Continuous terbutaline nebulization for the treatment of severe exacerbations of asthma in children

Twelve children with severe asthma were treated in an intensive care unit with continuously nebulized terbutaline at doses between 1.0 and 12.0 mg/hour. All patients showed improvement in blood gases, pulse, and respiratory rates. None experience significant side effects. The duration of therapy ranged from 1 to 24 hours (mean = 8.3 hours), and all were able to leave the intensive care unit within one day. The use of continuously nebulized terbutaline appears to be safe and effective for the treatment of severe asthma in children in this limited experience.     

Effect of sex of preceding child on birth interval

The study aim was to examine the effect on birth spacing of a prior female child's birth. The study site was a rural health center under observation by staff from the Dayanand Medical College in Ludhiana, India. The sample included 73 pregnant women who were grouped by the sex of the preceding child. The results showed that the average birth interval was significantly shorter for women with a preceding birth of a female child. The average interval in weeks was 90.73 weeks + or - 54.46 weeks for the 41 women who had a prior girl child compared to 133.68 weeks for the male child. When the female child was at a parity of one the birth interval averaged 73.36 weeks, compared to 137.2 weeks for a prior parity of one male child. At parity of two, the average birth interval was 106.2 for a prior girl child and 144.38 for a prior male child. At a parity of three, the average birth interval was 88.22 weeks for a prior girl child and 96.5 weeks for a prior male child. At a parity of four, the average birth interval was 87.66 weeks for a prior girl child and 46.0 weeks for a prior male child. The significant effect of having a prior girl child was evident only at a parity of one. The intervals at a parity of two and three were shorter for girls but not significantly different. The recommendation was that young women and women with low parity be targeted for family planning in order to lengthen the birth interval, regardless of the desire for sons.     

Premature infants in car seats: effect of sleep state on breathing

SUMMARY  Previous studies have shown that premature infants may be at risk for hypoxemia and bradycardia when placed in standard car seats. However, the relationship of such breathing abnormalities to sleep state have not been studied. The purpose of the present study was to investigate the effect of car seat positioning on respiratory patterns in preterm infants during sleep and to evaluate their relationship to sleep state. Complete polysomnography, including sleep and breathing parameters, was performed on twenty-eight premature infants. Each infant was randomly assigned to the car seat or prone (crib) position for the first recording period. Following the recording of at least two sleep cycles, the position was reversed. The percentage of active and quiet sleep was calculated and breathing parameters were measured. In the car seat, the infants spent significantly more time in active sleep and less time in quiet sleep than in the prone position, of the respiratory parameters, periodic breathing (PB) was significantly higher in the car seat. The presence of at least one abnormal breathing events (bradycardia, desaturation, PB apnoea) was also significantly higher in the car seat. An analysis of variance (ANOVA) of PB revealed significant sleep-state effect (active vs. quiet sleep), but no significant condition or interaction effects, indicating that PB was more frequent in active sleep regardless of the sleeping condition. It is concluded that increased active sleep in the car seat condition, rather than the positioning of the infant in the seat per se, may account for the increase in periodic breathing and possibly other breathing abnormalities reported in car seats.     

Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P<0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.     

Hanging-delayed death (a rare phenomenon)

Hanging is one of the most common methods of suicide in India in which death of the individual occurs instantaneously. However, a few cases have been reported in literature in which death has occurred after a certain period of time or the patient has survived after prolonged resuscitative measures. A case of a 20-year-old female is described who survived for nine days after hanging, remaining unconscious throughout in the hospital. She died due to cerebral damage caused by cerebral anoxia.     

Brainstem auditory evoked responses in term small for gestational age newborn infants born to undernourished mothers.

Our aim was to assess the effect of intrauterine growth retardation on neurosensory development by evaluating brainstem auditory evoked responses (BAER) in term small for gestational age (SGA) newborn infants born to undernourished mothers. This prospective clinical study included 25 singleton healthy SGA newborn infants born between 38 and 41 weeks to undernourished mothers (weight <45kg, height <145cm, haemoglobin <8g/dl, and serum albumin <2.5g/dl). An equal number of age- and sex-matched appropriate for gestational age newborn infants born to healthy mothers served as controls. Mothers with other risk factors and newborns with complications during delivery or immediate newborn period were excluded. BAER was recorded within first 3 days of life. Interpeak latency (IPL), absolute peak latency (APL) and amplitudes of various waveforms were determined and compared between the groups.No statistically significant differences were observed for the mean interpeak and absolute latencies between term SGA and AGA infants (p>0.05). The absolute peak latency (wave V) and central conduction time (I-V interval) were borderline prolonged in the study group compared with controls (p=0.051 and 0.088 respectively). Using multiple regression analysis, maternal haemoglobin was identified to be the only parameter having a negative correlation with both IPL (waves I-V) (F[1,46]=4.12, p=0.048) and APL (wave V) (F[1,46]=5.80, p=0.02). Maternal undernourishment may have a minor effect on intrauterine development of the auditory brainstem. Maternal haemoglobin is the only factor significantly associated with these changes.     

Maternal and perinatal outcome in rheumatic heart disease.

OBJECTIVES: To study the maternal and perinatal outcome of pregnancies complicated by rheumatic heart disease. METHODS: A retrospective study was carried out in the cardio-obstetric clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh (India) over a period of 13 years (1987-1999) involving 486 pregnant patients with rheumatic heart disease. Maternal and perinatal outcome was reviewed. RESULTS: Three hundred and four patients (63.3%) had single valve involvement and mitral stenosis was the most predominant lesion (89.2%). One hundred and seventy one (38.6%) patients had undergone surgical correction prior to the onset of pregnancy. One hundred and thirteen patients (22.6%) were identified as NYHA class III-IV. Mitral valvotomy was performed during pregnancy in 48 patients. The incidence of preterm birth and small for gestational age newborns was 12% and 18.2%, respectively. There were 10 maternal deaths, of which eight patients were NYHA III and IV. CONCLUSIONS: Rheumatic heart disease in pregnancy is associated with significant maternal and perinatal morbidity in NYHA class III-IV patients.     

Induction of cell cycle arrest and apoptosis by the proteasome inhibitor PS-341 in Hodgkin disease cell lines is independent of inhibitor of nuclear factor-kappaB mutations or activation of the CD30, CD40, and RANK receptors.

PURPOSE: The malignant Hodgkin and Reed-Sternberg cells of Hodgkin disease (HD) are known to constitutively express high levels of activated nuclear factor kappaB (NF-kappaB), which plays an important role in their survival. The proteasome inhibitor PS-341 has been recently shown to modulate tumor cell proliferation and survival by inhibiting NF-kappaB and modulating critical cellular regulatory proteins, but its activity in cells carrying IkappaBalpha gene mutations has not been reported previously. Experimental Design: The activity of PS-341 in four well-characterized, HD-derived cell lines. Cell proliferation and apoptosis were determined by the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxy-phenyl)-2-(4-sulfonyl)-2H-tetrazolium (MTS) and Annexin-V binding methods, respectively. Cell cycle analysis was determined by flow cytometry. Intracellular protein levels were determined by Western blot. RESULTS: PS-341 demonstrated a strong antiproliferative activity, which was irrespective of the status of mutations in IkappaBalpha and even the presence of CD30, CD40, or RANK receptor activation. This effect was attributable to the induction of apoptosis and cell cycle arrest at the G(2)-M phase. PS-341 not only inhibited nuclear localization of NF-kappaB but also activated the caspase cascade, increased p21 and Bax levels, and decreased Bcl-2 levels. Furthermore, PS-341 enhanced the effect of gemcitabine chemotherapy and potentiated the effect of tumor necrosis factor-related apoptosis-inducing ligand/APO2L and two agonistic antibodies to tumor necrosis factor-related apoptosis-inducing ligand death receptors R1 and R2. CONCLUSIONS: The in vitro activity of PS-341 against HD-derived cell lines suggests that PS-341 may have a therapeutic value for the treatment of HD.     

An amazing case of working wrist watch in the esophagus

Foreign bodies in the esophagus are commonly seen in otolaryngologic practice. We report the successful removal of a working wrist watch dial lodged for one month in the esophagus of an adult schizophrenic patient, which is a rare incident.     

Evidence for selective expression of the p53 codon 72 polymorphs: implications in cancer development.

Polymorphism at codon 72 of p53 results in either the arginine or proline form of p53, whose functional significance in carcinogenesis is controversial. We have investigated if the expression of these p53 polymorphs is selectively regulated, using mRNA from peripheral blood of healthy Asian (Chinese) and the Caucasian (Polish) arginine/proline (arg/pro) heterozygote subjects. Asians were found to preferentially express the pro allele whereas the Caucasians preferentially express the arg allele. On the contrary, about 75% of the heterozygote Chinese breast cancer patients preferentially expressed the arg allele, which rarely contained any somatic mutations. Moreover, histologically normal tissues from Chinese heterozygote breast cancer patients showed selective expression of the arg allele, in contrast to the preferential expression of the pro allele in heterozygote healthy normal breast tissues. Together, the data suggest that the expression of the different p53 polymorphs is selectively regulated in different ethnic populations, and that the arg allele is activated during cancer development in Asians. Thus, the expression status of the p53 polymorphs, rather than the genotypic status, might be a useful indicator for cancer susceptibility.