Nasal sinus cancer registry of the province of Brescia

Sinonasal cancers (SNC) are neoplasm uncommon; although strictly related to occupational risk factors, in the Brescia province the professional SNC was unknown to the Occupational Health Service until short time ago. During the first nineties, a retrospective study has carried out to detect SNC and it has showed several occupational SNC cases. A local SNC population based Register was subsequently set up in 1994, covering 1,044,544 inhabitants. Between 1981 and 2000 104 SNC, occurred to 74 men and 30 women, have been collected; 98% of them was histologically diagnosed and 87.4% was of epithelial type. 36% of cases is located on maxillary sinus and the 31.7% on the ethmoidal sinus; 43% is the squamous cell carcinoma and 13.7% is the intestinal adenocarcinoma. The annual standardised incidence rates (on the Italian population, census 1981, x 100,000) on 1990-1995 and 1996-2000 are respectively 1 and 1 in men, 0.3 and 0.4 in women, in accordance with those esteemed in others industrialised provinces. In 1990-1995 the survival observed after 1, 3 and 5 years are respectively 83.8%, 67.7% and 48.3%. Anamneses were collected on 83 SNC cases among the epithelial type cancer. In men the 33% was exposed to occupational risk factors: wood (13 cases), leather (6 cases) and chromium (1 case) dusts. Among works probably related to SNC, agriculture, construction and textile reached respectively the 20.5% for both sex, 16.4% for men and 18% for women. As for non occupational risk factors suggested by literature, smoke appear to be the most relevant, related to the 52% of all cases and reaching the 64% in men. Among the women, polyps and inverted papillomas (31%), and also chronic rhinitis and sinusitis (13.6%) are more frequently observed. Some problems still limiting the work and its usefulness are discussed.     

Functional sequelae of tuberculous pleurisy in patients correctly treated

STUDY OBJECTIVES: To assess the functional sequelae (FS) of patients with tuberculous pleurisy (TP), to analyze the influence of different factors in the occurrence of these FS, and, finally, to evaluate the relationship between the FS and roentgenographic sequelae. DESIGN: An observational, retrospective study. SETTING: A community teaching hospital in Alicante, Spain. PATIENTS AND METHODS: From April 1986 to July 2000, all patients with a firmly established diagnosis of TP, who had been functionally studied at the end of follow-up, were included in the study. A diagnosis of TP was considered to be definitive when the presence of granuloma on a pleural biopsy specimen was demonstrated or when a culture was positive for Mycobacterium tuberculosis in pleural fluid (PF) or tissue. The general characteristics of the study population and PF were compared in patients with or without restrictive FS (ie, FVC or TLC < 80%), looking for risk factors for developing this complication. RESULTS: Eighty-one of 150 patients who had been treated for TP were eligible for the study. At the end of follow-up, eight patients (10%) had a restrictive FS. These patients had a lower PF lactate dehydrogenase concentration (p < 0.001), a higher PF concentration of cholesterol (p < 0.03) and triglycerides (p < 0.03), and a higher percentage of lymphocytes (p < 0.04). A weak correlation was found between the FVC and the intensity of radiographic pleural thickening (r = - 0.298; p < 0.01). CONCLUSIONS: The FS in patients with TP is restrictive in type, infrequent, and usually mild. A higher PF lipid content or a more chronic inflammatory pleural reaction at diagnosis appear to be risk factors for developing a FS. The correlation between FS and roentgenographic sequelae is poor.     

Urea cycle disorders

Opinion statement Urea cycle disorders comprise a group of inborn errors of metabolism that represent unique gene-nutrient interactions whose significant morbidity arises from acute and chronic neurotoxicity associated with often massive hyperammonemia. Current paradigms of treatment are focused on controlling the flux of nitrogen transfer through the hepatic urea cycle by a combination of dietary and pharmacologic approaches. Evolving paradigms include the development of cell and gene therapies. Current research is focused on understanding the pathophysiology of ammonia-mediated toxicity and prevention of neural injury.     

Esophago-glottal closure reflex in human infants: a novel reflex elicited with concurrent manometry and ultrasonography

BACKGROUND AND AIMS: Our aims were to identify and characterize the glottal response to esophageal mechanostimulation in human infants. We tested the hypotheses that glottal response is related to the type of esophageal peristaltic response, stimulus volume, and respiratory phase. METHODS: Ten infants (2.8 kg, SD 0.5) were studied at 39.2 wk (SD 2.4). Esophageal manometry concurrent with ultrasonography of the glottis (USG) was performed. The sensory-motor characteristics of mechanostimulation-induced esophago-glottal closure reflex (EGCR, adduction of glottal folds upon esophageal provocation) were identified. Mid-esophageal infusions of air (N = 41) were given and the temporal relationships of glottal response with deglutition, secondary peristalsis (SP), and the respiratory phase were analyzed using multinomial logistic regression models. RESULTS: The frequency occurrence of EGCR (83%) was compared (P < 0.001) with deglutition (44%), SP (34%), and no esophageal responses (22%). The odds ratios (OR, 95% CI) for the coexistence of EGCR with SP (0.4, 0.06-2.2), deglutition (1.9, 0.1-26), and no response (1.9, 0.4-9.0) were similar. The response time for esophageal reflexes was 3.8 (SD 1.8) s, and for EGCR was 0.4 (SD 0.3) s (P < 0.001). Volume-response relationship was noted (1 mL vs 2 mL, P < 0.05). EGCR was noted in both respiratory phases; however, EGCR response time was faster during expiration (P < 0.05). CONCLUSION: The occurrence of EGCR is independent of the peristaltic reflexes or the respiratory phase of infusion. The independent existence of EGCR suggests a hypervigilant state of the glottis to prevent retrograde aspiration during GER events.     

Effects of immunosuppressive drugs on the cognitive functioning of renal transplant recipients: a pilot study

Some renal transplant patients show cognitive, emotional, and behavioral changes as part of possible neurotoxic effects associated with immunosuppressive medication, especially tacrolimus. This study evaluated effects of immunosuppressive drugs on some cognitive tasks. Patients treated with sirolimus and cyclosporine reported some of the noncognitive side effects related to immunosuppressive treatment. We observed attention and working memory impairment in patients treated with sirolimus or tacrolimus. Performance of cyclosporine-treated subjects was similar to that of healthy volunteer controls. Since the mood, anxiety, and sleep patterns measured were unaffected, it could be concluded that the cognitive deficit found was partly related to treatment.     

Use of quorum sensing antagonists to deter the formation of crystalline Proteus mirabilis biofilms

Proteus mirabilis biofilms are a major cause of urinary catheter blockage. Antibiotic-impregnated catheters used to prevent catheter blockage have achieved limited success. Research has examined the efficacy of quorum sensing inhibitors against Pseudomonas aeruginosa biofilms, but there are few reports of the effects of these compounds against crystalline P. mirabilis biofilms. This study examined the effect of two quorum sensing antagonists, p-nitrophenyl glycerol (PNPG) and tannic acid, against crystalline P. mirabilis biofilms. Tannic acid and PNPG were observed to inhibit the quorum sensing system and the formation of P. mirabilis biofilms grown in artificial urine. The success of these compounds provides a possible means of preventing urinary catheter encrustation.     

Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country

Background

Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of patients with infantile spasms from Pakistan.

Methods

All patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned above. The type of drug distribution was random according to the availability, cost and ease of administration.

Results

Fifty six cases fulfilled the inclusion criteria. 62.5% were males. Mean age at onset of seizures was 5 ± 1.4 months. Fifty two (92.8%) patients demonstrated hypsarrythmia on electroencephalography. 64.3% cases were identified as symptomatic while 19.6% were cryptogenic and 16.1% were idiopathic. Eighteen patients received ACTH while 38 patients received Vigabatrin as first line therapy. Initial response to first line therapy was similar (50% for ACTH and 55.3% for Vigabatrin). Overall, the symptomatic and idiopathic groups responded better to Vigabatrin. The relapse rate was higher for ACTH as compared to Vigabatrin (55.5% vs. 33.3%) when considering the first line therapy. Four patients evolved to Lennox-Gastaut variant; all of these patients had initially received Vigabatrin and then ACTH.

Conclusion

Vigabatrin and ACTH showed no significant difference in the initial treatment of infantile spasms. However, patients receiving ACTH were 1.2 times more likely to relapse as compared to the patients receiving Vigabatrin when considering monotherapy. We suggest that Vigabatrin should be the initial drug of choice in patients presenting with infantile spasms. However, larger studies from developing countries are required to validate the therapeutic trends observed in this study.     

Perinatal distress,an appraisal perspective

Objective: The aim of this study was to identify the particular appraisals that shape maternal distress using the theoretical framework of Appraisal Theory of Emotions, which suggests that experienced emotions are triggered by the appraisal of specific situations. Background: Perinatal distress has been extensively studied. Symptoms range from mild to clinically significant. While major risk factors have been elucidated, cognitive components that may trigger distress need further clarification. Method: 122 women recruited during their third trimester of pregnancy completed measures of distress and appraisal during late pregnancy, within 7–10 days after delivery, and at 10–12 weeks postpartum. Mood scales included the Edinburgh Postnatal Depression Scale and the Depression, Anxiety and Stress Scale. Appraisal items addressed the experiences of pregnancy and motherhood. Results: Correlation and regression analyses showed a significant and stable association between symptoms of depression, anxiety and stress, and appraisals of low coping potential and future expectancy across the three assessment times. Low motivational congruence (incongruence) was associated with depression, anxiety, and stress during late pregnancy and the first days after childbirth, and with symptoms of depression at 10–12 weeks postpartum. Conclusion: In this sample of women experiencing low to moderate distress, findings suggest that the perceived ability to cope practically and emotionally with pregnancy and maternal-related issues, as well as pessimistic ideas about the future, form the core appraisal basis of perinatal distress. Implications for practice and intervention are discussed.     

Anxiolytic-like effect of a serotonergic ligand with high affinity for 5-HT1A, 5-HT2A and 5-HT3 receptors

S-(-)-2-[[4-(napht-1-yl)piperazin-1-yl]methyl]-1,4-dioxoperhydropyrrolo[1,2-alpha]-pyrazine (CSP-2503) is a serotonin (5-HT) receptor ligand with selectivity and high affinity for 5-HT1A, 5-HT2A and 5-HT3 receptors. CSP-2503 reduced rectal temperature and 5-HT neuronal hypothalamic activity in mice, decreased electrical activity of raphe nuclei cells in rats and blocked the enhancement of adenylate cyclase activity induced by forskolin in HeLa cells transfected with the human 5-HT1A receptor. This compound also blocked head-twitches induced by the 5-HT(2A/2C) receptor agonist 2,5-dimethoxy-4-iodoamphetamine (DOI). Contractions of guinea pig ileum induced by the 5-HT3 receptor agonist 2-methyl-5-HT were prevented by CSP-2503. Moreover, it reduced the bradycardia reflex induced by 2-methyl-5-HT in anaesthetized rats. In the light/dark box and social interaction tests, CSP-2503 presented anxiolytic activity, an action shared by 5-HT1 agonists and 5-HT3 antagonists. Taken together, these results suggest that CSP-2503 is a new 5-HT1 receptor agonist with 5-HT2A and 5-HT3)receptor antagonist activities that might be useful in a number of conditions associated with anxiety.