Effect of air pollution on peak expiratory flow rate variability.

Exposure to air pollution affects pulmonary functions adversely. Effect of exposure to pollution on diurnal variation of peak flow was assessed in healthy students. Three hundred healthy age-matched nonsmoker students were studied. They were categorized into two groups on the basis of their residence: commuters and living on campus. Peak expiratory flow (PEF) recordings were made twice daily for 2 days with the Pink City Flow Meter. The measurement was then used to calculate for each subject the amplitude percentage mean, which is an index for expressing PEF variability for epidemiological purposes (Higgins BG, Britton JR, Chinns Jones TD, Jenkinson D, Burnery PG, Tattersfield AE. Distribution of peak expiratory flow variability in a population sample. Am Rev Respir Dis 1989; 140:1368-1372). Air pollution parameters were quantified by measurement of sulfur dioxide (SO2), oxides of nitrogen (NO2), carbon monoxide (CO), and respirable suspended particulate matter (RSPM) in the ambient air at the campus and on the roadside. The mean values of PEF variability (amplitude percent mean) in the students living on campus and in the commuters were 5.7 +/- 3.2 and 11 +/- 3.6, respectively (P < .05). Among the commuters, maximum number of subjects showed amplitude percentage mean PEFR at the higher end of variability distribution, as compared to the students living on campus, among whom the majority of subjects fell in the lower ranges of variability distribution. The ambient air quality parameters, namely SO2, NO2, CO, and RSPM were significantly lower on the campus. It can be concluded that long-term periodic exposure to air pollution can lead to increased PEF variability even in healthy subjects. Measurement of PEF variability may prove to be a simple test to measure effect of air pollution in healthy subjects.     

An unusual case of mediastinal mass due to Fonsecaea pedrosoi.

Phaeohyphomycosis is a disease caused by dematiaceous fungi. Here, the first culture-proven case of mediastinal mass due to Fonsecaea pedrosoi is reported. The patient was a 40-yr-old male who had presented with history of dyspnoea and dysphagia. Computed tomography of the chest disclosed a mediastinal mass. Cultures of a specimen from the mediastinum grew Fonsecaea pedrosoi. The patient received amphotericin B and itraconazole and showed a remarkable recovery. Repeat computed tomography revealed a reduction in the mediastinal mass. The case highlights the need for a high degree of clinical suspicion and appropriate histopathological and mycological examination of clinical specimens.     

Betropharyngeal abscesses: Revisited

Retropharyngeal abscesses were fairly common in preantibiotic era but the advent of antibiotics has reduced the overall incidence of these abscesses. They still continue to occur specially in developing world and carry significant morbidity and even mortality if not managed properly. The prevalence of this abscess in the young children pose a bigger challenge, as the examination of oral cavity is difficult. Emphasis is placed on the age, sex, type, and duration of symptoms, bacteriology, methodology of diagnosis, therapy and complications. With proper antibiotic cover and surgical management, majority of patients today survive without major residual squeal. Hereby we present a series of 15 cases of retropharyngeal abscess.     

Transurethral resection of a bladder tumor in pregnancy: A report of 2 cases

Carcinoma of the urinary bladder presenting during pregnancy is rare. We report two such cases presenting with gross hematuria, both of which were managed by transurethral electroresection of the tumor; there was no adverse effect on the pregnancies. Transurethral resection thus appears to be the procedure of choice in the management of this condition, and carries minimal morbidity even when performed during pregnancy. EDITORIAL COMMENT: As these authors point out, bladder tumors are rare in pregnancy and frequently present as gross hematuria that is mistaken for vaginal bleeding due to the pregnancy. Ultrasound is very helpful in distinguishing the causes of bleeding, and will show the bladder filled with clots and frequently the tumor as well. Standard transurethral resection is effective when performed during pregnancy, bearing in mind the need to heed to the anesthetic risks inherent in any operative procedure during pregnancy.     

Epidural block for obstetrics: Comparison of bolus injection of local anesthetic with gravity flow technique

Study Objective: To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection.

Design: Prospective, randomized study.

Setting: Teaching hospital.

Patients: 600 ASA physical status I and II parturients scheduled for labor and delivery or elective cesarean section.

Interventions: After identification of the epidural space with pulsations of an air-fluid column, parturients for vaginal delivery (n = 380) were randomized to receive a test dose of 3 ml 3% 2-chloroprocaine with epinephrine 20 μg, two doses of 7 ml bupivacaine 0.03 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow (Group 1) given over 30 seconds or by bolus injection (Group 2) given over 5 seconds through the epidural needle; parturients for Cesarean delivery (n = 220) were randomized to receive a test dose and two doses of 6 ml lidocaine 2 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow or by bolus injection through the epidural needle. Changes in maternal heart rate (HR) and blood pressure, signs of intravascular injection, and adverse effects of epidural bupivacaine-sufentanil were recorded after each dose.

Measurements and Main Results: Gravity flow administration (Group 1) was associated with a smaller increase in mean maternal HR (p < 0.001), less hypotension (p < 0.01), sedation (p < 0.01), nausea (p = 0.01), and segmental spread (p < 0.0001) than were corresponding doses given by traditional bolus injection (Group 1) for vaginal or Cesarean deliveries. The incidence of systemic toxicity was zero of 300 (0%) with gravity flow and 4 of 300 (1.3%) by bolus injection, p = 0.12, Fisher's exact test. No patient in either group had an accidental intrathecal injection.

Conclusion: Gravity flow administration of local anesthetic-opioid solution during epidural block for obstetrics was associated with fewer signs of systemic drug absorption and cardiovascular perturbations than was the traditional bolus injection. This study supports the current opinion that slow administration of local anesthetic during epidural black contributes to fewer adverse events.     

Changes in glucose/amino acid/calcium uptake and brush-border membrane-associated enzymes in rat small intestine after the administration of embelin (plant benzoquinone), an antifertility agent

Administration of Embelin, an experimental antifertility agent, to male rats (20 mg/kg body wt/day, daily for 15 and 30 days), caused an elevation in the uptake of D-glucose, L-alanine, L-leucine, and calcium in the small intestinal segments. An increase was also noted in the intestinal brush border membrane (BBM)-associated enzymes, sucrase, lactase, maltase, alkaline phosphatase, and leucine aminopeptidase in both the intestinal homogenates and partially purified BBM preparations, particularly after 30-day administration of the drug. Embelin treatment also caused a significant increase in the microsomal glucose-6-phosphatase and the cytosolic enzyme, lactate dehydrogenase. In the Embelin-treated animals BBM-associated total lipids, phospholipids, cholesterol, triacylglycerol, unesterified fatty acids, ganglioside-sialic acids as well as the cholesterol/phospholipids molar ratio showed a considerable increase. All these changes in the Embelin-treated animals were restored back to the normal or near normal biochemical makeup when the drug therapy was withdrawn and the animals were allowed to recover for another 15 and 30 days, respectively.     

Efficacy of various methods in evaluation of eustachian tube function

In the present study 35 patients with preforated and 15 cases with intact ear drums, were studied and eustachian tube function was assessed by Saccharine test. Bortnick-Miller test, and manual impedance audiometry. The merits and demerits of one over the other were evaluated. It was observed thal more than one test when employed provides better information as every test has its own advantages and limitations     

Induction of MHC class II expression in recipient tissues caused by allograft rejection

MHC class II antigens (DR) are not commonly expressed on parenchymal cells of kidney and liver except when they are allografts undergoing rejection. The objective of this study was to determine whether allograft rejection can also induce DR upregulation in parenchymal cells of autologous recipient organs. Dogs had unilateral renal autografts to facilitate kidney sampling. All kidneys were tubular cell DR-negative. After 8-14 days each dog received a tubular cell DR-negative allograft. Tubular cell DR became positive in both allograft and autograft simultaneously, its onset and intensity correlating with blast cell infiltration and rejection in the allograft. Blast cells were first detected in the autograft after allograft nephrectomy, and then disappeared as autograft tubular cell DR diminished over the next 6-8 days. This was reproduced on repeat allografting. In 2 untreated dogs hepatocytes became positive on day 4, with no hepatic blast infiltrate. Four other dogs received cyclosporine immunosuppression. Allograft and autograft tubular cell DR, and hepatocyte DR, increased in all dogs, but were delayed while on CsA until onset of rejection despite transient earlier allograft blast infiltration. Downregulation in autograft and liver occurred together after allograft nephrectomy. An interferon-like substance appeared in plasma after allografting in association with the DR changes in native kidney and liver. Renal allorejection therefore induces upregulation of parenchymal DR expression in autologous liver and kidney of the recipient. It is probably mediated by an interferon-like substance derived from cells infiltrating the allograft. The effect is modified by CsA.     

Does malnutrition predispose to diarrhoea during childhood? Evidence from a longitudinal study in Matlab, Bangladesh

It is posited that diarrhoeal illness during one period has influence on diarrhoeal illness in a subsequent period. This relationship may potentially mask the association between malnutrition and subsequent diarrhoea. To test this, we analysed data on cross-sectional anthropometry in combination with data on diarrhoeal morbidity collected longitudinally in a community-based study of 1262 children (aged 6-60 months) during March-December, 1976, in Matlab, Bangladesh. The results confirmed the posited relationship between diarrhoeal morbidities in two consecutive periods and showed that the risks of diarrhoeal attack and longer diarrhoeal illness increased more than threefold during the 2 months following diarrhoeal illness during the preceding 2 months (previous diarrhoea). Children with no previous diarrhoea indicated a positive association between malnutrition and subsequent diarrhoea, but the pattern found among children with previous diarrhoea was not understandable. Logistic regression analyses performed separately for younger and older children showed that controlling for effects of previous diarrhoea, maternal illiteracy and household poverty, severe malnutrition as assessed by weight-for-age was found to be strongly associated with the risk of longer diarrhoeal illness in a 2-month interval in the age group 24-60 months; in the same age group the association with the risk of diarrhoeal attack was significant at the 10 per cent level. No such association for malnutrition, however, was found in the age group 6-23 months.