Liquefaction necrosis of mitral annulus calcification

Liquefaction necrosis of the mitral annulus is a rare form of peri‐annular calcification that the cardiologist must be able to differentiate from other cardiac masses. It classically looks like a round or semilunar hyperdense mass with a denser peripheral rim, located mainly in the posterior mitral annulus. The case we report here was diagnosed in a 78‐year‐old female patient who presented with an embolic cerebral vascular accident, which raises the question of its etiopathogenic responsibility. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :382–383, 2014     

Preparation and optimization of various parameters of enteric coated pellets using the Taguchi L9 orthogonal array design and their characterization

Duloxetine hydrochloride enteric coated pellets were formulated using fluidized bed. Three separate layers, the drug layer, the barrier layer, and the enteric layer, were coated onto the inert core pellets. The pellets were optimized with the acid resistance and drug release in simulated intestinal fluid as the process parameters, using the Taguchi L9 orthogonal array. Various other properties, such as surface morphology, bulk and tapped density, Hausner's ratio, hardness, friability, yield of pellets, moisture content, and particle size distribution, were also studied in the optimized pellets. The concentration of the enteric polymer played a vital role in acid resistance, while the type of enteric polymer affected the drug release in simulated intestinal fluid. In both cases, it was determined that binder polymer concentration was not affected much. The comparisons between the optimized pellets and a market formulation yielded f1 and f2 values within a range of 4–5 and 60–65, respectively. Three month stability studies, conducted at accelerated conditions, showed the optimized pellets to be stable. Taguchi plays an important role in optimizing parameters, and optimization of duloxetine hydrochloride can be achieved with minimal trials.     

How Is Substance Use Linked to Psychosis? A Study of the Course and Patterns of Substance Dependence in Psychosis

ABSTRACT

Substance use in mentally ill patients is now a major problem that influences the course and outcome of psychosis. With prevalence ranging up to 60%, several theories were postulated to explain the link. It would be interesting to know if substances have different effects in persons with psychosis than in those without. This study aimed to explore patterns of symptomatology of dependence and comorbid psychiatric illness by comparing and contrasting it with a group suffering from pure substance dependence. Consecutively admitted patients who were matched for age, sex, and tobacco use were divided into 3 groups. These were substance dependence without any comorbid psychiatric disorder (SD; n = 32), schizophrenia with substance dependence (SC; n = 31), and bipolar disorder with substance dependence (BD; n = 31). Patients were administered the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and Mini International Neuropsychiatric Inventory (MINI) to evaluate the chronology of criterion of International Classificiation of Diseases (ICD)-10 dependence. Results showed that cannabis was the most common substance used by both the SC (100%) and BD (80%) groups. This was followed by alcohol as the most common substance used, with prevalence of 87% in SC and 77% in BD groups. There was a significant difference in the pattern of use of cannabis in patients with psychosis, who developed tolerance much faster (P = .018) and had longer durations of cannabis use (P = .001) than the SD group. The presence of “loss of control” over drug use criterion seems to be a specific marker predicting development of dependence and psychosis. Cannabis use is more strongly associated with development of psychosis than any other substance.     

Trends and determinants of mortality in women of reproductive age in rural Guinea-Bissau,West Africa – a cohort study

Background

There are few studies reporting mortality of women of reproductive age (WRA) in developing countries. The trend and patterns of their mortality may be important for documenting the health status of the population in general.

Methods

We used a prospective open cohort of women aged 12 to 49 years living in the Bandim Health Project’s rural Health and Demographic Surveillance System (HDSS) in 5 regions of Guinea-Bissau from 1996 to 2007. Information on in- and out-migration and deaths were collected through the HDSS routine procedures. We assessed the trends in mortality and the associated determinants using Cox regression models.

Results

We followed 27,185 WRA for 141,693 person-years-at-risk (PYO) among whom 9,093 moved out and 1,006 died. Overall standardized mortality rate was 759 per 100,000 PYO. WRA mortality did not decline, but three periods could be distinguished: a stable mortality between 1996–2000 followed by 14% increase in mortality [Hazard rate ratio (HRR)?=?1.14; 95% confidence interval (CI): 0.98-1.32; p?=?0.08] between 2001–2003, and then in the last period from 2004–2007 a 25% decline (HRR?=?0.75; 95% CI: 0.64-0.87; p?<?0.001) in relation to the first period. Compared with the years 1990–1996 mortality increased in the first two periods until 2003; only in the last period did mortality reach the same level as in 1990–1996 (HRR?=?0.96; 95% CI: 0.82-1.13; p?=?0.62). The level of mortality differed between regions. In the adjusted analysis the eastern regions Bafata (HRR?=?1.79; 95% CI: 1.38-2.32; p?<?0.001) and Gabu (HRR?=?1.70; 95% CI: 1.28-2.26; p?<?0.001) had significantly higher mortality, but the hazard rate did not differ by ethnic group. As expected the rate increased with increasing age.

Conclusions

Over the twelve-year period mortality of WRA did not decline. A stable mortality in the beginning was followed by an increase and then a return to the previous levels. Further monitoring of mortality is needed to identify the risk factors for the striking regional differences. Advantage should be taken of the HDSS to monitor progress towards the MDGs and beyond.

     

Association of IL-13 rs20541 and rs1295686 variants with symptomatic asthma in a Saudi Arabian population

Objective: Interleukin 13 (IL-13) plays a critical pro-inflammatory role in asthma. Several single nucleotide polymorphisms (SNPs) are associated with asthma susceptibility in specific populations; however, further replicative studies in other ethnic groups are mandatory. Methods: The association between IL-13 SNPs rs762534, rs20541, rs1295686, and rs1800925 (risk alleles A, A, T, and A, respectively) and asthma predisposition in a Saudi Arabian cohort was examined via a case–control cross-sectional study. Results: The frequencies of alleles between asthmatics and control populations were significantly different for rs20541 and rs1295686 SNPs (p < 0.001), whereas the frequencies of genotypes between asthmatics and controls were significantly different only for rs20541. The association of the risk (minor) alleles with asthma was examined using the dominant genetic model. Individuals with at least one copy of the risk alleles A (for rs20541) and T (for rs1295686) had significantly greater odds of being asthmatic (OR = 2.13, 95% CI = 1.39–3.26, p < 0.0001; OR = 1.69, 95% CI = 1.12–2.54, p = 0.008) relative to their most common homozygous genotypes. On the other hand, the minor A alleles for rs762534 and rs1800925 were not significantly associated with asthma risk. Regarding haplotype association analysis, individuals with at least one copy of the minor “risk” allele for both rs20541 and rs1295686 (CATG and CATA, respectively) had greater odds of being asthmatic relative to CGCG haplotype; however, this trend was not statistically significant (p > 0.3). Conclusions: IL-13 minor T and A alleles for rs1295686 and rs20541, respectively, were associated with significantly higher risk of asthma in the Saudi Arabian population.     

Increased expression and activity of heme oxygenase-2 in pregnant rat aorta is not involved in attenuated vasopressin-induced contraction

Pregnancy is associated with attenuated vascular reactivity to a variety of contractile agonists. Heme oxygenases are expressed in the placenta, and it has been suggested that the heme oxygenase/carbon monoxide (HO/CO) pathway plays a significant role in regulating blood flow through the feto-placental unit. In this study we investigated the possible involvement of heme oxygenases in the reduced vascular reactivity associated with pregnancy. Arginine vasopressin (AVP) (10⁻¹⁰–3×10⁻⁷ M) induced concentration-dependent contraction of aortic ring segments from non-pregnant and pregnant (16–19 days) rats. Pregnancy did not alter the sensitivity to AVP (pD₂=8.5±0.1 and pD₂=8.4±0.2 in non-pregnant and pregnant rats, respectively) but significantly reduced the maximum response (107.9±12.7% and 38.6±7.4%, respectively, relative to noradrenaline-induced contraction). Western blot analysis revealed the expression of HO-2 but not HO-1 isoform in both groups. There was a significant increase in the expression and activity of HO-2 protein in aortic tissues from pregnant rats compared with those from age-matched non-pregnant rats. In the presence of L-NAME to inhibit nitric oxide (NO) synthesis, tin protoporphyrin IX (SnPP-IX, 10⁻⁵ M), an inhibitor of heme oxygenase, did not significantly affect AVP-induced contraction in aorta segments from pregnant and non-pregnant rats. It was concluded that, though pregnancy increased the expression and activity of HO-2 in the aorta, HO-2 was not involved in the attenuated response to AVP.     

Lung transplantation following death by drowning: a review of the current literature

While multiple donor characteristics have been cited as ideal for lung transplantation, there are minimal widely accepted exclusion criteria. One criterion that many centers view with hesitation is death by drowning. However, recent literature suggests such donors may result in acceptable outcomes following transplantation. This review highlights a case of a patient who underwent a successful bilateral lung transplant from a donor following a drowning event. A review of the current literature is presented, concluding with a new proposed set of favorable donor criteria following death by drowning.     

The impact of implementing an enteral tube feeding protocol on caloric and protein delivery in intensive care unit patients.

BACKGROUND: The purpose of this study was to determine the effect of an enteral tube feeding protocol on caloric and protein delivery to intensive care unit (ICU) patients. METHODS: This prospective study consisted of 2 phases: before and after the implementation on an enteral-feeding protocol. The following data were collected: demographics, Acute Physiology and Chronic Health Evaluation II score and Simplified Acute Physiology Score II, caloric and protein requirements, the location of the feeding tube tip, and prokinetic agents use. The primary endpoint was caloric and protein intake as a percentage of the requirement. Secondary endpoints were gastric residuals >150 mL, vomiting episodes, ICU and hospital lengths of stay, mechanical ventilation duration, and ICU and hospital mortality. RESULTS: There were no significant differences between the control (n = 100) and protocol groups (n = 103) in baseline characteristics. The protocol was associated with significant improvement in the 7-day average of caloric intake/requirement (53.9 +/- 2.3% vs 64.5 +/- 2.2%, p = .001) and protein intake/requirement (56.7 +/- 2.6% vs 67.4% +/- 2.7%, p = .005). Caloric and protein intake improved whether the patient was receiving prokinetic agent or not. There was a trend toward lower gastric residual volumes and vomiting episodes in the protocol group. Patients receiving gastric feeding showed significant improvement in caloric intake to levels comparable to patients with postpyloric feeding. CONCLUSIONS: Enteral tube feeding protocol is effective in improving feeding delivery in ICU patients independent of prokinetic agent use. Protocol for enteral tube feeding should be considered in the management of ICU patients, given the positive impact of this nonpharmacologic, non-interventional tool.     

Hypothyroidism impairs antioxidant defence system and testicular physiology during development and maturation

In the present study, effects of transient hypothyroidism (from birth to 30 days) and persistent hypothyroidism (from birth to 90 days) on testicular antioxidant defence system of mature rats were compared in order to know the role of hypothyroidism induced oxidative stress in testicular development and maturation. Rats were made hypothyroid by feeding lactating mothers and adult rats with 0.05% 6-n-propyl thiouracil (PTU) in drinking water. PTU treatment for 30 days or for 90 days to rats from birth resulted in a decrease in body weight at the age of 90 days in comparison to the controls. The testicular germ cell counts were significantly decreased in persistent hypothyroid rats whereas they were increased in the transient hypothyroid rats. However, a significant reduction in the number of live sperms in epididymis of both 30 day and 90-day PTU treated rats was noticed on 90 days of age. Mitochondrial lipid peroxidation (LPx) levels were decreased in transient hypothyroidism whereas LPx and protein carbonylation were elevated during persistent hypothyroidism in the testis. Reduced testicular superoxide dismutase (SOD), catalase and glutathione reductase (GR) and glutathione peroxidase (GPx) activities were marked during transient hypothyroidism. In contrast, an elevation in SOD (PMF) and catalase activities with a significant decline in GPx and GR activities was found following persistent hypothyroidism. Marked histological changes were observed in the testis of both experimental groups. These results suggest a direct regulatory role of thyroid hormone on testicular physiology and antioxidant defence system during development and maturation.