Disseminated nocardiosis in an immunocompetent child

We report a 2-month-old child with a disseminated Nocardia farcinica infection that presented with suppurative lymphatic abscess. The child did not have any predisposing factors and responded to treatment with co-trimoxazole and amikacin. This is first case report of disseminated nocardiosis caused by Nocardia farcinica in an immunocompetent child.     

Current trends in wound management

Laceration and wound are common emergencies for which children are brought to emergency room. Pediatricians can manage most of these himself. Recently few more methods have become available for wound closure, which are very useful to pediatricians in their office settings. This article stresses on the current trends in wound management. A tidy wound can be repaired primarily while untidy wound requires conversion to tidy wound before closure. Host and environmental factors, which can affect wound healing, should be identified and managed accordingly. Parental presence can be very useful in certain cases. Wound should be examined and irrigated thoroughly to remove foreign bodies and debris. Associated injuries should be assessed and treated appropriately. Suturing, staplers or tissue adhesives can do the wound closure. Last method is particularly useful in pediatric office settings. Antibiotics are needed in certain selected conditions.     

Poisoned child: emergency room management

Poisoning is one of the commonest pediatric emergencies. Most of poisonings in children below 5 years of age, are accidental and fortunately trivial, related to their exploratory nature. However a poisoned child may present as an acute emergency with or without multisystem involvement. The initial phase of management focuses on support of airways, breathing and cardiac function (ABCD of Resuscitation). The second phase includes Evaluation and Detoxification phase. The Evaluation phase involves identification and severity of toxic exposure. Recognizing a Toxidrome (constellation of the signs and symptoms seen with the ingestion of a particular poison) is particularly very helpful when the child presents with an unknown poisoning. Detoxification should proceed simultaneously. The current literature suggests that activated charcoal is the mainstay of GI decontarmination. Whole bowel Irrigation is a new addition to the armamentarium of GI decontamination. At present antidotes are available for few toxins only so the management remains supportive for most poisons.     

Isoniazid associated,painful, bilateral gynaecomastia

Gynaecomastia is a rarely reported adverse drug reaction due to isoniazid therapy. We describe a 25-year-old, human immunodeficiency virus (HIV)--negative man, who was started on antituberculosis treatment (ATT) with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E) in the combination RHZE for the first two months and RH there on. After four months, while receiving RH, he developed painful bilateral gynaecomastia. ATT had to be stopped because of this adverse drug reaction. Gynaecomastia, however, persisted even after three months of cessation of therapy. A year later, the patient reported complete disappearance of pain and swelling, although right breast continued to appear larger than the left.     

Association of vitamin A, vitamin C and zinc with laryngeal cancer

BACKGROUND: The incidence of the cancers of the oral cavity, pharynx, esophagus and larynx in different population groups of India is amongst the highest reported in Asian countries. There is evidence that high dietary carotenoids and vitamin C may possibly decrease the risk of laryngeal cancer. Limited data is available from India on the association between these micronutrients and the risk of laryngeal cancer. AIMS: To assess the levels of vitamin A, vitamin C and zinc in laryngeal cancer patients and healthy controls. SETTING AND DESIGN: A hospital based case- control study. MATERIAL AND METHODS: One hundred and fifty five laryngeal cancer patients and a control group of 155 healthy individuals constituted the study population. Individuals in the control group were individually matched with the patients for their age +/- 2 years, sex and place of residence. Venous blood was drawn from the cases and controls and estimations of vitamin A, zinc and vitamin C was done utilizing the standard procedures. STATISTICAL ANALYSIS USED: Paired 't' test to compare the mean serum levels of vitamin A and zinc and plasma vitamin C between laryngeal cancer patients and controls. Univariate logistic regression analysis to calculate the odds ratios and the confidence intervals. RESULTS: The mean serum vitamin A, zinc and plasma vitamin C levels were significantly lower in laryngeal cancer patients as compared to the controls. CONCLUSIONS: The findings of the present study indicated a strong association of these micronutrients with laryngeal cancer in the Indian population.     

Flavopiridol down-regulates antiapoptotic proteins and sensitizes human breast cancer cells to epothilone B-induced apoptosis

The molecular mechanisms underlying the cell cycle growth-inhibitory and apoptotic effects of flavopiridol (FP) were determined in human breast cancer cells. Treatment with FP caused accumulation in the G(1) phase of the cell cycle and induced apoptosis of SKBR-3 and MB-468 cells. This was associated with down-regulation of the levels of cyclins D1 and B1, as well as with inhibition of cyclin-dependent kinase (cdk) 1, cdk2, and cdk4. FP-induced apoptosis was accompanied by a conformational change and mitochondrial localization of Bax. This resulted in the accumulations of cytochrome c, Smac, and Omi/HtrA2 in the cytosol and induced the poly(ADP-ribose) polymerase cleavage activity of caspase-3. Treatment with FP also attenuated the mRNA and protein levels of XIAP, cIAP-2, Mcl-1, Bcl-x(L), and survivin. In MB-468 cells with overexpression of Bcl-2 (468/Bcl-2), FP-induced Bax conformational change and apoptosis were inhibited, whereas the FP-mediated decline in the levels of IAP proteins, Mcl-11 and Bcl-x(L) remained unaltered. The effects of cotreatment with FP and the nontaxane tubulin-polymerizing agent epothilone (Epo) B were also determined in MB-468 cells. Sequential treatment with Epo B followed by FP induced significantly more apoptosis of MB-468 cells than treatment with the reverse sequence of FP followed by Epo B or treatment with either agent alone (P < 0.05). Treatment with Epo B followed by FP induced more Bax conformational change and was associated with a greater decline in the levels of XIAP, cIAP-2, Mcl-1, and Bcl-x(L). However, MB-468/Bcl-2 cells remained relatively resistant to Epo B followed by FP. Taken together, these findings suggest that the superior sequence-dependent anti-breast cancer activity of Epo B followed by FP may be due to FP-induced Bax conformational change and down-regulation of the antiapoptotic IAP, Bcl-x(L), and Mcl-1 proteins, but this treatment may not overcome the resistance to apoptosis of breast cancer cells conferred by overexpression of Bcl-2.