CLINICO-EPIDEMIOLOGICAL ALGORITHM FOR PREDICTING SYSTEMIC ARTERIAL HYPERTENSION AT HIGH ALTITUDE THROUGH MATHEMATICAL MODELLING

A population based hybrid design combining element of cohort and cross-sectional approach was used to develop a simple clinical algorithm to predict individual probability of developing hypertension (systolic BP > 140 mm Hg and/or diastolic BP > 90 mmHg). 3615 soldiers initially normotensive at the time of induction into high altitude, were studied by systematic random sampling. Multiple logistic regression analysis showed a high significant association between hypertension and age, body mass index (BMI), tobacco smoking and alcohol consumption. Using the constant/coefficient values obtained from the logistic model and the receiver operating characteristics (ROC) curve analysis, the following predictive rule was developed – To the age in years, add (BMIx 3.86); also add 5.53 if he is a smoker; and add 19.81 if he consumes alcohol. If the total exceeds 142, the individual is at high risk of developing hypertension. This algorithm carries a sensitivity of 68.2% and specificity of 78.5%.KEY WORDS: Hypertension, High altitude     

Reduction in anaemia in pregnant women in three Caribbean countries. Possible results of different types of interventions

The Caribbean Food and Nutrition Institute conducted a survey of anemia status of pregnant and/or lactating women in Jamaica (1982), Montserrat (1981), and St. Vincent and the Grenadines (1985). After various interventions designed to reduce the prevalence of anemia in pregnant women, follow-up surveys were conducted in the same countries five years after the initial surveys to determine whether or not the prevalence of anemia in pregnant women did indeed fall after these interventions. As of July 1984, the Jamaica Flour Mills began fortifying all baking flour and counter flour with iron (44 mg/kg) (a 70% increase in the amount of iron added), thiamine (6.3 mg/kg), riboflavin (3.9 mg/kg), and niacin (52.8 mg/kg). During the five year period following the initial survey in Montserrat, health workers had changed the type of iron administered to pregnant women, a constant supply of iron tablets was established, and the economy had improved. The changes in St. Vincent and the Grenadines were that the government provided a constant supply of iron folate (ferrous folate) tablets and there was a 1988 workshop on a manual on the control of anemia where nurses were trained in better clinic management of anemia. The prevalence of anemia (Hb 11 g/dl) in pregnant women fell from 61.6% to 53% (p 0.09) in Jamaica. It fell from 82.3% to 22.1% in Montserrat (p 0.0001). The prevalence of anemia (Hb 10 g/dl) in pregnant women fell from 25% to 14.5% (p 0.001) in St. Vincent and the Grenadines. These findings show that different interventions may have contributed to the reduction in the prevalence of anemia in pregnant women in Jamaica, Montserrat, and St. Vincent and the Grenadines.     

Retroperitonial, teratoma as fetus in fetu--a case report

We report a rare case of Retroperitonial teratoma containing Axial Skeleton long bone. Jaw, pelvis & scapula in a 27 yrs old male. Aberration in monozygotic twinning may rarely present as Fetus in Fetu. Rarer is presentation in Adult.     

Craving for alcohol: findings from the clinic and the laboratory.

This paper presents a review of the current status of empirical research in the area of alcohol craving. After an introduction on the origins of the construct of craving, we first present clinical studies that have examined craving as a hallmark symptom of alcohol dependence and demonstrated its sensitivity as an outcome measure in assessing change in pharmacotherapy trials of alcohol dependence. There is also discussion regarding new multifactorial self-report instruments of alcohol craving with good reliability and predictive validity, that may be sensitive to detecting alcohol craving and assessing change in craving as it relates to relapse during treatment. Next, we examine the experimental paradigms that have been used to induce alcohol craving in the laboratory. Further, the methodological issues affecting laboratory-based paradigms are presented, while also elucidating the potential use of effective laboratory-based craving induction paradigms, both in clinical studies as well as in laboratory studies that examine the brain mechanisms associated with the concept of craving. Finally, directions for future research on craving in the laboratory and the clinic are presented in the context of developing more effective treatments for different phases of recovery from alcohol dependence.     

Neuronal responses of periaqueductal gray to peripheral noxious stimulation

Central pathways transmit pain from peripheral regions to one of the most important area of the descending pain modulatory system, the Periaqueductal gray (PAG). Independent discoveries in the past suggest that the PAG contains afferent input, output neurons and intrinsic interneurons. An attempt was made in the present study to find out the effects of more than one kind of noxious stimulus on the PAG neuronal activity. Experiments were conducted in rhesus monkeys and the effects of noxious mechanical, thermal and tooth-pulp stimulation on the activity of 14 neurons were studied. The neurons responded to more than one kind of noxious stimuli by increasing or decreasing its firing rate. No limb specificity could be identified and homogeneous distribution of the excitatory and inhibitory neurons was found.     

Late bronchoplasty for missed traumatic rupture of bronchus

Two patients of traumatic rupture of main bronchus are reported here. One patient presented 2 years after blunt chest trauma while the other patient presented 9 weeks after trauma. Lesion in both patients were missed in the immediate post-trauma period. In both patients pulmonary angiogram demonstrated normal vasculature in the atelectatic lung, while intraoperatively good compliance and elasticity were found. Bronchoplasty done in both patients had good postoperative results.     

Suramin inhibits DNA damage in human prostate cancer cells treated with topoisomerase inhibitors in vitro

Suramin, a highly sulfonated drug, has been reported to be effective against several human malignancies in vitro and in vivo, and currently is undergoing clinical trials against prostate tumors. The biochemical and molecular mechanisms for suramin's antiproliferative activity are not clear. In order to define the biochemical basis for its antitumor activity and to enhance suramin's chemotherapeutic potential while decreasing its toxicity, we have examined interactions of suramin with topoisomerase I and 11 and several clinically active anticancer drugs against the human prostate (PC3 and LNCaP) cancer cell line. While etoposide, m-AMSA, camptothecin, and SN-38 (the active metabolite of CPT-11) were active in killing prostate cells as single agents, combinations of suramin and these agents were antagonistic against these cells. We found that suramin inhibited activities of purified topoisomerase I and II in vitro as measured by relaxation and cleavage assays. Further studies indicated that suramin also inhibited the drug-induced DNA damage in vitro and in isolated nuclei. These findings indicate that combinations of suramin with topoisomerase inhibitors, for example, VP-16, m-AMSA, or CPT, may not be beneficial to patients receiving suramin-containing chemotherapy. © 1993 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America

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