The genetics of Adamantiades-Behcet's disease.

Adamanitiades-Behcet's disease (ABD) is a relapsing systemic vasculitis that may involve the eyes, skin, and almost all other organ systems. Current research on the pathogenesis of ABD suggests a genetic basis for the disease, with certain MHC genes such as those coding for HLA-B51 being the most obvious candidates. Environmental factors such as infectious disease are thought to be responsible for triggering an immunological reaction and systemic features of the disease in genetically susceptible individuals. Identification of genes responsible for this susceptibility may lead to more definitive diagnostic tests and new approaches to the management of this potentially blinding condition.

Predictors of in-hospital mortality for intracerebral hemorrhage: a hospital-based study in Pakistani adults.

INTRODUCTION: Intracerebral hemorrhages (ICHs) comprise 5% to 30% of all strokes with a case fatality rate of 30% to 50%. With an increasing elderly population, nontraumatic ICH is likely to present as a recurring medical emergency in Pakistan. There is scarce documentation in Pakistan regarding the predictors for mortality in patients with ICH that can guide physicians in their management. We conducted a hospital-based study to determine the predictors of in-hospital mortality from ICH in patients admitted to a tertiary care facility. MATERIALS AND METHODS: We reviewed case records of patients above 17 years admitted to The Aga Khan University Hospital, Karachi, Pakistan, between July 1995 and December 1997, with the primary diagnosis of ICH confirmed on computed tomography scanning. Clinical and risk factors were also evaluated. RESULTS: The data of 221 patients was analyzed. Seventy-one (32%) patients died during hospital stay, half of whom died during the first 2 days of hospitalization. Patients who died during hospital stay were more likely on admission to have intraventricular extension of the primary hemorrhage (odds ratio = 10.6, P < .01), a Glasgow Coma Score less than 12 on admission (odds ratio = 4.8, P < .01), and a systolic blood pressure greater than or equal to 180 mm Hg (odds ratio = 2.7, P = .03). CONCLUSIONS: Our study suggests that Glasgow Coma Score and intraventricular extension are predictors of acute mortality, consistent with published results. Elevated systolic blood pressure at admission, also found to be a predictor of acute mortality from ICH, may be explained alternatively by internal and external stroke-induced stress factors. The actual mechanisms for high admission systolic blood pressure remain unclear.

Clinical scoring system: a valuable tool for decision making in cases of acute appendicitis.

OBJECTIVE: Decision making in cases of acute appendicitis poses a clinical challenge specially in developing countries where advanced radiological investigations do not appear cost effective and so clinical parameters remain the mainstay of diagnosis. The aim of our study was to devise a scoring system from our local database and test its accuracy in the preoperative diagnosis of acute appendicitis. METHODS: Clinical data from 401 patients having undergone appendectomy were collected to identify predictive factors that distinguished those with appendicitis from those who had a negative appendectomy. Ten such factors were identified and using Bayesian probability a weight was assigned to each and the results summated to get an overall score. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was then retrospectively applied to a second population of 99 patients in order to compare suggested actions (derived from the scoring system) to those actually taken by surgeons. The sensitivity, specificity and accuracy for the level of decision was then calculated. RESULTS: Of the 99 patients, the method suggested immediate surgery for 65 patients, 63 of whom had acute appendicitis (3.1% diagnostic error rate). Of the 33 patients in whom the score suggested active observation, 18 had appendicitis. The accuracy of our scoring system was 82%. The method had a sensitivity of 78%, specificity 89% and a positive predictive value of 97%. The negative appendectomy rate determined by our study was 7% and the perforation rate 13%. CONCLUSION: Scoring system developed from a local database can work effectively in routine practice as an adjunct to surgical decision making in questionable cases of appendicitis.

Method of obtaining and preparation of fresh human amniotic membrane for clinical use.

Amniotic membrane was obtained from 36 mothers seronegative for hepatitis B surface antigen and syphilis, undergoing caesarean section. Membrane was separated from placenta and was washed first with saline and then saline solution containing penicillin. The processed membrane was found to be sterile and useable for up to one week. Of 36 placentas obtained, 33 were utilized in 22 patients, with no history of penicillin allergy, as biological dressing in acute burns. Each patient received three applications of membrane one every other day, over a period of six days. This method of obtaining amniotic membrane was simple and more practical for maintaining the biological effectiveness of membrane, as shown by quantitative reduction of bacterial counts in burn wounds.

Comparative study of mineral oil and talcum powder as lubricants for cutting of skin grafts in burns.

Although the series is a very small one, the results of this study would seem to indicate that mineral oil is a better vehicle compared with talcum powder for use as lubricant for the donor site of skingrafts. Better results may be expected by deferred grafting after preparation of the recipient site by scraping of granulation.