Chronomics: circadian and circaseptan timing of radiotherapy, drugs, calories, perhaps nutriceuticals and beyond

We suggest a putative benefit from timing nutriceuticals (substances that are both nutrients and pharmaceuticals) such as antioxidants for preventive or curative health care, based on the proven merits of timing nutrients, drugs, and other treatments, as documented, i.a., in India. The necessity of timing melatonin, a major antioxidant, is noted. A protocol to extend the scope of chronoradiotherapy awaits testing. Imaging in time by mapping rhythms and broader time structures, chronomes, for earliest diagnoses, for example detection of vascular disease risk, is recommended. The study of rhythms and broader chronomes leads to a dynamic functional genomics, guided by imaging in time of free radicals and antioxidants, amongst many other variables.     

Current management of mediastinal infection following open heart surgery

Postoperative mediastinal wound complications occur in 0.5 to 5 per cent of patients undergoing cardiac operations requiring median sternotomy. Superficial infections can be effectively managed by debridement and repeated dressing changes. Deeper infections of short duration and of limited extent may respond to aggressive debridement and continuous closed catheter irrigation with antimicrobial solutions. The patients with greater involvement and delayed infections are best managed by extensive debridement of the sternum and costal cartilages and coverage of the exposed mediastinal wound with either an omental flap or muscle flaps constructed from pectoralis major and/or rectus abdominis. Systemic administration of adequate dosages of appropriate antibiotics and maintainance of positive nitrogen balance by enteral or intravenous hyperalimentation are also necessary to control infection and promote healing. This research was funded by the Veterans Administration Medical Research Service, VA Central Office, Washington, DC, USA.     

Acute respiratory distress syndrome from chlorine inhalation during a swimming pool accident: a case report and review of the literature

Chlorine inhalation can result in significant morbidity and mortality. The most common clinical ramification is mucosal irritation. Rarely, depending upon the degree of exposure, patients can develop acute respiratory distress syndrome. Management is usually supportive with an unproven role for inhaled or systemic corticosteroids. A case of a young woman who developed respiratory failure secondary to acute respiratory distress syndrome from accidental exposure to chlorine fumes at a community swimming pool is described. The patient suffered a prolonged hospitalization with the need for mechanical ventilation. Despite limited data to support the decision, the patient was started on treatment with corticosteroids. She recovered completely from her illness and was discharged home without supplemental oxygen. A concise discussion of chlorine inhalation injury and a literature review on the utility of inhaled and/or systemic corticosteroids for this clinical entity is presented.     

Acquired Left Ventricular–Right Atrial Fistula Following Aortic Valve Replacement

Intracardiac communications produced as a complication of valve replacement can result in left-to-right shunts and a poor surgical result. The successful surgical closure of a left ventricular–right atrial fistula following aortic valve replacement is discussed. The intricate relationships of the membranous interventricular septum, the aortic, mitral, and tricuspid valves, and the aortic root predispose to the creation of abnormal intracardiac shunts when aggressive debridement of extensive valvular calcification is performed at the time of valve excision and replacement.     

Assessment of cell viability,lipid peroxidation and quantification of DNA fragmentation after the treatment of anticancerous drug mitomycin C and curcumin in cultured human blood lymphocytes

Mitomycin C (MMC) is an antineoplastic agent used to fight a number of different cancers including cancer of the stomach, colon, rectum, pancreas, breast, lung, uterus, cervix, bladder, head, neck, eye and oesophagus. It is a potent DNA cross-linker. The prolonged use of the drug may result in permanent bone marrow damage and other various types of secondary tumors in normal cells. The toxic effect of anticancerous drugs may be reduced if supplemented with natural antioxidants/plant products. With this view, the effect of 5, 10 and 15 μM of curcumin was studied against the genotoxic doses of MMC, i.e. 10 and 20 μM, in cultured human lymphocytes using cell viability, lipid peroxidation and DNA damage quantification as parameters. The treatment of curcumin with MMC results in a significant dose-dependent increase in cell viability and decrease in lipid peroxidation and DNA damage suggesting a protective role of curcumin against the anticancerous drug mitomycin C.     

Genotypic distribution of human papillomavirus and phylogenetic analysis of E6 and E7 gene of HR-HPV variants isolated from Pakistani population

High-risk-human papillomavirus (HR-HPV)-induced cervical cancer is the second most common cause of death among females worldwide. HPV16 is the most prevalent HR-HPV infection worldwide. This study found the genotypic distribution of HR-HPV in the local population and investigated the sequence variations among the E6 and E7 oncogenes of the local HPV16 genotype to the E6 and E7 oncogenes of the foreign HPV16 genotypes and constructed a phylogenetic relationship based on nucleotide sequence comparison among the variants identified in our study along with previously reported isolates that were obtained from different regions of the world. The samples were collected from patients with cervical cancer. Genomic DNA was extracted, and HR-HPV genotypes were determined using real-time PCR. The HPV16 E6 and E7 genes were amplified and sequenced. A HPV16 phylogenetic tree was constructed using the maximum likelihood method with MEGA 7. HPV16 was the most prevalent human papillomavirus (HPV) type identified in the present study. HPV16 isolates belonged to the A1 sublineage of the European branch. Twenty-one nucleotide sequences were included in this analysis. The first, second, and third codon positions are also included. The final dataset included 776 positions.     

Torsional strength estimates of femoral diaphyses with endosteal lytic lesions: dual-energy X-ray absorptiometry study.

Pathologic fracture is a significant problem for individuals with metastatic bone disease. Current guidelines for prophylactic internal fixation are neither reliable nor easily applied. The purpose of this study was to validate dual-energy X-ray absorptiometry (DXA) as an accurate method for estimating torsional bone strength of diaphyseal bone with endosteal lytic lesions. Endosteal lesions of varying sizes were simulated in the diaphyses of 12 adult cadaveric femurs. Unaltered contralateral femurs served as matched controls. Machined lesions ranged from 3 to 6.5 cm in length, 1 to 3 cm in width, 15 to 48 cm(2) in elliptical area, with 10% to 100% removal of the cortical thickness. Morphology and density data obtained from DXA images were used to estimate torsional strength. All femora were mechanically tested to failure in torsion. Physically measured torsional strength was not significantly correlated to lesion elliptical area (r = 0.542, p > 0.05) or percentage cortical thickness removed (r = 0.257, p > 0.05). Measured torsional strength was significantly correlated to DXA-based torsional strength estimates (r = 0.855, p < 0.01). Lesion size alone did not correlate with the strength of bones with simulated endosteal lytic lesions. In contrast, calculations based on DXA (morphology, density) did correlate with torsional strength. This is the first step in the development of a DXA-based tool for objectively estimating bone strength in the presence of endosteal lytic lesions.     

Management of the Obstetric Patient With Tuberculosis

Tuberculosis in obstetric patients presents a challenging nursing problem to facilities caring for populations at high risk: the economically disadvantaged, minorities, the foreign-born, and patients with human immunodeficiency virus. Coordination of public health, outpatient, and inpatient services is essential for obtaining the desired outcome of a healthy family unit with a minimum of interruption of the attachment process. This article presents issues related to nursing care and medical management of tuberculosis in the perinatal period.     

Serotonin syndrome in maintenance haemodialysis patients following sertraline treatment for depression

Sertraline, a selective serotonin reuptake inhibitor (SSRI), was used in a dose of 25 mg orally daily in 12 moderate to severely depressed patients of end stage renal disease (ESRD) on maintenance haemodialysis. Virtually all of them showed features of hyperserotonin state and in 11 drug was stopped within 3 weeks. One of the patients developed almost fatal serotonin syndrome and required intensive care with ventilatory support. In our experience the use of SSRI, sertraline for depression in ESRD patients on maintenance haemodalysis was associated with a high incidence of serotonergic side-effects and toxic serotonin syndrome.