Anti-inflammatory effects of statins: clinical evidence and basic mechanisms

Chronic inflammation is a key feature of vascular disease states such as atherosclerosis. Multiple clinical studies have shown that a class of medications termed statins lower cardiovascular morbidity and mortality. Originally developed to lower serum cholesterol, increasing evidence suggests that these medications have potent anti-inflammatory effects that contribute to their beneficial effects in patients. Here, we discuss the clinical and experimental evidence underlying the anti-inflammatory effects of these agents.     

The treatment of primary central nervous system lymphoma in 122 immunocompetent patients: a population-based study of successively treated cohorts from the British Colombia Cancer Agency

BACKGROUND: The objective of this study was to evaluate the clinical outcome of a population-based cohort of immunocompetent patients with primary central nervous system lymphoma (PCNSL) treated with 3 different strategies over 13 years. METHODS: One hundred twenty-two consecutive patients (median age, 66 years) with PCNSL were identified. Three treatment strategies were employed: 1) whole-brain irradiation with (from January, 1990, to June, 1991) or without (from April, 1995, to December, 1999) cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-type chemotherapy (n=50 patients); 2) combined-modality therapy, including 1 g/m2 methotrexate plus whole-brain irradiation (from July, 1991, to March, 1995; n=34 patients); and 3) 8 g/m2 methotrexate alone (from January, 2000, to March, 2003) with whole-brain irradiation reserved for those with progressive disease (n=38 patients). Treatment failure was defined as progressive disease, disease recurrence, death from toxicity or lymphoma, or toxicity that necessitated a change in primary treatment. RESULTS: The median failure-free survival was 7 months, and the median overall survival (OS) was 17 months. The median OS was similar in all 3 eras. In this population-based analysis, one-third of patients did not receive the treatment strategy of the era. Therefore, the data also were analyzed by treatment received. On multivariate analysis (including era of treatment), 3 factors-age > 60 years, lactate dehydrogenase > normal, and omission of methotrexate-were associated significantly with poorer OS (hazard ratio: 2.3, 2.2, and 2.3, respectively). CONCLUSIONS: Outcomes for a general population with PCNSL remained constant despite different treatment strategies over three eras. For the two-thirds of patients who could receive potentially curative treatment, age, lactate dehydrogenase level, and receipt of > or = 1 g/m2 methotrexate appeared to be important determinants of OS.     

Renal tumor with associated venous tumor thrombus prolapsing through tricuspid valve during diastole

We describe the case of a 76-year-old man with a renal cell carcinoma thrombus extending into the right atrium, prolapsing across the tricuspid valve into the right ventricle during diastole, and producing sufficient portal venous pressure to result in intestinal venous thrombosis and necrosis of the upper gastrointestinal mucosa. The related published studies are reviewed and discussed.     

Knowledge of general public and health professionals about tetanus immunization

Objective : To study the awareness among general public and health care providers about tetanus immunization in relation to injuries, and their knowledge about tetanus immunization schedules in children, pregnant females and adults.Methods : It was a cross-sectional study done at a perfect health mela and all the government allopathic health agencies in Delhi.Results : The knowledge of tetanus immunization was poor among general public as well as health care providers. A substantial proportion of them indicated tetanus injection after every injury, which was unwarranted. The knowledge of tetanus immunization schedule for adults was poor among all categories of respondents, though it was comparatively better for pregnant females, but only 75% of doctors and 51.1 % of nursing personnel correctly knew the immunization schedule against tetanus in children.Conclusion : There is a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of tetanus are followed properly and unnecessary repeated immunizations are avoided and the same knowledge is passed on to the general public also.     

Infant feeding—An evaluation of text and taught

Objective: Study was conducted to 1) assess knowledge of doctors, medical interns and nurses/ANMs regarding exclusive breast-feeding, management of common problems related to breast feeding and appropriate complementary foods 2) review the above aspects in books commonly read by medical and nursing students.Methods: Cross-sectional study conducted in the department of Community Medicine, Maulana Azad Medical College, New Delhi during a seven-month period on 93 interns, 58 medical officers and 44 nurses/Auxillary Nurse Midwives (ANMs) with the help of a pre-tested structured multiple choice questionnaire and review of some commonly read books of Pediatrics, Community Medicine and Nursing.Results: The concept of ‘exclusive breast-feeding’ was clear to most health personnel but the fact that water should also not be given was not clear in the books reviewed. The books also lacked emphasis on management of common lactation problems and this was also seen in the knowledge of the health personnel.Conclusion: As inappropriate feeding practices are widely prevalent, knowledge of large proportion of health personnel is incorrect and commonly read books are inadequate on this issue, there is need for greater emphasis on this in books and training sessions.     

Keratomalacia in a neonate secondary to maternal vitamin A deficiency

A 40-day-old male child was admitted with complaints of not opening eyes from 2–3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neontes, although in children it is reported form developing countries.     

Silent blast in oral cavity: is the car battery innocuous?

Low voltage energy source is not free from danger. An exceptionally rare and peculiar mode of facial blast injury is reported. The blast took place silently in the mouth of a 15-year-old boy, due to short-circuiting of wires connected to a12-volt car battery while peeling off insulation with the intent of running a musical instrument. Airway compromise due to soft tissue injury produced further problem during tracheostomy. Emergent airway management is discussed. Post-healing sequel resulted in loss of voice and prevented normal oral feeding. The case report emphasizes need for education to public in handling low voltage energy source.