 6.21 and 11.7 days, respectively. There was one (3%) death and one case of pulmonary embolism. Three patients (8%) developed stress incontinence. Two failed to void after surgery and one developed acute retention 3 years later. Five patients developed recurrent obstructive symptoms. CONCLUSION: Open simple prostatectomy with early vascular control reduces the amount of blood loss, rendering it a safe option for treating BPH.     

Primary extranodal non-Hodgkin's lymphoma of the oral cavity

Non-Hodgkin's lymphoma (NHL) belongs to a group of lymphoid neoplasms that is diverse in manner of presentation, response to therapy and prognosis. Usually the oral manifestations of NHL are secondary to a more widespread involvement throughout the body. Though primary intraoral lesions in NHL are uncommon, it is important to be aware of them, since intraoral manifestations are the presenting symptom in these patients. A 55 year old woman presented with a swelling in the maxillary right alveolus and buccal vestibule. There were no palpable lymph nodes. A CT scan revealed a mass on the labial aspect of the right maxilla with no involvement of the maxillary sinus. Incisional biopsy of the lesion showed a dense lymphocytic infiltrate with formation of variably sized lymphoid follicles. The infiltrate showed a mixed neoplastic lymphocyte composition which was suggestive of follicular mixed type of malignant B cell primary extranodal lymphoma. The patient was treated with chemotherapy followed by radiation.