Oedema

The space between the vocal cords and the mucosa covering them is the glottis. Glottic oedema can be caused by various reasons like hypersensitivity, inflammation, infection or by mechanical obstruction. Glottic oedema causes obstruction of air passages resulting in asphyxia and causes sudden unexpected death. Glottic oedema due to hypersensitivity or inhalation of smoke in cases of burn death and endotracheal intubations will come across during autopsies. Glottic oedema by local infection resulting in death is rare. At Government Medical College, Thiruvananthapuram we had two such cases of death due to glottic oedema. In these cases glottic oedema resulted from local infection at different sites.
Key Words: Glottic Oedema; Pharyngeal Abscess; Epiglottic Abscess; Asphyxia.

What we know: Both weight-for-height z-score (WHZ) and mid-upper arm circumference (MUAC) are recommended to identify severely malnourished children for treatment. MUAC has distinct advantages for community-level screening; however several countries have gone further to instigate MUAC-only admissions for treatment.

What this article adds: A recent review examined the consequences of excluding children with severe acute malnutrition (SAM) identified using WHZ from admission to treatment programmes. Analysis of individual data from 14,935 children admitted to a range of treatment programmes over 22 years and a literature review examined case fatality rates (CFR) with different indicators and caseload. Simpson’s paradox (mathematical coupling) results in reversal of significance that affects interpretation of the relative mortality rates of WHZ and MUAC. The analysis suggests that children with SAM identified by WHZ <-3Z and admitted for treatment have as high a risk of death as children in treatment with MUAC <115mm.  Review of 21 datasets that compared WHZ and MUAC mortality rates show problems with interpretation of the reported CFRs; inconsistencies greatly limit analysis, comparability and interpretation. Caseload is a more important determinant of the number of SAM-related child deaths than the relative CFR to give SAM-attributable deaths. Where most of the children are identified as SAM using WHZ rather than MUAC, it is estimated that fewer than half of all SAM-related deaths will be identified using a MUAC-only programme. Strong advocacy for the use of MUAC to maximise coverage of treatment programmes has developed into MUAC-only programmes that are inadequately evidenced on the consequences of excluding WHZ cases. Urgent research is needed to develop simple methods to identify children with low WHZ at community level.

Several studies have associated the earlobe crease sign, discovered by Sanders T. Frank in 1973, with cardiovas-cular pathology, yet very few studies have focused on the antiquity of this trait, with the most ancient one thought to date back to the Roman Emperor Hadrian (76-138 CE). This article presents two more cases from the Italian Renaissance in the works of the artist Andrea Mantegna (1431-1506) and examines them in a multidisciplinary fashion.

It is well established that end-stage renal disease patients often have other health problems that can be improved by participation in regular exercise programmes. In addition, the reduced physical functioning that is experienced by patients who are on dialysis is potentially addressable through exercise interventions. Very few studies are undertaken to investigate the effect of exercise on solute removal and oedema in patients undergoing hemodialysis in South Africa. In this study, a sample of thirty four patients (17 in the intervention group aged between 25 and 60; 17 in the control group aged between 18 and 60) performed airogym exercises on a cushion for fifteen minutes every hour to achieve a total of sixty minutes of exercise over a four-hour dialysis session, for period of nine months. Results showed there was a significant reduction in the mean serum urea clearance of 30% (p < 0.001) during post hemodialysis over a six month period as compared to pre hemodialysis. A significant reduction was also seen in the creatinine levels post hemodialysis of 17% (p = 0.01) as compared to that of the baseline. The serum urea Kt/V mean values increased from 1.2 at baseline to 1.4 after six months of exercising, suggesting 17% increase in serum urea (p = 0.5). Furthermore, the potassium levels during pre and post hemodialysis dropped by 8% between April and September in both the intervention and control groups. The airogym exercise programme improves the wellbeing and quality of life (QoL) of dialysis patients and can be integrated into a hemodialysis routine with a high long-term adherence.

Columbin, a diterpenoid furanolactone, was isolated purely for the first time from the plant species Tinspora bakis. The anti-inflammatory effects of columbin were studied in vitro, in silico and in vivo. The effect of columbin on nitric oxide was examined on lipopolysaccharide–interferon-gamma (LPS/IFN) induced RAW264.7 macrophages. In vitro and in silico cyclooxygenase-1 and cyclooxygenase-2 inhibitory activities of columbin using biochemical kit and molecular docking, respectively, were investigated. Mechanism of columbin in suppressing NF-kappaB-translocation was tested using Cellomics®NF-κB activation assay and ArrayScan Reader in LPS-stimulated RAW264.7 cells. Moreover, effects of columbin in vivo that were done on carrageenan-induced mice paw-oedema were tested. Lastly, the in vitro and in vivo toxicities of columbin were examined on human liver cells and mice, respectively. Treatment with columbin or Nω-nitro-L-arginine
methyl ester (L-NAME) inhibited LPS/IFN-γ-induced NO production without affecting the viability of RAW264.7. Pre-treatment of stimulated cells with columbin did not inhibit the translocation of NF-κB to the nucleus in LPS-stimulated cells. COX-1 and COX-2 inhibitory activities of columbin were 63.7±6.4% and 18.8±1.5% inhibition at 100 μM, respectively. Molecular docking study further helped in supporting the observed COX-2 selectivity. Whereby, the interaction of columbin with Tyr385 and Arg120 signifies its higher activity in COX-2, as Tyr385 was reported to be involved in the abstraction of hydrogen from C-13 of arachidonate, and Arg120 is critical for high affinity arachidonate binding. Additionally, columbin inhibited oedema formation in mice paw. Lastly, the compound was observed to be safe in vitro and in vivo. This study presents columbin as a potential anti-inflammatory drug.