Gorlin-goltz syndrome.

The Gorlin-Goltz syndrome (GGS) (the nevoid basal cell carcinoma syndrome) is a rare autosomal dominant syndrome caused due to mutations in the patched gene found on chromosome arm 9 q. It shows high penetrance and variable expressivity; is characterized by basal cell carcinomas, odontogenic keratocysts, palmar and/or plantar pits and ectopic calcifications of the falx cerebri. Until date, very few cases of GGS have been reported in India. Early diagnosis and treatment as well as genetic counseling are essential for this syndrome. A rare case report of a patient with characteristic features of GGS diagnosed at a rural dental college of Gujarat, India is presented here. This case report draws attention of the valuable role of dentist in diagnosis and early management of this syndrome.

A prospective study of patients absconding from a general hospital psychiatry unit in a developing country.

Characteristics of patients absconding from an open psychiatry ward in a developing country may be different from both those in developed countries and a mental hospital setting. The aim of this paper is to study the incidence and characteristics of patients absconding from an open psychiatric ward in a general hospital-based psychiatric unit in India. We studied patients consecutively admitted to an open psychiatric ward over a 2-month period. We compared those who absconded with those who did not. Out of 231 patients admitted, 33 absconded. Among those who absconded, 15 had bipolar disorder, 11 had schizophrenia and five had substance-related disorders. Nine had indicated their intention to do so at admission. Ten patients had absconded by the second day. The treatment cost was the likely influencing factor for seven patients who absconded after deemed fit for discharge on clinical grounds. Only 10 patients were readmitted to the hospital within 2 weeks of absconding. The risk of absconding is highest in the early days following. Absconding patients did not differ significantly from others in many socio-demographic and clinical features. Treatment costs are an important consideration in India.

The academic environment: the students' perspective.

Dental education is regarded as a complex, demanding and often stressful pedagogical procedure. Undergraduates, while enrolled in programmes of 4-6 years duration, are required to attain a unique and diverse collection of competences. Despite the major differences in educational systems, philosophies, methods and resources available worldwide, dental students' views regarding their education appear to be relatively convergent. This paper summarizes dental students' standpoint of their studies, showcases their experiences in different educational settings and discusses the characteristics of a positive academic environment. It is a consensus opinion that the 'students' perspective' should be taken into consideration in all discussions and decisions regarding dental education. Moreover, it is suggested that the set of recommendations proposed can improve students' quality of life and well-being, enhance their total educational experience and positively influence their future careers as oral health physicians. The 'ideal' academic environment may be defined as one that best prepares students for their future professional life and contributes towards their personal development, psychosomatic and social well-being. A number of diverse factors significantly influence the way students perceive and experience their education. These range from 'class size', 'leisure time' and 'assessment procedures' to 'relations with peers and faculty', 'ethical climate' and 'extra-curricular opportunities'. Research has revealed that stress symptoms, including psychological and psychosomatic manifestations, are prevalent among dental students. Apparently some stressors are inherent in dental studies. Nevertheless, suggested strategies and preventive interventions can reduce or eliminate many sources of stress and appropriate support services should be readily available. A key point for the Working Group has been the discrimination between 'teaching' and 'learning'. It is suggested that the educational content should be made available to students through a variety of methods, because individual learning styles and preferences vary considerably. Regardless of the educational philosophy adopted, students should be placed at the centre of the process. Moreover, it is critical that they are encouraged to take responsibility for their own learning. Other improvements suggested include increased formative assessment and self-assessment opportunities, reflective portfolios, collaborative learning, familiarization with and increased implementation of information and communication technology applications, early clinical exposure, greater emphasis on qualitative criteria in clinical education, community placements, and other extracurricular experiences such as international exchanges and awareness of minority and global health issues. The establishment of a global network in dental education is firmly supported but to be effective it will need active student representation and involvement.

Metaanalysis of statins and survival in de novo cardiac transplantation.

BACKGROUND: The use of HMG CoA reductase inhibitors (statins) after cardiac transplantation has been suggested to decrease the incidence of severe rejection and improve survival. Individual investigations that have led to this suggestion are randomized (but not placebo-controlled) studies, including small patient numbers that have (and thus underpowered) and enrolling heterogeneous subjects (including retransplant recipients). The purpose of this pooled analysis was to quantify the benefit of statins on survival in de novo cardiac transplant recipients. METHODS: Medline (1966 to 2003) was queried using the keywords statin, HMG CoA reductase inhibitors, cardiac transplantation, transplant, cholesterol, atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin. In addition, we searched the cited literature and previously published systematic reviews. Of 36 articles retrieved, 3 randomized controlled studies met our population inclusion criteria; namely age >18 years, de novo heart transplant recipients, statin therapy within 3 months, and > or = 1-year follow-up. Pooled data were metaanalyzed by Mantel-Haenszel tests using a random effects model that included tests for heterogeneity. RESULTS: The three pooled studies included 246 patients (statin, n = 129; no statin, n = 117) and 27 events (11%). The pooled analysis demonstrated a significant reduction in mortality with statin use (RR 0.31; 95% CI 0.13 to 0.7; P = .006) without significant heterogeneity (P = .7) among the studies. Two of the three studies reported allograft rejection with hemodynamic compromise. The pooled analysis demonstrated a significant benefit on this endpoint (RR 0.22, 95% CI 0.08 to 0.63; P = .004). CONCLUSION: This meta-analysis demonstrates that statin therapy decreases rejection episodes with hemodynamic consequences and improves 1-year heart transplant survival.

Umbilical venous catheters: evaluation of radiographs to determine position and associated complications of malpositioned umbilical venous catheters.

To evaluate the ability of radiography to detect malpositioned umbilical venous catheters in the left atrium and to determine the frequency of associated complications, we retrospectively compared radiographs and echocardiograms of 31 infants who had malpositioned catheters in the left atrium by echocardiography (cases) and 31 infants who had properly positioned catheters (controls). The case and control infants were of similar gestational age and birthweight (gestational age, 32 +/- 5 weeks; birthweight, 1672 +/- 899 g for cases; gestational age, 31 +/- 5 weeks; birthweight, 1666 +/- 958 g for controls). Malposition was defined as the catheter tip above the seventh thoracic vertebra by radiography. Radiography had sensitivity of 45%, specificity of 87%, positive predictive value of 77%, negative predictive value of 61%, accuracy of 66%, and prevalence of 50%. Thrombus formation in the heart was detected in 8 of 31 (26%) of cases and in 1 of 31 (3%) of controls (p = 0.03). The incidence of complications, such as necrotizing enterocolitis, culture-positive sepsis, total number of sepsis cases, thrombocytopenia, embolism to extremities, and hematuria were similar in both groups (difference not significant). These results suggest that radiography is unreliable in determining incorrect catheter placement. Catheters malpositioned in the left atrium were associated with thrombus formation. There was no significant increase in systemic complications in the infants with a malpositioned catheter.

Predicting length of hospitalization of sick neonates from their initial status.

It has been suggested that the estimated date of confinement (EDC) may be used to predict the length of hospital stay for sick newborns. We have found this method unreliable and designed the following study to develop a mathematical model to predict length of stay (LOS). We reviewed the records of 393 neonates. Statistical analysis was performed using multiple linear regression. The factors that reached statistical significance were birth weight (BW), gestational age (GA), and a combined respiratory score (RES). The RES was developed to quantify the degree of initial respiratory illness. Through this model we developed the following formula: log(e) (LOS) = 4.395-0.023 (GA) -0.00054(BW) + 0.0274 (RES). The R value is 0.78. The model predicts an LOS +/- 10 days in 73% of cases. Overall, this model yields a 29% improvement in predictability of LOS compared with a model which used EDC only. This formula may provide useful information for parents and caregivers of hospitalized neonates.

New strains of seizure-prone mice.

The origins of two new strains of seizure-prone mice are provided, and some of their behavioral characteristics are described. Comparison of the hippocampal granule cell layer of one of the new strains with the two inbred strains from which it was derived revealed strain differences in the diameter of granule cell nuclei and in the number of granule cells in the suprapyramidal blade. Basket cell counts did not differ between the strains, but both basket cell and granule cell number were consistently higher for the suprapyramidal blade than for the infrapyramidal blade. The existence of these and other blade differences suggests that the two blades will prove to be functionally distinctive neuronal systems.

Bilateral hydrocoele and spermatogenesis - abstract

Hydrocoele, a common problem in Guyana, is regarded as mainly of nuisance value. We therefore investigated the effects of hydrocoele on seminal fluid analyses of patients (20-48 yrs) who had bilateral hydrocoele for 6 months to eight years. Three separate preoperative masturbation specimens were collected into glass jars and analysed within one hour from eight patients. Similar specimens were analysed within 3 months and after 3 months of Lord's repair of their hydrocoeles. The quantity of fluid at operation was measured. In five patients where each sac contained more than 100 ml (125-825 ml), the sperm count was consistently less than 20 million/ml and motility was less than 50 percent. The lowest counts and motility were seen in patients with long-standing hydrocoeles. In three patients, one of the two sacs contained less than 25 ml. The sperm count averaged 70 million/ml and motility was approximately 60 percent. Cross seminal fluid volume was similar in the two groups. Seminal analysis returned to preoperative or improved levels within 3 months. These findings suggest that hydrocoele is a potential cause of infertility and that early operation may preserve spermatogenesis (AU)