Physicians' management of filarial lymphoedema and hydrocele in Pondicherry, India

Many countries have implemented mass drug administration programmes to eliminate lymphatic filariasis, but few have also implemented morbidity management programmes to help patients with chronic lymphoedema or hydrocele due to the infection. A study was carried out to assess current morbidity management by physicians in Pondicherry, India. Fifty-two physicians were interviewed, using a semi-structured questionnaire. For the management of hydrocele, all physicians referred hydrocele patients for surgery and 83% prescribed diethylcarbamazine (DEC). For the management of chronic lymphoedema patients, most doctors (75%) prescribed DEC and 56% mentioned the possibility of surgery. Only 10% of the physicians gave advice about limb hygiene, although recent research has shown the importance of hygiene measures to prevent further progression of lymphoedema. For the management of lymphoedema patients presenting with acute attacks, all physicians prescribed DEC and antibiotics and only 15% gave advice about limb hygiene. We conclude that limb hygiene instruction for home care should be more strongly emphasised to optimize management of lymphoedema patients in Pondicherry.     

The long-term effect of successful mitral balloon valvotomy on left atrial size.

BACKGROUND AND AIM OF THE STUDY: The study aim was to determine the extent of regression of left atrial (LA) enlargement following mitral balloon valvotomy (MBV) for mitral stenosis. METHODS: Data obtained from 205 patients before, and at a mean of 31.0 +/- 21.1 months (range: 6 to 86.3 months) after successful MBV were analyzed retrospectively. RESULTS: The invasively determined mitral valve area increased from 0.81 +/- 0.27 cm2 at baseline to 1.73 +/- 0.54 cm2 immediately after valvotomy (p <0.0001), and the mean mitral gradient fell from 15.6 +/- 5.3 to 5.4 +/- 2.5 mmHg (p <0.0001). Similar changes were noted in Doppler-determined mitral valve area (0.89 +/- 0.16 to 1.97 +/- 0.29 cm2; p <0.0001) and gradient (12.6 +/- 5.3 to 4.9 +/- 1.7 mmHg; p <0.0001). In comparison with baseline, significant (p <0.0001) reductions were noted at follow up in the echocardiographic anteroposterior (48.7 +/- 6.9 to 42.4 +/- 6.6 mm), superior-inferior (68.5 +/-8.1 to 59.6 +/- 8.2 mm) and medial-lateral LA dimension (51.2 +/- 6.7 to 44.1 +/- 7.7 mm) and calculated LA volume (91.6 +/- 29.1 to 60.7 +/- 23.8 cm3) Patients in atrial fibrillation had larger LA dimensions, but substantially smaller absolute and relative reduction in LA size at follow up than patients in sinus rhythm. Among patients with prevalvotomy LA enlargement, normalization of LA dimension at follow up was seen in 29.2% of patients in sinus rhythm, but in none of the 32 with atrial fibrillation. CONCLUSIONS: Successful MBV results in significant long-term reduction in LA size in most patients, but normalization of LA size is unusual.     

Patterns of occurrence and concordance between subjective and objective hot flashes among Muslim and Hindu women in Sylhet,Bangladesh

This study examined the pattern of occurrence and the rate of concordance between objective hot flashes measured by sternal skin conductance and the subjective experience of “gorom vap laga” (feeling steaming hot) among Muslim and Hindu women living in Sylhet, Bangladesh. Participants were aged 40–55, not pregnant or lactating, not using hormone therapy, and with no history of hysterectomy. Thirty women wore an ambulatory hot flash monitor for 8 h on average, from mid‐morning to early evening. True positive, false negative, and false positive measures of hot flashes were examined in relation to demographic, reproductive, and lifestyle variables. On body diagrams, women were most likely to indicate hot flashes on the top of their head (64%) and upper chest (68%). The greatest number of objective hot flashes occurred during the hour of 17:00, perhaps due to the heat of the day, and the clothing and activity associated with prayer. Muslim participants demonstrated more objective hot flashes per woman than Hindu participants (1.5 vs. 0.1, P < 0.05), and Muslims had more false positive measures (86%) compared with Hindu participants (0%, P = 0.06). Among all women who reported subjective hot flashes (n = 19), the proportion of true positive scores was 19%. Overall, the frequency of objective hot flashes was low compared with reports from studies in the United States. The pattern of sweating assessed by body diagrams was not associated with variation in hot flash experience. Am. J. Hum. Biol., 2008. © 2008 Wiley‐Liss, Inc.     

Variance inflation in sequential calculations of body surface area, plasma volume, and prostate-specific antigen mass

OBJECTIVE

To assess the magnitude of variability among 11 formulae for human body surface area (BSA) and then among eight for plasma volume (PV), as used to represent physiological indices for body metabolism, drug dosages and body fluid management, and to evaluate the potential cumulative effect of variance inflation with prostate‐specific antigen (PSA) mass as an endpoint.

PATIENTS AND METHODS

In 3020 men undergoing robotic radical prostatectomy (RRP) at the Vattikuti Urology Institute between 2001 and 2008, the variation in BSA and PV formulae was calculated, as well as PSA mass, using analysis of variance (anova ), Bland‐Altman plots, linear regression, and correlation analyses.

RESULTS

For estimating BSA, anova indicated significant variance among the 11 formulae used (P < 0.001) with a between‐groups variance of 5.45. Bland‐Altman plots reported bias when the Dubois formula was compared to other BSA formulae. Furthermore the anova for PV, with BSA as a predictor, indicated significant variance among the eight formulae used (P < 0.001), with a mean between‐group variance of 444.4 and a mean inflation factor of 81.5. Scatter plots between one PV formula (Boer) and others had a good linear fit. For PSA mass, anova indicated significant variance (P < 0.001) using PV as a predictor, with a mean between‐group variance of 16 799.6 and a mean variance inflation factor of 37.8.

CONCLUSIONS

There is significant variation in the BSA calculated by commonly used formulae. This variation is carried over and further magnified in the sequential calculation of PV and PSA mass. Hence arbitrary selection of BSA and PV formulae is likely to affect inferences.     

Effect of Semecarpus anacardium nut extract on ECM and proteases in mammary carcinoma rats

The early stages of invasion are characterized by the extracellular proteolysis and the accumulation of specialized extracellular matrix (ECM) scaffold, that are responsible for the development of vascular bed, endothelial cell proliferation and invasion of tumour cells. The ground substance of provisional matrix consists of collagen, elastin, glycoaminoglycans and proteoglycans that facilitate the interaction of tumour cells with the host environment. In the present work, we have studied the influence of Semecarpus anacardium nut milk extract on localized differentials of ECM component and proteases involved in matrix metabolism of tumour tissue. Mammary carcinoma was induced in Sprague Dawley rats with 7,12, dimethyl benz(a)anthracene and treated with S. anacardium nut milk extract administered orally for 14 days. The altered amount of ECM components in tumour tissues was almost reverted back to normal level in the drug treated animals. The activities of reported proteases and glycohydrolases were also decreased on treatment with S. anacardium nut milk extract indicating decreased turnover of the matrix. Also, the factors associated with the matrix turnover and expression of MMP-1, MMP-2, MMP-3, TIMP-1 and TIMP-2 were restored back to near normal values. The stabilization of the ECM with the decreased activity of proteases might inhibit the epithelial-endothelial interaction and tumour cell migration thus, preventing the adjacent invasion and tumour growth and might be regarded as antineoplastic agent which demands further studies.