A prospective study on the safety of sublingual immunotherapy in pregnancy.

BACKGROUND: The aim of this study was to determine the safety of sublingual immunotherapy in pregnancy, which has not yet been reported. METHODS: One hundred and fifty-five patients received sublingual immunotherapy with either house dust mite (D. farinae) or a mixture of up to five allergens during 185 pregnancies. Twenty-four patients received sublingual immunotherapy for the first time during pregnancy. Follow-up data were analysed with regard to abortion, perinatal mortality, prematurity, toxaemia and congenital malformation. Two control groups did not receive immunotherapy; group A (85 patients) received budesonide 400 µg twice daily and group B (40 patients) received rescue salbutamol inhalation. All three groups were on appropriate avoidance measures. RESULTS: Six-year follow-up data for the sublingual immunotherapy group revealed an incidence of complications less than that in the general population and a higher incidence of complications in both control groups. CONCLUSIONS: This study concludes that sublingual immunotherapy is safe during pregnancy and is also safe when initiated for the first time in a pregnant patient.

Antifungal activity of Dodonaea viscosa Jacq extract on pathogenic fungi isolated from superficial skin infection.

Antimicrobial activity of solvent extracts of leaves and shoot of Dodonaea viscosa Jacq have been determined against fungi, Aspergillus niger, Aspergillus flavus, Paecilomyces varioti, Microsporum gypseum, and Trichophyton rubrum causing skin diseases. All crude extracts were found to be effective against tested fungi. However chloroform has strong inhibition activity against fungi as compared to ethanol, methanol, ethylacetate and aqueous extracts. More over in present study some basic elements have been analyzed, Al, Ca, Cu, Fe, Mg, Mn, P, S and Zn from the medicinal plant Dodonaea viscosa Jacq. by using atomic absorption spectrophotometry and UV spectrophotometry. The medicinal plant Dodonaea viscosa Jacq contains considerable amount of elements which have therapeutic effects in skin diseases.

Gaucher's disease.

Gaucher's disease is the most common group of lysosomal storage disorders caused by defective activity of an enzyme beta-glucosidase leading to accumulation of glucocerebroside in cells of macrophage lineage. Accumulation of glucosylceramide in tissues leads to multisystem organ involvement viz. liver, spleen, bone marrow, lungs and central nervous system. Serum beta=glucosidase levels <15% of mean normal activity confirms the diagnosis, enzyme replacement being the only definitive treatment. We report a clinical case of a 21 year male with Gaucher's disease. To the best of our knowledge only six cases of Gaucher's disease have been reported from India so far.

Electroconvulsive therapy in drug resistant neuroleptic malignant syndrome.

We report a case of a 20 years female referred to us with a history of a brief psychotic episode for which she was given inj. Haloperidol. The patient presented in an unconscious state with high grade fever. The diagnosis was kept as neuroleptic malignant syndrome after ruling out other possibilities. The patient did not respond to Bromocriptine and Dantrolene. With the recent evidence of electroconvulsive therapy being useful in these patients, we went ahead with the same. We present this case to share our experience of the excellent response of neuroleptic malignant syndrome to electroconvulsive therapy.

Magnetic resonance spectroscopy in pituitary tuberculoma.

Magnetic resonance spectroscopy (MRS) is a new, noninvasive method of diagnosing a lesion in cases where magnetic resonance (MR) imaging cannot reliably differentiate between two or more possible aetiologies. This case report describes a 20-year-old pregnant woman who developed sudden onset of left-sided hemiparesis. MR imaging of the brain revealed an infarct of the right middle cerebral artery and a suprasellar mass. The endocrine workup was normal. As she was 20 weeks pregnant, the option of a transsphenoidal biopsy of the pituitary lesion was rejected in favour of MRS . It demonstrated features characteristic of a tuberculoma. She showed marked clinical improvement after she was started on anti-tuberculous drugs. MRS is a rapidly-developing diagnostic modality, and may be a useful and safe option for investigating intracranial lesions in patients who cannot undergo invasive procedures.

35 J broadband femtosecond optical parametric chirped pulse amplification system.

We report on what is believed to be the first large-aperture and high-energy optical parametric chirped pulse amplification system. The system, based on a three-stage amplifier, shows 25% pump-to-signal conversion efficiency and amplification of the full 70 nm width of the seed spectrum. Pulse compression to 84 fs achieved after amplification indicates a potential of 300 TW pulse power for 35 J amplified pulse energy.

Klippel Trénaunay syndrome.

Klippel-Trénaunay syndrome (KTS) is an uncommon entity. This congenital malformation is characterized by the triad of soft tissue or bony hypertrophy, cutaneous vascular malformations, and atypical venous abnormalities. We report here a case of KTS and discuss the clinical features, investigations, and management of this enigmatic condition.

Patent ductus arteriosus with a left to right shunt in a 64-year-old asymptomatic male.

We report here the unusual case of a 64 year old male, who was incidentally found to have a patent ductus arteriosus (PDA). The patient was asymptomatic. Echocardiography revealed a moderate sized PDA with normal left ventricular function and mild pulmonary hypertension. As the patient was asymptomatic and was not willing for any form of intervention, he was discharged and is currently under close follow-up. To the best of our knowledge this is the oldest reported case of a PDA in Indian literature.

Kerosene poisoning--varied systemic manifestations.

We report here unusual clinical manifestations in a case of kerosene poisoning. The patient presented with encephalopathy and in the course of stay in the hospital developed renal tubular acidosis, delayed first-degree burns and myocarditis. With supportivetherapy the patient recovered completely and was discharged without any sequelae.

Primary systemic amyloidosis.

We report here a case of a 35-year-old male who presented with multi-system disease, which on evaluation was found to be due to primary systemic amyloidosis. We present the myriad manifestations of this uncommon disease entity.

The changing face of antihistamines and cardiac adverse drug reactions: a clinical perspective.

Recent times have witnessed a qualitative shift in the recognition and management of adverse drug effects. Many of them occur in organs that are unconnected to the primary target of pharmacological action. Out of these, cardiac side-effects have drawn particular attention because of their potential to cause death. Starting with the early observations on antibiotics such as macrolides, followed by fluoroquinolones and others, the focus has now shifted to the antihistamine class of drugs which are used extensively by patients all over the world, thanks to the ever increasing levels of environmental pollution. The occurrence of prolonged QTc interval following treatment with terfenadine leading to ventricular tachycardia of torsades de points variety with a potentially fatal outcome has forced many regulatory authorities of the world to clamp a ban the use of this drug. Alerted by these developments, studies on a new member, followed by fluoroquinolones and others, the focus has now shifted to the antihistamine class of drugs which are used extensively by patients all over the world, thanks to the ever incresing levels of envrionmental pollution. The occurrence of prolonged QTc interval following treatment with terfenadine leading to ventricular tachycardia of torsades de points variety with a potentially fatal outcome has forced many regulatory authorities of the world to clamp a ban use of this drug. Alerted by these developments, studies on a new member of non-sedating antihistamine class viz, fexofenadine, have been reviewed especially because of the structural similarity between terfenadine and fexofenadine. It is now clear that despite the closeness of its chemical structure to terfenadine fexofenadine behaves in a different manner and does not affect the electrophysiology of the heart muscle tissue, as proved by data from extensive clinical trials as well as membrane models in vitro. Interestingly, the solitary false alarm that was sounded on the drug by a group of workers in the Netherlands was later rectified by the same group. Clinically speaking, the cardiovascular safety of fexofenadine has been convincingly demonstrated at various dose levels and various time intervals, alone and together with other drugs of potential toxigenicity. All things put together, it appears reasonable to conclude that fexofenadine is free from cardiovascular ADRs of clinical significance. It could also be concluded that cardiac side-effects of antihistamines is not a class effect.

Exhaling a budesonide inhaler through the nose results in a significant reduction in dose requirement of budesonide nasal spray in patients having asthma with rhinitis.

Budesonide, an inhaled corticosteroid is used routinely in the treatment of bronchial asthma and rhinitis. Although inhaled corticosteroids in therapeutic doses are unlikely to result in systemic side effects, there is as yet skepticism about their routine and prolonged use. The aim of this study was to determine whether budesonide inhalation through a metered dose inhaler, when exhaled through the nose could result in a reduction in the dose requirement of budesonide metered nasal spray in patients having perennial allergic asthma with rhinitis. This study was an open, parallel, comparative, crossover trial in which 49 young patients having perennial allergic asthma with rhinitis were divided into two groups and administered either a combination of budesonide metered dose inhaler with a budesonide nasal spray or a budesonide inhaler alone, which was to be exhaled through the nose. Both groups were later crossed over and weekly symptom scores and peak nasal inspiratory flow rates were monitored during each phase of the study. Finally, patients who volunteered from both groups were instructed to note the reduction in dose requirement of budesonide nasal spray while using a budesonide inhaler and exhaling it through the nose. The results of this study reveal that when a budesonide inhaler is exhaled through the nose, it results in an improvement in symptom scores and peak nasal inspiratory flow rates, which were significantly less than those obtained in the group using both a budesonide nasal spray and a metered dose inhaler. In addition, exhaling budesonide through the nose results in a 40.1% reduction in the dose requirement of a budesonide nasal spray, which is statistically significant (p < 0.001).

Efficacy of low dose intra-dermal hepatitis B vaccination schedule.

Efficacy of low-dose, intra-dermal hepatitis B vaccination was assessed among sixty-one doctors and paramedical staff of Chandka Medical College Hospital, Larkana. Subjects were randomly divided into two groups. Group-A (n = 25) received 20 micrograms of purified Hepatitis B Surface Antigen (Euvax B, LG Chemicals) by i.m. injection in the deltoid by 0, 1 and 6 schedule while group B (n = 36) received 5 micrograms intra-dermally by same schedule. The mean value of HBsAb titers checked 4 weeks after the last dose in group A were 158.6 +/- 51.8 mlU/ml and that in Group B were 68.2 +/- 26.6 mlU/ml (p < 0.0001; 95% C.I. 69.2 and 111.5). Number of subjects attaining the protective titers of 10 mlU/ml in group A was 95.7% and that in group B was 90.9% (p = 0.5). We conclude that 5 micrograms intradermal hepatitis B vaccination is effective.

Immunotherapy vs inhaled budesonide in bronchial asthma: an open, parallel, comparative trial.

BACKGROUND: Budesonide, an inhaled corticosteroid and specific immunotherapy, are both routinely used in the treatment of bronchial asthma. However, there are as yet, no studies comparing the effects of budesonide vs immunotherapy. OBJECTIVE: The aim of this study is to compare the effects of budesonide with immunotherapy in patients having perennial asthma. METHODS: This study is an open, parallel, comparative trial, in which 51 young patients were administered either immunotherapy or budesonide for 1 year and their global symptom scores and FEV1 values assessed. Both treatments were abruptly discontinued after 12 months and the effects of cessation analysed. RESULTS: The use of budesonide resulted in a faster and more striking improvement during the first few months as compared to immunotherapy, with an even more rapid decline in benefits on cessation of budesonide. Immunotherapy on the other hand, resulted in slow but steady improvement which did not decline as rapidly as budesonide on cessation. CONCLUSION: Although this was an open trial, it could be concluded that relief with inhaled corticosteroids in bronchial asthma is more rapid than immunotherapy; however the decline in benefit on cessation of inhaled corticosteroid is even more rapid, a phenomenon not seen with immunotherapy.

Ephedrine-saline nasal wash in allergic rhinitis.

BACKGROUND: Ephedrine nasal wash (0.25% to 1%) was once used in the treatment of sinusitis and other nasal and paranasal symptoms, but there are no reported controlled trials in allergic rhinitis. METHODS: In a blinded study, 118 patients with perennial allergic rhinitis were randomly divided into two groups of 65 and 53 patients, respectively, and administered either a placebo or a 1% ephedrine-saline nasal wash once every 48 hours for a period of 4 weeks. These groups were then crossed over after a 4-week interval, and their weekly symptom scores and peak nasal inspiratory flow rates were monitored. RESULTS: Use of ephedrine-saline nasal wash resulted in significant improvement in symptom scores and peak nasal inspiratory flow rates as compared with placebo (p < or = 0.001). A statistically significant difference between the two groups began in the second week. The effects of treatment lasted for more than 2 weeks after the study, without notable side effects, in most patients. CONCLUSION: A 1% ephedrine-saline nasal wash is an inexpensive and effective treatment for allergic rhinitis.

High-brightness femtosecond laser using titanium-sapphire technology and amplification in dyes.

We modify a conventional picosecond dye-amplifier system to achieve maximum brightness for 100-fs pulses derived from a titanium-sapphire oscillator. We obtain near transform-limited 4-GW pulses by using efficient chirped-pulse amplification and compression based on a prism-pair stretcher and a glass-block compressor. Good beam quality and minimum beam divergence are obtained with a Bethune cell final amplifier. The system is shown to be capable of generating beam brightness in excess of 2 × 10(7) W cm(-2) sr(-1), within a factor of 2 of that expected for a diffraction-limited beam.