Characteristics and outcome of acute stroke patients not investigated with computerised tomography scan

BACKGROUND: It is desirable that all acute stroke patients are investigated with a computerised tomography (CT) scan, but there may be situations when this is not possible. OBJECTIVE: To investigate the characteristics and outcome of acute stroke patients not investigated with a CT scan and whether 'not performing a CT scan' influences mortality. METHODS: Consecutive acute stroke patients admitted to a general hospital were studied for baseline characteristics, previous stroke, pre-stroke Rankin score, post-stroke neurological details, functional disability, complications and acute phase and 3-month mortality. Patients were categorised into two groups depending on whether or not they were investigated with a CT scan. chi(2) and regression analysis were performed to study characteristics and mortality. RESULTS: Ninety-four of the 296 patients did not undergo investigation with a CT scan. These patients were older (p = 0.001), had suffered previous strokes and had a poorer general health prior to admission (p < 0.001). Although there was no difference in clinical stroke syndromes and immediate post-stroke functional impairment, they had a greater impairment of level of consciousness (p = 0.003) and had a higher acute phase and 3-month mortality (p = 0.001). Not being investigated with a CT scan had an adverse influence on 3-month mortality independent of other variables. CONCLUSION: Whilst not investigating with a CT scan in acute stroke patients carries a poor prognosis, a group of patients may be managed without this investigation because of their poor pre-existing general health. These facts may be considered when preparing local guidelines for brain imaging for acute stroke patients.     

Hyperoxia and Nitric Oxide Reduce Surfactant Components (DSPC and Surfactant Proteins) and Increase Apoptosis in Adult and Fetal Rat Type II Pneumocytes

Nitric oxide (NO) alone or in conjunction with hyperoxia can have protective or detrimental effects on the lung. Our hypothesis was that hyperoxia in conjunction with NO would result in increased cellular dysfunction and apoptotic cell death in adult and fetal Type II pneumocytes (TIIP) in a dose-dependent manner. The TIIP were obtained from adult and 19-day fetal rat lungs. The TIIP were then exposed to 100, 200 and 500 micro M of the NO-donor, Glyco-SNAP-2, alone or in conjunction with 95% oxygen for 24 h. While low-dose NO exposure alone did not increase cytotoxicity, in conjunction with hyperoxia, there was a significant dose-dependent increase in apoptotic cell death of adult TIIP as well as fetal TIIP. Choline incorporation into disaturated phosphatidylcholine was markedly decreased in adult TIIP while the fetal TIIP had similar values as controls. However, the mRNAs of surfactant proteins A, B and C as well as iNOS were significantly reduced in fetal TIIP. Exogenous peroxynitrite also increased nitrotyrosine formation in fetal TIIP as did hyperoxia and NO. The effect of hyperoxia and NO could be abrogated with catalase and superoxide dismutase. These findings may have significant clinical implications in the use of NO in premature infants.     

Epidemiology of Helicobacter pylori and peptic ulcer in India

BACKGROUND: There is a wide variation in the prevalence of peptic ulcer in India both before and since the use of endoscopy. We studied the prevalence of peptic ulcer disease in a community in northern India and its relationship with Helicobacter pylori infection. METHODS: A house-to-house survey of residents aged 15 years or above in a sub-sector of Chandigarh was performed as part of a pilot survey. Subsequently, the study randomly covered all sectors of Chandigarh and we screened 2649 persons. A questionnaire was administered to each subject by trained staff. All individuals with history of peptic ulcer/dyspepsia and an equal number of asymptomatic individuals were asked to attend the outpatient department of the Institute. Diagnosis of peptic ulcer was based on endoscopy or history of previous ulcer surgery. RESULTS: Two hundred and fifty-four individuals attended the outpatient department at the Institute and 147 underwent endoscopy, biopsy for histology and rapid urease test, and blood was collected for H. pylori serology. There were 80 symptomatic and 67 asymptomatic individuals. Helicobacter pylori was positive in 38 (56.7%) asymptomatic and 49 (61.3%) symptomatic individuals (P > 0.05). The point prevalence of active peptic ulcer was 3.4% and the lifetime prevalence was 8.8%. The duodenal-to-gastric ulcer ratio was 12:1. Helicobacter pylori was present in 11/13 (84.6%) subjects with peptic ulcer. Peptic ulcer was more common in elderly and dyspeptic individuals and there was no effect of sex or socioeconomic status. Helicobacter pylori was associated with age only and did not depend on sex, socioeconomic status or dyspepsia. Of the 38 asymptomatic persons having H. pylori infection, none had active peptic ulcer. CONCLUSIONS: This study demonstrates frequent occurrence of peptic ulcer and H. pylori in this part of the country. Peptic ulcer was more prevalent in the elderly and dyspeptic subjects. Helicobacter pylori was not associated with dyspepsia, and was more prevalent in elderly subjects. There was a low prevalence of peptic ulcer in asymptomatic H. pylori-infected persons in this community.     

Antipyretics in children

Fever is an important symptom of underlying disease condition and in general is considered harmful in pediatric age group as it may lead to febrile seizures, stupor, dehydration increase work of breathing, discomfort and tachycardia. The increase metabolic demands stress the patient with marginal cardiac and cerebral vascular supply. The hypothalamus controls the body temperature. The fever results due to resetting of the hypothalamus that occur from the prostaglandins produced by the pyrogens. Fever is treated variedly by the pediatricians. The physical therapy offers a simple and cost effective way of lowering the body temperature. The drugs as paracetamol, nimesulide and ibuprofen lower the temperature by inhibiting the prostaglandin synthesis. Paracetamol is considered the safest of all the antipyretic drugs. It is recommended that a combination of physical therapy such as tepid sponging and paracetamol is best way of controlling temperature.     

In vitro permeability and binding of hydrocarbons in pig ear and human abdominal skin

Human skin has continual exposure to chemicals due to various occupational activities. Chemicals that get on skin have the potential to be absorbed. Hence, the potential human health hazards of a chemical must include an estimate for percutaneous absorption. An inexpensive, easy, and adequate model for the quantitative measurement of skin penetration of chemicals from JP-8 is absent. Cutaneous penetration studies in vitro through human skin are severely limited due to the lack of availability of the human skin. In this study, we have shown that pig ear skin can be used as a model for risk assessment from the percutaneous absorption of chemicals. We determined flux and permeability coefficient (Kp) of three chemicals--heptane, hexadecane, and xylene--from their permeation profile through porcine and human skin. Binding of these chemicals to porcine stratum corneum (SC) and human SC were also determined. Factors of difference (FOD) in the permeability of pig and human skin were 1.71, 1.28, and 1.16, respectively, for heptane, hexadecane, and xylene. FOD in binding of heptane, hexadecane, and xylene to pig and human SC were found to be 1.04, 0.76, and 1.31, respectively. Since, FOD for permeability and binding parameters were less than 2, hence, we conclude that pig ear skin can be used as model for humans for risk assessment from percutaneous absorption of chemicals.     

Port-site tuberculosis: a rare complication following laparoscopic cholecystectomy

The rare complication of port-site tuberculosis following laparoscopic cholecystectomy is reported. In this case, the source of infection was most probably the laparoscope or its accessories. Thus, proper sterilization of the laparoscope and instruments is of utmost importance in preventing infectious complications and ideally autoclaving should be used for this purpose.     

Comparison between plethysmometer and micrometer methods to measure acute paw oedema for screening anti-inflammatory activity in mice

The present study was undertaken to evaluate the sensitivity of the plethysmometer and micrometer, which are the most commonly employed methods to measure the paw oedema for screening anti-inflammatory agents. Acute paw swelling was induced by s.c. injection of 0.02 ml carrageenan in mice. The maximum paw oedema (59.4%) was found to be at 3.5 h after injection of carrageenan in the hind paw of mice. Oral indomethacin treatment in the dose of 5 mg/kg 1 h prior to the induction of paw oedema, caused a significant (P < 0.05) reduction in paw swelling, when the plethysmometer method was used. When the micrometer method was used to measure the paw swelling, oral indomethacin at the dose of 1 mg/kg resulted in a significant reduction in paw oedema. These findings suggest that micrometer method is more sensitive to detect the lowest antiinflammatory dose of indomethacin when compared with the plethysmometer method. The possible significance of these findings is discussed.     

Vascular applications of Spiral CT : an initial Experience

Since the clinical introduction of computed tomography (CT) in the mid 1970s, several technological and clinical advances have improved image quality and reduced scanning time. During the past decade technological breakthroughs have ushered in an exciting advance in medical imaging : spiral CT. Spiral CT technology with its high speed and volumetric data acquisition has spawned a new vascular imaging technique - spiral CT angiography which is noninvasive, accurate, faster and less expensive than conventional angiography. We report our experience of having performed 100 CT angiographies with 3-D reconstructions of various vascular territories of the body. Details of technique of data acquisition, methods of 3-D reconstruction and clinical applications are discussed.Key Words: CT angiography, Spiral CT, Vascular imaging