VOLUME 16 NUMBER
6 November/December 2003
With increasing awareness, a clinical diagnosis
of deep vein thrombosis (DVT) is being made more often by physicians.
However, in the outpatients, it is still not easy to rule in
or rule out the condition with certainty. Measurement of the
degradation products of cross-linked fibrin (D-dimer) circulating
in plasma is known to be a highly sensitive test for suspected
thromboembolism. Assay for D-dimer levels in blood samples is
now available. A randomized study in outpatients suggests that
DVT can be ruled out in a patient who is judged clinically to
be unlikely to have DVT and who has a negative D-dimer test.
Testing by ultrasound examination can be safely omitted in such
patients (N Engl J Med 2003;349:1227–35).
A hybrid technology using the principles
of radiation and monoclonal antibodies (mAb) may be an answer
to the shortcomings of currently
available antimicrobial drugs. Dadachova et al. successfully
delivered ionizing radiation to a fungal cell by labelling a
specific mAb with therapeutic radioisotopes, rhenium-188 and
bismuth-213. The radiolabelled antibody killed the cells of Cryptococcus
neoformans in vitro and thus converted an antibody with no inherent
antifungal activity into a microbicidal molecule. It worked in
a mouse model as well (Proc Natl Acad Med Sci 2003;100:10942–7).
Highly creative individuals have always
been perceived to be a little ‘different’. Studies have demonstrated a
link between psychopathology and creativity in the arts. It has
been postulated that ‘...there is a common genetic basis
for potential in creativity and for psychopathological deviation … it
appears to be psychopathology in the absence of psychosis that
is the vital element in creativity.’ Biographical material
relating to 40 eminent jazz musicians revealed a connection between
creativity and sensation seeking. A high level of psychopathology,
especially affect disorders and substance/drug-related problems,
was noted (Br J Psychiatry 2003;183:255–9).
A cross-sectional survey of middle-aged
subjects in an urban city of Kerala, India reported that over
half (54%) of all middle-aged
individuals were hypertensive but less than one-third (29%) were
under treatment. Further, adequate control of blood pressure
was achieved in less than a third of the treated individuals
(Indian Heart J 2003;55:245–51). These figures are alarming,
especially in the context of the major advances made in tackling
Nosocomial infections are an intensivist’s nightmare.
Oropharnygeal and intestinal colonization provides the foothold
for pathogens before the occurrence of overt infections. In a
large randomized trial, selective decontamination of the digestive
tract using oral and enteral polymyxin E, tobramycin, amphotericin
and 4 days of intravenous cefotaxime decreased the intensive
care unit and hospital mortality and reduced colonization rates
with Gram-negative aerobic bacteria (Lancet 2003;362:1011–16).
The WHO estimates that approximately 5
million infants die worldwide every year and 98% of these deaths
occur in the developing world.
Various health programmes have imparted skills to women health
workers for the diagnosis and referral of sick infants. The quality
of assessment made by health workers in correctly identifying
a sick infant was evaluated in a study. Using physician assessment
as the gold standard, the sensitivity and specificity of the
health workers’ assessment was 77% and 76%, respectively,
and the level of agreement between them was poor. The areas of
major performance were in elicitation of respiratory rate, chest
retraction, purulent discharge and jaundice (Indian Pediatr 2003;40:713–17).
Children who snore get a poor academic
score! A study looked at the association of snoring and intermittent
hypoxia with academic
performance in third grade schoolchildren and found that habitual
snoring (i.e. snoring frequently or always) was associated with
poor academic performance (lowest quintile grades) in mathematics,
science and spelling (Am J Respir Crit Care Med 2003;168:464–8).
India was predicted to become a major
reservoir for HIV/AIDS patients. Recent data suggest that we
are headed in that direction.
A tertiary care hospital reported an HIV seropositivity rate
of 9.4% among adults with tuberculosis in 2000–02. This
is a dramatic rise from the seropositivity rate of 0.4% in 1994–99
(Indian J Med Res 2003;117:239–42).
A firm mattress is commonly believed to
be beneficial for low back pain. In a randomized, double-blind,
trial of adults with chronic, non-specific, low back pain, but
no referred pain, who complained of backache while lying in bed
and on rising, the effect of mattress firmness was studied. The
participants were assigned firm mattresses or medium–firm
mattresses. At 90 days, patients with medium–firm mattresses
had better outcomes in all aspects of back pain and disability
Caffeine is the most widely used behaviourally active substance.
Excessive consumption of caffeine mostly in the form of coffee
and tea, is a well recognized cause of headache or migraine,
and withdrawal can cause headache. Cola drinks can do the same.
A study (Cephalalgia 2003;23:332–5) reported 36 children
and adolescents who had daily or near-daily headache related
to excessive caffeine intake in the form of cola drinks. All
were heavy (at least 1.5 L/day) consumers of cola drinks (192.88
mg of caffeine daily). Gradual withdrawal of cola drinks led
to complete cessation of the headaches.
We close this year’s Masala with salutations to the eminent
physiologist Dr Arthur C. Guyton who died in a tragic accident.
He was regarded by some as the person who had the greatest impact
on medical education in all time. His Textbook of Medical Physiology
has been the world’s bestselling textbook of physiology
since it was first published in the 1950s. The book is now into
its tenth edition and the first 8 editions were written solely