Use of high-dose prednisolone to overcome rifampicin-induced corticosteroid non-responsiveness in childhood nephrotic syndrome.

Inducing remission in nephrotic children on anti-tubercular therapy is difficult due to the increased metabolism of prednisolone induced by rifampicin. We report a child with nephrotic syndrome treated successfully with an increased dose of steroids without discontinuing anti-tubercular therapy.

Mapping FACT-P to EQ-5D in a large cross-sectional study of metastatic castration-resistant prostate cancer patients.

PURPOSE: To construct a model to predict preference-adjusted EuroQol 5D (EQ-5D) health utilities for patients with metastatic castrate-resistant prostate cancer (mCRPC) using the disease-specific health-related quality of life (HRQoL) measure, functional assessment of cancer therapy-prostate (FACT-P). METHODS: HRQoL data were collected from patients with mCRPC who were enrolled in an observational study conducted in 47 centers across six European Union countries. Utility values were generated using a UK-specific EQ-5D value set. The predictive validity of the five FACT-P subscales, patient demographics, comorbidities and prior chemotherapy was tested using ordinary least squares (OLS), median, Gamma and Tobit multivariate regression models. RESULTS: FACT-P and EQ-5D questionnaires were completed by 602 (86 %) patients. Mean age [standard deviation (SD)] was 72.1 (7.9) years, mean time from diagnosis (SD) was 5.4 (4.4) years, and mean time since failure of androgen deprivation therapy (SD) was 1.0 (1.6) years. At study inclusion, 39 % of patients were chemotherapy-naïve, 37 % were undergoing chemotherapy, and 24 % were post-chemotherapy. Mean FACT-P and EQ-5D utility values were 104 and 0.66, respectively. OLS regression was the best-performing model, explaining 61.2 % of the observed EQ-5D variation. All FACT-P subscales were significantly predictive; the physical and functional well-being subscales had the highest explanatory value (coefficient 0.023 and 0.001, respectively, p < 0.0001). The other variables did not add additional explanatory value. CONCLUSIONS: The algorithm developed enables translation of cancer-specific HRQoL measures to preference-adjusted health status in patients with mCRPC. The function may be useful in calculating EQ-5D scores when EQ-5D data have not been gathered directly.

In vitro effects of cAMP-elevating agents and glucocorticoid either alone or in combination on the production of nitric oxide, interleukin-12 and interleukin-10 in IFN-gamma- and LPS-activated mouse peritoneal macrophages.

The effects of cAMP-elevating agents, N6-2'-O-dibutyryl cAMP (Bu2cAMP), and glucocorticoid (dexamethasone) on the production of inflammatory mediators--nitric oxide and interleukin-12 (IL-12) and anti-inflammatory mediator interleukin-10 (IL-10) were demonstrated in murine peritoneal macrophages. Inducible nitric oxide synthase (iNOS) and iNOS mRNA were detected by northern blot and western blot, respectively. The cAMP elevating agents Bu2cAMP and prostaglandin E2 each alone did not show any effect on NO production but along with IFN-gamma and lipolysaccharide (LPS) they slightly enhanced NO production. Dexamethasone inhibited NO production in IFN-gamma- and LPS-treated cells; cAMP elevating agents interfered with the NO production inhibited by dexamethasone. Inhibition was revealed at the mRNA level as well as at protein level. Bu2cAMP or dexamethasone either alone or synergistically inhibited IL-12 production; Bu2cAMP interfered with dexamethasone-mediated inhibition of IL-10 production in IFN-gamma- and LPS-treated macrophages. The use of glucocorticoids along with cAMP elevating agents was beneficial in lowering the level of inflammatory mediator IL-12 and producing high levels of the anti-inflammatory mediator IL-10 active in cell protection. On the other hand, interference of Bu2cAMP with dexamethasone-mediated NO inhibition may have adverse effect. Therefore, adverse effects due to cAMP-mediated interference (inhibition) with NO synthesis may occur in many inflammatory diseases during combined drug therapy by glucocorticoids and cAMP elevating agents.

The influence of counselling on patient return following uncomplicated posterior vitreous detachment.

PURPOSE: To investigate the effect of patient counselling together with the use of information leaflets on the number of return visits for patients with acute, symptomatic, uncomplicated posterior vitreous detachment (PVD). METHODS: The study group comprised the first 50 patients diagnosed with uncomplicated PVD in 1998 when a standard protocol of structured patient counselling and leaflet distribution was employed following diagnosis of PVD. The control group comprised the first 50 patients in 1997 diagnosed with uncomplicated PVD before structured patient counselling was in place. A retrospective analysis of casualty case notes was made comparing the two groups. The number of eye casualty attendances within 1 year of first presentation with PVD was compared in the two groups. RESULTS: Seven patients from the control group returned because of photopsia or floaters; 3 of the 7 returned with no change in their original symptoms. Six patients from the study group returned. All had a definite change in their symptoms of photopsia or floaters. No patient in the study group who returned had old or persistent symptoms. Statistical analysis comparing return visits of patients with no change in symptoms in the two groups by Fisher's Exact Test gave a p value of 0.13. CONCLUSION: Patients counselled following uncomplicated PVD did not return to eye casualty in the absence of new symptoms. Patient counselling is an important part of the management of PVD because it makes patients aware of which symptoms are important predictors of serious vitreoretinal pathology.

Primary experimental infection of riverine buffaloes with Fasciola gigantica.

The clinical course of the primary experimental Fasciola gigantica infection was investigated in riverine buffalo calves of the Murrah breed. Nine male calves aged 12-15 months were randomly assigned to two groups of five (Group I) and four (Group II) animals. Each animal in Group I, was orally infected with 1000 metacercariae (mc) of F. gigantica, whereas Group II animals did not receive any infection dose and served as uninfected controls. No clinical signs of fasciolosis were observed until the sixth week post-infection (PI). Group I animals, however, developed recognised symptoms of acute fasciolosis, comprising apyrexic inappetance, anemia, poor weight gain, diarrhoea and sub-mandibular and facial oedema, respectively, from 5, 6, 8, 16 and 17 weeks PI. The signs were intermittent in nature and of variable duration. The prepatent period was of 92-97 days (mean 95.2 +/- 3.1). One of the five infected animals died on Day 147 PI. At necropsy, 36.8 +/- 11.0% of the infection dose was recovered as adult fluke population. The gross lesions were primarily biliary in nature. Group II, the uninfected controls, throughout the study period of 165 days PI, did not show any symptom and were negative for F. gigantica. The study demonstrated that the onset of adverse effects of F. gigantica on the growth and health of the infected host was mainly noted during late prepatency much before coprological prediction and diagnosis. The significance of preventive therapy against fasciolosis during prepatency has been stressed in endemic areas.

Histopathological study of placental bed biopsy in placenta previa.

BACKGROUND: To study placental bed biopsy changes in placenta previa and normally implanted placenta. SUBJECT AND METHOD: Fifty placental bed biopsies from 50 patients with placenta previa and 50 placental bed biopsies from normally implanted placenta were taken at cesarean section. Placental bed biopsy was stained with hematoxyline and eosin for histological examination. Both the groups were compared for trophoblastic invasion and vascular changes of placental bed spiral arteries. Statistical analysis was done by Chi-square test. RESULTS: Placenta bed biopsy was representative in 42/50 (84%) biopsy samples of the study group (placenta previa) and 35/50 (70%) of the control group (normally located placenta). Trophoblastic giant cell migration into decidua was present in 100% of representative samples of both the groups while migration into myometrium was seen in 66.67% and 51.14% of samples of study and control group. Average number of trophoblastic giant cells per sample was significantly higher in placenta previa (decidua 41.3%, myometrium 52%) than the control group (decidua 17.4%; myometrium 14.5%). Trophoblastic giant cell infiltration into myometrial spiral arterioles was higher in placenta previa (81.83 cells per vessel). Percentage of myometrial spiral arterioles showing physiological changes was significantly higher in the study group (50.39%) compared to the control group (21.14%). Incidence of inflammatory cell infiltration was higher in the study group (42.86%). Hemorrhage into decidua and myometrium were seen in biopsy samples of the placenta previa. CONCLUSION: Placenta previa is associated with significantly higher trophoblastic giant cell infiltration and physiological changes of the myometrial spiral arterioles.

Effects of Fasciola gigantica infection on growth and nutrient utilisation of buffalo calves.

The effects of Fasciola gigantica infection on bodyweight gain, dry matter intake, digestibility of nutrients and feed conversion efficiency in buffalo calves were investigated. Nine male buffalo calves of the Murrah breed, aged 12 to 15 months with a mean (se) bodyweight of 166 (12.5) kg, were randomly assigned to groups of five (group 1) and four (group 2). The animals in group 1 were given 1000 viable, mature metacercariae of F gigantica orally, while the animals in group 2 served as uninfected controls. They were stall fed on diets containing a concentrate mixture and ad libitum wheat straw and were maintained by standard management practices for a period of 165 days after infection. The average daily liveweight gain of the infected animals was 110.6 g, compared with 439.4 g in the uninfected controls, and was associated with the appearance and establishment of immature flukes in hepatic bile ducts. The feed conversion efficiency declined significantly (P<0.01) from 41 days after infection and was lowest at the end of the experiment. F gigantica infection did not influence the digestibility of the nutrients. The impaired feed conversion efficiency was mainly due to a reduction in dry matter intake due to inappetence.

Development of a dextran kit for labelling with 99mTc and its evaluation for lymphoscintigraphy.

A cold dextran (molecular weight 60,000-90,000) kit has been developed by a modified procedure to produce instant preparation of 99mTc-dextran suitable for lymphoscintigraphy. The preparation was subjected to various quality control measures. Effect of pH and amount of stannous chloride as a reducing agent on the labelling efficiency using ITLC were studied. The labelled complex was separated from both the reduced pertechnetate and pertechnetate and quantified. In a series of experiments hydrolysed/reduced 99mTc was found to be less than 3.0%, whereas pertechnetate was approx. 1.0%. Biokinetics of the agent in mice and blood clearance and rate of disappearance from the site of intradermal injection of the agent in rabbits were studied. The tagged agent for imaging of the lymphatic system activated by administering Freund's complete adjuvant (FCA)/E. coli in rabbits exhibited its suitability for lymphoscintigraphy.