MR imaging for predicting neoplastic invasion of the cervical esophagus

BACKGROUND AND PURPOSE: Esophageal invasion (EI) by head and neck neoplasm has important prognostic and surgical management implications. Our purpose was to determine the accuracy of MR imaging for predicting neoplastic cervical esophageal invasion. METHODS: MR scans of the neck obtained from 22 patients with periesophageal masses were retrospectively reviewed independently and by consensus by two experienced head and neck radiologists who were unaware of surgical findings. The patients were selected from clinical, radiologic, or pathologic reports suggesting EI. The following imaging criteria for EI were evaluated: effacement of periesophageal fat planes, circumferential mass, paraesophageal lymph nodes, luminal size, wall thickening, increased T2 wall signal, and wall enhancement. There were eight patients with EI and 14 patients without EI, as confirmed by surgical findings or pathologic examination. RESULTS: The consensus criteria with the best sensitivities were any wall thickening (100%), effaced fat plane (100%), and any T2 wall signal abnormality (100%). The criteria with the best specificities were circumferential mass greater than 270 (100%) or 180 degrees (93%) and focal T2 wall signal abnormality (86%). The overall kappa value for the two readers for all criteria was 0.57 (moderate agreement). CONCLUSION: A circumferential mass or focal T2 signal abnormality on the esophageal wall suggests the presence of EI. An intact fat plane, absence of wall thickening, and no T2 wall signal abnormalities imply that the esophagus is not invaded.     

Psychopharmacology in general practice

With the advent of more safe and user-friendly drugs in the modern era of psychopharmacology and their use in general practice, a brief discussion regarding the pharmacological aspect of the new drugs has been attempted in the present article so that they may be used more effectively in practice.     

Tobacco control practices in 25 schools of West Bengal

Information about tobacco use prevalence, knowledge and attitude was assessed among school personnel in schools of West Bengal. Statistical analysis was done using SUDAAN and the C-sample procedure in Epi-Info. The school response rate was 100%. Current any smoking and smokeless tobacco use was reported by 30.9% and 13.1% school personnel, respectively. Current daily smoking, and smokeless tobacco use reported by 20.4%, and 5.8% school personnel respectively. Men reported significantly more for all kinds of daily tobacco use as compared to women. School tobacco control policy on three scales was reported poor (17.7-30%). However most of the school personnel felt need for such policies (82.7-93.6%). Teaching and training on tobacco was reported low (29.9%-50.4%). However most of the school personnel (79.1-93.6%) were supportive on different measures of tobacco control. Training of school personnel may provide students with essential tools to help them adopt and maintain a smoke free lifestyle.     

Respiratory and general health impairments of ragpickers in India: a study in Delhi

Objective: This study attempted to assess the respiratory and general health of ragpickers who rummage through the garbage dumps and landfill sites in India to collect and sell recyclable materials for a living. Methods: 98 ragpickers and 60 controls from Delhi, matched for age, sex, and socioeconomic conditions, were examined. Health data were obtained from questionnaire survey, clinical examination, and laboratory investigations. Lung function was evaluated by spirometry. Results: After controlling for smoking as a confounder, respiratory symptoms and lung function decrement were recorded in 94% and 52% of the ragpickers, respectively, compared with 56% and 34% of controls. The ragpickers showed a higher prevalence of low hemoglobin, high circulating eosinophil and monocyte counts, unhealthy gums, frequent diarrhea, and dermatitis, when compared with controls. Their sputum showed an abundance of alveolar macrophages, siderophages and inflammatory cells, and a very high frequency of squamous metaplasia and dysplasia of bronchial epithelial cells, suggesting inflammation and cellular changes in the airways. Conclusion: The ragpickers suffer from a multitude of health problems which seem related to their occupation.     

Effective resolution with olanzapine of acute presentation of behavioral agitation and positive psychotic symptoms in schizophrenia

Behavioral agitation and prominent positive psychotic symptoms often characterize the acute presentation of schizophrenia. The clinical treatment goal is a rapid control of these symptoms. The relative efficacy of olanzapine, a novel antipsychotic drug, was compared with that of the conventional antipsychotic drug haloperidol. A post hoc analysis conducted on a large multicenter, double-blind, 6-week study of acute-phase patients with DSM-III-R schizophrenia or schizophreniform or schizoaffective disorders treated with olanzapine (5-20 mg/day) or haloperidol (5-20 mg/day) assessed the treatment effects on agitation (Brief Psychiatric Rating Scale [BPRS] agitation score) and positive symptoms (BPRS positive symptom score). Overall, olanzapine-treated patients experienced significantly greater improvement in behavioral agitation than did haloperidol-treated patients (last observation carried forward [LOCF]; p < .0002). Both groups showed similar reductions in agitation scores during the first 3 weeks of therapy; olanzapine was associated with significantly greater improvements at weeks 4, 5, and 6 (observed cases [OC]). Similarly, patients with predominantly positive psychotic symptoms experienced significantly greater improvement in BPRS positive symptom scores with olanzapine compared with haloperidol (LOCF; p = .013). In olanzapine-treated patients, improvement in BPRS agitation and positive symptom scores was significantly greater at weeks 4, 5, and 6 (agitation scores, p < or = .01; positive symptom scores, p < .05) (OC). These data suggest that olanzapine may be considered a first-line treatment for the patient in an acute episode of schizophrenia.     

Modulation of cytochrome-P450 inhibition (CYP) in drug discovery: a medicinal chemistry perspective

Cytochrome P450 (CYP450) has widely been implicated for drug-drug interactions (DDI) in the pharmaceutical industry. Inhibition or induction of this enzyme family has led to withdrawal of multiple drugs from the market leading to major time and financial losses for the pharmaceutical industry. CYP450 plays a prevailing role in the biotransformation of a large number of structurally diverse drugs. Few isoenzymes of the CYP enzyme family (CYP3A4, 2D6 and 2C9 family) are mainly involved in metabolism of most of the drugs. To avoid such interactions and potentially minimize DDI, major pharmaceutical organizations prefer to incorporate CYP enzyme screening at an early stage of their discovery program. While this has been a prevalent practice in the pharmaceutical industry lately, there is very limited literature available reviewing the relationship between chemotypes and CYP isoforms. This review will collate literature pertaining to CYP-inhibition modulation through physicochemical parameters and chemical modification and thus bring to focus commonly used trends by medicinal chemists world-wide.     

Changing trends of an endemic trauma

The incidence of severe burn is extremely high in the Low and Middle Income Countries with an estimated 90% of the world incidence of which 50% is in South East Asia. Through an earlier analysis of 11,196 burn admission over 8 years (1993–2000—Phase I) to our burn unit we established the endemic nature of the injury [Ahuja RB, Bhattacharya S. An analysis of 11,196 burn admissions and evaluation of conservative management techniques. Burns 2002;28:555–61]. A continued analysis of 5566 burn admissions over the next 7 years (2001–2007—Phase II) and its comparison with the Phase I reveals a significant change in the epidemiological profile. The average yearly admissions have fallen by 43.14%, from 1399.5 patients in Phase I to 795.14 patients in Phase II. This fall in average yearly admissions is predominant in the age group 16–35 years (52.61% decline) and 36–55 years (46.51% decline). The overall female to male ratio has also changed from 1.26:1 to 0.91:1. However, the overall mean %TBSA burn has reduced only mildly from 49.12% TBSA in Phase I to 44.39% in Phase II. During Phase II there was also a significant decline of 46.93% and 56.25% in the yearly admission of flame and scald burn respectively. Non-intentional incidents still remain the main mode of injury accounting for 87.12% in Phase I and 89.89% in Phase II. But, the yearly admissions of non-intentional burns fell from 1219.25 in Phase I to 714.71 in Phase II, which is a significant drop of 41.38%. Kitchen continues to dominate as the main location for flame incidents, but the yearly admission rate from kitchen accidents dropped from 897.5 patients in Phase I to 368.43 patients in Phase II. At the same time, liquefied petroleum gas (LPG) leaks which accounted for only 0.72% of all kitchen accidents in Phase I rose to 10.74% in Phase II. Another redeeming feature is the reduction in overall mortality from 51.8% in Phase I to 40.20% in Phase II. Interestingly, a very significant negative correlation exists (being significant at 0.01 level—2 tailed) between burn admissions and the yearly per-capita income of Delhi, from 1993 to 2005, to prove that the incidence and profile of burns directly reflects the economic development of the society. We see this as the first long term study from a burn unit of a developing country to directly reflect this association of burn incidence and its changing profile with economic prosperity.