Pathophysiology of Himalayan endemic goiter

Goiter prevalence and iodine metabolism were studied in areas of endemic goiter in the Himalayas in India and Nepal. Similar studies were also made in Ceylon. The results are compatible with the hypothesis that severe environmental deficiency of iodide is the primary factor responsible for endemic goiter in these areas. The endemicity was less severe in Ceylon than in India and Nepal. The thyroid glands of persons living in endemic areas show an interesting adaptive response to maintain internal homeostasis in the face of severe iodine deficiency. The mechanism of this adaptation was studied in thyroids of goats raised in endemic and nonendemic areas. Thyroids of goats living in an area of severe iodine deficiency showed higher MIT/DIT and T3/T4 ratios than glands of those in an area of iodine abundance. There was a higher incorporation of 131I in 27S iodoproteins in the iodide-deficient glands. A decrease in iodine concentration of the thyroid and an increase in circulating TSH levels are possibly involved in mediating this response but of the two, the former mechanism seems more likely than the latter

Hairy cell leukemia : experience at a tertiary cancer centre in Northern India

Background : The prognosis of Hairy cell leukemia (HCL) has improved markedly following treatment with cladribine (2- CdA), a nucleoside analogue. We reviewed data on patients with HCL treated in our department. Methods . Between 1995 and 2004, 23 patients with hairy cell leukemia (HCL) were diagnosed Patients median age was 48.5 years (range, 32 to 66 years), there were 18 males and 5 females. The common presenting symptoms were: fatigue (82.6%), fever (34.7%), abdominal discomfort (21.7%), arthralgia/bone pains (13%) and bleeding (17.3%). 22 of 23 (95.6%) patients had enlarged spleen, and hepatomegaly (65%). Lymph node enlargement was present in 17% of patients. Investigations revealedmedian Hb of 7.8g% (5.7 to 12.9 g%), thrombocytopenia (median 55000/cmm) and median WBC count of 3500/cmm (range, 600 to 20,200/cmm). Bicytopenia or pancytopenia was present in 87% and bone marrow fibrosis in 75% of cases. Immunophenotyping studies revealed expression of CD11C (60%), CD25 (60%), FMC7(47.8%), CD23(34.8%), CD103 in 39% of cases. 20 of 23 patients received treatment; two received treatment else where and one patient died of liver failure prior to treatment. 17 of 20 patients were treated with 2-CdA, 2 with interferon alfa (IFN-a) and one patient underwent splenectomy alone. Three patients received 2-CdA as second line therapy for treatment of relapse: this includes . one patient each, treated with IFN- α and splenectomy both and one patient received 2-cdA twice in view of relapse. Results . Following treatment with 2CdA . 95% of patients responded; complete-84.2% and partial response in 10.5%. one (5.2%) patient died of toxicity. Two patients relapsed at a mean follow up of 25 months. The common side effects were febrile episodes (n=10) and grade I-II myelosuppression. One patient died of toxicity to 2-CdA. This patient was a known case of multidrug resistant disseminated tuberculosis. He had severe myelosuppression with fungal sepsis with multiorgan failure and BM Aspirate was positive for AFB. Other infections documented were Pulmonary tuberculosis in 2 and herpes zoster in one patient. The patient who underwent Splenectomy achieved remission but relapsed after 3 years and was salvaged with 2-CdA again. Median time for normalization of blood counts after 2-CdA was 28 days and median time to regress spleen was 41.5 days . Conclusion . Present study confirms good outcome with 2-CdA (cladribine) therapy for patients of hairy cell leukemia

EFEKTIVITAS DESENTRALISASI PENDIDIKAN DALAM MENINGKATKAN PROFESIONALISME GURU DI SMA NEGERI 1 LAKEA

Skripsi ini membahas tentang efektivitas desentralisasi pendidikan dalammeningkatkan profesionalisme guru di SMA Negeri 1 Lakea dengan pokok pembahasana bagaimana deskripsi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea? dan bagaimana implikasi desentralisasi pendidikan dalam meningkatkan profesionalisme guru di SMA Negeri 1 Lakea. Tujuan penelitian ini untuk mengetahuideskripsi dan implikasi desentralisasi pendidikan dalam meningkatkan prodfesionalisme guru di sekolah tersebut.Untuk menjawab permsalahan tersebut, penelitian ini menggunakan metode kualitatif dengan teknik pengumpulan data melalui observasi, wawancara dan dokumentasi, serta menggunakan teknik analisis data melalui reduksi data, penyajian data, verifikasi data dan penarikan kesimpulan.Hasil penelitian skripsi ini yaitu: deskripsi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Desentralisasi pendidikan merupakan pemberian kewenangan kepada daerah untuk mengelola pendidikannya, lalu daerah melimpahkan kepada masing-masing sekolah (2) Pemerintah pusat tetap mengontrol pendidikan yang diselenggarakan oleh pemerintah daerah dan masing-masing sekolah melalui akreditasi nasional yang dilaksanakan oleh BAN-SM (3) Aspek-aspek yang menjadi kewenangan sekolah dalam melaksanakan desentralisai pendidikan yakni: (a) Perencanaan dan evaluasi program sekolah dalam hal ini sekolah berupaya meningkatkan mutu pendidikan dengan cara merencanakan kegiatan-kegiatan yang dapat meningkatkan profesionalisme guru, misalnya mengutus guru untuk mengikuti Musyawarah Guru Mata Pelajaran (MGMP) dan merencanakan bimbingan teknis untuk meningkatkan keterampilan guru dan mengevaluasi berbagai perencaan kegiatan program sekolah (b) Aspek pengelolaan proses belajar, memberikan kewenangan kepada masing-masing guru untuk mengelola proses pembelajaran pada mata pelajaran yang dipegangnya dan kepala sekolah melukan supervisi kepada guru untuk mengevaluasi dan membimbing pelaksanaan proses pembelajaran guru tersebut (c) Aspek pengelolaan ketenagaan, SMA Negeri 1 Lakea mengelola 25 orang guru dan 3 orang tenaga administrasi, pengelolaan yang dilakukan misalnya memberikan guru mata pelajaran yang sesuai dengan keahliannya, dan mengutus guru sebagai perwakilannya dalam kegiatan seminar mapun workshop (d) Aspek pengelolaan keuangan, sekolah mengelola dana BOS dengan prosedur sesuai dengan aturan penggunaan dana tersebut yakni sebagai operasional sekolah, misalnya mengupayakan pembayaran honor guru honorer yang tidak pernah terlambat dibayarkan. Implikasi Desentralisasi Pendidikan dalam Meningkatkan Profesionalisme Guru di SMA Negeri 1 Lakea: (1) Program sekolah dalam meningkatkan profesionalisme dapat terlaksana dengan baik (2) Masing-masing guru berupaya meningkatkan pengelolaan proses belajarnya sebagai implikasi dari pelaksanaan supervisi (3) Sekolah memiliki tenaga pendidik sesuai dengan kebutuhan dan (4) Pengelolaan keuangan yang dilaksanakan oleh sekolah dapat memotivasi guru untuk melaksanakan tugasnya dengan baik.Kata Kunci        :    Desentralisasi pendidikan, profesionalisme gur

A randomized, prospective open labeled study of oral amoxicillin-clavulanate and levofloxacin with intravenous ceftriaxone and amikacin in chemotherapy induced low risk febrile neutropenia

Background : We compared the efficacy of oral antibiotics with intravenous antibiotics in low risk febrile neutropenia. Design : A prospective, randomized study Methods: Between April 2004 - December 2005, 55 patients with low risk febrile neutropenia (expected neutropenia duration < 7 days with no co-morbid features) between 15 and 75 years of age, were randomized to receive either oral amoxicillin-clavulanate 625mg twice daily and levofloxacin -500mg once daily OR intravenous (i.v.) ceftriaxone 2g and amikacin 15mg/kg once daily. Most patients were treated on out patient basis. The primary end point was response to therapy, defervescence of fever within 72 hours with improvement in any clinical manifestation of infection and no recurrence of fever for 48 hours without use of antipyretics. Use of growth factors was not permitted except in treatment failure. Results: A total of 64 febrile episodes were recorded (mean 1.20 ); 33 in the IV group and 31 in the oral antibiotics group. Both groups were equally matched for age (median 25 years in the IV group and 19 years in the oral group), gender, type of cancer, baseline absolute neutrophil count (median 200/cmm in both arms) and duration of neutropenia (5 days and 4 days in the IV and oral groups, respectively). A focus of infection was identified clinically in 15% of episodes and microbiologically in 11% of episodes; 57% of which were Gram positive organisms and the rest Gram negative. 72% in the IV arm and 77% in the oral arm responded to therapy (p=ns). One patient in IV group had one episode of seizure. Non-responding patients received second line IV antibiotics. There was no mortality in either group. Age > 60 years, neutropenia lasting > 7 days after the onset of fever and positive blood culture were predictors for lack of response to antibiotics on multivariate analysis. Conclusion: Oral antibiotics have comparable efficacy as IV antibiotics in the management of low risk febrile neutropenia

Evaluation of pulmonary infiltrates in patients with haematological malignancies using fibreoptic bronchoscopy and bronchoalveolar lavage

Background : Chest infection is the major cause of morbidity and mortality among patients with haematological malignancies. Conventional diagnostic methods - chest x-ray , blood and sputum culture have limited yield . We used fibreoptic bronchoscopy and bronchoalveolar lavage to evaluate nature of pulmonary infiltrates on chest x-ray. Patients and Methods : 25 patients with haematological malignancies with fever and pulmonary infiltrates were studied. Patients median age was 32 years, ranging from 16 to 65 years. There were 21 males and 4 females. Initial evaluation included - detailed physical examination including chest to see for any focus of infection. In all patients , base line blood counts (total and differential), chest x-ray and cultures from blood and other body fluids were taken before starting broad spectrum antibiotics . Those not responding over next 48-72 hours received gram positive coverage followed by amphotericin-B therapy . Patients with persistent fever and pulmonary infiltrates were subjected to fibre-optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) and samples were collected for bacterial, fungal, AFB and viral studies. The findings were correlated with Chest x-ray and CT scan. Results The median time for FOB and BAL was 16 days (range, 3 to 32 days) after the clinical diagnosis of chest infection.. BAL fluid examination/culture grew microbial isolates in 21 of 25 patients (84%). Of thesebacteria alone were present in 10, fungi alone in 1 and polymicrobial isolates were seen in 10 patients (40%). Later included- a combination of bacteria and fungi - in 2 patients, bacteria and AFB - 6 and a combination of bacteria, AFB and fungi were seen in 2 patients. BAL changed the radiological diagnosis in 14 patients (56% diagnostic utility). Therapy was modified according to BAL results in 6 patients (therapeutic utility of 24 %). Concordance between radiological and BAL findings were found only in 5 patients (20%). FOB procedure was tolerated well, with mild and reversible complications (throat pain, transient hypoxia, tachycardia) in some patients. Conclusions: Infections are the main cause of pulmonary infiltrates in patients with haematological malignancies. Bacterial , fungal and mycobacterium tubercular organisms are the main isolates. Isolation of ESBL positive organisms and polymicrobial isolates suggest inclusion of appropriate initial empirical antibiotics in these patients to prevent development of resistant organisms. Higher frequency of AFB isolates (32%) was the surprising finding and need to be confirmed in future studies

The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer

The role of vitamin D (VitD) in calcium and bone homeostasis is well described. In the last years, it has been recognized that in addition to this classical function, VitD modulates a variety of processes and regulatory systems including host defense, inflammation, immunity, and repair. VitD deficiency appears to be frequent in industrialized countries. Especially patients with lung diseases have often low VitD serum levels. Epidemiological data indicate that low levels of serum VitD is associated with impaired pulmonary function, increased incidence of inflammatory, infectious or neoplastic diseases. Several lung diseases, all inflammatory in nature, may be related to activities of VitD including asthma, COPD and cancer. The exact mechanisms underlying these data are unknown, however, VitD appears to impact on the function of inflammatory and structural cells, including dendritic cells, lymphocytes, monocytes, and epithelial cells. This review summarizes the knowledge on the classical and newly discovered functions of VitD, the molecular and cellular mechanism of action and the available data on the relationship between lung disease and VitD status

Aspectos de salud pública y nutricionales del bocio endémico y del cretinismo en Asia

En IDL-682

Aspects nutritionels et de santé publique du goitre et du crétinisme endémiques en Asie

Dans IDL-668

Infections in neutropenic cancer patients

Severe infections duue to gram negative bacilli, staphylococci, enterococci and candida species are common in cancer patients due to profound neutropenia during aggressive therapy. Altered gut flora because of frequent antibiotics administration, disruption of skin and mucous membranes by invasive devices and damage of epithelial surfaces by cytotoxic agents also contribute for the development of infections. Frequent hand washing or the use of gloves which must be changed after each examination as well as barrier techniques reduce hospital bsed infections. Flouroquinolones are required to prevent infections from patient's own endogenous microbial flora. Frequency and severity of bacterial and fungal infections despite preventive measures, however, necessitates empiric antibiotic combination therapy. Third generation cephalosporins in combination withh ureidopenicillin or aminoglycosides are recommended to combat gram negative bacterial infections. Vancomycin may be required to treat gram positive infections. Antifungals are added at 72 hours or subsequently if fever and/or general condition of patient deteriorates. For severe neutropenia of longer duration, such as that seen among bone marrow transplant recipients and among those undergoing aggressive chemotherapy for acute leukemia, prophylactic antifungal therapy in addition to antibacterial gut prophylaxis appears justified