Microbial keratitis in Sydney,Australia: risk factors,patient outcomes,and seasonal variation

Graefe's Archive for Clinical and Experimental Ophthalmology - To provide recent data on patient demographics, clinical profile and outcomes of patients with microbial keratitis over a 5-year...     

Malaria: a 10-year (1994-2003) retrospective study at University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia

Malaria is still one of the most important vector-borne diseases in Malaysia, particularly in remote areas. This retrospective study was carried out to find the prevalence of malaria among patients admitted to UMMC Kuala Lumpur, from 1994-2003. A total of 86 malaria cases were analyzed. Most cases occurred among foreigners [57% (49 cases)] while Malaysians constituted 43% (37 cases). Among foreigners, Indonesians constituted the most [57% (28 cases)]. Among Malaysians, most cases occurred among the Chinese [35% (13 cases)] followed by the Malays [30% (11 cases)]. Males [70%(60 cases)] were more commonly affected. The majority of cases were within the 20-39 year age group (69%). Three species of malaria parasites were reported, of which Plasmodium vivax constituted the most [55%( 47 cases)], followed by Plasmodium falciparum [29% (25 cases)], and only four cases (5%) of Plasmodium malariae. Nine percent (8 cases) were mixed infections. In this study, 12%(10 cases) developed chloroquine resistance: 7 cases of P. falciparum, and 3 cases of P. vivax. The most common complications were jaundice and anemia [77% (23 cases)], followed by blackwater fever [13% (4 cases)] and cerebral malaria [10% (3 cases)]. Most of the complications were due to P. falciparum [43% (13 cases)]. There were no reported deaths. This new source of malaria coming from foreigners must be given serious attention, as it has great potential of increasing malaria cases in urban Malaysia.     

Chronic fissure-in-ano: A randomized study comparing open and subcutaneous lateral internal sphincterotomy

A prospective study comparing open and subcutaneous lateral internal sphincterotomy for chronic anal fissure was conducted. One hundred twelve patients were randomized to open (n=54) or subcutaneous (n=58) sphincterotomy. There was no significant difference in acute complications between the subcutaneous (8.6 percent) and open (7.4 percent) groups. Postoperative length of stay was significantly shorter for the subcutaneous group (1.7±0.2 days) than for the open group (2.3±0.1 days;P <0.001). Although the response rate to a pain questionnaire was <50 percent, the data suggest a lower level of postoperative pain in the subcutaneous group. Fissure healing was similar between the subcutaneous (96.6 percent) and open (94.4 percent) groups. We conclude that subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano is effective and may result in significantly less postoperative discomfort, shorter postoperative lengths of stay, and a comparable rate of complications compared with the open technique.     

Low density lipoprotein rich in oleic acid is protected against oxidative modification: implications for dietary prevention of atherosclerosis.

Oxidative modification of low density lipoprotein (LDL) enhances its potential atherogenicity in several ways, notably by enhancing its uptake into macrophages. In vivo studies in the rabbit show that inhibition of LDL oxidation slows the progression of atherosclerotic lesions. In the present studies, rabbits were fed either a newly developed variant sunflower oil (Trisun 80), containing more than 80% oleic acid and only 8% linoleic acid, or conventional sunflower oil, containing only 20% oleic acid and 67% linoleic acid. LDL isolated from the plasma of animals fed the variant sunflower oil was highly enriched in oleic acid and very low in linoleic acid. These oleate-rich LDL particles were remarkably resistant to oxidative modification. Even after 16-hr exposure to copper-induced oxidation or 24-hr incubation with cultured endothelial cells, macrophage uptake of the LDL was only marginally enhanced. The results suggest that diets sufficiently enriched in oleic acid, in addition to their LDL-lowering effect, may slow the progression of atherosclerosis by generating LDL that is highly resistant to oxidative modification.     

Hormonal requirements for growth and differentiation of ob17 preadipocyte cells in vitro

The ob17 cell line is a clonal line established from epididymal fat pads of C57 BL/6J ob/ob mice. After conversion into adipose-like cells, ob17 presents both the morphological and biochemical properties of mature rodent fat cells. The adipose conversion process is best represented by a stochastic model in which a pool of stem cells (adipoblasts) gives rise to clusters of adipose cells and to additional stem cells that remain in the population. The role of the different factors involved in the adipose conversion process of ob17 cells is discussed, i.e. 1) mitogenic factors, that enhance the number of committed cells (ACF or adipose conversion factor(s)) 2) lipogenic factors, that enhance the expression of adipocyte enzyme markers (insulin) and 3) adipogenic factors, that are obligatory requirements for adipose conversion (triiodothyronine, growth hormone and other pituitary factors).     

Calculated mean arterial blood pressure in critically ill neonates

Summary Mean arterial pressure (MAP) is the area under the pressure wave form averaged over the cardiac cycle. A widely used rule of thumb to estimate MAP of peripheral arterial pressure waves in adults is adding one-third of the pulse pressure (PP) to diastolic arterial pressure (DAP). However, radial artery pressure waves in newborns differ from those in adults and resemble proximal aortic pressure waves, so that the above-mentioned calculation of MAP may not be correct. The present study was set up to obtain an arithmetical approximation to derive MAP from blood pressure waves measured in the radial artery of the neonate. We accurately recorded about 300 invasively obtained blood pressure curves in the radial artery of 10 neonates admitted for intensive care. We found that MAP in the radial artery in these neonates can be well approximated by adding 46.6% PP to DAP (range 43.0–50.1%). We suggest that the rule of thumb to derive MAP from radial artery waves in the neonate to be approximately the average of systolic and diastolic pressure, as opposed to adding one-third of the pulse pressure to the diastolic value in the adult.Abbreviations ABP Arterial blood pressure - SAP Systolic arterial pressure - DAP Diastolic arterial pressure - MAP Mean arterial pressure - PP Pulse pressure - MAP% (MAP-DAP)/(SAP-DAP)×100% (i.e., level of the MAP in the wave, expressed in % PP) - PDA Patent ductus arteriosus - IRDS Idiopathic respiratory distress syndrome     

Identification of low density lipoprotein as a regulator of Fc receptor-mediated phagocytosis.

Optimal expression of the high-affinity Fc receptor for IgG (FcRI) by the human monocyte cell line U-937 requires the presence of low density lipoprotein (LDL), and neither cholesterol nor high density lipoprotein can provide the component necessary for optimal FcRI expression. Here we show that FcR-mediated phagocytosis also requires LDL. U-937 cells were cultured in medium containing interferon gamma and either fetal calf serum (FCS) or delipidated FCS (DLFCS). The phagocytosis of IgG-coated erythrocytes was measured by a colorimetric assay. U-937 cells cultured in DLFCS medium had less than 16% of the phagocytic activity of cells cultured in normal FCS medium. Phagocytosis of IgG-coated erythrocytes could be inhibited 85% by the addition of murine IgG2a myeloma protein (5 micrograms/ml). U-937 cells cultured in DLFCS medium supplemented with pure cholesterol in ethanol (10 micrograms/ml) had only 30% of the phagocytic activity of cells grown in FCS medium. Addition of very low density lipoprotein (0.2 mg of protein per ml) to DLFCS medium also failed to increase phagocytosis. However, the addition of LDL (0.2 mg of protein per ml) to DLFCS medium restored 90% of the phagocytic activity. Since neither pure cholesterol nor very low density lipoprotein restored normal phagocytic function to U-937 cells despite a normalization of cellular cholesterol content, the restoration of phagocytosis observed with LDL replacement cannot be explained by mere delivery of cholesterol by LDL. Thus, LDL is required for the expression of FcRI and FcR-mediated phagocytosis by U-937 cells and may be an important regulator of phagocytic activity of monocytes and macrophages in vivo.