Use of methylene blue in pheochromocytoma resection: case report

We report the use of intravenous Methylene blue to treat the hypotension occurring following adrenal vein ligation in a case of pheochromocytoma resection in a child. The potential benefits and problems, including correct dosage, are discussed.     

Perioperative cardiac arrests in children at a university teaching hospital of a developing country over 15 years

Objective/Aim:  To study the incidence, causes, and outcome of perioperative cardiac arrests in children at a university teaching hospital with an aim of improving quality of care.
Background:  Analysis of anesthesia-related complications is routinely performed by most anesthesia departments to make prevention strategies.
Methods:  All perioperative cardiac arrests in children up to 18 years from induction of anesthesia to postanesthesia care unit discharge or ICU admission during noncardiac surgery from January 1992 to December 2006 were analyzed. Outcome variable was noted as survival to discharge. Anesthesia-related cardiac arrests were identified and their causes analyzed.
Results:  Ten cardiac arrests occurred among 20216 patients. Overall incidence was 4.95 per 10000 (95% CI: 1.88–8.01). Six (6.53/10000) were females. Seven (19.44/10000) patients belonged to the classification III–IV of ASA physical status, eight (18.28/10000) were below 1 year, and two (1.26/10000) above 1 year. Three patients (6.53/10000) were undergoing emergency surgery. Anesthesia was primarily responsible in four cases. The causes of anesthesia-related arrests were medication-related (two), airway-related (one), and under-replacement of fluids (one). Seven patients died during the arrest and three were discharged home. The event was considered avoidable in seven (70%) cases.
Conclusion:  Perioperative cardiac arrests were higher in patients with poor physical status, in those under 1 year of age, and in female patients. Anesthesia-related cardiac arrests were mainly due to medication- or airway-related causes. The majority of arrests were avoidable indicating the importance of prevention strategies.     

Possible role of superantigens in inducing autoimmunity in pemphigus patients

The diagnostic and pathological relevance of anti‐desmoglein autoantibodies in common forms of pemphigus has been well established, and T cells have been shown to play a role in the onset and progression of these diseases. The role of superantigens in provoking polyclonal activation of T cells with many different fine specificities, possibly including autoreactive T cells and T‐cell mediated autoantibody response, is unknown. Further, abnormal T‐cell function may lead to opportunistic infections particularly with Candida. The response of T cells of pemphigus patients to recall antigens of these opportunists is not clear. The aim of this study was to investigate the in vitro response of T lymphocytes from pemphigus patients to common bacterial superantigens such as streptococcal pyrogenic exotoxin A and staphylococcal enterotoxin B, and recall antigens such as Candida antigen. Changes in CD3⁺CD4⁺ and CD3⁺CD8⁺ T‐cell sub‐populations and expression of naive/memory markers (CD45RA⁺/RO⁺) on different T cells were analyzed by flow cytometry. Significant elevation in CD3⁺CD4⁺ and expression of the memory (CD45RO⁺) markers on these cells was observed both in pemphigus vulgaris and pemphigus foliaceus patients, as compared to healthy controls, upon stimulation with streptococcal pyrogenic exotoxin A and staphylococcal enterotoxin B. However, only memory T cells (CD45RO⁺) were significantly increased upon Candida antigen stimulation. Our study suggests that CD4⁺ memory T lymphocytes may modulate the pathogenic autoantibody response in pemphigus patients, and also emphasizes the possibility that the superantigen‐reactive T cells participate in the triggering of autoimmunity in pemphigus.     

Microleakage and penetration of a hydrophilic sealant and a conventional resin‐based sealant as a function of preparation techniques: a laboratory study

International Journal of Paediatric Dentistry 2013; 23: 13–22 Background. Optimal pit and fissure sealing is determined by surface preparation techniques and choice of materials. Aim. This study aimed (i) to compare the microleakage and penetration depth of a hydrophilic sealant and a conventional resin‐based sealant using one of the following preparation techniques: acid etching (AE) only, a diamond bur + AE, and Er:YAG laser combined with AE, and (ii) to evaluate the microleakage and penetration depth of the hydrophilic pit and fissure sealant on different surface conditions. Design. Eighty recently extracted 3rd molars were randomly assigned to eight groups of ten teeth according to the material, preparation technique, and surface condition. For saliva contamination, 0.1 mL of fresh whole human saliva was used. All samples were submitted to 1000 thermal cycles and immersed in 2% methylene blue dye for 4 h. Sections were examined by a light microscope and analysed using image analysis software (Sigmascan^®). Results. The combination of Er:YAG + AE + conventional sealant showed the least microleakage. The sealing ability of the hydrophilic sealant was influenced by the surface condition. Conclusion. Er:YAG ablation significantly decreased the microleakage at the tooth–sealant interface compared to the non‐invasive technique. The hydrophilic sealant applied on different surface conditions showed comparable result to the conventional resin‐based sealant.     

Subcutaneous Implantable Cardioverter Defibrillator in a Patient with Pectus Excavatum

Sudden cardiac arrest in young healthy adults has concerned the medical and social communities due to its fatal effect. Implantable cardioverter defibrillator (ICD) has been demonstrated to be an effective measure for prevention of sudden death in patients at risk of ventricular arrhythmia. Subcutaneous ICD has been developed to overcome some problems associated with transvenous leads in the conventional ICD. In this case report, we describe the use of completely subcutaneous ICD for a young patient with pectus excavatum following presentation with out‐of‐hospital VF arrest with no complication in device or lead positioning. (PACE 2013; 36:e138–e139)     

The expression of retinoblastoma protein in epidermis is induced by ultraviolet B exposure

DNA damage induced by ultraviolet light (UV) can be repaired while cells are arrested in the cell cycle. Tumour suppressor gene p53 has been implicated as being involved in the G₁ arrest after UV irradiation. Normal human skin from three volunteers was exposed to UVB and the expression of p53. Ki-67 and retinoblastoma gene product (pRb) was examined immunohistochemically, in addition to observation for sunburn cells, p53 protein started to be expressed at 6 h after UVB irradiation. It peaked at 12–48 h. Ki-67 expression was induced after 48 or 72 h or irradiation. pRb begun to be expressed at 24 or 48 h and peaked at 48–96 h. p53-positive cells were distributed throughout the epidermis, while Ki-67 and pRb positive cells were seen mainly at the lower epidermis. Finally, sunburn cells, which are presumably apoptotic cells, appeared at 24 h and peaked at 24–48 h and were seen at upper epidermis. The different and co-ordinated expression, although variable between individuals, indicates important roles for p53 and pRb on the maintenance of the homeostasis of the epidermis after UV irradiation.     

THE PERFECT STATE OE TRICHOPHYTON VIOLACEUM

Background. Trichophyton violaceum is the most common etiologic agent causing dermatophytosis in Egypt. This report deals with attempts to produce the perfect state of T. violaceum that may play a role in the epidemiology of T. violaceum. Materials and Methods. Ten strains of T. violaceum were inoculated on hair soil culture and on rice agar media. Results. Cultures on hair soil media failed to produce the ascogenous form of the fungus, but after 6 weeks of culture on rice agar media, fertile cleistothecium were seen and 2 weeks later separate asci appeared. Conclusion. This is the first report on the production of the perfect (sexual) state of T. violaceum. Details of the ascogenous form of this dermatophyte should be studied in the future.     

Novel pyridine‐2,4,6‐tricarbohydrazide thiourea compounds as small key organic molecules for the potential treatment of type‐2 diabetes mellitus: In vitro studies against yeast α‐ and β‐glucosidase and in silico molecular modeling

A range of novel pyridine‐2,4,6‐tricarbohydrazide thiourea compounds ( 4a–i ) were synthesized in good to excellent yields (63–92%). The enzyme inhibitory potentials of these compounds were investigated against α‐ and β‐glucosidases because these enzymes play a crucial role in treating type‐2 diabetes mellitus (T2DM). As compared to the reference compound acarbose (IC₅₀ 38.22 ± 0.12 μM), compounds 4i (IC₅₀ 25.49 ± 0.67 μM), 4f (IC₅₀ 28.91 ± 0.43 μM), 4h (IC₅₀ 30.66 ± 0.52 μM), and 4e (IC₅₀ 35.01 ± 0.45 μM) delivered better inhibition against α‐glucosidase and were quite inactive/completely inactive against β‐glucosidase. The structure–activity relationship of these compounds was developed and elaborated with the help of molecular docking studies.     

Antidepressant prescribing and suicide rate in Northern Ireland.

PURPOSE: Although antidepressants are the most commonly used treatment for depressive illness, there is uncertainty if their use is associated with a reduction in suicide rate. Antidepressant prescribing in Northern Ireland has increased over fivefold in the decade 1989-1999. The authors sought to explore whether this increase was associated with a reduction in suicide rate taking into account social and political factors thought also to have an influence on suicide. MATERIALS AND METHODS: Factors that have been suggested to influence suicide were entered into a linear regression with frequency of suicide and undetermined deaths (referred to as suicide rate) as the dependent variable. The above factors were antidepressant prescribing, unemployment rate, household alcohol expenditure and persons charged with terrorist offences. The rise in younger suicides, in recent decades, suggests this analysis should be carried out separately for younger (less than 30 years) and older (30 years and above) suicides separately. The predictors in the two models are based on aggregate data for the total group. RESULT: In the younger group there was no association between antidepressant prescribing and suicide. For the older group increased antidepressant prescribing was associated with a reduction in suicide rate over the 10 years of the study. CONCLUSION: Increasing antidepressant prescribing appears to be an effective strategy for reducing suicide. This has been demonstrated in older individuals.