Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa

In order to help primary health care (PHC) workers in developing countries in the care of common skin diseases, an algorithm for the management of pyoderma, scabies, superficial mycoses, contact dermatitis and referral of early leprosy cases (based on the identification of diseases through the presence of objective key signs, and on treatments by generic drugs) was elaborated. One thousand patients were seen by trained dermatologists, who established diagnoses and treatments; in addition, there was systematic recording of each key sign, according to the successive algorithm steps. We compared the diagnostics and treatments obtained for several combinations of diagnostic signs, with those of the dermatologists. Sensitivity, specificity, positive predictive value and negative predictive value of defined combinations were high for pyoderma, scabies and superficial mycoses. Values were less exact for dermatitis and leprosy, but were considered sufficient for the level of health care targeted. The apportionment of treatments between the algorithm and the dermatological approaches was considered appropriate in more than 80% of cases; mismanagement was possible in 7% of cases, with few predictable harmful consequences. The algorithm was found satisfactory for the management of the dermatological priorities according to the standards required at the PHC level.     

Role of uterine artery velocimetry using color-flow Doppler and electromyography of uterus in prediction of preterm labor

AIM: To evaluate the role of Doppler waveforms of uterine vessels and electromyography (EMG) of the uterus in predicting preterm labor. METHODS: One hundred ante-natal women at >or=24 weeks of gestation who fulfilled the selection criteria were included in the study. A single Doppler recording for bilateral uterine vessels was taken at >or=26 weeks gestation using the transvaginal route. Transabdominal EMG of the uterus was recorded serially at 4-week intervals from 24 weeks until delivery or until 37 weeks were completed. RESULTS: Women with a sensation of heaviness in the lower abdomen during pregnancy had a significant association with preterm delivery. Of the three Doppler indices, the systolic/diastolic ratio and the resistivity index of uterine vessels were found to have a sensitivity as high as 83-95% for the prediction of preterm labor. The electrical activity of uterine musculature, as recorded using EMG, showed that there was a statistically significant difference between the electrical activity recorded for the two groups at 31 weeks and later, while the duration of burst activity was significantly longer in the preterm group at 26 weeks and later. CONCLUSIONS: Patients with a dull aching sensation in the lower abdomen should not be neglected. Doppler of the uterine vessels and EMG of the uterus could prove to be a good predictor of preterm labor.     

A longitudinal study of crevicular fluid in periodontal disease in beagles

A longitudinal study on the composition of crevicular fluid (CF) and serum was carried out in seven beagle dogs during a period from health to 16 weeks of gingivitis and then 8–10 weeks of ligature induced periodontitis (LIPD). The fluids were collected at weekly intervals and the pH and the concentrations of Ca, Mg, Na, and K and the protein profile were determined. Also at weekly intervals, the plaque index, gingival index, calculus index, and pocket depth and attachment loss were recorded for the teeth from which crevicular fluid was collected. Radiographs were taken on the 0 day and after the dogs were sacrificed. Histopathological studies were carried out following sacrifice of the dogs, and the distances between the cemento-enamel junction and the coronal end of the junctional epithelium and the cemento-enamel junction and the crest of the alveolar bone were measured. A two-way ANOVA analysis of the two fluids (CF and serum) and of the two diseases (gingivitis and periodontitis) showed significant differences between the two fluids and between the two diseases. Further statistical analysis showed that in serum none of the constituents studied differed significantly between gingivitis and LIPD, but a significant rise in the concentrations of Ca, Mg, and K was observed in CF during LIPD. The pH of CF was significantly lower during LIPD, but no significant change was observed in the concentration of Na ion. An apparent relationship was observed only between the concentration of K ion in CF and the attachment loss during LIPD. The serum protein profile remained unchanged throughout the period of this study. During gingivitis the CF protein profile was identical to that of serum, but during LIPD a new protein peak appeared. This material had a molecular weight of < 200,000 daltons. Histopathological and radiographic analysis showed bone loss in all but one dog during LIPD. Histopathological study also showed no significant difference in the distance between CEJ and the coronal end of the junctional epithelium between the ligated and the non-ligated sides. This study showed that in beagle dogs the CF differed significantly from that of serum. Also, LIPD caused significant changes in both ionic concentrations and protein profile of crevicular fluid.     

Effect of garlic oil in experimental cholesterol atherosclerosis

Addition of cholesterol in the diet of male albino rabbits produced hypercholesterolaemia, increased tissue cholesterol, and atheromatous changes in the aorta. Supplementation of garlic oil along with cholesterol significantly inhibited the hypercholesterolaemia, decreased tissue cholesterol and minimised the atheromatous changes in the aorta. These results show that the active constituent(s) in garlic responsible for its anti-atherogenic action is present in the oily fraction of garlic.     

Bilateral ovarian hydatid disease--an unusual case

Hydatid disease is caused by parasitic tapeworm Echinococcus. The larval stage of this parasite can thrive in many parts of the body, most frequently in the liver. Primary ovarian location is very rare. In our case the patient had bilateral ovarian cysts which on histopathological study was found to be hydatid cysts. Moreover one of the cysts was multilocular which is also unusual.     

Xanthan gum derivatives: review of synthesis,properties and diverse applications

Natural polysaccharides are well known for their biocompatibility, non-toxicity and biodegradability. These properties are also inherent to xanthan gum (XG), a microbial polysaccharide. This biomaterial has been extensively investigated as matrices for tablets, nanoparticles, microparticles, hydrogels, buccal/transdermal patches, tissue engineering scaffolds with different degrees of success. However, the native XG has its own limitations with regards to its susceptibility to microbial contamination, unusable viscosity, poor thermal and mechanical stability, and inadequate water solubility. Chemical modification can circumvent these limitations and tailor the properties of virgin XG to fulfill the unmet needs of drug delivery, tissue engineering, oil drilling and other applications. This review illustrates the process of chemical modification and/crosslinking of XG via etherification, esterification, acetalation, amidation, and oxidation. This review further describes the tailor-made properties of novel XG derivatives and their potential application in diverse fields. The physicomechanical modification and its impact on the properties of XG are also discussed. Overall, the recent developments on XG derivatives are very promising to progress further with polysaccharide research.

Due to presence of hydroxy and carboxy functional groups, xanthan gum is amenable to various chemical modification for producing derivatives such as carboxymethyl xanthan and carboxymethyl hydroxypropyl xanthan with desirable properties for end use.     

Fifteen-year trends in indications for enucleation from a tertiary care center in South India

Aim:

To analyze the trends in clinicopathologic indications for enucleations over a 15-year period.

Materials and Methods:

Clinicopathologic details of all eyes that underwent enucleation from January 1996 to December 2010 were drawn up from a computerized database. The study was divided into three periods of 5 years each and comparison tables for each cause of enucleation during these periods were generated. Chi-square test was used to compare proportions.

Results:

Out of a total 1467 enucleations performed during the study period, 693 (46%) were attributable to retinoblastoma, 189 (12.5%) to uveal melanoma, 228 (15%) to trauma, and 149 (10%) to phthisis bulbi. Intraocular tumors accounted for more than 63% of all enucleations performed. Over the three time periods, proportion of enucleations secondary to retinoblastoma increased from 38% in the 1^st period to 58% in the 3^rd period (P < 0.001). Enucleations for trauma showed statistically significant reduction in trends over the three periods (24% in the 1^st period vs. 4.4% in the 3^rd period, P < 0.001). Similar trends were also seen in the proportion of enucleations due to intractable glaucoma and chronic uveitis. The absolute number of enucleations secondary to retinoblastoma out of the total cases seen during the study period did not change over the three periods (range 51–60%).

Conclusion:

Intraocular tumors were the commonest indications for enucleation in our patient population despite the availability of globe-conserving treatments such as chemotherapy and radioactive plaques. We observed increasing trends in the proportion of enucleations due to retinoblastoma and reduction of enucleations secondary to trauma, chronic uveitis, and glaucoma.