An objective way to predict remission and relapse in Cushing disease using Bayes' theorem of probability.

OBJECTIVE: In this study on patients with Cushing disease, post-transsphenoidal surgery (TSS), we attempt to predict the probability of remaining in remission, at least for a year and relapse after that, using Bayes' theorem and the equation of conditional probability. The number of parameters, as well as the weightage of each, is incorporated in this equation. DESIGN AND METHODS: The study design was a single-centre ambispective study. Ten clinical, biochemical, radiological and histopathological parameters capable of predicting Cushing disease remission were identified. The presence or absence of each parameter was entered as binary numbers. Bayes' theorem was applied, and each patient's probability of remission and relapse was calculated. RESULTS: A total of 145 patients were included in the study. ROC plot showed a cut-off value of the probability of 0.68, with a sensitivity of 82% (range 73-89%) and a specificity of 94% (range 83-99%) to predict the probability of remission. Eighty-one patients who were in remission at 1 year were followed up for relapse and 23 patients developed relapse of the disease. The Bayes' equation was able to predict relapse in only 3 out of 23 patients. CONCLUSIONS: Using various parameters, remission of Cushing disease can be predicted by applying Bayes' theorem of conditional probability with a sensitivity and a specificity of 82% and 94%, respectively. This study provided an objective way of predicting remission after TSS and relapse in patients with Cushing disease giving a weightage advantage to every parameter.

Detection of Pre-clinical Involvement of the Second Eye in Viral Acute Retinal Necrosis Using Optical Coherence Tomography.

PURPOSE: To report the detection of retinitis in the second eye of a patient with viral acute retinal necrosis (ARN), before the appearance of clinical change, using swept-source optical coherence tomography. RESULTS: A 63 year-old male developed right-sided varicella-zoster virus (VZV) ARN, confirmed with aqueous sampling. High-dose intravenous aciclovir caused renal impairment and was suspended for two-days. One day later, left eye macular SS-OCT revealed focal retinal thickening and disruption of retinal architecture without clinically detectable retinitis. The patient was asymptomatic. Aqueous sampling was VZV PCR positive. He received bilateral foscarnet injections and renal adjusted dose of aciclovir. The left OCT signs improved with full restoration of retinal layers. CONCLUSIONS: We report for the first time the use of OCT to detect pre-clinical second eye retinitis during ARN. Prompt diagnosis and combined systemic and intensive local antiviral therapy resulted in a favourable structural and functional outcome.

Effectiveness of Interventional Strategies in Modulating Knowledge and Attitude of Health Care Professionals for Promoting Organ Donation: A Study in Tertiary Care Public Hospital of North India.

OBJECTIVE: To evaluate the impact of interventional "educational module" on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance. STUDY DESIGN: Interventional and prospective. METHODS: We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention. RESULTS: A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the "concept of organ donation," while nurses were more familiar with "procedures and protocols." Both had low knowledge about "clinical criteria for brain death" and "legal issues" preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause. CONCLUSION: Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

Ischemic Colitis Caused by Intra-Aortic Balloon Pump Counterpulsation.

Intra-aortic balloon pump counterpulsation (IABP) has been shown to prolong life in critically ill cardiac patients. However, complications including distal emboli, balloon rupture, bleeding, limb loss, and bowel ischemia continue to be associated with them. We present a case of a 56-year-old male who suffered bowel ischemia as a result of a malpositioned IABP. While the benefit of such devices in critically ill patients is not disputed, patients as well as clinicians should be aware of the potential side effects and patients undergoing IABP placement should be monitored for complications.

Assessment of Ethnicity in Indian Population using Tooth Crown Metric Dental Traits.

BACKGROUND: Tooth crown dimensions vary between different ethnic groups, providing insights into the factors controlling human dental development. This present study compares permanent mesiodistal (MD) and buccolingual crown dimensions between four ethnic groups, highlighting patterns of tooth size between these groups and considers the findings in relation to genetic and environmental influences. MATERIALS AND METHODS: MD and buccolingual tooth crown dimensions were recorded using digital vernier calipers on dental casts derived from four different human population: Iranians, Hindus, Muslims, and Christians. RESULTS: Obtained measurements were subjected to statistical analysis. The Christian sample was found to have the largest teeth overall, whereas the Iranian sample generally displayed the smallest MD and buccolingual crown dimensions (P < 0.001). Comparisons of coefficients of variation for teeth within each class showed that the later-forming teeth displayed greater variation in MD size than the earlier-forming teeth. CONCLUSION: The different patterns of tooth size observed between the study samples are thought to reflect differences in the relative contributions of genetic and environmental influences to dental development between the four population. Using a standardized methodology, significant differences in MD and buccolingual crown dimensions have been demonstrated between four human ethnic groups. There were also distinct differences in the patterns of crown size between the groups, with the later-forming teeth in each type generally showing greater size variation.

DAMTC regulates cytoskeletal reorganization and cell motility in human lung adenocarcinoma cell line: an integrated proteomics and transcriptomics approach.

DAMTC (7,8-diacetoxy-4-methylcoumarin) is a thioderivative of 4-methyl coumarin, and previously we have shown that DAMTC is a potent inhibitor of cell growth and an inducer of apoptosis in non-small cell lung cancer (A549) cells. It induces apoptosis through mitochondrial pathway by modulating NF-κB, mitogen-activated protein kinase (MAPK) and p53 pathways. Herein, we explored the genome-wide effects of DAMTC in A549 cells using the concerted approach of transcriptomics and proteomics. In addition to apoptotic pathways, which have been validated earlier, the bioinformatic analysis of microarray data identified small GTPase-mediated signal transduction among the significantly altered biological processes. Interestingly, we observed significant downregulation of some members of the Rho family GTPases in the proteomics data too. Downregulation of Rho GTPases (RhoGDIα (Rho GDP dissociation inhibitor-α, also known as ARHGDIA), Ras homolog family member A, Ras-related C3 botulinum toxin substrate 1 and cell division cycle 42) was validated by western blotting. The Rho protein family is implicated in maintaining the actin filament assembly and cell motility, and we also observed that DAMTC treatment causes actin cytoskeletal reorganization, promotes filopodia formation and inhibits cell motility in A549 cells. The effect of DAMTC treatment on cytoskeleton was reversed after the overexpression of RhoGDIα. In addition, DAMTC augmented the apoptotic effect of etoposide, a proapoptotic chemotherapeutic drug. This elucidation of the mechanism behind DAMTC-induced apoptosis and inhibition of cell motility in A549 cells may make it a potential therapeutic for lung cancer.

Levitating spherical particle in a slightly tapered tube at low Reynolds numbers: application to the low-flow rate rotameters.

In this study, a theoretical framework is developed to predict the equilibrium conditions of a non-neutrally buoyant sphere placed in a vertical conical tube as encountered in liquid rotameters. The analysis presented herein is applicable for a sphere heavier than the surrounding fluid, situated on the axis of a slightly tapered tube. The sphere is subject to the laminar flow conditions with the Reynolds numbers ranging between the Stokes type regimes up to values corresponding to slightly inertial regimes. In this work, we assume that the aperture angle of the tube is small and that the drag force is mainly due to the dissipation located in the gap between the tube and the sphere. Under these conditions, it is possible to consider the tube as locally cylindrical and we can use the results previously obtained for the correction factor of the Stokes force on a sphere subject to a Poiseuille flow in a tube of constant cross-section. We obtain an equation relating the flow rate to the vertical position of the sphere in the tube and the validity of this analysis is demonstrated by applying it to a commercially available rotameter. The present study provides a simple but sound theoretical method to calibrate such flowmeters.

Footrot on a sheep breeding farm in the Himalayan state of Jammu and Kashmir.

In the present study ovine footrot was detected clinically on a sheep farm in the Himalayan state of Jammu and Kashmir. Dichelobacter nodosus was confirmed by culture and polymerase chain reaction (PCR) using species-specific 16S ribosomal RNA primers. When cultured, the organism appeared as flat colourless colonies having a fine granulated structure with irregular margins, and showing characteristic Gram-negative rods with swollen ends. Detection by PCR from cultured bacteria resulted in amplification of a 783 base pairs (bp) product. Serogrouping by multiplex PCR using group (A-I)-specific primers revealed the presence of serogroup B-specific bands of 283 bp.

Carcinogenesis studies of cresols in rats and mice.

Cresols, monomethyl derivatives of phenol, are high production chemicals with potential for human exposure. The three isomeric forms of cresol are used individually or in mixtures as disinfectants, preservatives, and solvents or as intermediates in the production of antioxidants, fragrances, herbicides, insecticides, dyes, and explosives. Carcinogenesis studies were conducted in groups of 50 male F344/N rats and 50 female B6C3F1 mice exposed to a 60:40 mixture of m- and p-cresols (m-/p-cresol) in feed. Rats and mice were fed diets containing 0, 1500, 5000, or 15,000 ppm and 0, 1000, 3000, or 10,000 ppm, respectively. Survival of each exposed group was similar to that of their respective control group. Mean body weight gains were depressed in rats exposed to 15,000 ppm and in mice exposed to 3000 ppm and higher. A decrease of 25% over that of controls for the final mean body weight in mice exposed to 10,000 ppm appeared to be associated with lack of palatability of the feed. A marginally increased incidence of renal tubule adenoma was observed in the 15,000-ppm-exposed rats. The increased incidence was not statistically significant, but did exceed the range of historical controls. No increased incidence of hyperplasia of the renal tubules was observed; however, a significantly increased incidence of hyperplasia of the transitional epithelium associated with an increased incidence of nephropathy was observed at the high exposure concentration. The only significantly increased incidence of a neoplastic lesion related to cresol exposure observed in these studies was that of squamous cell papilloma in the forestomach of 10,000-ppm-exposed mice. A definitive association with irritation at the site-of-contact could not be made because of limited evidence of injury to the gastric mucosa at the time of necropsy. However, given the minimal chemical-related neoplastic response in these studies, it was concluded that there was no clear evidence of carcinogenicity in male rats or female mice exposed to the cresol mixture.

Emergencies in HIV medicine--part I.

Human immunodeficiency virus (HIV) infection is now a chronic manageable disease due to which is it imperative for reviewing various medical emergencies which an individual case may encounter. Emergencies may occur at any stage of the disease. HIV infection is associated with several opportunistic infections/malignancies that may be life threatening and need quick intervention by health care workers. These emergencies could be related to opportunistic infections that are seen at presentation or that occur as the immune system gets weaker, or may be HIV induced diseases like enteropathy and wasting, diarrhea leading to dehydration and its sequel, neurological complication like PML etc. and from complications resulting from use of anti-HIV medication like lactic acidosis, pancreatitis, bone marrow suppression and may include the immune reconstitution syndromes.

Brainstem abscess: the nonsurgical management.

The brainstem is an unusual location for a pyogenic abscess. Stereotactic aspiration or microsurgical drainage may be required in antibiotic refractory cases. Prolonged antibiotic therapy, along with symptomatic treatment may provide successful outcome. We report a case of cerebellar and brainstem abscess, managed successfully with prolonged antibiotic administration.

Emergencies in HIV--part 2.

In a short span of two and a half decades, HIV/AIDS has emerged as second largest killer disease that has affected mankind. The triple drug antiretroviral therapy (ART) has ensured a reasonably good quality of life to HIV infected individuals. Human immunodeficiency virus (HIV) infection is associated with several opportunistic infections/malignancies that may be life threatening and need quick intervention by health care workers. These emergencies could be related to opportunistic infections that are seen at presentation or that occur as the immune system gets weaker, or may bedue to HIV itself per se. The emergencies could also result from use of antiretroviral drugs like lactic acidosis, pancreatitis, bone marrow suppression and may include the immune reconstitution syndromes. The emergencies due to the opportunistic conditions and HIV per se had been dealt with in detail in the part 1, and this part describes various emergencies that could be encountered due to the administration of the anti retroviral treatment. Some patients may present due to emergencies as a result of co-administration of antiretroviral drugs with drugs used for treatment of some opportunistic infections like ATT etc.