VOLUME 16 NUMBER 6 November/December 2003

Masala: [PDF]

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 this problem.

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, controlled, multicentre 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 (Lancet 2003;362:1599–604).

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 by him.

Jyoti Nath

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