Aminophylline versus caffeine citrate for apnea and bradycardia prophylaxis in premature neonates

We investigated the efficacy and adverse effects of aminophylline and caffeine citrate in 180 premature neonates for 10 days and nights. Aminophylline ( n = 98) and caffeine citrate ( n = 82) were equally effective in preventing apnea and bradycardia. The caffeine citrate group had a lower median heart rate on day 3, fewer neonates with tachycardia and a smaller amount of gastric aspirate on day 7. The need for mononasal continuous positive airway pressure and respirator therapy was similar in both groups. We conclude that caffeine citrate is the drug of choice for apnea and bradycardia prophylaxis in premature neonates with a gestational age ≤33 full weeks.     

Protein intake affects phenylalanine requirements and growth of infants with phenylketonuria

Growth and metabolic status of 25 infants with PKU were evaluated based on protain intake. Food A-fed infants received a medical food containing 3.12g protein equivalent per 100 kcal and Food B-fed infants received a medical food containing 2.74 g protein equivalent per 100 kcal. Growth percentiles of infants in the Food A group were significantly greater than those for infants in the Food B group at 6 months of age (Food A percentiles: crown-heel length 55, head circumference 60, weight 73. Food B percentiles: crown-heel length 28; head circumference 29, weight 39). At study entrance, only crown-heel length of the two groups differed; Food B infants had a significantly greater mean crown-heel length percentile ( p < 0.05). Mean phenylalanine (PHE) intake was 38% greater by Food A-fed infants than by Food B-fed infants. Plasma PHE concentrations and mean energy intakes of the two groups did not differ. Mean protein intake of Food A-fed infants was greater during the first three months of life and significantly greater ( p < 0.05) during the second three months of life than by Food B-fed infants. Mean protein intake 24% greater than Recommended Dietary Allowances (RDA) was associated with better PHE tolerance and growth than was found when mean protein intake was 9% greater than RDA.     

Acute osteomyelitis in children: combined Tc-99m and Ga-67 imaging

This retrospective study was done to determine the value of combined bone (technetium-99m methylene-diphosphonate) and gallium-67 citrate imaging in selected children with complicated clinical situations. Thirty-one children were evaluated for suspected osteomyelitis by bone scan followed within 4 days by a gallium scan. These 31 children represented a subpopulation in whom the Tc-99m scan is known to be potentially unreliable in diagnosing acute osteomyelitis. Eight children had acute osteomyelitis by strict criteria, while 23 did not. The bone scan successfully identified five of the eight with osteomyelitis but was positive in ten of the other 23. The gallium scan correctly identified all eight with osteomyelitis but was positive in seven of the other 23. The gallium scan was significantly less specific when the suspected lesion was in the extremities compared with central locations; causes of false-positive gallium scans included fracture and juvenile rheumatoid arthritis. Combined gallium and bone scanning increased accuracy of the scintigraphic diagnosis of acute osteomyelitis. Both tests may, however, be abnormal in conditions other than osteomyelitis. These findings emphasize the importance of correlating all imaging studies in detection of osteomyelitis.     

A SURVEY OF HEAD INJURIES IN A GENERAL HOSPITAL

This paper reports the incidence of head injuries as patients attended a general hospital Accident & Emergency Department. The survey was carried out over a twelve-month period. The Accident & Emergency Department of Luton & Dunstable Hospital sees approximately 60,000 new patients every year. It is situated in close proximity to the M1 motorway and other major road systems. Facilities are available on site for computerised tomography from Monday to Friday between 9.00 am and 5.00 pm. At other times, if it is considered necessary after consultations with our neurosurgical colleagues, they are referred to the Royal Free Hospital, 30 miles away.     

Isolation of phytosterols and antihyperlipidemic activity of <Emphasis Type="Italic">Lagenaria siceraria</Emphasis>

Lagenaria siceraria (Molina) Standl in the Cucurbitaceae family is a large, pubescent, climbing, or trailing herb cultivated throughout India and the tropical regions of the world. Phytochemical investigation of the methanol extract obtained from the fruits of the plant L. siceraria showed a positive Liebermann-Burchard test for sterols. The white sterol crystals or phytosterols from the methanol extract were isolated for the first time and identified as a mixture of four sterols, including fucosterol (1), racemosol (2), stigmasterol (3), and stigmasta-7,22-dien-3β,4β-diol (4). These compounds were identified by spectroscopic evidence including FTIR, ¹H-NMR, MS, and GC. The white sterol crystals, which are the mixture of four sterols, were evaluated for antihyperlipidemic activity in Wistar rats. The blood samples were collected from the retro-orbital plexus and serum was separated and analyzed for lipid profiles. These sterol crystals (30 mg/kg) showed significant reductions in lipid profiles which included cholesterol, triglycerides, LDL and VLDL. In addition, a significant increase in HDL cholesterol observed, which is a good cholesterol that protects hearts from coronary artery diseases. These sterol crystals or phytosterols can be used as an antihyperlipidemic agent to treat the hyperlipidemic.     

Study of distribution and factors affecting syphilis epidemic among inner-city minorities of Baltimore

Disparities in health and medical conditions among ethnic and racial groups have been repeatedly documented. These inequalities, which have been noted in the recent past, include health outcomes such as quality of life and mortality, process, accessibility and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. Syphilis, a sexually transmitted disease (STD) which seemed to have disappeared or had been controlled over the years, has now re-emerged as a major public health problem in many rural, urban and suburban communities. Progression of the current rate of syphilis, which erupted in Baltimore during the later part of 1994, has continued unabated, most especially among the ethnic minorities, despite efforts of the Baltimore City Health Department and Maryland Department of Health and Mental Hygiene to control the epidemic. With the current incidence rates of 270 per 100 000 live births for congenital syphilis and 99.3 per 100 000 population for primary, secondary and latent syphilis (96% of the cases being in the non-white population), Baltimore becomes the city with the highest number of syphilis cases in the nation, surpassing the national average of 2.6 cases per 100 000 population. This study, which utilizes a combination of retrospective and questionnaire-oriented approach, was designed to assess factors that influenced the high incidence of syphilis among Baltimore inner-city dwellers between 1994 and 1998. Data for the study included syphilis reports from private physicians, the Baltimore City Health Department, STD clinics, the Center for Disease Control (CDC), and ethnographic interviews. Factors favoring the distribution and infectivity of the disease among the inner-city dwellers include greater poverty, high level of communication gaps between providers and a cross-section of minority inner-city dwellers, exchange of sex for crack cocaine, lower educational background, and inadequate and inappropriate health education/health promotion programs for the ethnic minorities.The paper calls for, among other things, culturally-sensitive and competent syphilis elimination/prevention health education and health promotion programs for the ethnic minority inner-city dwellers of Baltimore.     

Dual modulation of urinary bladder activity and urine flow by prostanoid EP3 receptors in the conscious rat

Background and purpose:

Cyclooxygenase inhibitors function to reduce levels of prostaglandin E₂ (PGE₂) and are broadly efficacious in models of bladder overactivity. We therefore investigated a regulation of urinary bladder function in conscious rats by modulation of the EP₃ receptor for PGE₂.

Experimental approach:

The activity of the EP₃ receptor agonist GR63799X, and EP₃ receptor antagonists, CM9 and DG041, at recombinant EP₃ receptors was evaluated in vitro. In vivo, intraduodenal dosing during conscious, continuous-filling cystometry of spontaneously hypertensive rats was utilized to determine the urodynamic effect of EP₃ receptor modulation.

Key results:

GR63799X dose-dependently (0.001–1 mg·kg⁻¹) reduced bladder capacity, as indicated by a reduction in both the micturition interval and volume of urine per void. In contrast, CM9 (10 and 30 mg·kg⁻¹) and DG041 (30 mg·kg⁻¹) enhanced bladder capacity, as indicated by significantly longer micturition intervals and larger void volumes. CM9 and DG041 inhibited the responses to GR63799X supporting the in vivo activity of these pharmacological agents at the EP₃ receptor. In addition to its effect on bladder capacity, GR63799X increased endogenous urine production. Intra-arterial infusion of saline mimicked the enhancement of urine flow observed with GR63799X, and the response was inhibited by CM9.

Conclusions and implications:

These data support the EP₃ receptor as a modulator of urinary bladder activity in the conscious rat, and in addition, indicate a role for EP₃ receptor activity in regulating urine flow.     

Tracheobronchial tree and pulmonary arteries: MR imaging using electronic axial rotation

Standard coronal magnetic resonance (MR) imaging cannot depict long segments of the tracheobronchial tree and left pulmonary artery owing to the normal thoracic kyphosis and posteriorly angled course of these structures. By the use of electronic axial rotation (EAR), however, MR is capable of imaging any plane. We used EAR in 25 patients undergoing MR examinations of the thorax. This technique allowed superior definition of the longitudinal axis of the tracheobronchial tree and left pulmonary artery. The right pulmonary artery was satisfactorily imaged by the standard coronal plane.     

An Evaluation of Coverage and Compliance of Mass Drug Administration 2006 for Elimination of Lymphatic Filariasis in Endemic Areas of Gujarat

Background:

Mass drug administration (MDA) means once-in-a-year administration of diethyl carbamazine (DEC) tablet to all people (excluding children under 2 years, pregnant women and severely ill persons) in identified endemic areas. It aims at cessation of transmission of lymphatic filariasis.

Objective:

What has been the coverage and compliance of MDA in Gujarat during the campaign in December 2006?

Study Design:

Cross-sectional population based house-to-house visit.

Setting:

Urban and rural areas in Gujarat identified as endemic for filariasis where MDA 2006 was undertaken.

Study Variables:

Exploratory - Rural and urban districts; Outcome - coverage, compliance, actual coverage, side effects.

Analysis:

Percentage and proportions.

Results:

Twenty-six clusters, each comprising 32 households from six endemic districts, yielded an eligible population of 4164. The coverage rate was 85.2% with variation across different areas. The compliance with drug ingestion was 89% with a gap of 11% to be targeted by intensive IEC. The effective coverage (75.8%) was much below the target (85%). Side effects of DEC were minimum, transient and drug-specific. Overall coverage was marginally better in rural areas. The causes of poor coverage and compliance have been discussed and relevant suggestions have been made.