Comparison of tolterodine with standard treatment in pediatric patients with non-neurogenic dysfunctional voiding/over active bladder : A systematic review.

To examine the efficacy, safety and tolerability of tolterodine in children with overactive bladder in comparison with standard treatment i.e. oxybutynin as demonstrated in randomized clinical trials and other studies. A systematic search was done to screen the studies evaluating the effect of tolterodine in children with nonneurogenic overactive bladder. Results of studies were pooled and compared. Efficacy was determined from micturition diaries and dysfunctional voiding symptoms score. Safety and tolerability were assessed from the reported treatment emergent adverse events. A total of six randomized clinical trials and 11 other studies of tolterodine in children with urinary incontinence were included in the present systematic review. The dose of tolterodine used in different settings ranged from ‘0.5 to 8 mg/day’ instead of ‘0.5 to 8 mg/kg per day’ and the duration of studies ranged from 2 weeks to 12 months. Both extended and immediate release preparations of tolterodine were shown to have comparable efficacy and tolterodine proved to have comparable efficacy with better tolerability than oxybutynin in these studies. It can be concluded that tolterodine is efficacious in treatment of urinary incontinence in children. Moreover, its efficacy is comparable to oxybutynin, the most commonly prescribed anticholinergic in this condition, while having better tolerability. Hence, it can be considered as first line therapy for the treatment of urinary incontinence in children.

Biosorption of Lead by Bacillus cereus Isolated from Industrial Effluents.

Aims: To study the biosorption of lead ions from solution using Bacillus cereus isolated from industrial effluents collected from Peenya industrial area, Bangalore, India and to determine the optimum conditions for biosorption. Study design: Experimental study. Place and Duration of Study: Department of Microbiology and Biotechnology, Bangalore University, Bangalore, Karnataka, India, between October 2008 and December 2009. Methodology: Sixty bacterial strains were isolated from industrial effluents collected from Peenya industrial area. Among the sixty isolates only six were selected for further investigation due to their high minimum inhibition concentration for lead. Lead biosorption studies were carried out for all the six isolates using atomic absorption spectrometry. The optimum conditions (temperature, pH and culture age) for biosorption were determined for the isolate showing highest lead biosorption. Results: The lead biosorption capability of all six isolates was studied at different concentrations of lead (100, 200, 300, 400 and 500 mg/l). The isolate 6 showed highest lead biosorption capability and was identified as Bacillus cereus. Studies on the control of environmental factors revealed that an optimum temperature of 30°C and pH 5, facilitates maximum biosorption of lead by 24hrs old culture of Bacillus cereus. Conclusion: Biosorption is an alternative to traditional physicochemical methods for removing toxic metals from wastewaters. The results of this study are discussed in the light of the biosorption capacity of Bacillus cereus that could be exploited in the bioremediation of lead.

A pilot study on area under curve of mycophenolic acid as a guide for its optimal use in renal transplant recipients.

Background & objectives: The immunosuppressants administered to renal transplant subjects are usually monitored therapeutically to prevent graft rejection and drug toxicity. Mycophenolic acid (MPA) is an immunosuppressant. The present prospective study was undertaken to establish the utility of plasma level monitoring of MPA and to correlate it with clinical outcomes in renal transplant receipients. Methods: MPA plasma level at 2, 4 and 9 h and the area under concentration-time curve (AUC) were estimated using high performance liquid chromatography in 24 renal transplant recipients receiving immunosuppressant MPA plus tacrolimus and steroid. Results: There was wide inter-individual variation in MPA plasma level and the AUC. The incidences of gastrointestinal adverse drug events (diarrhoea and acidity) were significantly more in the high MPA AUC patients. Though biopsy proven acute rejection was not found, of the six subjects with lower MPA AUC (<30 mg.h/l), three were clinically diagnosed to develop tacrolimus nephrotoxicity. The Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) scores represented better health related quality of life in lower MPA AUC than in the higher MPA AUC (>60 mg.h/l). Interpretation & conclusions: The present findings suggest the MPA AUC of 30 - 60 mg.h/l in the maintenance stage of renal transplant patients to have optimum clinical benefit and relegated adverse events profile indicating the usefulness of AUC of MPA with limited sampling strategy in optimizing its use.

Periorbital melanosis is an extension of pigmentary demarcation line-F on face.

BACKGROUND: To date, periorbital melanosis is an ill-defined entity. The condition has been stated to be darkening of the skin around the eyes, dark circles, infraorbital darkening and so on. AIMS: This study was aimed at exploring the nature of pigmentation in periorbital melanosis. METHODS: One hundred consecutive patients of periorbital melanosis were examined and investigated to define periorbital melanosis. Extent of periorbital melanosis was determined by clinical examination. Wood's lamp examination was performed in all the patients to determine the depth of pigmentation. A 2-mm punch biopsy was carried out in 17 of 100 patients. RESULTS: In 92 (92%) patients periorbital melanosis was an extension of pigmentary demarcation line over the face (PDL-F). CONCLUSION: Periorbital melanosis and pigmentary demarcation line of the face are not two different conditions; rather they are two different manifestations of the same disease.

Transdiaphragmatic intercostal hernia due to chronic cough.

Intercostal transdiaphragmatic hernia is a rarely reported lesion. Trauma is the commonest cause. We report a 75-year-old man who presented with transdiaphragmatic intercostal hernia due to chronic cough. He recovered after surgical repair.