Wednesday, February 16, 2011

Reason for Egypt Revolution


Egypt’s internet is severe pain a critical disruption, as a grass-roots critique mutation prepares for infamous rallies captious the ouster of President Hosni Mubarak after perceptibly thirty years in power.

a infamous operate provider for Egypt, Italy-based Seabone, reported early Friday that there was no internet traffic going into or out of the commonwealth after 12.30am inner time.

Associated Press reporters in Cairo were also experiencing outages. Messages abounded on Facebook as good as Twitter from users outside of the country.

Egypt has been besieged by its biggest protests in years this week as the shred sees incentive in transport protests that degraded the organisation in Tunisia.

Social networking sites have been infamous to pulling the protests.

The country’s largest discord movement, the Muslim Brotherhood, said it would knowledge in Friday’s protests, in a skip from the watchful ensue it took towards the protests that started on Tuesday.

at smallest twenty members of the Muslim Brotherhood were arrested overnight Friday, its warn Abdelmoneim Abdel Maqsoud told AFP.

Among those arrested at their homes were five former members of legislature as good as five members of the done during home bureau, whose best known leaders are Essam El-Eriane as good as Mohammed Moursi.

The country’s streamer dissident, Nobel Laureate Mohamed ElBaradei, also said he would take prejudiced in the protests after impending from a revisit to Vienna.

“It is a infamous time in the reason up of Egypt. you have come to knowledge with the Egyptian people,” ElBaradei, a outspoken bury of Mubarak, said before to withdrawal Cairo airport.

Earlier, in Vienna, he told reporters he was ready to “lead the transition” in Egypt if asked.

Fuelled by madness over financial deprivation, the reeling roiling Egypt threatens to criticize the country’s trading enlargement as good as further mangle the government.

Egypt’s routine has warned that it will take “decisive measures” against anti-government protesters who plan further demonstrations.

The third loyal day of protests sent the collection marketplace plummeting Thursday, rattled investors as good as clouding what the organisation has portrayed as its crowing legacy: receiving moody GDP as good as a surging in siege section led by a structure the total crash as good as vibrant, obviously recession-proof banks.

Many say the fruits of enlargement in this formerly insubordinate control to buy have been funnelled almost entirely to a politically successive elite, withdrawal normal Egyptians surrounding by unattainable black of resources such as oppulance housing as good as price elections as they assault to find jobs, recompense each day bills as good as find affordable housing.

The 10.5 percent bearing in the marketplace left the market’s year-to-date balderdash at over twenty percent as good as traders warned that trading repairs could distend if vast protests manifest Friday, as in danger by the opposition.

“Tomorrow will be a trigger,” said Mostafa Abdel-Aziz, a profession with the Cairo-based investment bank, Beltone Financial. “If things pass quietly, there should be a technical rebound” when the marketplace reopens on Sunday.

“But you do not think the exactly perspective will be reversed,” he said.

Egypt’s government jubilee said it was ready for a sermon with the open yet charity no concessions to chateau last for a restraint to prevalent wretchedness as good as done during home shift listened in the country’s largest anti-government protests in years.

Safwat El-Sherif, the cupboard partial of entire of the National Democratic Party as good as a longtime playmate of Mubarak, was dismissive of the protesters at the primary headlines contention by a more aged government jubilee figure since the protests began.

“We are positive of our capacity to listen. The NDP is ready for a sermon with the public, lady as good as certified parties,” he said. `”But democracy has its manners as good as process. The minority does not force its will on the majority.”

The 82-year-old Mubarak has not been seen in open or listened from since the protests began Tuesday with tens of thousands marching in Cairo as good as a twine of other cities.

Mubarak has not said yet possibly he will mountain for an one more six-year reign as trainer in elections this year. he has never allocated a intermediary as good as is theory to be showering his son Gamal to achieve him in spite of popular opposition. according to leaked U.S. memos, paternal duration also does not confront with the defeat of the comprehensive military.

The sustainability of most of the government’s pass unknown income sources – tourism, the Suez Canal, as good as unknown investment – hinges on investors’ notice of restraint in this commonwealth of 80 million, the Arab world’s most populous.

It’s an design the organisation has smoothly attempted to gift for years, looking to founder a insubordinate leave characterised by inefficiency, a judicial bureaucracy as good as waste, as good as fanciful moves toward a free-market control to buy in the early 1980s.

The budding dispense as good as the financial dispense “have undertaken outrageous reforms, yet they’re confusing to mislay some-more than 50 years of trading damage,” said Angus Blair, Beltone’s control of research, said.

following a promissory note difficulty in the late 1990s, the organisation enacted umbrella changes destined at softened determining the financial section as good as boosting in siege section development. It set up a credit bureau, a debt law was inspected as good as unstinting housing communities sprang up around the background of brisk Cairo.

The enlargement rate shot up from almost 4.1 percent in 2004 to almost 7.2 percent in 2008 before to the person from earth financial meltdown sent the star control to buy crashing.

even then, Egypt fared well. While many of the West was in a recession, Egypt’s gross done during home product came in at 4.7 percent in 2009 as good as 5.15 percent in 2010. Relying on buyers’ lay payments instead of uncertain credit, the real-estate section was the singular of the few in the star that transitory the person from earth difficulty often unscathed.

But critics remonstrate the gains were little some-more than window dressing. Roughly 40 percent of Egyptians assault along at the World Bank-set wretchedness spin of under $2 per day.

Food prices have customarily augmenting over the past 3 years, healthful their soaring levels even as person from earth commodity prices fell. Beef, which solitary at 40 Egyptian pounds per kilogram ($3.20 per pound) a few months ago, right divided hovers at 65 pounds per kilo ($5.13 per pound) – making it a oppulance many atmosphere once a month or less.

“Food price as good as increase in speed is a material begin in Egypt,” said Ann Wyman, control of taking flight markets at Nomura. “Egypt ranks, for us, as the singular of the most unprotected countries for high food prices. It’s something you’re observant in the popular response.”

Analysts theory that food price increase in speed is right away at an unsustainable seventeen percent yearly.

Clashes in January 1977 over an increase in the price of bread – known in internal Egyptian Arabic as Aish, or reason up – ended with several killed.

Housing stays an one more pass adhering point. While villas in ultimate communities with names identical to Beverly Hills as good as Allegria is free-flowing for the abounding or the tip core class, the rest of the competition struggles even to find one-bedroom apartments.

The begin came to a control late last year when Talaat Mustafa Group, the biggest publicly businessman developer, was sued by a bureau workman over a outline under which it accumulative millions of acres of dusty land to set up its unstinting Madinaty project.

The box in danger to cut the country’s genuine estate section apart on deposit that the organisation overlooked the law in awarding the land through a no-bid process. The begin was resolved when the organisation set up an individualist cupboard – the singular which included in the mailing members of the same housing government that illegally presumed the land – as good as decided to re-award the land to TMG under often the same terms.

“We saw the crime in Madinaty,” said Ahmed Sayed El-Naggar, an researcher with state-sponsored Al-Ahram Center for Political as good as Strategic Studies. “This was land that should have left to the people yet went to people in (the government National Democratic Party).”

TMG was headed at the time by Talaat Mustafa, a nobleman who was convicted of plotting to attempted attempted murder his Lebanese diva girlfriend. Mustafa was, identical to several other blurb operation moguls, a partial of of the parliament.

The organisation aced an descending trading dispute even before to the protests. Subsidies are coming to assimilate about 100 billion pounds ($17.4 billion) of the country’s check this year, as good as any attempts at rupturing these benefits are dangerous.

The censure becomes some-more baleful if the tensions continue or shift to Red Sea coastal hotspots where tens of thousands of tourists organisation to evade wintry winters.

So far, tourism appears to be often unaffected, with operators across Europe saying cancellations have yet to really surface. Only side-trips trips to Cairo as good as Luxor have been cut, while resorts identical to Sharm el-Sheikh are still on the itinerary.

Atopic Dermatitis

Atopic dermatitis (AD) is a pruritic disease of unknown origin that usually starts in early infancy (an adult-onset variant is recognized); it is characterized by pruritus, eczematous lesions, xerosis (dry skin), and lichenification (thickening of the skin and an increase in skin markings). Atopic dermatitis may be associated with other atopic (immunoglobulin E [IgE]) diseases (eg, asthma, allergic rhinitis, urticaria, acute allergic reactions to foods).1 Atopic dermatitis has enormous morbidity, and the incidence and prevalence appear to be increasing. Other conditions with different etiologies and prognoses are often grouped under the umbrella of a diagnosis of atopic dermatitis.
Pathophysiology

Good evidence indicates that genetic factors are important in the development of atopic dermatitis, but the pathophysiology is still poorly understood. Two main hypotheses have been proposed regarding the development of the inflammatory lesions. The first suggests an immune dysfunction resulting in IgE sensitization and a secondary epithelial-barrier disturbance. The second proposes a defect in epithelial cells leading to the defective barrier problem, with the immunological aspects being epiphenomena.

In healthy individuals, balance exists between 2 important subdivisions of T cells (ie, TH 1, TH 2). The immune hypothesis invokes an imbalance in the T lymphocytes, with TH 2 cells predominating; this results in cytokine production of interleukins 4, 5, 12, and 13 and granulocyte macrophage colony-stimulating factor, causing an increase in IgE and lowered interferon gamma levels. Later, in persons with chronic atopic dermatitis, the TH 1-type cells predominate. Other cell types are also involved in the process, including eosinophils, Langerhans cells, keratinocytes, and B cells.2

The second hypothesis involves defective barrier function in the stratum corneum of Atopic dermatitis patients, leading to the entry of antigens that result in the production of inflammatory cytokines. Some authors question whether the antigens can also be absorbed from the gut (eg, from food) and the lungs (eg, from house dust mites). Xerosis is known to be an associated sign in many atopic dermatitis patients. Evidence has shown multiple loss-of-function mutations in the filaggrin gene (FLG) on band 1q21.3 in patients with atopic dermatitis in Europe and other filaggrin mutations in Japanese patients. This gene is mutated in persons with ichthyosis vulgaris; it is associated with early-onset atopic dermatitis and with airway disease in the setting of atopic dermatitis. These changes are only found in 30% of European patients, begging the question of whether other genetic variants may also be responsiblefor some of the findings in the pathogenesis of atopic dermatitis.

In atopic dermatitis, transepidermal water loss is increased. Defective lamellar bodies may be caused by abnormalities of ceramide production. Whether the inflammation causes primary or secondary epidermal barrier breakdown is not known, but with the knowledge that filaggrin is involved in epithelial disruption, it is now thought that this finding leads to increased transepidermal penetration of environmental allergens, increasing inflammation and sensitivity.3,4
Frequency
United States

The prevalence rate for atopic dermatitis is 10-12% in children and 0.9% in adults. More recent information examining physician visits for atopic dermatitis in the United States from 1997-2004 estimates a large increase in office visits for atopic dermatitis occurred. In addition, blacks and Asians visit more frequently for atopic dermatitis than whites. Note that this increase involves all disease under the umbrella of atopic dermatitis and it has not been possible to allocate which type has increased so rapidly.5
International

The prevalence rate of atopic dermatitis is rising, and atopic dermatitis affects 15-30% of children and 2-10% of adults. This figure estimates the prevalence in developed countries. In China and Iran, the prevalence rate is approximately 2-3%. The frequency is increased in patients who immigrate to developed countries from underdeveloped countries.6
Mortality/Morbidity

Incessant itch and work loss in adult life is a great financial burden. A number of studies have reported that the financial burden to families and government is similar to that of asthma, arthritis, and diabetes mellitus. In children, the disease causes enormous psychological burden to families and loss of school days. Mortality due to atopic dermatitis is unusual.

* Kaposi varicelliform eruption (eczema herpeticum) is a well-recognized complication of atopic dermatitis.
o It usually occurs with a primary herpes simplex infection, but it may also be seen with recurrent infection. Vesicular lesions usually begin in areas of eczema and spread rapidly to involve all eczematous areas and healthy skin. Lesions may become secondarily infected. Timely treatment with acyclovir ensures a relative lack of severe morbidity or mortality.
o Another cause of Kaposi varicelliform eruption is vaccination with vaccinia for the prevention of small pox, but because this is no longer mandatory, patients with atopic dermatitis do not develop the sequelae of eczema vaccinatum that has been seen in the past. It was usually contracted by the patient from the vaccination of themselves or their close relatives. This condition had a high mortality rate (up to 25%). In the current climate of threats of bioterrorism, vaccination may once again become necessary, and physicians should be aware of eczema vaccinatum in this setting.
o Note that chickenpox vaccine does not carry the same risk as herpes simplex and vaccinia.
* Bacterial infection with Staphylococcus aureus or Streptococcus pyogenesis is not infrequent in the setting of atopic dermatitis . The skin of patients with atopic dermatitis is colonized by S aureus. Colonization does not imply clinical infection, and physicians should only treat patients with clinical infection. The emergence of methicillin-resistant S aureus (MRSA) may prove to be a problem in the future in these patients. Eczematous and bullous lesions on the palms and soles are often infected with beta-hemolytic group A Streptococcus.
* Urticaria and acute anaphylactic reactions to food occur with increased frequency in patients with atopic dermatitis. The food groups most commonly implicated include peanuts, eggs, milk, soya, fish, and seafood. In studies in peanut-allergic children, the vast majority were atopic.
* Latex allergy is more common in patients with atopic dermatitis than in the general population.
* Of atopic dermatitis patients, 30% develop asthma and 35% have nasal allergies.

Race

* Atopic dermatitis affects persons of all races. Immigrants from developing countries living in developed countries have a higher incidence of atopic dermatitis than the indigenous population, and the incidence is rapidly rising in developed countries

Sex

* The male-to-female ratio for atopic dermatitis is 1:1.4.

Age

* In 85% of cases, atopic dermatitis occurs in the first year of life; in 95% of cases, it occurs before age 5 years. The incidence of atopic dermatitis is highest in early infancy and childhood. The disease may have periods of complete remission, particularly in adolescence, and may then recur in early adult life.
* In the adult population, the rate of atopic dermatitis frequency is 0.9%, but onset may be delayed until adulthood.

Clinical
History

Incessant pruritus is the only symptom of atopic dermatitis, children often scratch themselves uncontrollably. Although pruritus may be present in the first few weeks of life, parents become more aware of the itch as the itch-scratch cycle matures when the patient is aged approximately 3 months. The disease typically has an intermittent course with flares and remissions occurring, often for unexplained reasons.
Physical

Primary findings of atopic dermatitis include xerosis, lichenification, and eczematous lesions. Excoriations and crusting are common. The eczematous changes and its morphology are seen in different locations depending on the age of the patient.

* Infancy
o Atopic dermatitis is usually noticed soon after birth. Xerosis occurs early and often involves the whole body; the diaper area is usually spared.
o The earliest lesions affect the creases (antecubital and popliteal fossae), with erythema and exudation. Over the following few weeks, lesions usually localize to the cheeks, the forehead and scalp, and the extensors of the lower legs; however, they may occur in any location on the body, usually sparing the diaper area. Lesions are ill-defined, erythematous, scaly, and crusted (eczematous) patches and plaques.
o Lichenification is seldom seen in infancy. A typical presentation is shown in the image below.
o

Typical atopic dermatitis on the face of an infan...
Typical atopic dermatitis on the face of an infant.

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Typical atopic dermatitis on the face of an infan...

Typical atopic dermatitis on the face of an infant.
* Childhood
o Xerosis is often generalized. The skin is flaky and rough.
o Lichenification is characteristic of childhood atopic dermatitis. It signifies repeated rubbing of the skin and is seen mostly over the folds, bony protuberances, and forehead.
o Lesions are eczematous and exudative. Pallor of the face is common; erythema and scaling occur around the eyes. Dennie-Morgan folds (ie, increased folds below the eye) are often seen. Flexural creases, particularly the antecubital and popliteal fossae, and buttock-thigh creases are often affected. See the image below.
o

Flexural involvement in childhood atopic dermatit...
Flexural involvement in childhood atopic dermatitis.

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Flexural involvement in childhood atopic dermatit...

Flexural involvement in childhood atopic dermatitis.
o Excoriations and crusting are common. The crusting with atopic dermatitis should not be confused with infection because both may manifest oozing and crusting.
* Adulthood
o Lesions become more diffuse with an underlying background of erythema. The face is commonly involved and is dry and scaly.
o Xerosis is prominent.
o Lichenification may be present.
o A brown macular ring around the neck is typical but not always present. It represents localized deposition of amyloid. See the image below.
o

Dirty neck sign in chronic atopic dermatitis.
Dirty neck sign in chronic atopic dermatitis.

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Dirty neck sign in chronic atopic dermatitis.

Dirty neck sign in chronic atopic dermatitis.

Until Hanifin and Rajka7 developed diagnostic criteria for the diagnosis of atopic dermatitis in 1980, no standardized methods were available to make the diagnosis. Since then, numerous other experts have developed different criteria suitable for their own environment, and varying with age. The original criteria of Hanifin and Rajka have been modified many times. Efforts to develop practical clinical criteria have not been successful, and those available are not suitable for all geographic areas and age groups. The lack of a good chemical marker for diagnosing the disease is an enormous obstacle to the study of atopic dermatitis.
The following is a constellation of criteria commonly used for the diagnosis of atopic dermatitis:

* Pruritus
* Eczematous changes that vary with age
* Chronic and relapsing course
* Early age of onset
* Atopy (IgE reactivity)
* Xerosis
* Personal history of asthma or hay fever or a history of atopic diseases in a first-degree relative in patients younger than 4 years
* Onset younger than age 2 years (not used if child is aged <4 y)

A firm diagnosis of atopic dermatitis depends on excluding conditions such as scabies, allergic contact dermatitis, seborrheic dermatitis (SD), cutaneous lymphoma, ichthyosis, psoriasis, immunodeficiency, and other primary disease entities.
Causes

* Genetics8,9 : A family history of atopic dermatitis is common. Genome-wide scans have highlighted several atopic dermatitis–related loci on 3q21, 1q21, 16q, 17q25, 20p, and 3p26. Several candidate genes have been identified (5q31-33); they all encode cytokines involved in the regulation of IgE synthesis.
* Infection: The skin of patients with atopic dermatitis is colonized by S aureus. Clinical infection with S aureus often causes a flare of atopic dermatitis, and S aureus has been proposed as a cause of atopic dermatitis by acting as a superantigen.
* Hygiene: The hygiene hypothesis is touted as a cause for the increase in atopic dermatitis. This attributes the rise in atopic dermatitis to reduced exposure to various childhood infections and bacterial endotoxins.10,11
* Climate: Atopic dermatitis flares occur in extremes of climate. Heat is poorly tolerated, as is extreme cold. A dry atmosphere increases xerosis. Sun exposure improves lesions, but sweating increases pruritus. These external factors act as irritants or allergens, ultimately setting up an inflammatory cascade.
* Food antigens: The role of food antigens in the pathogenesis of atopic dermatitis is controversial, both in the prevention of atopic dermatitis and by the withdrawal of foods in persons with established atopic dermatitis. Most reported studies have methodologic flaws. Because of the controversy regarding the role of food in atopic dermatitis, most physicians do not withdraw food from the diet. Nevertheless, acute food reactions (urticaria and anaphylaxis) are commonly encountered in children with atopic dermatitis.
* Probiotics12 : The role of probiotics in the diet of patients with atopic dermatitis remains controversial
* Aeroallergens: A role for aeroallergens and house dust mites has been proposed, but this awaits further corroboration.

Monday, February 14, 2011

Polio eradication in India

ndia is one of only four countries (including Afghanistan, Nigeria, and Pakistan) where wild poliovirus (WPV) transmission has never been interrupted.[1] Historically, WPV transmission in India has centered largely in Uttar Pradesh and Bihar, two states with low routine vaccination coverage, large migrant and remote populations, and lower relative vaccine effectiveness than other areas of the country (2–4). However, during a 9-month period from November 2009 to August 2010, no WPV type 1 (WPV1) cases were reported in Uttar Pradesh or Bihar. This report summarizes the substantial progress made in India toward polio eradication during January 2009–October 2010, according to data reported as of December 4, and updates previous reports.[2,4] During January–October 2010, only 40 WPV cases were confirmed in India, a 94% decrease from the 626 WPV cases confirmed during the same period in 2009; the decrease likely resulted, in large part, from the introduction of bivalent oral poliovirus vaccine types 1 and 3 (bOPV). Increasingly important contributors to WPV transmission are large migrant subpopulations; surveys have indicated that up to 11% of children aged <5 years in these subpopulations were missed during supplementary immunization activities (SIAs). Interruption of all WPV transmission in India will require maintaining high levels of immunity in Uttar Pradesh and Bihar and additional efforts directed toward children in migrant subpopulations that are not vaccinated as readily during SIAs.

Immunization Activities

Using population-based survey data, India estimated nationwide routine coverage with 3 doses of oral poliovirus vaccine (OPV) at 66% among children aged 12–23 months during 2007–2008, the most recent years for which coverage data were available.[5] Routine coverage estimates in Bihar (53%) and Uttar Pradesh (40%) were among the lowest in the country.[5]

SIAs* conducted in India during 2009–2010 (Figures 1 and 2) included two national immunization days (NIDs) each year. In addition, seven subnational immunization days (SNIDs) and four large-scale (multidistrict) mop-up† activities were conducted during 2009, and five SNIDs and three large-scale mop-ups were conducted during January–October 2010 (Figure 1). After introduction of bOPV in January 2010, six SIAs were conducted using bOPV.
Abbreviations: mOPV1 = monovalent oral poliovirus vaccine type 1; mOPV3 = monovalent oral poliovirus vaccine type 3; tOPV = trivalent oral poliovirus vaccine; bOPV = bivalent oral poliovirus vaccine.
* SIAs are mass campaigns conducted over a period of multiple days in which 1 dose of oral polio vaccine is administered to all children aged <5 years, regardless of vaccination history. Surveillance data analysis determines the geographic extent of campaigns (i.e., national or subnational).
Abbreviations: mOPV1 = monovalent oral poliovirus vaccine type 1; mOPV3 = monovalent oral poliovirus vaccine type 3; tOPV = trivalent oral poliovirus vaccine; bOPV = bivalent oral poliovirus vaccine.
* SIAs are mass campaigns conducted over a period of multiple days in which 1 dose of oral polio vaccine is administered to all children aged <5 years, regardless of vaccination history. Surveillance data analysis determines the geographic extent of campaigns (i.e., national or subnational).

In 2010, SIA monitoring data§ indicated >99% coverage among children aged <2 years in Bihar and >97% in Uttar Pradesh. After enhanced efforts during 2009–2010 to identify specific areas in other states where migrant populations resided, directed surveys conducted with specific migrant subpopulations (e.g., construction laborers, nomads, and brick kiln workers) after SIA rounds indicated that 3%–11% of children aged <5 years had been missed. In Uttar Pradesh during 2010, surveys after SIAs indicated that, on average, 4.1% of children in the migrant subpopulations, compared with 2.2% missed among children aged <5 years in the general population.

* SIAs are mass campaigns conducted over a period of multiple days in which 1 dose of OPV is administered to all children aged <5 years, regardless of vaccination history. Surveillance data analysis determines the geographic extent of campaigns (i.e., national or subnational).
† Mop-up rounds are intensive house-to-house SIAs conducted in a limited area (groups of districts) with evidence of recent transmission.
§ SIA monitoring data are obtained from systematic surveys conducted after every SIA in high-risk areas to identify children aged <5 years who were missed with vaccination.

WPV Surveillance
Acute Flaccid Paralysis (AFP) Surveillance

The national nonpolio AFP rate,¶ a measure of surveillance system sensitivity, was 11.4 per 100,000 children aged <15 years in 2009 and 11.1 per 100,000 (annualized) during January–October 2010. The highest state-level nonpolio AFP rates were in Bihar (33.9) and Uttar Pradesh (22.8) in 2010. Adequate stool specimen collection** in India was 83% in 2009 and 84% during January–October 2010.
Environmental Surveillance

Wastewater testing for poliovirus began in Mumbai in January 2001 and in Delhi in May 2010. Although WPV was isolated frequently from samples taken in Mumbai in previous years, no WPV was detected in Mumbai wastewater in 2010. Environmental testing during May–August 2010 detected both WPV1 and WPV type 3 (WPV3) in wastewater at Delhi sites. Genetic analysis has suggested WPV circulation within Delhi was linked to 2009 WPV1 and WPV3 Bihar isolates. No WPV has been detected in environmental samples since mid-August.
Laboratory Network

During January–October 2010, >90% of stool specimens submitted for virus isolation had laboratory results reported within 14 days of specimen receipt. The mean interval from onset of paralysis and confirmation of WPV isolation was 24 days.††

¶ The nonpolio AFP rate is the number of AFP cases not caused by WPV per 100,000 children aged <15 years. India's operational target for each district is two or more AFP cases per 100,000.
** The percentage of reported AFP cases with two stool specimens collected within 14 days of paralysis onset (target: ≥80%).
†† The eight polio laboratories in India processed 100,102 stool specimens during 2009 and 91,952 stool specimens during January–October 2010.


WPV Epidemiology

During all of 2009, a total of 741 WPV cases were reported in India from 56 districts in nine states of 35 states/union territories in India (Figure 3). During January–October 2010, a total of 40 WPV cases had been reported from 17 districts in seven states, a 94% decrease from the 626 WPV cases from 52 districts in nine states during the same reporting period in 2009. Among the 40 WPV cases reported in 2010, 28 (70%) occurred in children aged <2 years. Six (15%) of the 40 children had received 1–3 OPV doses, eight (20%) had received 4–7 doses, and 25 (63%) had received >7 doses; one child had unknown vaccination status. In Uttar Pradesh and Bihar, 19 cases had been reported from 10 districts; all of these patients had received >7 OPV doses. According to data reported as of December 4, 2010, during January–October 2010, a total of 17 WPV1 and 23 WPV3 cases were confirmed, representing a 78% decrease from 76 WPV1 cases and a 96% decrease from 550 WPV3 cases confirmed during the same period in 2009.



Wild poliovirus (WPV) cases, by type — India, 2009 and 2010*
* Data of December 4, 2010.

In 2009, a total of 80 WPV1 cases were reported (including one case with both WPV1 and WPV3 isolated) from 35 districts in six states. During January–October 2010, a total of 17 WPV1 cases were reported from seven districts in five states. WPV1 isolates related to 2009 Bihar WPV1 strains have been isolated from AFP patients with onset of paralysis during January–October 2010 in West Bengal (five patients), Jharkhand (three), and Maharashtra (five). In addition, WPV1 strains circulating in Bihar during 2009 were associated with a WPV1 case in Jammu and Kashmir in 2010 after importation into Punjab in 2009. The most recent WPV1 case in India had onset on September 21 in West Bengal.

The last confirmed WPV1 case in Uttar Pradesh was in a patient with onset of paralysis on November 13, 2009. In Bihar, no WPV1 cases were reported from October 30, 2009, to August 7, 2010. Subsequently, three cases have been reported in a single Bihar district bordering Nepal (Champaran East), with onset in the most recent case on September 1. The recent Bihar outbreak began after an outbreak was identified in Nepal in May 2010 immediately across the border from Champaran East; WPV1 isolates from both areas are related to WPV1 strains circulating in Bihar during 2009.
WPV3

In 2009, a total of 661 WPV3 cases were reported from 47 districts in eight states; 569 (86%) were from Uttar Pradesh, and 79 (12%) were from Bihar. During January–October 2010, a total of 23 cases were reported from 12 districts in five states, compared with 550 cases from 43 districts in seven states during the same 10-month period in 2009. Of the 23 cases reported during January–October 2010, 10 (43%) were from Uttar Pradesh, six (26%) from Bihar, four (17%) from Jharkhand, two (9%) from West Bengal, and one (4%) from Haryana. The most recent WPV3 case in India had onset on August 31 in Jharkhand.


During 2009–2010, India made substantial progress toward polio eradication. The absence of reported WPV1 cases in Uttar Pradesh and Bihar for 9 months during November 2009–August 2010 was unprecedented; Uttar Pradesh has remained free of detected WPV cases since April 2010. For the first 10 months of 2010, the total number of WPV cases in India reached a new low at 40, compared with 626 cases during the same reporting period in 2009.

The introduction of bOPV in SIAs beginning in January 2010 likely contributed substantially to the simultaneous reduction in WPV1 and WPV3 cases. Previous SIAs were conducted predominantly using monovalent oral poliovirus vaccine type 1 (mOPV1) and occasionally monovalent oral poliovirus vaccine type 3 (mOPV3); trivalent oral poliovirus vaccine (tOPV) was used less often because higher type-specific seroconversion per dose has been observed with mOPV formulations than with tOPV.[3,6] A recent clinical trial demonstrated the superiority of bOPV compared with tOPV and noninferiority compared with mOPV1 and mOPV3.[7] Once supplies became available, bOPV became the predominant formulation used in SIAs. Preliminary data from August 2010 seroprevalence studies among infants aged 6–7 months in high-risk areas of Uttar Pradesh and Bihar indicate that, after bOPV introduction, seroprevalence against WPV3 increased and high levels of seroprevalence against WPV1 were maintained (Enterovirus Research Center, Mumbai, India, unpublished data, 2010).

Appropriately targeted environmental surveillance can be more sensitive in detecting low-level WPV circulation than AFP surveillance.[8] WPV was last detected in sewage in Mumbai in May 2009 and in Delhi in mid-August 2010, where sewage sampling was initiated in May of this year. The recent lack of detection of WPV in any samples is encouraging; however, sewage sampling in India still is restricted to these two major metropolitan areas.

Despite India's gains in 2010, the risk remains for WPV circulation and reintroduction among migrant populations and residents of high-risk areas in western Uttar Pradesh and central Bihar, primarily because of high population density, weak routine immunization, and suboptimal hygiene and sanitation. Families of certain migrant subpopulations (e.g., construction laborers, nomads, and brick kiln workers) that move regularly to and from Uttar Pradesh and Bihar have higher proportions of undervaccinated children than the general population, according to 2010 directed surveys of these subpopulations and supported by reported vaccination rates among nonpolio AFP case patients.

The risk for persistence of low-level, undetected, WPV transmission among Uttar Pradesh or Bihar residents, or among migrant subpopulations, is a concern. All WPV1 isolates from India and Nepal in 2010 are genetically linked to strains detected in central Bihar in 2009, and the 2010 WPV1 outbreak in Tajikistan was linked to WPV1 from Uttar Pradesh in 2009.[9] OPV-vaccinated children with serologic immunity can excrete WPV, which might contribute to transmission despite high OPV coverage in SIAs.[6,10] Moreover, transmission has continued in some areas with recent outbreaks (Maharashtra and West Bengal). WPV could spread to other parts of India with relatively low population immunity months after the last observed case in the outbreak area.

The current high season for polio in India has passed with historically low incidence of WPV cases. Successful interruption of all residual WPV transmission in India will require maintaining high levels of immunity in Uttar Pradesh and Bihar through SIAs and programs to strengthen routine vaccination, along with continued mop-ups to control outbreaks in areas where WPV was reintroduced. SIAs planned for 2011 represent an opportunity to interrupt transmission, provided that high coverage during SIAs is maintained, immediate large-scale mop-ups are conducted in response to any new WPV detected, and focus is continued on vigorous vaccination of migrant subpopulations.

Diagnosis and Treatment of Gout Review


"Gout is a type of inflammatory arthritis induced by the deposition of monosodium urate crystals in synovial fluid and other tissues," writes Tuhina Neogi, MD, PhD, from the Section of Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; and the Department of Epidemiology, Boston University School of Public Health, in Massachusetts. "It is associated with hyperuricemia, which is defined as a serum urate level of 6.8 mg per deciliter (404 μmol per liter) or more, the limit of urate solubility at physiologic temperature and pH. Humans lack uricase and thus cannot convert urate to soluble allantoin as the end product of purine metabolism. Hyperuricemia that is caused by the overproduction of urate or, more commonly, by renal urate underexcretion is necessary but not sufficient to cause gout."

Definitive diagnosis of gout requires synovial fluid or tophus aspiration to identify negatively birefringent monosodium urate crystals under polarizing microscopy, but crystal evaluation is not routinely performed in clinical practice. Hyperuricemia may not be present during acute gout attacks and therefore may not be useful for diagnosis.

Diagnosis of acute gout is largely clinical based on a characteristic presentation with rapid (within 24 hours) development of severe pain, erythema, and swelling in the first metatarsophalangeal joint (podagra) or other typical distribution. Differential diagnosis of acute gout includes calcium pyrophosphate dehydrate or other crystal-induced arthritides and a septic joint. If a septic joint is suspected, joint aspiration with Gram staining and culture must be performed.

"The main aim of therapy for acute gout is rapid relief of pain and disability caused by intense inflammation," Dr. Neogi writes. "Options for managing acute attacks include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, and possibly corticotropin. The choice of agent, dose, and duration of therapy is guided by consideration of coexisting illnesses that preclude the safe use of a particular regimen, as well as the severity of the gout."

First-line agents for acute attacks are NSAIDs and colchicines, and adjunctive measures include applying ice to and resting the affected joint. NSAIDs should be avoided in patients with renal or hepatic impairment, bleeding disorder, congestive heart failure, or allergy and may increase the risk for adverse thrombotic and gastrointestinal tract events.

Naproxen may be used at a dose of 375 to 500 mg orally twice daily for 3 days, then 250 to 375 mg orally twice daily for 4 to 7 days or until the attack resolves. Indomethacin may be given 50 mg orally 3 times daily for 3 days, then 25 mg orally 3 times daily for 4 to 7 days or until the attack resolves.

Oral colchicine has a long history of use but was only approved in 2009 by the Food and Drug Administration (FDA) for use in patients with acute gout. Based on a randomized trial, colchicine 1.2 mg at the onset of a flare, followed by 0.6 mg 1 hour later, was significantly more likely than placebo to be associated with pain reduction of 50% or more 24 hours later (rates, 37.8% vs 15.5%, respectively). Colchicine should be avoided in older adults and in patients with renal or hepatic impairment or known gastrointestinal tract symptoms, and there are numerous drug-drug interactions.

When the use of NSAIDs or colchicine is poorly tolerated or contraindicated, glucocorticoids such as prednisolone or prednisone or corticotropin may be prescribed for acute gout, although evidence from randomized controlled trials is lacking for the use of intraarticular and intramuscular glucocorticoids and corticotropin.

To help prevent acute flares and development of tophi in the patient with gout, urate-lowering therapy may be helpful, but not without risk. Urate-lowering therapy should be considered in patients with hyperuricemia who have 2 or more gout attacks per year or tophi, as determined either clinically or radiographically. Additional considerations are the severity and frequency of flares, the presence of kidney stones and other coexisting illnesses, and patient preference.

Xanthine oxidase inhibitors, uricosuric agents, and uricase agents are 3 classes of drugs approved for lowering urate levels. Allopurinol is the most commonly prescribed xanthine oxidase inhibitor, with an acceptable adverse effect profile in most patients. Approximately 2% of patients experience a mild rash, with potentially life-threatening severe hypersensitivity to allopurinol much less common. Most patients receive 300 mg of allopurinol daily, but this dose may not achieve target urate levels, and daily doses up to 800 mg may be used in patients with normal renal function. Patients with renal impairment are typically given a lower dose.

Febuxostat, another xanthine oxidase inhibitor approved by the FDA in 2009 for treatment of hyperuricemia in patients with gout, is second-line therapy. Starting dose is 40 mg orally daily, increasing to 80 mg daily after 2 to 4 weeks if needed to achieve a target serum urate level. It is contraindicated for use with theophylline. No dose adjustments are needed for patients with mild to moderate renal or hepatic impairment, but data are insufficient regarding patients with severe impairment.

Probenecid, sulfinpyrazone, benzbromarone, and other uricosuric drugs block renal tubular urate reabsorption, but they are contraindicated in patients with a history of nephrolithiasis.

"Because rapid lowering of urate levels is associated with gout flares, with an increased risk associated with therapies that more effectively lower urate levels, prophylaxis against acute flares is advised during the initiation of urate-lowering therapy," Dr. Neogi concludes. "...[T]he general recommendation for flare prophylaxis is to use colchicine at a dose of 0.6 mg once or twice daily, with dose adjustments as needed for renal impairment, potential drug interactions, or intolerance. Although NSAIDs are also used for prophylaxis, there are few studies that support their use."

Dr. Neogi has served as a core expert panel leader for the American College of Rheumatology Gout Treatment Guidelines and has disclosed no other relevant financial relationships.

N Engl J Med. 2011;364:443-452. Abstract

Related Link
The Arthritis Foundation’s Gout Living Web site provides a range of resources appropriate for patients.
Clinical Context

Gout is a type of an inflammatory arthritis with deposition of monosodium urate crystals in synovial fluid. It is associated with hyperuricemia, defined as a urate level of 6.8 mg/dL or higher, but an elevated urate level is necessary but no always sufficient to cause gout.

This is a review of the presentation, differential diagnosis, and management of gout.
Study Highlights

* Gout has 2 clinical phases: (1) a first phase of intermittent acute attacks that spontaneously resolve during 7 to 10 days with asymptomatic periods between attacks, and (2) a second phase of chronic tophaceous gout involving polyarticular attacks with crystal deposition (tophi) in the soft tissues or joints.
* Risk factors include use of thiazide diuretics, cyclosporine, and low-dose aspirin (< 1 g/day); insulin resistance metabolic syndrome; renal insufficiency; hypertension; congestive heart failure; and organ transplantation.
* Increased dietary intake of purines, ethanol, soft drinks, and fructose also increase the risk for gout. Intake of coffee, dairy products, and vitamin C reduces the risk for gout.
* Triggers for gout attacks include alcohol intake, diuretic use, hospitalization, and surgery.
* The diagnostic standard is synovial fluid examination for negatively birefringent monosodium urate crystals under polarizing microscopy.
* Hyperuricemia may not be present in an acute attack and may not be helpful in diagnosis.
* The differential diagnosis of acute gout includes other crystal-induced arthritides, rheumatoid arthritis, and a septic joint.
* The main aim of treatment is rapid pain relief and prevention of disability.
* Options include the use of NSAIDs; colchicine; glucocorticoids; and, sometimes, corticotrophin.
* Adjunctive measures include applying ice and resting the affected joint.
* NSAIDs and colchicine are first-line treatments of acute gout.
* Colchicine, given at 1.2 mg at the start of an attack and repeated at 0.6 mg 1 hour later, is more effective than placebo for pain relief within 24 hours.
* Glucocorticoids and corticotrophins may be used, but the evidence for intramuscular injections is limited.
* A 5-day course of prednisolone has been shown to be equivalent to indomethacin and naproxen.
* 7 to 10 days of treatment of gout may be needed for symptom control.
* Lowering urate levels may prevent acute flares of gout and development of tophi.
* Urate-lowering therapy for hyperuricemia is recommended for those with at least 2 gout attacks per year or tophi, but such therapy should not be initiated during acute attacks.
* Urate-lowering therapy should be started 2 to 4 weeks after flare resolution, with a low initial dose increased for weeks to months.
* The dose should be adjusted to achieve a urate level below 6 mg/dL, which is associated with a reduced risk for acute attacks and tophi.
* Allopurinol, a xanthine oxidase inhibitor, is the most commonly prescribed agent to lower urate levels.
* Febuxostat is another xanthine oxidase inhibitor approved by the FDA in 2009. At daily doses of 80 mg and 120 mg, has been shown to be 2.5 to 3 times more likely to achieve urate levels less than 6 mg/dL at 1 year.
* Uricosuric drugs (probenecid, sulfinpyrazone, and benzbromarone) block renal tubular urate reabsorption.
* Uricase and pegloticase were FDA approved in 2010 for chronic gout refractory to conventional treatments.
* Lifestyle changes such as avoidance of alcohol and diet modification may not be sufficient to control attacks.
* Intake of vitamin C and dairy products have been shown to reduce urate levels.
* For patients starting allopurinol therapy, the use of colchicine at a dose of 0.6 mg twice daily for an average of 5.2 months has been shown to reduce the risk for gout attacks and severity of flares.
* The optimal duration of treatment of tophi is uncertain, and ongoing prophylaxis until resolution of tophi occurs may be necessary.
* The author concluded that patients suspected of having gout should have the diagnosis confirmed by synovial fluid examination, and acute treatment after multiple attacks should be followed by allopurinol for urate lowering, with colchicine prophylaxis to prevent recurrence of attacks.

Clinical Implications

* The diagnostic standard for gout is examination of synovial fluid.
* Treatment of acute gout is aimed at symptom control, and treatment of chronic gout involves prevention of attacks and tophi and reduction of urate levels.

Endometrial cancer



ndometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year. The most common subtype, endometrioid adenocarcinoma, typically occurs within a few decades of menopause, is associated with excessive estrogen exposure, often develops in the setting of endometrial hyperplasia, and presents most often with vaginal bleeding. Endometrial carcinoma is the third most common cause of gynecologic cancer death (behind ovarian and cervical cancer). A total abdominal hysterectomy (surgical removal of the uterus) with bilateral salpingo-oophorectomy is the most common therapeutic approach.

Endometrial cancer may sometimes be referred to as uterine cancer. However, different cancers may develop not only from the endometrium itself but also from other tissues of the uterus, including cervical cancer, sarcoma of the myometrium, and trophoblastic disease.

Saturday, February 12, 2011

Valentines day


February has long been a month of romance. It is the month associated with Valentine's Day celebrations. We have, time and again, heard the name St. Valentine being uttered before us in this season of love. But just who is this St. Valentine? Why is this month associated with love and romance? Learn about St. Valentine, how Valentines day came into practice as it is today. The origin of this lovers day goes back as early as 270 A.D and started with the clash between a kindly priest and a mighty ruler. To know more, just read on and discover the true meaning of this festival.

Wish you a Happy Valentine!

Every year, the fourteenth day of the month of February has millions across the world presenting their loved ones with candy, flowers, chocolates and other lovely gifts. In many countries, restaurants and eateries are seen to be filled with couples who are eager to celebrate their relationship and the joy of their togetherness through delicious cuisines. There hardly seems to be a young man or woman who is not keen to make the most of the day.
Gifts for Valentine's Day

The reason behind all of this is a kindly cleric named Valentine who died more than a thousand years ago.

It is not exactly known why the 14th of February is known as Valentine's Day or if the noble Valentine really had any relation to this day. Saint ValentineThe history of Valentine's Day is impossible to be obtained from any archive and the veil of centuries gone by has made the origin behind this day more difficult to trace. It is only some legends that are our source for the history of Valentine's Day.

The modern St. Valentine's Day celebrations are said to have been derived from both ancient Christian and Roman tradition. As per one legend, the holiday has originated from the ancient Roman festival of Lupercalis/Lupercalia, a fertility celebration that used to observed annually on February 15. But the rise of Christianity in Europe saw many pagan holidays being renamed for and dedicated to the early Christian martyrs. Lupercalia was no exception. In 496 AD, Pope Gelasius turned Lupercalia into a Christian feast day and set its observance a day earlier, on February 14. He proclaimed February 14 to be the feast day in honor of Saint Valentine, a Roman martyr who lived in the 3rd century. It is this St. Valentine whom the modern Valentine's Day honors.

According to the Catholic Encyclopedia, there were at least three early Christian saints by the name of Valentine. While one was a priest in Rome, another was a bishop in Terni. Nothing is known about the third St. Valentine except that he met his end in Africa. Surprisingly, all three of them were said to have been martyred on 14th February.

It is clear that Pope Gelasius intended to honor the first of these three aforementioned men. Most scholars believe that this St. Valentine was a priest who lived around 270 AD in Rome and attracted the disfavor of Roman emperor Claudius II who ruled during this time.

The story of St. Valentine has two different versions - the Protestant and the Catholic one. Both versions agree upon Saint Valentine being a bishop who held secret marriage ceremonies of soldiers in opposition to Claudius II who had prohibited marriage for young men and was executed by the latter. During the lifetime of Valentine, the golden era of Roman empire had almost come to an end. Lack of quality administrators led to frequent civil strife. Education declined, taxation increased and trade witnessed a very bad time. The Roman empire faced crisis from all sides, from the Gauls, Slavs, Huns, Turks and Mongolians from Northern Europe and Asia. The empire had grown too large to be shielded from external aggression and internal chaos with existing forces. Naturally, more and more capable men were required to to be recruited as soldiers and officers to protect the nation from takeover. When Claudius became the emperor, he felt that married men were more emotionally attached to their families, and thus, will not make good soldiers. He believed that marriage made the men weak. So he issued an edict forbidding marriage to assure quality soldiers.

The ban on marriage was a great shock for the Romans. But they dared not voice their protest against the mighty emperor. The kindly bishop Valentine also realized the injustice of the decree. He saw the trauma of young lovers who gave up all hopes of being united in marriage. He planned to counter the monarch's orders in secrecy. Whenever lovers thought of marrying, they went to Valentine who met them afterwards in a secret place, and joined them in the sacrament of matrimony. And thus he secretly performed many marriages for young lovers. But such things cannot remain hidden for long. It was only a matter of time before Claudius came to know of this "friend of lovers," and had him arrested.

While awaiting his sentence in prison, Valentine was approached by his jailor, Asterius. It was said that Valentine had some saintly abilities and one of them granted him the power to heal people. Asterius had a blind daughter and knowing of the miraculous powers of Valentine he requested the latter to restore the sight of his blind daughter. The Catholic legend has it that Valentine did this through the vehicle of his strong faith, a phenomenon refuted by the Protestant version which agrees otherwise with the Catholic one. Whatever the fact, it appears that Valentine in some way did succeed to help Asterius' blind daughter.

Claudius IIWhen Claudius II met Valentine, he was said to have been impressed by the dignity and conviction of the latter. However, Valentine refused to agree with the emperor regarding the ban on marriage. It is also said that the emperor tried to convert Valentine to the Roman gods but was unsuccesful in his efforts. Valentine refused to recognize Roman Gods and even attempted to convert the emperor, knowing the consequences fully. This angered Claudius II who gave the order of execution of Valentine.

Meanwhile, a deep friendship had been formed between Valentine and Asterius' daughter. It caused great grief to the young girl to hear of his friend's imminent death. It is said that just before his execution, Valentine asked for a pen and paper from his jailor, and signed a farewell message to her "From Your Valentine," a phrase that lived ever after. As per another legend, Valentine fell in love with the daughter of his jailer during his imprisonment. However, this legend is not given much importance by historians. The most plausible story surrounding St. Valentine is one not centered on Eros (passionate love) but on agape (Christian love): he was martyred for refusing to renounce his religion. Valentine is believed to have been executed on February 14, 270 AD.

Thus 14th February became a day for all lovers and Valentine became its Patron Saint. It began to be annually observed by young Romans who offered handwritten greetings of affection, known as Valentines, on this day to the women they admired. With the coming of Christianity, the day came to be known as St. Valentine's Day.

But it was only during the 14th century that St. Valentine's Day became definitively associated with love. UCLA medieval scholar Henry Ansgar Kelly, author of "Chaucer and the Cult of Saint Valentine", credits Chaucer as the one who first linked St. Valentine's Day with romance. In medieval France and England it was believed that birds mated on February 14. Hence, Chaucer used the image of birds as the symbol of lovers in poems dedicated to the day. In Chaucer's "The Parliament of Fowls," the royal engagement, the mating season of birds, and St. Valentine's Day are related:

"For this was on St. Valentine's Day, When every fowl cometh there to choose his mate."

By the Middle Ages, Valentine became as popular as to become one of the most popular saints in England and France. Despite attempts by the Christian church to sanctify the holiday, the association of Valentine’s Day with romance and courtship continued through the Middle Ages. The holiday evolved over the centuries. By the 18th century, gift-giving and exchanging hand-made cards on Valentine's Day had become common in England. Hand-made valentine cards made of lace, ribbons, and featuring cupids and hearts began to be created on this day and handed over to the man or woman one loved. Valentine's day greeting cardThis tradition eventually spread to the American colonies. It was not until the 1840s that Valentine's Day greeting cards began to be commercially produced in the U.S. The first American Valentine's Day greeting cards were created by Esther A. Howlanda Mount Holyoke, a graduate and native of Worcester. Mass. Howland, known as the Mother of the Valentine, made elaborate creations with real lace, ribbons and colorful pictures known as "scrap". It was when Howland began Valentine's cards in a large scale that the tradition really caught on in the United States.

Today, Valentine's Day is one of the major holidays in the U.S. and has become a booming commercial success. According to the Greeting Card Association, 25% of all cards sent each year are "valentine"s. The "valentines", as Valentine's Day cards are better known as, are often designed with hearts to symbolize love. The Valentine's Day card spread with Christianity, and is now celebrated all over the world. One of the earliest valentines was sent in 1415 AD by Charles, Duke of Orleans, to his wife during his imprisonment in the Tower of London. The card is now preserved in the British Museum.

There may be doubts regarding the actual identity of Valentine, but we know that he really existed because archaeologists have recently unearthed a Roman catacomb and an ancient church dedicated to a Saint Valentine.

Friday, February 11, 2011

Schizophrenia gene mutation


February 3, 2011 — Scientists have discovered a gene mutation that is strongly linked to schizophrenia and a signalling pathway that may be treatable with existing drugs.

"This discovery is the latest in a series of studies by our group and by others that have changed the tables in terms of genetic studies in schizophrenia," Jonathan Sebat, PhD, assistant professor of psychiatry and cellular and molecular medicine at the University of California (UC), San Diego, who led the team that made the discovery, told Medscape Medical News.

"Mutations in the VIPR2 gene, which can be found in about 1 in 300 patients, are responsible for some amount of schizophrenia, but the fact that this mutation is rare does not necessarily diminish its importance because this is a drug-able gene," he said.

The findings were published online February 3 in Nature.

Important Piece of the Puzzle

Uncovering such a gene affords important insight into the biology of schizophrenia, he said.

"Just because only 1 in 300 patients has this mutation doesn't mean that only 1 in 300 patients has a problem with this signaling pathway. There may actually be a broader segment of schizophrenia patients who have something that is related to this, so uncovering this particular piece of the puzzle is actually quite important."

Schizophrenia is thought to be caused by environmental and genetic factors and occurs in 1% of the population or 10% of those with a first-degree relative, such as a parent or sibling, who has the disorder.

In previous research, Dr. Sebat, together with renowned geneticist Mary-Claire King, PhD, a professor of medical genetics at the University of Washington, Seattle, discovered that rare mutations at many locations in the human genome resulted in a significantly higher risk for schizophrenia.

These mutations consisted of copy number variants (CNVs) — a type of genetic variation in which the number of copies of a gene differs between individuals.

"This work showed that mutations that cause schizophrenia in individuals can be quite rare and that the primary cause of the disease in one patient is different than the cause of the disease in another patient," said Dr. Sebat, who is also chief of the Beyster Center for Molecular Genomics of Neuropsychiatric Diseases and a member of the Institute for Genomic Medicine at UC San Diego.

However, the work did not identify the specific genes involved.

Turning Down the Volume

In this research, Dr. Sebat and his team scanned for CNVs in the genomes of 8290 patients diagnosed as having schizophrenia and 7431 healthy controls.

"We found very strong links to multiple sites in the genome. Some had been picked up in our earlier work, but we uncovered an important new finding — duplications at the tip of chromosome 7q were detected in individuals with schizophrenia at a rate that was 14 times higher than in healthy controls. These CNVs impact the VIPR2 gene, which is important for brain development."

Vasoactive intestinal peptide receptor 2 (VIPR2) is expressed in the nervous system, in blood vessels and the gastrointestinal tract, in addition to the brain.

When the scientists measured the expression of the VIPR2 gene in blood cells from the patients with schizophrenia, they found that individuals with mutations had greater expression of VIPR2 and greater activity of the receptor.

"We concluded that the effect of the causal mutations is to raise the volume on the VIP signaling pathway," Dr. Sebat said.

"VIP is already in clinical trials because of its known roles in regulating vasodilation. It regulates the nervous system, and the cardiovascular system, and the gut. In the case of patients with schizophrenia, you wouldn't want to use VIP because their problem is that the volume is already turned up too high on VIP signaling, so in this case you'd want to use an antagonist that would turn the volume down," he said.

New Diagnostics

In addition to the opportunity to develop new drugs, there is also the opportunity to develop new diagnostics, Dr. Sebat added.

A genetic test for mutations in VIPR2 could help to identify people who are at risk for schizophrenia and could also help to identify those who would most likely benefit from treatment.

"A genetic test for mutations in VIPR2 could help to identify people who are at risk for schizophrenia and could also help to identify those who would most likely benefit from treatment."

It has been known for decades that genetics plays an important role in schizophrenia, and yet genetics has not been used at all in the diagnosis of the disorder. Dr. Sebat called this a paradox.

"This is a segment of the population that is completely underserved in terms of molecular diagnostics. So you would want to apply a genetic test like this for VIPR2 in mental illness. It may only identify a small group of patients, but it would still provide very valuable information."

Psychiatry is in serious need of new, more effective drugs, and in the absence of any strong genetic findings uncovering a clear drug target, there really haven't been any leads or any real avenues for the rational development of new therapies.

Discovery of this gene means that there is hope for the development of new drugs for schizophrenia, he said.

"The first antipsychotics were developed in the 1950s and little has changed since then. Psychiatry is in serious need of new, more effective drugs, and in the absence of any strong genetic findings uncovering a clear drug target, there really haven't been any leads or any real avenues for the rational development of new therapies," he said.

"The fact that large-scale genetic studies can uncover something like this is very encouraging, and we are hopeful that this and other findings that are likely to emerge from this type of research will kick start the development of new drugs," Dr. Sebat added.

Thursday, February 10, 2011

jai bolo telangana songs download

Food for thought

We are more often treacherous through weakness than through calculation. ~Francois De La Rochefoucauld


A man with one watch knows what time it is; a man with two watches is never quite sure. ~Lee Segall


Begin at the beginning and go on till you come to the end; then stop. ~Lewis Carrol, Alice in Wonderland


Believe those who are seeking the truth. Doubt those who find it. ~Andre Gide


Beware lest you lose the substance by grasping at the shadow. ~Aesop


Only that in you which is me can hear what I'm saying. ~Baba Ram Dass


I am a part of all that I have met. ~Alfred Lord Tennyson


There's more to the truth than just the facts. ~Author Unknown


The obscure we see eventually. The completely obvious, it seems, takes longer. ~Edward R. Murrow


Even a clock that does not work is right twice a day. ~Polish Proverb


Losing an illusion makes you wiser than finding a truth. ~Ludwig Börne


If a man who cannot count finds a four-leaf clover, is he lucky? ~Stanislaw J. Lec


We are all but recent leaves on the same old tree of life and if this life has adapted itself to new functions and conditions, it uses the same old basic principles over and over again. There is no real difference between the grass and the man who mows it. ~Albert Szent-Györgyi


Sometimes it's necessary to go a long distance out of the way in order to come back a short distance correctly. ~Edward Albee


When the student is ready, the master appears. ~Buddhist Proverb


A gun gives you the body, not the bird. ~Henry David Thoreau


Before enlightenment - chop wood, carry water. After enlightenment - chop wood, carry water. ~Zen Buddhist Proverb


Many men go fishing all of their lives without knowing that it is not fish they are after. ~Henry David Thoreau


Wars and elections are both too big and too small to matter in the long run. The daily work - that goes on, it adds up. ~Barbara Kingsolver, Animal Dreams


I tell you everything that is really nothing, and nothing of what is everything, do not be fooled by what I am saying. Please listen carefully and try to hear what I am not saying. ~Charles C. Finn


Oh, Heaven, it is mysterious, it is awful to consider that we not only carry a future Ghost within us; but are, in very deed, Ghosts! ~Thomas Carlyle


Knock on the sky and listen to the sound. ~Zen Saying


The fish trap exists because of the fish. Once you've gotten the fish you can forget the trap. The rabbit snare exists because of the rabbit. Once you've gotten the rabbit, you can forget the snare. Words exist because of meaning. Once you've gotten the meaning, you can forget the words. Where can I find a man who has forgotten words so I can talk with him? ~Chuang Tzu


By daily dying I have come to be. ~Theodore Roethke


There are some remedies worse than the disease. ~Publilius Syrus


You never know what is enough, until you know what is more than enough. ~William Blake, Proverbs of Hell


It requires a great deal of faith for a man to be cured by his own placebos. ~John L. McClenahan


What you see, yet can not see over, is as good as infinite. ~Thomas Carlyle, Sartor Resartus, Book II, chapter 1


Philosophy is life's dry-nurse, who can take care of us - but not suckle us. ~Soren Kierkegaard


One man's quiet is another man's din. ~Carrie Latet


Men are probably nearer the central truth in their superstitions than in their science. ~Henry David Thoreau


Think like a man of action, act like a man of thought. ~Henri Louis Bergson


If you think you're free, there's no escape possible. ~Ram Dass


The fly that doesn't want to be swatted is most secure when it lights on the fly-swatter. ~G.C. Lichtenberg


Don't miss the donut by looking through the hole. ~Author Unknown


You can't wake a person who is pretending to be asleep. ~Navajo Proverb


Life has the name of life, but in reality it is death. ~Heraclitus, Eustathius ad Iliad


To learn something new, take the path that you took yesterday. ~John Burroughs


Whatever I take, I take too much or too little; I do not take the exact amount. The exact amount is no use to me. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


Alice came to a fork in the road. "Which road do I take?" she asked.
"Where do you want to go?" responded the Cheshire cat.
"I don't know," Alice answered.
"Then," said the cat, "it doesn't matter."
~Lewis Carroll, Alice in Wonderland


Each forward step we take we leave some phantom of ourselves behind. ~John Lancaster Spalding


The map is not the territory. ~Alfred Korzybski


No matter where you go or what you do, you live your entire life within the confines of your head. ~Terry Josephson


Would there be this eternal seeking if the found existed? ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


I was once a skeptic but was converted by the two missionaries on either side of my nose. ~Robert Brault, www.robertbrault.com


He who has seen present things has seen all, both everything which has taken place from all eternity and everything which will be for time without end; for all things are of one kin and of one form. ~Marcus Aurelius


If you chase two rabbits, you will not catch either one. ~Russian Proverb


The observer, when he seems to himself to be observing a stone, is really, if physics is to be believed, observing the effects of the stone upon himself. ~Bertrand Russell


Some people walk in the rain, others just get wet. ~Roger Miller


The obstacle is the path. ~Zen Proverb


It is better to know some of the questions than all of the answers. ~James Thurber


It is easy to stand a pain, but difficult to stand an itch. ~Chang Ch'ao


You cannot step into the same river twice. ~Heraclitus, in Diogenes Laertius, Lives


You are fastened to them and cannot understand how, because they are not fastened to you. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


One day, someone showed me a glass of water that was half full. And he said, "Is it half full or half empty?" So I drank the water. No more problem. ~Alexander Jodorowsky


Among creatures born into chaos, a majority will imagine an order, a minority will question the order, and the rest will be pronounced insane. ~Robert Brault, www.robertbrault.com


What deep wounds ever closed without a scar? ~George Gordon, Lord Byron, Child Harold's Pilgrimage


Extreme remedies are very appropriate for extreme diseases. ~Hippocrates, Aphorisms


Seeking is not always the way to find. ~Augustus William Hare and Julius Charles Hare, Guesses at Truth, by Two Brothers, 1827


It takes all the running you can do just to keep in the same place. ~Lewis Carroll, Through the Looking-Glass, 1872


We waste a lot of time running after people we could have caught by just standing still. ~Mignon McLaughlin, The Neurotic's Notebook, 1960


You can't reason someone out of a position they didn't reason themselves into. ~Author Unknown


I slept with faith and found a corpse in my arms on awakening; I drank and danced all night with doubt and found her a virgin in the morning. ~Aleister Crowley, Book of Lies


Tomorrow always comes, and today is never yesterday. ~S.A. Sachs


Weak eyes are fondest of glittering objects. ~Thomas Carlyle


You can see a lot by just looking. ~Yogi Berra, also often quoted as "You can observe a lot by just looking." (original wording as yet unverified)


Proverbs often contradict one another, as any reader soon discovers. The sagacity that advises us to look before we leap promptly warns us that if we hesitate we are lost; that absence makes the heart grow fonder, but out of sight, out of mind. ~Leo Rosten


Reason and faith are both banks of the same river. ~Doménico Cieri Estrada


Man is the only animal who enjoys the consolation of believing in a next life; all other animals enjoy the consolation of not worrying about it. ~Robert Brault, www.robertbrault.com


Sometimes the questions are complicated and the answers are simple. ~Dr Seuss


Who depends on another man's table often dines late. ~John Ray


[T]hings are entirely what they appear to be and behind them... there is nothing. ~Jean Paul Sartre, Nausea


You become responsible forever for what you've tamed. ~Antoine de Saint-Exupéry, The Little Prince, 1943, translated from French by Richard Howard


When the pain is great enough, we will let anyone be doctor. ~Mignon McLaughlin, The Neurotic's Notebook, 1960


A thousand men can't undress a naked man. ~Greek Proverb


May your passion be the kernel of corn stuck between your molars, always reminding you there's something to tend to. ~Jeb Dickerson, www.howtomatter.com


I stop wanting what I am looking for, looking for it. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


We often repent the good we have done as well as the ill. ~William Hazlitt, Characteristics, 1823


When I die, I will not see myself die, for the first time. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


The scars you can't see are the hardest to heal. ~Astrid Alauda


The human mind is inspired enough when it comes to inventing horrors; it is when it tries to invent a Heaven that it shows itself cloddish. ~Evelyn Waugh


It's very strange when the life you never had flashes before your eyes. ~Terri Minsky, Sex and the City, "The Baby Shower


The foot feels the foot when it feels the ground. ~Buddha


We become aware of the void as we fill it. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


If I make the lashes dark
And the eyes more bright
And the lips more scarlet,
Or ask if all be right
From mirror after mirror,
No vanity's displayed:
I'm looking for the face I had
Before the world was made.
~W.B. Yeats


Almost every wise saying has an opposite one, no less wise, to balance it. ~Santayana, Essays


The opposite of a correct statement is a false statement. But the opposite of a profound truth may well be another profound truth. ~Niels Bohr


How often one sees people looking far and wide for what they are holding in their hands? Why! I am doing it myself at this very moment. ~Augustus William Hare and Julius Charles Hare, Guesses at Truth, by Two Brothers, 1827


Our greatest pretenses are built up not to hide the evil and the ugly in us, but our emptiness. The hardest thing to hide is something that is not there. ~Eric Hoffer, Passionate State of Mind, 1955


Who is more foolish, the child afraid of the dark or the man afraid of the light? ~Maurice Freehill


I believe that men are generally still a little afraid of the dark, though the witches are all hung, and Christianity and candles have been introduced. ~Henry David Thoreau, "Solitude," Walden, 1854


Because they know the name of what I am looking for, they think they know what I am looking for! ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


There are things I have wanted so long that I would only consent to have them if I could keep wanting them. ~Robert Brault, www.robertbrault.com


Eggs cannot be unscrambled. ~American Proverb


A thing, until it is everything, is noise, and once it is everything it is silence. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


The road was new to me, as roads always are going back. ~Sarah Orne Jewett, The Country Road of Pointed Firs, 1896


Admiration and familiarity are strangers. ~George Sand


I am not certain of the hereafter. Frankly, I'm not all that certain of the here. ~Robert Brault, www.robertbrault.com


We used to think that if we knew one, we knew two, because one and one are two. We are finding that we must learn a great deal more about "and." ~Arthur Stanley Eddington


To know the hight [sic] of a mountain, one must climb it. ~Augustus William Hare and Julius Charles Hare, Guesses at Truth, by Two Brothers, 1827


No snowflake ever falls in the wrong place. ~Zen


The moment a little boy is concerned with which is a jay and which is a sparrow, he can no longer see the birds or hear them sing. ~Eric Berne


Nearly all men die of their remedies, and not of their illnesses. ~Jean Baptiste Molière, Le Malade Imaginaire


The charm of history and its enigmatic lesson consist in the fact that, from age to age, nothing changes and yet everything is completely different. ~Aldous Huxley


Will localizes us; thought universalizes us. ~Henri Frederic Amiel


I've observed that there are more lines formed than things worth waiting for. ~Robert Brault, www.robertbrault.com


Genuine tragedies in the world are not conflicts between right and wrong. They are conflicts between two rights. ~Georg Hegel


When I break any of the chains that bind me I feel that I make myself smaller. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


We are spirits clad in veils. ~Christopher P. Cranch


If I am not pleased with myself, but should wish to be other than I am, why should I think highly of the influences which have made me what I am? ~John Lancaster Spalding


Before I travelled my road I was my road. ~Antonio Porchia, Voces, 1943, translated from Spanish by W.S. Merwin


If a man will begin with certainties, he shall end in doubts, but if he will content to begin with doubts, he shall end in certainties. ~Francis Bacon


To believe with certainty we must begin with doubting. ~Stanislaus I of Poland


The world always makes the assumption that the exposure of an error is identical with the discovery of truth - that the error and truth are simply opposite. They are nothing of the sort. What the world turns to, when it is cured on one error, is usually simply another error, and maybe one worse than the first one. ~H.L. Mencken


The future influences the present just as much as the past. ~Friedrich Nietzsche


When a watch goes ill, it is not enough to move the hands; you must set the regulator. When a man does ill, it is not enough to alter his handiwork, you must regulate his heart. ~Augustus William Hare and Julius Charles Hare, Guesses at Truth, by Two Brothers, 1827


When we try to pick out anything by itself, we find it hitched to everything else in the universe. ~John Muir, My First Summer in the Sierra, 1911


One does what one is; one becomes what one does. ~Robert von Musil, Kleine Prosa


In this, the late afternoon of my life, I wonder: am I casting a longer shadow or is my shadow casting a shorter me? ~Robert Brault, www.robertbrault.com


You can't fall off the floor. ~Author Unknown


A wise man can see more from the bottom of a well than a fool can from a mountain top. ~Author Unknown


In a mist the heights can for the most part see each other; but the valleys cannot. ~Augustus William Hare and Julius Charles Hare, Guesses at Truth, by Two Brothers, 1827


In general people experience their present naively, as it were, without being able to form an estimate of its contents; they have first to put themselves at a distance from it - the present, that is to say, must have become the past - before it can yield points of vantage from which to judge the future. ~Sigmund Freud, The Future of an Illusion


The only Zen you can find on the tops of mountains is the Zen you bring up there. ~Robert M. Pirsig


A stumble may prevent a fall. ~English Proverb


When you look into an abyss, the abyss also looks into you. ~Friedrich Nietzche


What you discover in a democracy is that it is difficult to build a house when each nail has an opinion. ~Robert Brault, www.robertbrault.com


Do not seek to follow in the footsteps of the wise. Seek what they sought. ~Matsuo Basho

Ectopic pregnancy


An ectopic pregnancy, or eccysis, is a complication of pregnancy in which the pregnancy implants outside the uterine cavity.[1] With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the mother, internal bleeding being a common complication. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death.

In a normal pregnancy, the fertilized egg enters the uterus and settles into the uterine lining where it has plenty of room to divide and grow. About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes.

Detection of ectopic pregnancy in early gestation has been achieved mainly due to enhanced diagnostic capability. Despite all these notable successes in diagnostics and detection techniques ectopic pregnancy remains a source of serious maternal morbidity and mortality worldwide, especially in countries with poor prenatal care.[2]

In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube and burrows into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding hematosalpinx expels the implantation out of the tubal end as a tubal abortion. Tubal abortion is a common type of miscarriage. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant. Sometimes the bleeding might be heavy enough to threaten the health or life of the woman. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into the nearby Sampson artery, causing heavy bleeding earlier than usual.

If left untreated, about half of ectopic pregnancies will resolve without treatment. These are the tubal abortions. The advent of methotrexate treatment for ectopic pregnancy has reduced the need for surgery; however, surgical intervention is still required in cases where the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or through a larger incision, known as a laparotomy.