Hypersensitivity to intravenous iron: classification, terminology, mechanisms and management.

Intravenous (IV) iron therapy is widely used in iron deficiency anaemias when oral iron is not tolerated or ineffective. Administration of IV-iron is considered a safe procedure, but severe hypersensitivity reactions (HSRs) can occur at a very low frequency. Recently, new guidelines have been published by the European Medicines Agency with the intention of making IV-iron therapy safer; however, the current protocols are still non-specific, non-evidence-based empirical measures which neglect the fact that the majority of IV-iron reactions are not IgE-mediated anaphylactic reactions. The field would benefit from new specific and effective methods for the prevention and treatment of these HSRs, and the main goal of this review was to highlight a possible new approach based on the assumption that IV-iron reactions represent complement activation-related pseudo-allergy (CARPA), at least in part. The review compares the features of IV-iron reactions to those of immune and non-immune HSRs caused by a variety of other infused drugs and thus make indirect inferences on IV-iron reactions. The process of comparison highlights many unresolved issues in allergy research, such as the unsettled terminology, multiple redundant classifications and a lack of validated animal models and lege artis clinical studies. Facts and arguments are listed in support of the involvement of CARPA in IV-iron reactions, and the review addresses the mechanism of low reactogenic administration protocols (LRPs) based on slow infusion. It is suggested that consideration of CARPA and the use of LRPs might lead to useful new additions to the management of high-risk IV-iron patients.

A clinical study to assess the pathological involvement of occult supraclavicular lymphnode metastasis in case of locally advanced operable breast carcinoma.

PURPOSE: The prognosis of ipsilateral supraclavicular lymph node (SCLN) recurrence after early breast cancer appears to be worse than for other locoregional recurrences, but better than for distant metastases. Prophylactic radiotherapy (RT) to supraclavicular region decreases risk of ipsilateral SCLN recurrence. Currently, all patients with locally advanced breast cancer are considered high-risk for SCLN metastasis and treated with prophylactic RT. This study is carried out to identify risk factors associated with occult SCLN metastases in locally advanced breast cancer. MATERIALS AND METHODS: Total 48 female patients of all ages presenting with locally advanced carcinoma of breast who were operable by protocol criteria were included in the study. All the patients underwent modified radical mastectomy with supraclavicular lymphnode dissection. The resected specimen was processed for the histopathological analysis. RESULTS: Occult SCLN metastases are found in 25% (12/48) of the patients in this study. Eleven factors were identified and analyzed to know whether or not they are associated with SCLN metastasis. Of those only pathological N stage (7% for

How good are the maternity services for 'drug misusers' in England and Wales? A national survey.

To assess the state of maternity services for pregnant drug misusers, a postal questionnaire-based survey was carried out in England and Wales in 2005. A total of 222 questionnaires were sent with a response rate of 80.63%, reporting a total of 5,324 births to drug-misusers. Data were collated and analysed using Microsoft Excel 2003. Despite improvement in the services provided to the pregnant drug-misusers, there is wide regional variation. Hepatitis-C screening is particularly under-offered. Pre-birth meetings appear to be the way forward to optimise overall outcome. Maternity-unit staff need appropriate training for providing sufficient knowledge of drug use and its consequences for the pregnancy.

An introduction to Toll-like receptors and their possible role in the initiation of labour.

Toll-like receptors (TLR) have emerged as key upstream mediators of inflammation at many tissue sites in humans. Inflammatory processes are involved in the process of parturition suggesting that TLR activity within gestation-associated tissues might have an important role in the initiation and/or maintenance of normal term labour and in various pathological states of pregnancy such as infection-associated preterm labour. Either TLRs or their signalling molecules might be excellent therapeutic targets for prevention of preterm labour.

The submental island flap for reconstruction of facial defects.

The procedure of facial resurfacing dictates that there should be an excellent colour and texture match between the facial and the transposed skin. Cervical flaps e.g. platysma flap are commonly used for reconstruction of facial defects but, with disadvantages like limited mobility, unacceptable donor site and unpredictable outcomes. The submental island flap is a new addition to the armamentorium of the Plastic Surgeon. It is an axial pattern flap based on the submental branch of facial artery and the submental tributary of common facial vein. We report the use of this flap for the reconstruction of postexcisional facial defects in two patients having basal cell carcinoma and recurrent parotid tumour. In both patients, the flap provided an excellent colour and texture match. Other advantages of this flap are inconspicuous donor site, wide arc of rotation, simple dissection and a reliable pedicle.

Hypervascular nasal metastasis from hepatocellular carcinoma.

Metastases is an uncommon cause of tumors in the sinonasal region. We report a patient with hepatocellular carcinoma which metastasized to the nasal cavity.

Serum and cerebrospinal fluid concentrations of rifampicin at two dose levels in children with tuberculous meningitis.

Twenty patients of tuberculous meningitis (TBM) in age group of 6 months to 10 years included in the study were divided into two groups of 10 patients each. Rifampicin was administered in dosage of 10 mg and 7.5 mg/kg bw to each patient of groups I and II respectively. Drug concentrations in serum and CSF of these patients were measured by a microbiological tube dilution method using a strain of Sarcina lutea. In group I mean serum and CSF concentration was 3.84 micrograms/ml and 0.178 microgram/ml respectively, while in group II it was 2.16 micrograms/ml and 0.206 microgram/ml respectively. These concentrations were many times higher than the MIC against Mycobacterium tuberculosis. Mean percentage penetration of rifampicin in CSF was 5 and 10% in group I and II respectively. We recommend similar studies in large number of children before advocating the therapy with low dose of rifampicin in TBM.

Mental morbidity in industrial workers of khetri copper complex.

There is dearth of researches pertaining to prevalence of mental morbidity in Industrial setups, particularly in our country.They are important as psychological ill health of workers may adversely effect the productivity in developing country like India.Khetri Copper Complex in Rajasthan was selected for present study. Aims were to determine the period prevalence of mental morbidity among workers and role of sociodemographic, psychological variables in such disorders. 330 workers were randomly selected from various departments. Each worker was given specially designed proforma and Goldberg's General Health Questionnaire. Workers scoring 12 or more were given "A standardised psychiatric interview schedule" suspected cases were examined by senior consultants to assign them diagnostic categories (I.C.D.-9).Period Prevalence in this study was 186.66/1000. As regards diagnostic categories, 75% were neurotic and 12.5% psychotics. Role of socio demographic, psychological and psychiatric variables in the development of these disorders has been discussed.Findings of this study are in expected direction and results obtained can be easily explained in terms of formulations given by other researchers in this field.Recommendation and plans for further research are discussed.

An evaluation of apomorphine action on doapminergic receptors.

The controversial literature reports leave open a question whether apomorphine (APO) and dopamine (DA) share a common receptor? After careful evlauation of the arguments, both for and against, about direct action of APO on DA receptor we propose that rigid molecules like APO hold trans-cisoid conformation and preferably interact with the pre-synaptic DA receptors while ADTN (2-amino-6,7-dihydroxy, 1,2,3,4-tetrahydrxonaphthalene) incorporates trans-transcoid conformation and primarily acts on post-synpatic DA receptors. Dopamine, by virtue of its molecular flexibility, can act on both the receptors.