Heavy alcohol use as a risk factor for severe outcomes among adults hospitalized with laboratory-confirmed influenza, 2005-2012.

We examined heavy alcohol use as a risk factor for severe influenza (intensive care admission or death) among hospitalized adults. In <65- and ≥65-year-olds, heavy alcohol use increased disease severity [relative risk (RR) 1.34; 95 % confidence interval (CI): 1.04-1.74, and RR 2.47; 95 % CI: 1.69-3.60, respectively]. Influenza vaccination and early, empiric antiviral treatment should be emphasized in this population.

Endothelial cells express a novel, tumor necrosis factor-alpha-regulated variant of HOXA9.

The expression of the class 1 homeobox (HOX) family of "master control" transcription factors has been studied principally in embryogenesis and neoplasia in which HOX genes play a critical role in cell proliferation, migration, and differentiation. We wished to test whether HOX family members were also involved in a differentiation-like process occurring in normal, diploid adult cells, that is, cytokine-induced activation of endothelial cells (EC). Screening of a human EC cDNA library yielded several members of the A and B groups of HOX transcription factors. One clone represented a novel, alternatively spliced variant of the human HOXA9 gene containing a new exon and the expression of which was driven by a novel promoter. This variant termed HOXA9EC appeared restricted to cells of endothelial lineage, i.e. expressed by human EC from multiple sources, but not by fibroblasts, smooth muscle cells, or several transformed cell lines. HOXA9EC mRNA was rapidly down-regulated in EC in response to tumor necrosis factor-alpha due to an apparent reduction in transcriptional rate. Reporter construct studies showed that the 400 base pairs of genomic DNA directly 5' to the transcription initiation site of HOXA9EC contained the information required for both up-regulation in response to cotransfection with a HOXA9EC expression vector and tumor necrosis factor-alpha-dependent down-regulation of this gene. These results provide evidence of a novel HOX family member that may participate in either the suppression or the genesis of EC activation.

Management of tarsal disintegration (T.D.) in leprosy.

Tarsal Disintegration (T.D.) is a known entity occurring exclusively in neuropathic foot of Leprosy and being influenced by several factors among which the disease itself and altered biomechanics constitute the main. In this study done on more than fifty cases at the Dr. Bandorawalla Leprosy Hospital, Kondhawa these factors have been studied in detail and it has been found that the increased and abnormal shearing forces constitute one of the major factors both in occurrence and progression of T.D. Treatment based mainly on the conservative lines is thus aimed at minimizing these forces which occur during the heel-toe pattern gait. Depending upon the severity of the case immobilization, periodic check x-rays, graded weight bearing and suitable modified footwear appliance is recommended. A Fixed Ankle Brace (FAB) serves well controlling the ankle movements by its rocker action and ultimately reducing the forces occurring during the normal heel-toe pattern. It has also been found that if the case is detected early and treated promptly the process can be controlled satisfactorily. Careful screening in high risk group is stressed and health education emphasized.

A new approach in muscle training to rehabilitate the hand in leprosy.

Rehabilitation of the hand in Leprosy with its deformities and anaesthesia no doubt poses a formidable challenge as far as rehabilitation is concerned. Here we have applied a combination of latest concepts in sports physiology and the exercise followed by the students of ancient Indian martial art known as Krishni Vidya. This exercise consists of crumpling a newspaper sheet with a single hand without any external support. We are unable to explain the type of exercise done by the people before existence of newspaper. They might be using naturally occurring materials for the same like woodbark. With this exercise we have been able to improve the function of the hand remarkably well and the rehabilitation time following surgery is drastically reduced, with function returning close to normalcy. The full function is achieved within four weeks from the date of removal of plaster as compared to eight to ten weeks or more with conventional physical therapy. This full function is not only in mobility but also in co-ordination, static and dynamic strength, speed of movement and flexibility required of a normal hand. 16 patients operated for lumbrical replacement (using sublimis as a motor from the long finger) at the Dr. Bandorawalla Leprosy Hospital were put under the paper crumpling exercise. It was observed that the average time for the achievement of fully close fist was two weeks. (All of them had thumb function intact, i.e. either normal or operated-out of sixteen, four patients were operated for opponens prior to lumbrical replacement).