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Neurological deterioration in a child following routine surgery, although rare, has potentially life threatening consequences. We report the case of a child who, following adentonsillectomy, developed quadriplegia and acute respiratory distress due to previously undetected atlanto-axial instability. Patients with atlanto-axial instability often have mild or non-specific symptoms, despite severe cervical cord compression. Subtle manifestations may be ignored or attributed to other disease processes, which render patients with undiagnosed atlanto-axial instability at risk of serious neurological injury during general anaesthesia, particularly at the time of laryngoscopy and tracheal intubation. [ABSTRACT FROM AUTHOR]

Oral Diseases (2012) 18, 127-131 Objectives: Sjögren's syndrome is a complex autoimmune disease of the salivary gland with an unknown etiology, so a thorough characterization of the transcriptome would facilitate our understanding of the disease. We use ultradeep sequencing of small RNAs from patients with Sjögren's syndrome and healthy volunteers, primarily to identify and discover novel miRNA sequences that may play a role in the disease. Methods: Total RNA was isolated from minor salivary glands of healthy volunteers and patients with either high or low salivary flow and sequenced on the SOLiD platform. Prediction of mature miRNAs from the sequenced reads was carried out using miRanalyzer, and expression was validated using Taqman qPCR assays. Results: We validated the presence of six previously unidentified miRNA sequences in patient samples and in several cell lines. One of the validated novel miRNAs shows promise as a biomarker for salivary function. Conclusion: Sequencing small RNAs in the salivary gland is largely unprecedented, but here, we show the feasibility of discovering novel miRNAs and disease biomarkers by sequencing the transcriptome. [ABSTRACT FROM AUTHOR]

Oral Diseases (2012) 18, 127-131 Objectives: Sjögren's syndrome is a complex autoimmune disease of the salivary gland with an unknown etiology, so a thorough characterization of the transcriptome would facilitate our understanding of the disease. We use ultradeep sequencing of small RNAs from patients with Sjögren's syndrome and healthy volunteers, primarily to identify and discover novel miRNA sequences that may play a role in the disease. Methods: Total RNA was isolated from minor salivary glands of healthy volunteers and patients with either high or low salivary flow and sequenced on the SOLiD platform. Prediction of mature miRNAs from the sequenced reads was carried out using miRanalyzer, and expression was validated using Taqman qPCR assays. Results: We validated the presence of six previously unidentified miRNA sequences in patient samples and in several cell lines. One of the validated novel miRNAs shows promise as a biomarker for salivary function. Conclusion: Sequencing small RNAs in the salivary gland is largely unprecedented, but here, we show the feasibility of discovering novel miRNAs and disease biomarkers by sequencing the transcriptome. [ABSTRACT FROM AUTHOR]

Objective: The present study examined the course of ADHD over 24 months in a preschool population.Method: n=48 preschoolers with ADHD, aged 3.0-5.11 years, subjects included in a larger sample of preschoolers with depression and other disorders (n=306) were comprehensively assessed at 3 annual time points over 24 months in a prospective longitudinal follow-up study.Results: Baseline diagnoses of preschool MDD, ODD, and CD were risk factors for ADHD diagnosis over 24 months in this preschool population. Among older preschoolers and after controlling for key demographic variables, ADHD predicted later ADHD diagnosis, along with other significant risk factors - baseline diagnosis of ODD, and/or family history of disruptive disorders, and stressful life events.Conclusions: ADHD showed greater homotypic continuity at later rather than earlier preschool ages. Other disruptive comorbidities also emerged as key predictors of stable ADHD course. Study findings may help to inform which preschool ADHD populations to target for early intervention. Larger sample sizes are needed to confirm these findings and to further explore the stability, course, and predictors of outcome of preschool onset ADHD. [ABSTRACT FROM AUTHOR]

The absence of preexisting immunity against porcine adenovirus (Ad) serotype 3 (PAd3) and bovine Ad serotype 3 (BAd3) in humans makes them attractive alternatives to human Ad serotype 5 (HAd5) vectors. To determine whether there is significant cross-reactivity among HAd5, BAd3 and PAd3 at the level of cell-mediated immune responses, BALB/c mice were inoculated intraperitoneally with wild-type (WT) or replication-defective (RD) HAd5, BAd3 or PAd3. After 35 days of the first inoculation, cross-reactive CD8+ cytotoxic T cells, as well as CD4+ Th1- and Th2-helper T cells, in the spleen were analyzed by enzyme-linked-immunospot, flow cytometry and cytotoxic T lymphocyte assays. Virus-neutralization assays were used to evaluate humoral cross-reactivity. CD8+ or CD4+ T cells primed with WT or RD HAd5, PAd3 or BAd3 showed significant (P<0.005) reactivity with homologous Ad antigens, whereas only minimal cross-reactivity was observed on stimulation with heterologous Ad antigens. Ad-neutralizing antibodies were found to be homologous Ad specific. Overall, these results suggest that there is no significant immunological cross-reactivity among HAd5, BAd3 and PAd3, thereby supporting the rationale for the use of BAd3 and PAd3 as alternative HAd vectors to circumvent anti-HAd immunity in humans. [ABSTRACT FROM AUTHOR]

Nutritional research has recently emphasized the role of nutrients on gene expression and regulation. Although not as broadly appreciated, availability of nutrients affects gene expression. The response to a nutrient status seems in many cases to be specific for each genotype and specific nutrient impairment results in altered gene expression, depending on each genotype. Recent literature has suggested that carbohydrates, fatty acids, minerals, and vitamins of all the dietary constituents participate in the regulation of gene expression. Here, we summarize the current knowledge on the role of nutrients on cancer, phenylketonuria, cardiovascular and other life threatening diseases. [ABSTRACT FROM AUTHOR]

Nutritional factors have been found to account for about 30 percent of cancers in western countries. The contribution of diet to cancer risk in developing countries has been considered to be lower, around 2O percent, when poor diet is included the incidences are much higher. 30 to 40 percent cancers can be prevented by appropriate diets, physical activities, and maintenance of appropriate body weight. The link between diet, nutrition and cancer is now fully appreciated and a new paradigm for diet, nutrition and cancer prevention can be developed as we have good epidemiological evidences that some foods prevent and cause cancer. New concepts for diet and cancer prevention include the nutritional modulation of the carcinogenesis pathway by nutrients, micronutrients and phytochemicals. Factors like over consumption of energy, obesity, alcohol drinking, high fat, low fibre diet, less vegetables and fruits, preserved food, tobacco, exposure to aflatoxin, less physical activity are linked to increased risk of one or another type of cancer. Dietary factors like more fibre, more fruits and vegetables in diet, along with micronutrients, phytochemicals and probiotics have been proved to have anti-caner effect. Unravelling the effects of diet on cancer risk is, therefore, of great public health importance. [ABSTRACT FROM AUTHOR]

Genomic diversity at 15 short tandem repeat loci is studied in four major endogamous populations of Uttar Pradesh (UP), India. The studied populations included Thakur, Khatri, Kurmi and Jat; all of whom belong to Hindi speaking linguistic group of UP State of India. All the STR loci of Powerplex 16™ System have been found highly significant in showing genomic diversity among the addressed populations. Homozygosity test values for all the 15 loci in studied population range between 0.053 and 0.999, following Hardy–Weinberg equilibrium. Distribution of allele pattern at fluorescent labeled 13 tetranucleotide repeat loci and two pentanucleotide repeat loci of Powerplex 16™ System portrays that these markers are highly polymorphic, and thus, suitable in human identity testing and human genetic studies. [Copyright &y& Elsevier]

The article focuses on research regarding the diagnosis and treatment of bipolar disorders (BPD) in young children. According to a study by researcher Joan L. Luby and colleagues, the preschoolers who meet BPD symptom criteria have high rates of comorbid oppositional defiant disorder (ODD) and attention deficit/hyperactivity disorder (ADHD). Empirical studies do not support combination pharmacotherapy for preschool BPD which may have adverse effects on the developing child.

The article discusses the effectiveness of the two-bougie technique in establishing safe orotracheal to nasotracheal tube exchange. It examines the case of a 56-year-old man with hepatic cirrhosis and acute respiratory distress which needs emergency tracheal intubation and adequate ventilation by inserting a bougie tube beside the orotracheal tube. It concludes that the two-bougie technique is a useful method in patients with difficult airway.

Background: MIC determination has became easier, with introduction of the E-test. The point of contention has been the cost of the commercial strips which has restricted its use in resource limited countries. We attempted to develop, standardize and validate a simple in - house agar gradient method, to determine MIC of vancomycin for clinical isolates of S. aureus. Methods & Materials: In - house strips were made from Whatmann filter paper no 1. The strips were impregnated with varying concentration of vancomycin solution so as to create an increasing antibiotic gradient along the strip. During the standardization step, MIC's of 90 clinical strains of S. aureus and ATCC 29213 were tested by the broth microdilution and commercial strip followed by the in - house strip. The results were kept blinded during the development stage. Variables for the preliminary considerations for optimization and standardization of the In - House Agar Gradient strip were considered to correct the outliers. This was followed by validation stage where MIC's of 90 different clinical strains of S. aureus and ATCC 29213 were determined by the in - house and results were kept blinded. This was followed by determination of MIC's by broth microdilution and commercial strips. An MIC reading of ± 1log2 dilution compared with broth microdilution was considered as an outlier. Results: During the optimization and standardization stage there were 7/90 outliers in the clinical strains and no outliers seen with the ATCC 29213 control strain. Corrective action was performed by increasing precaution during the antibiotic solution impregnation stage. During the validation stage, only 4/90 outliers were observed in the clinical strains. The commercial strips had 29/90 among clinical and 15/30 outliers in the control strain during the prevalidation phase. The supplier was informed to maintain cold chain and during the validation phase the outliers for commercial strip were 18/90 and 4/30 in the clinical and control strain respectively. Conclusion: Vancomycin sensitivity is reported as MIC. Expensive commercial strips can be replaced by in - house strips using this simple technique after validating it with a gold standard method like broth microdilution. [ABSTRACT FROM AUTHOR]

We have adapted a well-known constitutive model formulated by Morris and Boulay (1999) that describes the stress tensor for a mixture of particles in a Newtonian liquid into a two-phase finite-volume solver. The two-phase model treats each phase with a separate continuity and momentum equation that splits the stress of the constitutive model between the two phases, with the particle pressure applied only to the particle phase in addition to source terms related to the drag of particles in the fluid. We compare the resulting model using a variety of NMR experiments, considering the flow of neutrally buoyant monodisperse particles at low Reynolds number in the following geometries: 2D simple shear flow in a Couette device, axisymmetric and 3D pressure driven flow down a pipe and in a 2D and 3D asymmetric channel bifurcation. We find excellent agreement with velocity and volume fraction profiles in all of the comparisons with experimental data without much further numerical fitting beyond the original suspension stress model. [ABSTRACT FROM AUTHOR]

A response by A. Agarwal and colleagues to a letter to the editor about their article “Evaluation of Capsaicin Ointment at the Korean Hand Acupressure Point K-D2 for Prevention of Postoperative Nausea and Vomiting,” in the previous issue.

Context: Succinylcholine a depolarizing muscle relaxant with rapid onset, predictable course and short duration of action is associated with myalgia. Aim: The aim of this study is to evaluate the efficacy of pregabalin, gabapentin and diclofenac on the incidence and severity of succinylcholine-induced myalgia. Settings and Design: Tertiary Care Teaching Hospital. Materials and Methods: A total of 120 patients undergoing laparoscopic cholecystectomy were randomly assigned into three groups: Pregabalin group received 150 mg of pregabalin, gabapentin group received 600 mg of gabapentin and diclofenac group received 100 mg of diclofenac sodium orally 2 h prior to surgery. Anesthesia was induced with fentanyl 3 μg/kg, propofol 2-2.5 mg/kg and succinylcholine 1.5 mg/kg and was maintained with oxygen with sevoflurane in the air and intermittent vecuronium bromide. A blinded observer recorded post-operative pain scores on visual analog scale at different time intervals and myalgia at 24 h. Postoperative pain relief was provided with fentanyl based patient-controlled analgesia. Fentanyl consumption in 24 h was recorded as a primary outcome. Statistical Analysis: Patients' characteristics and total fentanyl consumption were compared using one-way ANOVA followed by post-hoc test. Pain score was compared amongst the groups using Kruskal Wallis test. Results: The myalgia occurred in 15, 14 and 13 patients in pregabalin, gabapentin and diclofenac sodium group respectively (P > 0.85). Patients in diclofenac group had significantly higher fentanyl consumption (674.85 ± 115.58 μg) compared with pregabalin group (601.87 ± 129.57 μg) (95% confidence interval [CI] = 34.8-120.7) and gabapentin group (612.29 ± 105.12 μg) (95% CI = 14.9-170.5). However, there was no significant difference in fentanyl consumption between pregabalin and gabapentin groups (95% CI = -34.8-120.7). There was a significant difference in visual analog score at time points 12, 18 and 24 h among the study groups. Conclusion: Pre-treatment with pregabalin, gabapentin and diclofenac had equal efficacy in reducing the incidence and severity of succinylcholine-induced myalgia. However, pre-treatment with pregabalin and gabapentin decreased post-operative pain scores and fentanyl consumption. [ABSTRACT FROM AUTHOR]

Background: In patients undergoing endoscopic third ventriculostomy (ETV), various cardiovascular changes occur in the intraoperative period. Aim: We tried to determine a pattern in these changes and their relation to different surgical steps. Materials and Methods: A total of 260 patients were studied over a period of six years. Heart rate and mean arterial pressures were recorded before introduction of the endoscope and thereafter at various stages of the operation. Results: Tachycardia was the predominant observed abnormality in 20% of patients, occurring mostly during manipulations and irrigation in the third ventricle (TV). Bradycardia was seen in 12% of patients, more often during fenestration of the floor of the third ventricle. Conclusions: Tachycardia observed during ETV may be related to hypothalamic stimulation or a rise in intracranial pressure and bradycardia may be due to stimulation of the hypothalamus or the third cranial nerve. Anticipation of these cardiovascular changes during the relevant steps of the operation can help in taking appropriate corrective action, thus preventing potentially serious complications of ETV. [ABSTRACT FROM AUTHOR]

The K-D2 point is the Korean hand acupressure point in Koryo Hand Therapy for prevention of postoperative nausea and vomiting. We evaluated the efficacy of capsaicin ointment at the K-D2 point in 186 patients undergoing laparoscopic cholecystectomy in a randomised, prospective, double-blind and placebo-controlled study. Patients were randomised to have either placebo ointment or capsaicin ointment applied to the K-D2 point of both hands 1 h before surgery under standardised anaesthesia. The ointment was removed 8 h later. Postoperative nausea and vomiting was evaluated 6 and 24 h following surgery. The incidence of postoperative nausea and vomiting was lower in the capsaicin group, with an absolute risk reduction (ARR) of 21%, a relative risk reduction (RRR) of 50% and a number-needed-to-treat (NNT) of 5 at 0–6 h (p = 0.001), and an ARR of 11%, a RRR of 85% and a NNT of 9 at 6–24 h (p = 0.003). The need for rescue anti-emetic treatment was also lower at 0–6 h (3 (3%) vs 11 (12%); p = 0.04) and at 6–24 h (5 (5%) vs 0; p = 0.02). [ABSTRACT FROM AUTHOR]

BACKGROUND The BCL2 inhibitor venetoclax has shown activity in patients with chronic lymphocytic leukemia (CLL), but its efficacy in combination with other agents in patients with CLL and coexisting conditions is not known. METHODS In this open-label, phase 3 trial, we investigated fixed-duration treatment with venetoclax and obinutuzumab in patients with previously untreated CLL and coexisting conditions. Patients with a score of greater than 6 on the Cumulative Illness Rating Scale (scores range from 0 to 56, with higher scores indicating more impaired function of organ systems) or a calculated creatinine clearance of less than 70 ml per minute were randomly assigned to receive venetoclax-obinutuzumab or chlorambucil- obinutuzumab. The primary end point was investigator-assessed progression- free survival. The safety of each regimen was also evaluated. RESULTS In total, 432 patients (median age, 72 years; median Cumulative Illness Rating Scale score, 8; median creatinine clearance, 66.4 ml per minute) underwent randomization, with 216 assigned to each group. After a median follow-up of 28.1 months, 30 primary end-point events (disease progression or death) had occurred in the venetoclax-obinutuzumab group and 77 had occurred in the chlorambucil-obinutuzumab group (hazard ratio, 0.35; 95% confidence interval [Cl], 0.23 to 0.53; P<0.001). The Kaplan-Meier estimate of the percentage of patients with progression- free survival at 24 months was significantly higher in the venetoclax-obinutuzumab group than in the chlorambucil-obinutuzumab group: 88.2% (95% Cl, 83.7 to 92.6) as compared with 64.1% (95% Cl, 57.4 to 70.8). This benefit was also observed in patients with TP53 deletion, mutation, or both and in patients with unmutated immunoglobulin heavy-chain genes. Grade 3 or 4 neutropenia occurred in 52.8% of patients in the venetoclax-obinutuzumab group and in 48.1% of patients in the chlorambucil-obinutuzumab group, and grade 3 or 4 infections occurred in 17.5% and 15.0%, respectively. All-cause mortality was 9.3% in the venetoclaxobinutuzumab group and 7.9% in the chlorambucil-obinutuzumab group. These differences were not significant. CONCLUSIONS Among patients with untreated CLL and coexisting conditions, venetoclax-obinutuzumab was associated with longer progression-free survival than chlorambucil-obinutuzumab. [ABSTRACT FROM AUTHOR]

Objectives: MicroRNAs (miRNAs) are single‐stranded RNAs that have been implicated in cancer initiation and progression and act as tumour suppressors or oncogenes. In this study, miRNA profiling was conducted on the most frequent malignancy of salivary glands, mucoepidermoid carcinoma (MEC), in comparison with normal tissues. Materials and Methods: The TaqMan Human miRNA Cards Array was used for the miRNA profiling of MEC and normal tissues. To validate the differentially expressed miRNAs in MEC, we used real‐time PCR (qRT‐PCR). Results: miR‐302a was the most significantly increased miRNA in cancer tissues (p < .05). Here, we demonstrate that the upregulation of miR‐302a expression in SGT cell lines induced cancer cell invasion in vitro. Conclusions: These promising results suggest the need for further studies to establish mir‐302a as a marker of invasion and aggressiveness in MEC. [ABSTRACT FROM AUTHOR]

Background: Coagulopathy after living donor hepatectomy (LDH) may endanger donor safety during removal of thoracic epidural catheter (TEC). The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. Materials and Methods: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC) and ALT of each donor for five days was noted. In addition, duration of surgery, remnant as percentage total liver volume (Remnant%), blood loss, day of peak in PC and INR were also noted. Coagulopathy was defined as being present if INR exceeded 1.5 or platelet count fell below 1 x 105/mm³ on any day. Data was analyzed using SPSS 20 for Windows. Between group comparison was made using the Student 't' test for continuous variables and chi square test for categorical variables. Univariate analysis was done. Multiple logistic regression analysis was used to find independent factor associated with coagulopathy. Results: Eighty four (84) donors had coagulopathy on second day (mean INR 1.9 ± 0.42). Low BMI, % of remnant liver and duration of surgery were independent predictors of coagulopathy. Right lobe hepatectomy had more coagulopathy than left lobe and low BMI was the only independent predictor. There was no correlation of coagulopathy with age, gender, blood loss, presence of epidural catheter, postoperative ALT or duration of hospital stay. High INR was the main contributor for coagulopathy. Conclusions: Coagulopathy is seen after donor hepatectomy. We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5. [ABSTRACT FROM AUTHOR]

Background: Endoscopic third ventriculostomy (ETV) has replaced shunt surgery for several indications. Failure of ETV secondary to restenosis can result in recurrence of symptoms of raised intracranial pressure. Objective: To analyze the rates of restenosis due to ostomy closure and factors resulting in failures and to assess the role of re-ETV in such cases. Materials and Methods: Re-ETV was performed after counselling and obtaining informed consent. The technique of re-ETV was essentially the same as in primary ETV. Video analysis of primary ETV was performed before selecting a patient for re-ETV. Factors analyzed included age, gender, etiology of hydrocephalus, cerebrospinal fluid (CSF) findings, presence of shunt tube and adequacy of ETV and bleeding at the time of ETV. Results: Thirty-two patients underwent re-ETV. The mean interval between the first ETV and re-ETV was 1.4 years (3 days to 2.9 years). Overall failure of ETV due to restenosis was 8.78%. The technical success rate of performing re-ETV was 93.2%. The overall clinical recovery following surgery was observed in 89% of the patients, three from early and 25 from delayed ETV failures. The radiological recovery was seen in 20 (63%) patients. The good flow of CSF via the re-ETV site was documented with cine mode magnetic resonance imaging (MRI) in seven patients. Unlike primary ETV, the success of re-ETV in children aged less than 2 years was 90% (P < 0.005). There were 56.25% failure of ETV in patients with previous infection or foreign body within the ventricle (P < 0.001). While the chances of restenosis were high in the procedure with some infections, the outcome was equally better. Gender of the patients and CSF findings had no influence on ostomy closure. Conclusions: re-ETV can be considered in carefully selected patients of failed ETV. It is more useful in delayed ETV failures and can be offered before a patient is advised VP shunt. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the incidence, risk factors and outcome of intra procedure rupture (IPR) during endovascular coiling of intracranial aneurysms, a neurosurgeons' experience. Materials and Methods: The frequency of IPR was studied in 168 aneurysms treated by endovascular coiling in 150 consecutive patients. Aneurysm size, morphology, history of previous subarachnoid hemorrhage (ruptured) and timing of treatment after subarachnoid hemorrhage were the data collected for comparison. Results: Procedure-related rupture during endovascular coiling occurred in five (2.97%) of the 168 aneurysms treated. IPR was the cause for 1.78% treatment-related deaths. Small aneurysm size was the major risk factor for IPR in this series (P < 0.001). Conclusions: In this study, the frequency of IPR was similar to the reported frequency in the procedures performed by neurointerventionists. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the incidence, risk factors and outcome of intra procedure rupture (IPR) during endovascular coiling of intracranial aneurysms, a neurosurgeons' experience. Materials and Methods: The frequency of IPR was studied in 168 aneurysms treated by endovascular coiling in 150 consecutive patients. Aneurysm size, morphology, history of previous subarachnoid hemorrhage (ruptured) and timing of treatment after subarachnoid hemorrhage were the data collected for comparison. Results: Procedure-related rupture during endovascular coiling occurred in five (2.97%) of the 168 aneurysms treated. IPR was the cause for 1.78% treatment-related deaths. Small aneurysm size was the major risk factor for IPR in this series (P < 0.001). Conclusions: In this study, the frequency of IPR was similar to the reported frequency in the procedures performed by neurointerventionists. [ABSTRACT FROM AUTHOR]

Background: Anterior cervical discoidectomy with or without fusion is a well established surgical remedy for cervical prolapsed intervertebral disc (PIVD) disease. If fusion is done by an iliac bone graft then internal fixation is commonly used to keep the graft in position. This study was conducted to determine the efficacy and tolerability of shape memory alloys, especially NiTi (nickel titanium) clips in the stabilization of grafts following anterior cervical discoidectomy. Methods: 133 NiTi clips were applied in 119 patients between January 2002 and December 2008. The patients age ranged from 38-60 years. There were 66 male and 53 females. Various indications for fixation of the spine included degenerated cervical spondylosis with single level PIVD (105) and two level PIVD in 14 patients. The cine mode fluoroscopy confirmed the perioperative correct placement of grafts and clips in all the patients. Follow-up ranged from 2 to 8 years (mean: 4.6 years). Results: Single level discoidectomy was performed in 105 patients and two level disc removal was done in 14 patients. A single NiTi clip was applied in all the cases except for 14 cases of two level PIVD. No procedural complication or adverse reaction to the clip was noted. There was no movement at the operated level in dynamic lateral view X-ray of cervical spine at the 1 st postoperative day as well as on follow-up. Graft extrusion was seen in one patient on the 2 nd day after surgery and was reoperated. Bony fusion occurred in all patients after 9 - 12 months of surgery. There was no incidence of breakage or dislodgement of the clip from the site where it was inserted. No artifact was noted in cervical MRI done in 33 patients. Conclusion: NiTi clips are a simple alternative for cervical spine stabilization after discoidectomy. Their insertion is simple, minimally invasive, does not require any special set of instruments and they are much more economical than other established methods of treatment. These clips are accepted well by human tissue and do not interfere with MRI. [ABSTRACT FROM AUTHOR]

Background: Because of the lack of suitable pediatric antiretroviral (ARV) agents, adult fixed-dose ARVs are commonly used in children. This practice poses concerns about dose inaccuracy, which may lead to resistance or toxicity. Objective: The objective of the present study was to evaluate the bioequivalence of a new pediatric fixed-dose combination (FDC) ARV tablet for oral suspension as compared with individual liquid formulations. Methods: The FDC ARV tablet for oral suspension contained lamivudine 40 mg, nevirapine 70 mg, and stavudine 10 mg. This formulation was compared with 4 mL of lamivudine 10 mg/mL, 7 mL of nevirapine 50 mg/5 mL, and 10 mL of stavudine 1 mg/mL. This was an open-label, balanced, randomized, 2-treatment, 2-period, 2-sequence, single-dose crossover study in 36 Indian male volunteers under fasting conditions. Blood samples were collected before dosing and at 0.167, 0.25, 0.333, 0.5, 0.667, 0.833, 1, 1.25, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 6, 12, 16, 24, 36, 48, 72, 96, 120, 144, 168, and 192 hours after dosing in each period. Results: The mean (SD) age, weight, and height of the Indian volunteers were 24.78 (5.31) years (range, 18-38 years), 57.06 (8.59) kg (range, 45-77 kg), and 165.14 (5.34) cm (range, 156-176 cm), respectively. The mean (SD) values for T(max), C(max), and AUC(0-t) for the FDC and the individual liquid formulations, respectively, were as follows: lamivudine, 0.71 (0.22) and 0.89 (0.50) hour, 594 (167) and 514 (139) ng/mL, 2382 (617) and 2227 (666) ng /mL per hour; nevirapine, 1.7 (1.1) and 2.5 (1.2) hours, 1248 (275) and 1185 (238) ng/mL, 70,372 (14,869) and 71,278 (17,435) ng/ mL per hour; and stavudine, 0.44 (0.11) and 0.43 (0.11) hour, 348 (82) and 395 (107) ng/mL, and 576 (113) and 631 (142) ng/mL per hour. The ratios and 90% CIs for the least-squares mean Cmax and AUC values were found to be within the prespecified range of 80% to 125% for each component. Conclusion: The FDC pediatric formulation of lamivudine, nevirapine, and stavudine was bioequivalent to the individual liquid formulations in these fasting, healthy Indian men. [ABSTRACT FROM AUTHOR]

We evaluated the efficacy of topical Myolaxin (capsaican ointment, Geno, Mumbai) ointment over EMLA (eutectic mixture of lignocaine, prilocaine; Neon, Goa) cream for attenuating venous cannulation pain in this prospective, randomised, double blind study. Sixty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned into two equal groups. Group I (EMLA) received EMLA cream, whereas Group II (Myolaxin) received Myolaxin ointment. For both groups the cream was applied at the venous cannulation site (dorsum of the non-dominant hand) one hour prior to venous cannulation and was covered with an occlusive dressing. Following venous cannulation patients were asked if they felt pain during venous cannulation. If the answer was yes, they were asked to rate the severity of venous cannulation pain using a VisualAnalogue Scale (VAS) of 0-10. The incidence of venous cannulation pain was similar between groups: in the EMLA group 65% (18/28) compared to 67% (20/30) in the Myolaxin group (P=0.19). The severity of pain (median VAS with inter quartile range) was also similar between the groups: in the EMLA group 1.5 (3) compared to 1.5 (2) in the Myolaxin group (P=0.46). As the topical application of Myolaxin ointment is cheaper than EMLA and has similar efficacy, it may be a suitable alternative for reducing the incidence and severity of venous cannulation pain. [ABSTRACT FROM AUTHOR]

Microwave-assisted radiohalogenation for the production of short-lived radiopharmaceuticals has now been applied to the synthesis and radiolabelling of azomycin nucleosides. (Radio)halogens were incorporated either by nucleophilic substitution of a leaving group or by halogen–halogen exchange, in the synthesis of IAZA, IAZP and FAZA. A comparison of conventional labelling and microwave-assisted labelling procedures reflects a clear advantage of the microwave technique. [Copyright &y& Elsevier]

Dietary deficiency of trace elements, minerals and vitamins has been associated with severe malnutrition among young children. Although levels of severe malnutrition among children are high in developing countries, data on dietary intake of trace elements, minerals, vitamins and other nutrients by severely malnourished (SMN) children are limited. The present prospective study was conducted for a period of 12 months in order to assess the intake of trace elements, minerals, vitamins and other nutrients by SMN children and its possible interrelationship with their nutritional status. The nutritional status of 1643 children in the age group of 6 months to < 6 years, registered at 50 Anganwadi centres at district Alwar and Bharatpur in Rajasthan in India, was assessed using weight-for-age criteria. A total of 150 children were identified as severely malnourished. Mothers of 130 of the children consented to their children's participation in the study. At the end of 12 months, full data was available for 60 of the 130 SMN children. The nutritional status and intake of trace elements, minerals, vitamins and other nutrients of the 60 SMN children were analysed at monthly follow-up visits. Results revealed that there was an increase in the intake of trace elements, minerals and other nutrients during the follow-up period as compared to the baseline survey. However, in all of the follow-up visits, an overall deficient intake of all of the trace elements, minerals, vitamins and other nutrients was observed in the SMN children except for protein, calcium and magnesium. Out of 60 children, 35 moved to higher nutritional grades. It was found that the intake of trace elements, minerals, vitamin and macro-nutrients was higher among children whose nutritional status improved as compared with the group that remained in the severe malnutrition category. The present study highlights that the existence of multiple trace element and vitamin deficiencies in the diets of SMN children could play a role in the severe malnutrition of these children. [ABSTRACT FROM AUTHOR]

Autonomic dysreflexia due to distended bladder is well known. Reflux of blood during endovascular procedure is also a common observation. It happens due to difference in pressure gradient between arterial pressure and that of infusing solution. Generally it happens when the infusion bottle is empty or the pressure in infusion bottles fall. We present an uncommon situation where distended bladder mechanically resulted in reflux of blood into endovascular catheters as well as alteration in hemodynamic parameters. Both settled once the bladder was empty. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 26-year-old male who developed supraventricular tachycardia after the administration of racemic bupivacaine toward the end of the surgery. The patient has undergone transthoracic fixation due to the fractured 9th thoracic vertebra and fractured 8th, 9th, 10th, and 11th right-sided ribs, with paraparesis. The hemodynamics and sinus rhythm returned to normal after the injection of 10 percent intralipid over 15 minutes.