Pulmonary immunization: deposition site is of minor relevance for influenza vaccination but deep lung deposition is crucial for hepatitis B vaccination

Vaccination the pulmonary route could be an attractive alternative to parenteral administration. Research towards the best site of antigen deposition within the lungs to induce optimal immune responses has conflicting results which might be dependent on the type of vaccine and/or its physical state. Therefore, in this study, we explored whether deep lung deposition is crucial for two different vaccines, .., influenza and hepatitis B vaccine. In view of this, influenza subunit vaccine and hepatitis B surface antigen were labeled with a fluorescent dye and then spray-dried. Imaging data showed that after pulmonary administration to mice the powders were deposited in the trachea/central airways when a commercially available insufflator was used while deep lung deposition was achieved when an in-house built aerosol generator was used. Immunogenicity studies revealed that comparable immune responses were induced upon trachea/central airways or deep lung targeting of dry influenza vaccine formulations. However, for hepatitis B vaccine, no immune responses were induced by trachea/central airways deposition whereas they were considerable after deep lung deposition. Thus, we conclude that deep lung targeting is not a critical parameter for the efficacy of pulmonary administered influenza vaccine whereas for hepatitis B vaccine it is.

Blind nasogastric lube insertion: be careful

Nasogastric tubes are used in all specialties of medical practice. In critically ill patients, these feeding tubes provide enteral nutrition, which maintains enteric mucosal integrity as well as the immune system of the body, less risk of sepsis and decrease in length of intensive care stay. The insertion of nasogastric tube [NGT] is being considered as a simple blind bedside procedure but this procedure is not free of complications and can be fatal as these tubes can be malpositioned into the respiratory tract or central nervous system. Critically ill patients with endotracheal and tracheostomy tube are at particular risk for malpositioning of the nasogastric tubes due to loss of protective reflexes. Here we report three cases, two intubated and one patient with tracheostomy, in whom the enteral feeding tube was malpositioned into the respiratory system, detected early and a new one inserted in correct position, confirmed by x-ray. The aim of this report is to increase awareness about malpositioning of gastric feeding tubes, proper confirmation of their positioning, risk factors for malpositioning and its prevention

Molecular markers in prostate cancer. Part II: potential roles in management / 亚洲男科学杂志(英文版)

Predicting treatment responses in advanced prostate cancer (PCa) currently centres on prostate-specific antigen (PSA) kinetics and on being able to visualize measurable changes in imaging modalities. New molecular markers have emerged as potential diagnostic and prognostic indicators; these were summarized in Part I of this review in the Asian Journal of Andrology. A number of molecular markers are now being used to enhance PCa imaging and staging. However, management options for advanced and hormone-resistant PCa (HRPC) are limited and additional therapeutic options are needed. Molecular markers have been proposed as potential therapeutic targets using gene therapy and immunomodulation. Additionally, markers identified in early PCa and precursor lesions may offer novel targets for chemoprevention and vaccine development. This review summarizes the current advances regarding the roles of these markers in the management of PCa.

case of acute respiratory failure

Pulmonary tuberculosis presenting as respiratory failure requiring mechanical ventilation is not very common. Since Miliary Tuberculosis [MT] without specific treatment is fatal, early diagnosis is critical, and it should be considered in the differential diagnosis of community acquired pneumonias. We present a case of respiratory failure presented as Acute Respiratory Distress Syndrome [ARDS] which failed to respond to nonspecific antibiotics and ventilator strategies, but promptly improved after initiation of Anti Tubercular Regimen [ATT]

High-ligation of varicocoele for scrotal pain: is it worthwhile?

Seventy-five consecutive patients with varicocoele were studied prospectively to determine the value of high ligation in infertile males and in symptomatic men; 14 [18.6%] were grade I, 28[37%] were grade II, and 33 [44%] were grade III. The patients were divided into two groups according to the mode of presentation, group I comprising 55 patients [73%] presented with dragging pain and/or scrotal swelling and group II consisting of 20 patients [27%] were seeking treatment for infertility. Fifty-one out of 55 patients [93%] in group I had high grades [grade II or grade Ill] compared to only 10/20 patients [50%] in group II [P < 0.05]. In both groups varicocoele grades did not significantly correlate with hormonal assay abnormalities. Despite lower varicocoele grades in group II all 20 patients [100%] were oligozoospermic compared to 6 [16%] out of 38 patients in group I who agreed to undergo semen analysis. All patients underwent high-ligation and were followed up for 4-29 months [mean = 5.1 months and median = 11 months]. Fourty-nine out of 55 [89%] patients were cured of their symptoms in group I. Out of 15 patients in group II only 9 [60%] had improvement in their semen quality but none fathered a child. In conclusion our study suggests that high-ligation of varicocoele is worthwhile for scrotal swelling and/or pain relief. Its value in fertility restoration could not be confirmed in our limited number of infertile patients