Unusual mode of firearm injury from the recoiled rear end of a gun barrel

Atypical gunshot wounds are caused by a diverse set of parameters relating to weapons and ammunition. We report a previously-unreported and atypical mode of gunshot wound produced by a detached rear end of the barrel of a gun following accidental gun fire, and discuss the difficulties in the management. A 36-year-old man presented to the emergency department with an alleged history of injury on the forehead with the rear end of a gun barrel following accidental gunfire while cleaning the nozzle. Since the time of injury, the patient was in an altered sensorium and had weakness on the right side of the body. There was minimal but continuous bleeding from the wound, with extrusion of brain matter. Skull radiograph showed that the rear end of the barrel had entered the left frontal bone, with associated depressed fracture of the frontal bone. The patient underwent a bicoronal, bifrontal craniotomy with a T-shaped extension towards the barrel to facilitate the reflection of the scalp flap and to avoid any movement of the barrel as it might further injure the brain. Necrotic brain, dura and bone pieces were removed. The patient was doing well at follow-up except for mild residual motor deficits. This case illustrates that while working with limited facilities, particularly in underdeveloped countries, a careful clinical assessment, interpretation of available images and a judicious operative approach can help to save the patient.

Properties of the tobacco mosaic virus intermediate length RNA-2 and its translation

The existence of subgenomic RNAs is well established in the case of plant viruses such as tobacco mosaic virus (TMV). However, except for the subgenomic coat protein mRNA, it is not known whether the other subgenomic RNAs have a function in the life cycle of the virus. In search of more information about one of the major subgenomic RNAs-intermediate length RNA-2 or I2 RNA-of TMV, in vitro and in vivo translational studies were performed. The I2 RNA, which codes in vitro for the synthesis of a 30K (K = kilodalton) protein, appears to be uncapped as judged by the need of different in vitro translation conditions for the synthesis of this protein, compared to the conditions required for the synthesis of the 126K and 183K proteins coded by the capped genomic RNA. In vivo a protein migrating in the same position as the 30K protein synthesized in vitro can be detected in infected tobacco leaves. Since this protein occurs transiently early upon infection, whether it is virus-coded or virus-induced, it could have an early function during infection.

Quantifying the accuracy of automated structure segmentation in 4D CT images using a deformable image registration algorithm

Four-dimensional (4D) radiotherapy is the explicit inclusion of the temporal changes in anatomy during the imaging, planning, and delivery of radiotherapy. One key component of 4D radiotherapy planning is the ability to automatically ("auto") create contours on all of the respiratory phase computed tomography (CT) datasets comprising a 4D CT scan, based on contours manually drawn on one CT image set from one phase. A tool that can be used to automatically propagate manually drawn contours to CT scans of other respiratory phases is deformable image registration. The purpose of the current study was to geometrically quantify the difference between automatically generated contours with manually drawn contours. Four-DCT data sets of 13 patients consisting of ten three-dimensional CT image sets acquired at different respiratory phases were used for this study. Tumor and normal tissue structures [gross tumor volume (GTV), esophagus, right lung, left lung, heart and cord] were manually drawn on each respiratory phase of each patient. Large deformable diffeomorphic image registration was performed to map each CT set from the peak-inhale respiration phase to the CT image sets corresponding with subsequent respiration phases. The calculated displacement vector fields were used to deform contours automatically drawn on the inhale phase to the other respiratory phase CT image sets. The code was interfaced to a treatment planning system to view the resulting images and to obtain the volumetric, displacement, and surface congruence information; 692 automatically generated structures were compared with 692 manually drawn structures. The auto- and manual methods showed similar trends, with a smaller difference observed between the GTVs than other structures. The auto-contoured structures agree with the manually drawn structures, especially in the case of the GTV, to within published interobserver variations. For the GTV, fractional volumes agree to within 0.2+/-0.1, center of mass displacements agree to within 0.5+/-1.5 mm, and agreement of surface congruence is 0.0+/-1.1 mm. The surface congruence between automatic and manual contours for the GTV, heart, left lung, right lung and esophagus was less than 5 mm in 99%, 94%, 94%, 91% and 89%, respectively. Careful assessment of the performance of automatic algorithms is needed in the presence of 4D CT artifacts.

Separating the vibrationally resolved Auger decay channels for a CO core hole state

The K-VV Auger spectrum of carbon monoxide (CO) excited by C 1s photoionization has been investigated with a novel electron-electron coincidence setup. The energy resolution is sufficiently high to resolve the vibrational energy levels of the core-ionized intermediate state and of most dicationic final states in the two-dimensional electron energy map. We demonstrate how the influence of vibrational states on a molecular Auger spectrum can be accessed experimentally without the constraint of averaging over all intermediate state energies.

First Order Decision Diagrams for Relational MDPs

Markov decision processes capture sequential decision making under uncertainty, where an agent must choose actions so as to optimize long term reward. The paper studies efficient reasoning mechanisms for Relational Markov Decision Processes (RMDP) where world states have an internal relational structure that can be naturally described in terms of objects and relations among them. Two contributions are presented. First, the paper develops First Order Decision Diagrams (FODD), a new compact representation for functions over relational structures, together with a set of operators to combine FODDs, and novel reduction techniques to keep the representation small. Second, the paper shows how FODDs can be used to develop solutions for RMDPs, where reasoning is performed at the abstract level and the resulting optimal policy is independent of domain size (number of objects) or instantiation. In particular, a variant of the value iteration algorithm is developed by using special operations over FODDs, and the algorithm is shown to converge to the optimal policy.

Posture and performance: sitting vs. standing for security screening

A classification of the literature on the effects of workplace posture on performance of different mental tasks showed few consistent patterns. A parallel classification of the complementary effect of performance on postural variables gave similar results. Because of a lack of data for signal detection tasks, an experiment was performed using 12 experienced security operators performing an X-ray baggage-screening task with three different workplace arrangements. The current workplace, sitting on a high chair viewing a screen placed on top of the X-ray machine, was compared to a standing workplace and a conventional desk-sitting workplace. No performance effects of workplace posture were found, although the experiment was able to measure performance effects of learning and body part discomfort effects of workplace posture. There are implications for the classification of posture and performance and for the justification of ergonomics improvements based on performance increases.

Primary umbilical adenocarcinoma

Primary umbilical tumours are extremely rare. We report primary serous adenocarcinoma arising from the coelomic mesothelium of the hernial sac. A 60-year-old woman presented with an umbilical swelling of six months duration that became painful in the last three days. Examination revealed a tender umbilical swelling diagnosed as obstructive hernia that needed surgery. When dissecting the sac during surgery, a small subcutaneous abscess was encountered. The sac contained an omentum with a hard nodule at the surface which was excised. Umbilical hernia repair was performed. Histology of the omental nodule revealed serous papillary adenocarcinoma. Chest and abdomen computed tomography, pelvic magnetic resonance imaging, gastroscopy, colonoscopy and laparotomy did not reveal the primary site of the tumour.

Acceptability of PRO2000 vaginal gel among HIV un-infected women in Pune, India

Acceptability of PRO2000 Gel, a candidate vaginal microbicide, among participants of its Phase I safety study in Pune, India is reported here. Forty-two eligible women were enrolled in a study requiring twice daily intra-vaginal product use for 14 consecutive days between menses. Acceptability was assessed at study exit through structured questionnaires among 41 participants who completed the product use, and five focus group discussions involving 31 study participants. The participants generally liked the product (40/41, 97.2%), especially its colour (40, 97.2%) and consistency (35, 85.3%). Thirty-four participants reported sexual intercourse within one hour of product use, at least once during the study period and sexual pleasure was reported to be better or unaffected among (30, 88.2%) participants. Nearly 70% did not like its smell and mentioned preference for a product that would be unnoticeable to the male partner. Participating women were concerned about privacy in usage and storage of the product. Acceptability of PRO2000 vaginal gel was good, but its smell will have to be improved. Counselling to address women's concerns about privacy and storage will be crucial. Women's preference for unnoticeable product indicates their empowerment and willingness to accept female-controlled options for HIV prevention.

Complete elimination of tetanus is still elusive in developing countries: a review of adult tetanus cases from referral hospital in Eastern Nepal

AIM

To analyse demography, clinical presentation, treatment, complications and outcome of patients with tetanus over a 2-year period.

MATERIALS AND METHODS

A retrospective analysis of medical records of all patients with tetanus admitted to the intensive care unit of B.P Koirala Institute of Health Sciences, Dharan, Nepal between July 2004 and June 2006.

RESULTS

Tetanus accounted for 1.1 % of our ICU admission. Eight tetanus patients (mean age 52 years; M: F ratio 7:1) were admitted. The tetanus prone wounds of seven patients were managed at home. The most common presenting complaints were trismus and stiffness of neck and back (87.5%). Elective intubation was followed by tracheostomy in all the patients. Overall mean duration of ventilatory support was 12.5 days. Treatments given in ICU were diazepam, magnesium sulphate, tetanus immunoglobulin, metronidazole, wound management and supportive measures. Five patients (62.5%) developed autonomic instability and three patients had ventilatory associated pneumonia (37.5%). Average ICU stay was 15.1 days while hospital stay was 20.1 days. Five patients (62.5%) survived the course of disease. Two patients (25%) left the hospital against medical advice while the other (12.5%) died in ICU.

CONCLUSION

Tetanus is a vaccine preventable disease. Tetanus prone wounds should be managed appropriately. Respiratory compromise and autonomic instability are the main causes of morbidity and mortality. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.

Fluoroquinolone resistance in Salmonella typhi and S. paratyphi A in Bangalore, India

Fluoroquinolone resistance in Salmonella typhi and S. paratyphi A is being increasingly reported. The minimum inhibitory concentrations (MICs) of ciprofloxacin, ofloxacin, levofloxacin and gatifloxacin against S. typhi and S. paratyphi A were compared. Fifty blood culture isolates, 25 S. typhi and 25 S. paratyphi A, were studied. The MICs were determined by the agar dilution method. Disc diffusion was done for the fluoroquinolones and other antibiotics. Nalidixic acid resistance was seen in 21/25 S. paratyphi A and 17/25 S. typhi isolates, and these had higher MICs to fluoroquinolones. Five S. typhi and six S. paratyphi A were fully resistant to ciprofloxacin (MIC >2 microg/l). No multidrug resistance was seen in S. typhi. The absence of multidrug resistance and presence of fluoroquinolone resistance warrants a review of therapy for enteric fever.

Observation of resonant interatomic coulombic decay in Ne clusters

We have measured the electron spectra of Ne clusters after excitation with photon energies around the 2s inner valence threshold. At two photon energies below threshold, a resonantly enhanced surplus of low kinetic-energy electrons is observed. The kinetic energy of the peak does not vary with the photon energy and is slightly larger than the transition energy of Interatomic Coulombic Decay (ICD) above threshold. This leads us to assume that an ICD-like process is present. In analogy to the Auger and the resonant Auger decay this new phenomenon is termed resonant ICD.