An asymptomatic 11 year child with ruptured sinus of Valsalva

Ruptured sinus of Valsalva (RSOV) is a rare lesion in a paediatric age group. A right sinus of Valsalva aneurysm usually ruptures into the right ventricle, while aneurysms of non-coronary sinus do so into the right atrium. RSOV usually presents in the third decade of life with congestive heart failure and is more common among Asians with male predominance. It may present as acute cardiogenic shock and sudden death or may remain completely asymptomatic with incidental detection by a murmur. Surgery is indicated as early as possible, once the diagnosis is made as without surgery, most cases will eventually succumb to uncontrollable congestive heart failure. This article reports an 11 year old child with the diagnosis of ruptured sinus of Valsalva.peer-reviewe

Reform for Midwest urban schools--conference summary

Education - Middle West - Chicago (Ill.)

Sustained remission in a case of lupus nephritis with cyclosporin therapy

Systemic lupus erythematosus (SLE) in severe form still presents a major therapeutic challenge. Aggressive treatment of severe renal lesions has improved the prognosis of renal disease over the last decade. However, this benefit is quite frequently offset by the side effects and toxicity of the treatment. Moreover, the disease may appear to be poorly responsive to treatment with steroids and cytotoxic drugs. We report a case of lupus nephritis that relapsed despite having adequate steroid and cytotoxic therapy, but later was successfully treated with cyclosporin. Fifteen months after discontinuing the treatment with cyclosporin, the patient continued to remain in remission

Evaluation of the anxiolytic effect of Nepeta persica Boiss. in mice

The aim of the present study was to evaluate the anxiolytic effects of hydroalcoholic extract (HE) of Nepeta persica Boiss. (Lamiaceae) on the elevated plus-maze (EPM) model of anxiety. The extract of arial parts of the plant was administered intraperitoneally to male NMRI mice, at various doses, 30 min before behavioural evaluation. The HE extract of N. persica at the dose of 50 mg kg−1 significantly increased the percentage of time spent and percentage of arm entries in the open arms of the EPM. This dose of plant extract affected neither animal's locomotor activity nor ketamine-induced sleeping time. The 50 mg kg−1 dose of the plant extract seemed to be the optimal dose in producing the anxiolytic effects, lower or higher doses of the plant produce either sedative or stimulant effects. At 100 mg kg−1, the plant extract increased the locomotor activity. These results suggested that the extract of N. persica at dose of 50 mg kg−1 possess anxiolytic effect with less sedative and hypnotic effects than that of diazepam and causes a non-specific stimulation at 100 mg kg−1

Cutaneous manifestations of systemic lupus erythematosus in Pakistani patients

Objective: Systemic Lupus Erythematosus (SLE) is an autoimmune process in which cutaneous lesions occur in majority of patients. This study from Karachi, Pakistan was conducted to determine the pattern and prevalence of such lesions in SLE in Pakistani patients.Methods: One hundred ninety eight patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatology Association were examined between 1986 and 2001 for the presence of cutaneous manifestations.Results: Skin changes noted were: noncicatricial diffuse alopecia (22%), malar rash (31%), mucosal lesions (20%), discoid eruptions (15%), photosensitivity (33%), vascular lesions (20%), pruritus (17%), and pigmentary changes (22%). Peripheral gangrene, chronic ulcers, Raynauds phenomenon, urticaria, chilblains, thrombophlebitis, palmar erythema, and erythema multiform were rare. Anti ANA and anti dsDNA were positive in 93% and 83% patients respectively.CONCLUSION: A different clinical pattern was noted in our patients than reported previously

RCC prolapse causing Aortic regurgitation in a restrictive VSD

The incidence of aortic right coronary cusp (RCC) prolapse in outlet ventricular septal defect (VSD) is reported at 5%- 16%. Detection of RCC prolapse is critical in patients with outlet VSD because this complication may cause permanent aortic regurgitation. Aortic regurgitation occurs due to a poorly supported RCC combined with the venturi effect due to the VSD jet resulting in cusp prolapse. This is an indication for VSD closure even if VSD is small and restrictive.peer-reviewe

Determination of nutrient values of the bivalve Anodonta cygnea in Selkeh area of the Anzali Lagoon during autumn and spring

Anzali Lagoon is one of the most important aquatic ecosystems of Iran which was registered as a Ramsar Convention site in 1999. This valuable ecosystem is located in the south west shores of the Caspian Sea, in Guilan Province. We randomly collected 30 and 20 samples of the bivalve Anodonta cygnea in autumn 2004 and spring 2005 respectively. The Selkeh area was chosen for the sampling because of its availability during autumn. The area receives water from the southern part of the lagoon basin. Nutrient content of the soft tissue of the bivalve was measured. Live sampled bivalves were transferred to laboratory and their length, width, height; total body weight and wet weight of the internal soft part were measured. Moisture, ash, protein, T.V.N, lipid and amino acid contents in soft tissue were also determined. Moisture content in spring and autumn samples were 84.84% and 83.6%, respectively. Ash content in autumn samples was higher than spring samples, being 4% and 2.32%, respectively. Assessment showed protein content in the autumn samples to be 12% while in spring samples this was 10.5%. T.V.N content in autumn and spring samples were 0.031 and 0.003% respectively. Measurements showed that autumn bivalves had 4% lipid content whereas this value in spring samples was 3%. We found Sixtheen amino acids, including seven essential ones in the samples

Aplikasi Teknologi Budidaya Kelengkeng Super Sleman Di Padukuhan Gejayan

Longan (Dimocarpus longan L.) is not an indigenous fruit from Indonesia. Thus, the demands for this fruit were supplied by importing them from nearby countries such as Vietnam, Thailand, and China. Longan has been cultivated and developed in Indonesia in order to supply the local needs and to reduce the rapid flows of importing Longan. Recently, a brand new breed of local Longan has been engineered from Sleman District of D.I.Yogyakarta Province, known as Kelengkeng Super Sleman (KSS). The KSS well adapted to medium-high above sea level- terrain, the most typical terrain in Sleman. Some prosperous features of this Longan cultivar were had a short harvesting time (2 years), thicky flesh, low water content, and able to be induced twice per year for flowering (to produce fruits). All of this goodness thus been introduced to rural communities of Padukuhan Gejayan, Desa Condongcatur, Depok, Sleman, D.I.Yogyakarta by a well designed community service programme. The kind of activites that was going on in this programme were workshop, training, and assistance. Workshop was emphasized on the prospectous consequences of planting Longan trees (KSS) for a long term until could be developed into local industrial product (One Village One Product/OVOP concept), basic knowledge on Longan diversity, KSS cultivation technology, basic knowledge on plant physiology, environmental development based on Education for Sustainable Development (EfSD), and potential local market for KSS. Training was mainly focused on KSS seedling production by both apical stem grafting method and medium preparation method, KSS plantation in some villager houses for a pilot project on how to maintain KSS such as health evaluation, health recovery for infested or unhealthy plant, method on lateral branching development, method on hormone-induced flowering, and application of resting period for after-harvesting plant. Assistance has been actively conducted during training to motivates villager to be get involved. Some positive indicators for implementation of this programme are both the great enthusiasm on KSS Longan plantation in communities and “the shifting paradigm” on KSS Longan maintenance for which has been long considered to be both impractical and arduous

Maximum tolerable dose of cyclophosphamide and azathioprine in Pakistani patients with primary renal disease

Objective: The immunosuppressive regimens, at present, mainly rely on western guidelines that were derived from studies conducted in western populations. No such study exists for South Asian population, which is home to almost two billion people different in both genetics and environment from west. Locally derived thresholds for side effects markedly different from western figures may warrant re-adjustment of current local immunosuppressive regimens that are at present based largely on western guidelines. In order to define optimum dose for Cyclophosphamide (CYC) and Azathioprine (AZA) based immunosuppressive therapy, we conducted this study to find out maximum tolerable doses of azathioprine (AZA) and cyclophosphamide (CYC) beyond which neutropenia and thrombocytepenia are most likely to occur in patients with primary renal pathology.METHOD: Patients with systemic vasculitis and idiopathic glomerulonephritis who were on CYC and AZA were identified through review of medical records at a tertiary care hospital in Pakistan (The Aga Khan University Hospital, Karachi). Patients were categorized under three principal diagnosis i.e. systemic lupus erythematosus (SLE), primary (idiopathic) glomerulonephritis (GN) and Wegener\u27s granulomatosis (WG). The Receiver Operating Curve (ROC) was used to calculate the maximum tolerable dose for both CYC and AZA.Results: We identified 94 patients aged 6-82 years (median 44.5 years) with primary renal disease (Wegener\u27s granulomatosis n=13, Systemic lupus erythematosis n=62 and idiopathic glomerulonephritis n=19) who received CYC or AZA. Of these 94 patients, 36.2% (n=34) received CYC and 63.8% (n=60) received AZA. The mean dose of CYC was 1.54 +/- 0.50 mg/kg of body weight (range: 0.77-2.93). The mean dose of AZA was 1.64 +/- 0.59 mg/kg of body weight (range: 0.47-2.97). The maximum tolerable doses calculated for CYC and AZA were 1.25 mg/kg and 1.30 mg/kg of body weight respectively. The maximum tolerable dose for CYC and AZA among males could not be calculated, because of insufficient number of patients who developed neutropenia and thrombocytopenia. The maximum tolerable doses for CYC and AZA among females were 1.34 mg/kg and 1.03 mg/kg of body weight respectively. Also we found out that AZA was relatively more likely to cause neutropenia and thrombocytopenia (p=0.07).CONCLUSION: We thereby recommend that CYC should be initiated at a dose no more than 1 mg/kg of body weight and AZA at an initial dose of 0.75-1.0 mg/kg of body weight. The dose may be adjusted later on the basis of clinical response and laboratory reports