Tea tree oil concentration in follicular casts after topical delivery: determination by high-performance thin layer chromatography using a perfused bovine udder model

Tea tree oil, a popular antimicrobial agent is recommended for the treatment of acne vulgaris, a disease of the pilosebaceous unit. Tea tree oil formulations (colloidal bed, microemulsion, multiple emulsion, and liposomal dispersion containing 5% w/w tea tree oil) were applied to bovine udder skin. The follicular uptake of tea tree oil upon application was determined by a cyanoacrylate method. Tea tree oil was determined by quantifying terpinen-4-ol content using high-performance thin layer chromatography. The accumulation of tea tree oil in the follicular casts was 0.43 +/- 0.01, 0.41 +/- 0.009, 0.21 +/- 0.006, and 0.16 +/- 0.005 percentage by weight (milligram oil/gram of sebum plug) for microemulsion, liposomal dispersion, multiple emulsion, and colloidal bed, respectively. This is the first study of its kind to quantify tea tree oil concentration in the follicles.     

Comparative study of perioperative infusion of diltiazem and nicorandil on myocardial protection during OPCAB surgery

We compared the effects of continuous intravenous infusions of nicorandil and diltiazem on left ventricular function, haemodynamics and as anti-ischaemic and anti-arrhythmic agents in 50 patients undergoing off pump coronary artery bypass surgery using arterial conduits. The patients were randomized into two equal groups to receive diltiazem or nicorandil. Both the drugs were given as a continuous infusion in the dose of 1microg/kg/min starting at induction and continued for 24 hours postoperatively. Haemodynamic parameters, cardiac enzyme levels and use of vasoactive agents were studied and compared using ANOVA, unpaired "t" and Fisher's exact tests. The two groups did not differ with respect to preoperative and operative data. Diltiazem group showed lower cardiac index (2.66+/-0.8 and 2.27+/-0.89 L/min/m2) as compared with nicorandil group (3.16+/-0.79 and 2.97+/-1.01 L/min/m2) during revascularisation of anterior (P=0.03) and inferior (P=0.01) circulation respectively. The systemic vascular resistance index was higher (2290+/-699 and 2545+/-911 dync.sec.cm-5.m2) in diltiazem group as compared with nicorandil group (1822+/-532 and 1877+/-548 dyne. sec.cm-5.m2) during revascularization of anterior (P=0.01) and inferior (P=0.002) circulation respectively. The mean pulmonary artery pressure was significantly higher in nicorandil group as compared with diltiazem group during revascularisation of anterior circulation (22.5+/-4.9 and 18.1+/-6.8 mmHg, P=0.01). The patients in the diltiazem group maintained a lower heart rate throughout the study period, but the difference was not statistically significant. None of the patients exhibited any arrhythmia except one in nicorandil group, who developed supraventricular arrhythmia 24 hours postoperatively. Cardiac enzyme levels were found to be similar in the two groups. The present study demonstrates that the anti-ischemic and antiarrythmic effects of diltiazem and nicorandil are comparable, but diltiazem causes a decrease in cardiac index and increase in systemic vascular resistance index during revascularization of anterior and inferior circulation.     

Predicting the development of diabetes in older adults: the derivation and validation of a prediction rule

OBJECTIVE: To create a simple prediction rule that could perform as well as the 2-h postchallenge plasma glucose (PCPG) test to predict those at risk for diabetes. We created a prediction rule in one sample and prospectively validated it for incident diabetes in a separate cohort. RESEARCH DESIGN AND METHODS: A cross-sectional analysis with data from the Rancho Bernardo Study (age 67 +/- 11 years) to derive a rule predicting abnormal PCPG >/=140 mg/dl, using demographic, clinical, and laboratory data of nondiabetic participants with fasting plasma glucose (FPG) <126 mg/dl. Data from the Health, Aging and Body Composition study (age 74 +/- 3 years) were used to prospectively validate this rule for incident diabetes and compare it with the predictive ability of the PCPG test. RESULTS: Of 1,549 RBS participants, 514 (33%) had PCPG >/=140 mg/dl. Female sex, age, triglycerides, and FPG were most significantly associated with abnormal PCPG. Based on standardized beta-coefficients, we allotted 1 point for female sex, triglycerides >/=150 mg/dl, or FPG 95-104 mg/dl. Age >/=70 years or FPG 105-115 mg/dl were given 2 points, and FPG 116-125 mg/dl received 3 points. In the validation cohort, this simple prediction rule was as good as the 2-h PCPG test for predicting incident diabetes (C-statistic: 0.71 for both). CONCLUSIONS: Advanced age, female sex, FPG, and triglycerides were able to predict adults at risk for diabetes equally well as the 2-h PCPG test. Using this rule, clinicians may better identify older persons who should receive intensive lifestyle intervention to prevent type 2 diabetes.     

An unusual presentation of parathyroid adenoma--a case report

A case of intrathyroid parathyroid adenoma which clinically and cytologically mimicked thyroid tumor is presented. The patient was normocalcemic inspite of clinical and radiological features suggestive of hyperparathyroid bone disease. The adenoma showed an area of infarction presumably accounting for the normocalcemic primary hyperparathyroidism. The case is reported for its unusual presentation.     

A case of extensive linear porokeratosis with evaluation of topical tretinoin versus 5-flourouracil as treatment modalities

A 19-year-old male presented with linear raised lesions over extensive areas of his body that followed Blaschko's lines. The lesions were asymptomatic with ridged borders. Histopathology confirmed a diagnosis of porokeratosis. He was given topical tretinoin and topical flourouracil for local application on specified areas. The cosmetic acceptability and the safety profile of tretinoin were found to be better than those of flourouracil. However, both the agents were equally efficacious. A rare case of extensive porokeratosis with comparative evaluation of two treatment modalities is hereby presented.     

Detecting fetomaternal hemorrhage after first-trimester abortion with the Kleihauer-Betke test and rise in maternal serum alpha-fetoprotein

OBJECTIVE: To compare the incidence and detect the volume of fetomaternal hemorrhage (FMH) during first-trimester abortion with the Kleihauer-Betke test (KBT) and rise in maternal serum alpha-fetoprotein (AFP). STUDY DESIGN: Blood samples were drawn immediately before and after first-trimester termination of pregnancy in 48 women. AFP was estimated using an enzyme-linked immunosorbent assay technique. Fetal cells were counted using the acid elution technique described by Kleihauer. Volume of FMH with both techniques was calculated using standard formulae. Significant FMH was reported when there was a > 40% rise in AFP or > 0.25 mL bleed detected by KBT. RESULTS: Of the 48 cases studied, 18 (37.5%) showed no indication of FMH by either AFP or KBT. In 30 (62.5%) cases there was evidence of FMH; in 7 (14.6%) this was shown by both AFP and KBT. Another 10 (21%) showed significant changes in AFP concentration only, and 13 (27%) showed abnormal KBT results with stable AFP levels. The incidence of detectable FMH after first-trimester abortion in this series was 35% when assessed by AFP and 42% when assessed by KBT (P > .05). The mean volume of FMH detected by KBT was 0.5+/-0.05 mL and by AFP was 0.01+/-0.02 mL. CONCLUSION: This study showed that AFP and KBT are equally sensitive methods of detecting the incidence of FMH in first-trimester abortion, but concordance between the 2 tests is poor. The volume of FMH detected by KBT and FMH is also significantly different.     

Daily versus intermittent iron supplementation in pregnant women: hematological and pregnancy outcome

AIM: To compare the hematological parameters and pregnancy outcome in women receiving daily versus weekly iron supplements during pregnancy. METHODS: A prospective randomized controlled study was carried out at the Department of Obstetrics and Gynaecology of the All India Institute of Medical Sciences, New Delhi, India, during which 111 women were randomized to receive either 100 mg elemental iron daily (n=55) or 200 mg elemental iron weekly (n=56). Hemogram and serum ferritin level estimation were carried out at the beginning of pregnancy and within the 32-34-week period of gestation. Side-effects, compliance and the number of tablets consumed were noted for each group. The mean birth weight, period of gestation at delivery and mode of delivery were also compared between the two intervention groups. RESULTS: There was no significant difference in the mean hemoglobin levels between the two intervention groups at the end of an average 17 weeks of iron supplementation. However, among anemic women who received daily supplementation, there was a greater rise in hemoglobin compared with those receiving supplementation weekly. The serum ferritin level was lower in the weekly supplemented group compared with that in the daily. There was no difference in the mean birth weight, period of gestation and mode of delivery between the two groups. Side-effects and non-compliance were significantly higher (P<0.001) in the daily supplemented group. CONCLUSIONS: Weekly iron supplementation is an effective option for prophylaxis in non-anemic pregnant women, but has less than optimal benefit in anemic women.