Lipodystrophy syndrome among HIV infected children on highly active antiretroviral therapy in northern India

Background

It is estimated that about 2.5 million people are living with HIV infection in India. Although antiretroviral drugs have been able to reduce the mortality, these drugs have serious side effects one of which is lipodystrophy syndrome. Most of the drugs used in HAART viz, protease inhibitors, stavudine and nevirapine are associated with lipodystrophy. Hence we conducted this study to assess the prevalence of lipodystrophy in HIV infected children on HAART and its associated risk factors.

Materials and methods

A cross sectional study was conducted on 80 HIV infected children aged 2–18 years of age who were on stavudine based HAART for ≥2 years. These children were assessed for presence of lipodystrophy, its metabolic complications and associated risk factors.

Results

Lipodystrophy was observed in 33.7% of children with lipoatrophy being the commonest subtype followed by lipohypertrophy. Older age, increased duration of treatment and dyslipidaemia were found to be associated in patients with lipodystrophy than those without. On further multivariate analysis of independent risk factors only increased duration of treatment was significantly associated with lipodystrophy. No association was found with insulin resistance.

Conclusion

We observed that lipodystrophy is a common finding in HIV patients treated with HAART for long duration.     

Classical galactosaemia in Chinese: A case report and review of disease incidence

We report a case of galactose-1-phosphate uridyl transferase (GALT) deficiency in a full-term Chinese neonate, who presented with atypical biochemical features of hyperammonaemia in addition to the classical presenting features of jaundice and lethargy after feeding. Red cell GALT activity was virtually absent in the patient while 50% of normal activity was found in parents and a sibling. Mutation screening excluded both Q188R and N314D as the causative mutation in GALT gene, which suggested a possible genetic segregation among ethnic groups. Data from a Taiwan screening program suggested that the incidence of the disease was approximately 1 in 400 000 in the Chinese population which was a sixth of that in Caucasian populations.     

Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients.     

MAPK和NF-κB通路抑制剂对IL-1β诱导滑膜细胞MMP-2活性的影响

目的研究白介素-1β(Interleukin-1β,IL-1β)对人膝关节滑膜细胞基质金属蛋白酶-2(Matrix metalloprotein-ase-2,MMP-2)活性的影响及MAPK和NF-κB信号通路抑制剂对该过程的影响。方法用不同浓度的IL-1β处理体外培养的滑膜细胞72 h,明胶酶谱法检测细胞培养液中MMP-2的活性;选取10 ng/ml的IL-1β单独或分别与4种信号通路抑制剂(NF-κB抑制剂Bay11-7082,MAPK抑制剂SB203580、PD98059和SP600125)处理滑膜细胞,处理后12、24、48、72 h检测MMP-2的活性。结果 IL-1β随浓度和处理时间的增加明显上调滑膜细胞MMP-2的活性(P<0.05);与IL-1β处理组比较,Bay11-7082明显抑制了IL-1β诱导MMP-2活性的上调,并使72 h时MMP-2的活性降至13%(P<0.01);其他抑制剂对IL-1β诱导MMP-2活性上调的影响无统计学差异(P>0.05)。结论 IL-1β以时间和剂量依赖方式,通过NF-κB信号通路诱导滑膜细胞MMP-2活性。     

钛颗粒对大鼠成骨细胞影响的mRNA差异显示研究

目的 观察钛金属颗粒对大鼠成骨细胞基因表达的影响。寻找与假体周围骨溶解有关的新基因,方法 在含10%牛血清的DMEM培养基中培养Wistar幼鼠成骨细胞,达80%丰满后加入0.1%钛颗粒,再培养24h后收获细胞并提取总RNA。用mRNA差异显示技术比较处理组与对照组之间在mRNA表达上的差别,将有差别的表达带回收、扩增、克隆化,用于Reverse Northern杂交、Northern杂交及测序,将测序细果与NCBI数据库比较,结果 在处理对照间找到35条差异表达带,经Reverse Norhern杂交得到5个阳性克隆,经测序及NCBI数据库分析,其中被命名为G46T的基因与单核细胞趋化蛋白-3达92%同源,另外4个是新基因。结论 钛颗粒可引起鼠成骨细胞基因表达的变化;G46T基因可能与假体周围骨溶解有关。     

Statements of the Malaysian Society of Gastroenterology & Hepatology and the National Heart Association of Malaysia task force 2012 working party on the use of antiplatelet therapy and proton pump inhibitors in the prevention of gastrointestinal bleeding

The working party statements aim to provide evidence and guidelines to practising doctors on the use of antiplatelet therapy and proton pump inhibitors (PPIs) in patients with cardiovascular risk as well as those at risk of gastrointestinal (GI) bleeding. Balancing the GI and cardiovascular risk and benefits of antiplatelet therapy and PPIs may sometimes pose a significant challenge to doctors. Concomitant use of anti‐secretory medications has been shown to reduce the risk of GI bleeding but concerns have been raised on the potential interaction of PPIs and clopidogrel. Many new data have emerged on this topic but some can be confusing and at times controversial. These statements examined the supporting evidence in four main areas: rationale for antiplatelet therapy, risk factors of GI bleeding, PPI–clopidogrel interactions and timing for recommencing antiplatelet therapy after GI bleeding, and made appropriate recommendations.