Paroxetine decreases respiratory irregularity of linear and nonlinear measures of respiration in patients with panic disorder. A preliminary report

Previous studies indicate that serotonin reuptake inhibitors do not appear to have serious cardiac side effects. However, the effects of these agents on respiratory measures have not been studied in detail. Several studies indicate that patients with anxiety exhibit irregular breathing patterns as measured by tidal volume and respiratory rate. In this study, we evaluated the effects of a serotonin reuptake inhibitor, paroxetine, on respiratory variability in patients with panic disorder (n = 13), using linear and nonlinear measures of regularity, approximate entropy (APEN) and a measure of chaos, the largest Lyapunov exponent (LLE), with pre- and posttreatment lung volume time series (256 s long sampled at 4 Hz). Our results show that paroxetine significantly decreases some of the linear measures of variability and supine APEN and standing LLE of lung volume series after successful treatment. The implications of these findings on respiratory and cardiovascular function have been discussed.     

Hallervorden Spatz Disease

A nine-month-old infant presented with fever and loss of milestones. Examination revealed intermittent rigidity and dystonic movements. Magnetic resonance imaging (MRI) shows decreased signal intensity in globus pallidus and substantia nigra, indicative of iron deposition, suggesting Hallervorden Spatz Disease. The dopamine–neuromelanine system has been postulated to be the possible pathogenesis. Gene mapping has located the defect to be in the coding sequence of a gene called PANK– 2. Prenatal diagnosis is possible. The case is reported because of its rarity and early presentation.     

Is juvenile obsessive-compulsive disorder a developmental subtype of the disorder?

Abstract. Juvenile obsessivecompulsive disorder (OCD) has been hypothesized to be different from adult-onset OCD suggesting that juvenile OCD may be a developmental subtype of the disorder. There is some evidence that juvenile OCD may be phenotypically different from juvenile-onset adult OCD. This study examines the phenotypic characteristics of juvenile OCD (current age 18 years, n = 39), juvenile-onset adult OCD (onset 18 years,cur rent age>18 years, n = 87) and adult-onset OCD (onset > 18 years, n = 105). Qualified psychiatrists expert in evaluating OCD subjects conducted clinical and structured interviews. In the multinomial logistic regression analysis, controlling for chronological age and gender, the juvenile OCD was associated with male preponderance, elev ated rates of certain obsessive-compulsive symptoms, a ttention-deficit hyperactivity disorder, chronic tics, body dysmorphic disorder and major depression. In addition, juvenile-onset adult OCD differed from juvenile OCD by having later age-atonset and low rate of ADHD. The juvenile-onset adult OCD was positively associated with social phobia and chronic tics compared to adult-onset OCD. The juvenile OCD appears to be different from both juvenile-onset adult OCD and adult-onset OCD supporting previous observations that juvenile OCD could be a developmental subtype of the disorder.     

Retropharyngeal Lipoma — A Case Report

Lipomas of the retropharyngeal region are rare. They attain a large size before producing symptoms like dyspnoea and dysphagia. A case of lipoma in the retropharyngeal space is reported with characteristic radiological findings and surgical management.     

Transforming growth factor beta related to extent of tumor angiogenesis but not apoptosis or proliferation in breast carcinoma

Background  Recent investigations have demonstrated the clinical significance of intralesional mean vessel density (ILVD), as a marker of tumor angiogenesis. The role of growth factors in mediating angiogenesis has also been well documented. Transforming growth factor beta (TGF/β) belongs to a family of polypeptides with diverse biological functions. Very few studies however have looked at the role of this growth factor in relation to angiogenesis. This study analyzed the significance of TGFβ in relation to CD34, an endothelial cell marker, the extent of apoptosis, and tissue proliferation defined by Ki67 expression in breast cancer. Methods  The extent of apoptosis was defined by morphological criteria and the Tdt-mediated dUTP biotin nick end labelling (TUNEL) assay. Immunocyfochemistry was performed to measure TGFβ, CD34 and Ki67 expression. Results  An inverse association was observed between TGFβ expression and ILVD as evident by CD34 labelling (r = - 0.311 82, p = 0.00005). TGFβ expression did not correlate with either TUNEL reactivity or Ki67 expression. CD34 and TGFβ expression also had no relationship with histopathological grade. No correlation was observed between CD34 expression and apoptosis. However a statistically significant correlation was observed between CD34 and Ki67 expression. Conclusions  These results suggesl that breast cancer cells synthesize TGFβ that, through paracrine mechanisms, may inhibit proliferation of vascular endothelium rather than their own growth Moreover the data also suggest that decreased expression of TGFβ was associated with on increase in neovascularization, which in turn would increase the tumor proliferative fraction.     

Harnessing trade and investment agreements to promote public health

There is an underlying tension between the goals of trade liberalisation and a nation's sovereign right to regulate on matters of public health. In terms of trade in goods, Article XX(b) of the General Agreement on Tariffs and Trade (GATT) allows for measures necessary to protect human health, as one of the general exceptions. The increasing proliferation of comprehensive Free Trade Agreements (FTA) also contains general exception clauses to protect human health. International Investment Agreements contain provisions carving out an exception for tobacco products, from the scope of Investor State Dispute Settlement (ISDS) claims against the host State. The aim of this article is to examine if the public health exceptions in FTAs differ from those under the GATT, and whether they can be used as an avenue for effective regulation. In the context of investment, the article examines if a ‘carve-out’ from ISDS is a feasible option. The article concludes by observing that it may be difficult for FTAs to provide for broader regulatory autonomy to States, given the resort to the World Trade Organization (WTO) jurisprudence in FTA dispute settlement. Effectively, measures to regulate alcohol for the protection of public health may have to be designed and structured in a WTO compatible manner. In terms of ISDS, a ‘carve-out’ from dispute settlement may provide increased regulatory space but would depend on whether consensus can be achieved in this regard. States should approach the regulation of alcohol in a comprehensive manner addressing potential challenges under the trade and investment regimes.     

Hookworm infection in a rural community in south India and its association with haemoglobin levels

Faecal samples were obtained from 1113 persons living in a rural area in South India, and the hookworm ova load (Necator americanus) was determined using Kato's thick smear method. Evidence of hookworm infection was present in 92%, 77% having a count of under 100 epg, 11% a count of 1000 to 1999 epg, and 4% having counts between 2000 and 12,000 epg. Females had significantly higher ova counts than males on the average, but age did not appear to have any effect. Haemoglobin was also estimated: 80% of adult males, 87% of adult females and 90% of children were anaemic. There was a significant negative association between ova load and haemoglobin level, and the decrease in haemoglobin for a doubling of the ova load was estimated by regression analysis to be 0.18, 0.29 and 0.16 g/dl in adult males, adult females and children, respectively. There was nearly perfect agreement in the ranking of 10 clusters by mean ova count and mean haemoglobin level or percentage with anaemia.     

Isolation and Characterisation of Degradation Impurities in the Cefazolin Sodium Drug Substance

Two unknown impurities were detected in the cefazolin sodium bulk drug substance using gradient reversed-phase high-performance liquid chromategraphy (HPLC). These impurities were isolated by preparative HPLC and characterized by using spectroscopic techniques like LC-MS, LC-MS/MS, 1D, 2D NMR, and FT-IR. Based on the spectral data, the impurities have been characterized as N-(2,2-dihydroxyethyl)-2-(1H-tetrazol-1-yl)acetamide (Impurity-I) and 2-{carboxy[(1H-tetrazol-1-ylacetyl)amino]methyl}-5-methylidene-5,6-dihydro-2H-1,3-thiazine-4-carboxylic acid (Impurity-II). The structures of these impurities were also established unambiguously by co-injection into HPLC to confirm the retention time. To the best of our knowledge, these two impurities were not reported elsewhere.     

Comparison of various measures of sensitivity of M. tuberculosis to ethambutol.

A sensitivity test for ethambutol was standardised, and performed on cultures isolated from patients before and after the start of chemotherapy with ethambutol and isoniazid. A discrimination type of approach was employed and three criteria of resistance were evolved: (a) growth of 20 colonies or more on ethambutol 4 microgram/ml, using a standard inoculum; (b) a proportion of 25% or more on ethambutol 1.4 microgram/ml; (c) a proportion of 5% or more on ethambutol 2 microgram/ml. The MIC definition appears to be the best in view of its simplicity and insensitivity of the classification (as sensitive or resistant) to variations in inoculum size.     

Assessment of Morphological and Biochemical Diversity in Seabuckthorn (<Emphasis Type="Italic">Hippophae salicifolia</Emphasis> D. Don.) Populations of Indian Central Himalaya

A survey was conducted in Uttarkashi, Rudraprayag and Chamoli districts of Garhwal division of Uttarakhand state to assess morphological and biochemical diversity of Hippophae salicifolia, which is widely distributed at an altitude of 2,229–3,287 m asl. Sixteen naturally growing populations selected for the study showed wide variation among qualitative traits viz. fruit shape, fruit colour at maturity, seed shape, seed colour and plant architecture. Maximum number of fruits per 10 cm of fruiting branch was recorded in Dharali-1 accession (102), while maximum fruits weight was observed in Bhyundar accession (24.8 g/100 fruit). Highest juice percentage (74.38 %) and highest total soluble solids (10.0°B) was recorded in Hanumanchatti and Rambara stands, respectively. Acidity, recorded as % citric acid (4.26–6.73 %) and ascorbic acid (261.37–748.15 mg/100 ml) content in fruit pulp also showed wide range of variation across the populations. To ascertain the extent of variability observed at the morphological level, dendrogram prepared using euclidean distance revealed presence of three major clusters. Based on the morphological observations it was evident that large diversity exists in naturally growing populations of H. salicifolia in the Indian Central Himalaya, and this morphological variation can be exploited for the further selection of suitable genotypes to accelerate the domestication process of this important species.