Torsion of the gallbladder

The authors report a case of a 79-year-old female who presented with signs and symptoms of acute cholecystitis. She was taken to theatre within 24 h of acute admission to undergo laparoscopic cholecystectomy. The gallbladder was found to have undergone torsion upon its mesentery leading to its infarction and necrosis. Laparoscopic cholecystectomy was performed, and the patient made an uneventful recovery.

Acute infra-renal aortic dissection presenting as back pain and transient paralysis of the lower limbs

Spinal cord injury is a rare complication in patients with aortic dissection. Spinal ischaemia has been reported as a complication of aortic dissection due to impairment of its extrinsic supply in the great radicular artery (GRA) of Adamkiewicz. The extrinsic arterial blood supply to the spinal cord, diminishes caudally and is believed to become critically dependent upon the GRA.(1) infra-renal aortic dissections (IAAD) inducing spinal ischaemia are exceptionally rare in the literature. We present a case of an infra-renal aortic dissection (IAAD) presenting with transient spinal ischaemia.

Studies on the antidiarrhoeal, antimicrobial and cytotoxic activities of ethanol-extracted leaves of yellow oleander (Thevetia peruviana)

This study screened the antidiarrhoeal, antimicrobial and cytotoxic effects of ethanol-extracted leaves of yellow oleander (Thevetia peruviana). The extract was tested against castor oil-induced diarrhoea in a model of albino rats and showed significant antidiarrhoeal activity (P<0.01). Disc diffusion technique was used to test the in vitro antibacterial activities of the extract and exhibited poor antibacterial activities against both Gram positive and Gram negative bacteria (mainly Bacillus sp). Ethanol-extracted leaves of yellow oleander showed narrow zone of inhibition in the bacterial lawns of Shigella flexineri, Salmonella typhi, Klebsiella sp, Staphylococcus aureus and Shigella sonnei. Cytotoxicty was determined against brine shrimp nauplii and LC50 of the plant extract was determined as 627.21�g/ml. The wide range of LC50 value denotes the safety effect of the extract.

Effect of a prescan patient-radiologist encounter on functional MR image quality

BACKGROUND AND PURPOSE

A substantial number of clinical fMRI examinations inadequately assess language localization or lateralization, usually due to patient movement and suboptimal participation. We hypothesized that a prescan interview of the patient by the radiologist would reduce the fraction of nondiagnostic scans.

MATERIALS AND METHODS

A single noise score for each acquisition was produced from time-series data on the basis of a weighted sum of 22 factors. Scores were recorded as the following quartiles: 0-5 = excellent, 5-10 = adequate, 10-15= marginal, and >15 = unacceptable. This measure was evaluated for 202 consecutive fMRI patients: 96 without and 106 with a physician prescan interview. The data were analyzed to compute the fraction of all nondiagnostic sequences and entire studies and were compared between the 2 groups. Image-noise characteristics included the SDs of linear and angular displacements of the head and the number of time-series outliers caused by focal motion.

RESULTS

Of 999 sequences acquired, 539 had a prescan interview. The mean noise score significantly decreased for both individual sequence (from 7.9 to 6.3, P = <.001) and study-based (from 7.7 to 6.2, P = .05) methods. The fraction of sequences or studies scored as unacceptable decreased for sequence-based (from 15.2% to 10.9%, P = .04) and study-based (from 9.4% to 1.9%, P = .02) analyses. SDs of head motion decreased for linear (by 12%-14%, P < .01) and angular displacement (by 38%-48%, P < .001). The number of time-series spikes decreased by 10% (P = .004).

CONCLUSIONS

We report that a prescan physician-patient interview modestly but significantly reduces fMRI noise scores. These results support the newly added billable costs of professional intervention before fMRI scans.

The correlation between ultrasonography and histology in the search for gallstones

INTRODUCTION

The majority of published data on the sensitivity and specificity of ultrasound in the diagnosis of gallbladder pathology was conducted over 30 years ago and, since the 1990s, ultrasound imaging has been the accepted gold standard. The quality and resolution of ultrasonography has improved significantly since then and we have, therefore, set out to assess whether the progression in technology has translated into improved diagnostic accuracy.

PATIENTS AND METHODS

In the period December 2005 to December 2008, a total of 2100 patients underwent laparoscopic cholecystectomy for symptoms related to gallbladder disease. All patients underwent ultrasound examination prior to their surgery and histopathological analysis of their gallbladder postoperatively. We undertook a retrospective analysis of these patients comparing their pre-operative ultrasound scan and their histopathology report for the presence or absence of gallstones. Ultrasound scans were performed by a combination of radiologists and ultrasonographers.

RESULTS

The study identified a sensitivity of 0.85 and a specificity of 1 for ultrasound in the identification of gallstones. We found a sensitivity of 0.84 and 0.83 for the radiologists and ultrasonographers, respectively.

CONCLUSIONS

This study suggests that, despite an evolution in the resolution of ultrasound imaging, there has not been a corresponding improvement in sensitivity. There is a false positive rate of 16% which remains unchanged since the early 1990s.

Clinical profile and outcome of swine flu in Indian children

Objective

To describe the clinical characteristics and outcome of Indian children infected with 2009 H1N1 influenza virus.

Study design

Retrospective chart review.

Setting

Outpatient department and hospitalized patients in a tertiary care hospital.

Methods

Clinical details of 85 children (positive for the 2009 H1N1 virus infection tested by real-time reverse-transcriptase-polymerase-chain-reaction assay) were analyzed from medical charts.

Results

Of the 85 (55 boys) children positive for 2009 H1N1 virus infection, 64.7% were between 5 years to 16 years, and 35.3% were below 5 years age. The mean age of these children was 7.5±3.5 yr. Contact history was positive only in 22 (26%) cases. High grade fever was the most common symptom, followed by cough and rhinorrhea. Twenty-nine (34%) patients had an underlying co-morbid condition. Of the 34 patients who underwent chest radiography during evaluation, 18 children (52.9%) had findings consistent with lower respiratory tract infection. Antiviral therapy was initiated in 76 patients. Hospitalization was required in 30 (35.3%) children. Risk factors for hospitalization included underlying co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph. Mean length of hospitalization was 131±76 hours, irrespective of underlying disease. Three children developed Acute Respiratory Distress Syndrome and died.

Conclusions

Clinical features and routine laboratory investigations in children with swine origin influenza were non-specific. Children with co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph were at higher risk of hospitalization.

Muscle healing and nerve regeneration in a muscle contusion model in the rat

The nervous system is known to be involved in inflammation and repair. We aimed to determine the effect of physical activity on the healing of a muscle injury and to examine the pattern of innervation. Using a drop-ball technique, a contusion was produced in the gastrocnemius in 20 rats. In ten the limb was immobilised in a plaster cast and the remaining ten had mobilisation on a running wheel. The muscle and the corresponding dorsal-root ganglia were studied by histological and immunohistochemical methods. In the mobilisation group, there was a significant reduction in lymphocytes (p = 0.016), macrophages (p = 0.008) and myotubules (p = 0.008) between three and 21 days. The formation of myotubules and the density of nerve fibres was significantly higher (both p = 0.016) compared with those in the immobilisation group at three days, while the density of CGRP-positive fibres was significantly lower (p = 0.016) after 21 days. Mobilisation after contusional injury to the muscle resulted in early and increased formation of myotubules, early nerve regeneration and progressive reduction in inflammation, suggesting that it promoted a better healing response.

Cytogenesis in the adult rat dentate gyrus is increased following kindled seizures but is unaltered in pharmacological models of absence seizures

The production of new neurons continues throughout adulthood in the dentate gyrus of the hippocampal formation, and is believed to play a role in hippocampus-dependent learning and memory. Seizure-induced changes in adult neurogenesis have been examined primarily in convulsive rodent seizure models, but not in models of nonconvulsive absence seizures. This study examined progenitor cell proliferation in the gamma-hydroxybutyrate (GHB) model of typical absence seizures and the AY-9944 model of atypical absence seizures, and compared these results with changes seen in the rat amygdala kindling model. Kindled subjects were found to have 189% more proliferating cells than sham-kindled control subjects, whereas no significant difference was found between the GHB or AY-9944 model and control subjects. These results suggest that changes in adult neurogenesis in models of absence seizures do not occur, and that seizure-induced enhancement of neurogenesis could depend on the characteristics of the seizure discharge.

Urinary tract pathogens and resistance pattern

BACKGROUND

Epidemiology and resistance patterns of bacterial pathogens in paediatric urinary tract infections (UTIs) show large inter-regional variability, and rates of bacterial resistance are changing due to different antibiotic treatment. Empiric therapy to treat UTI should be tailored to the surveillance data on the epidemiology and resistance patterns of common uropathogens to reduce treatment failures and emergence of bacterial resistance within the community.

OBJECTIVE

A retrospective data review was carried out to evaluate the resistance patterns to commonly used antibiotics in children with culture proven UTIs.

METHODS

All infants and children with culture proven UTI from 2002 to 2008 were included. Urine culture was deemed positive with a pure growth >10(5) (single organism).

RESULTS

A total of 547 UTIs were confirmed on urine cultures in 337 patients. An average of 78 cases were diagnosed each year. E coli was the most commonly grown pathogen (92%). From 2002 to 2008, rising resistance patterns were noted for trimethoprim (p<or=0.05) and Augmentin (p<or=0.001). In contrast, resistance to cefalexin and nitrofurantoin remained relatively low (11% and 7%, respectively, in 2008).

CONCLUSION

Our data suggest that there has been an increasing resistance trend to the first-line antibiotics like trimethoprim and Augmentin against E coli. In accordance with NICE (National Institute for Health and Clinical Excellence) guidance, each region should monitor resistance patterns to urinary pathogens on a regular basis and use antibiotics with a low resistance pattern. Further studies are required from other centres in the UK to look at similar data.

Social constraints before sanitation improvement in tea gardens of Sylhet, Bangladesh

Sylhet, the northeastern divisional city of Bangladesh, is the major tea-producing region of the country where a large number of low-income workers completely depending on extremely labor-intensive economic activity for their bread and butter, live in and around the tea gardens. The living conditions of these communities are remarkably meager due to the lack of proper utility facilities, especially in water supply and sanitation sectors. A study was conducted at Lakkatura and Ali Bahar Tea Estates to assess the deteriorated sanitation condition of the tea garden workers community and to determine the constraints before the improvement of the condition. It was found that the existing sanitary condition of both of the tea garden slums is very poor because of the same topographical condition and socioeconomic and cultural status of the dwellers. About 50% to 60% tea garden workers still are used to open defecation causing various excreta related diseases and not practiced with washing hand after defecation. Lack of knowledge and awareness about health and hygiene, unwillingness, poverty, superstitions, etc. are responsible for the deteriorated condition of the sanitation system. Based on the analysis, providing latrines free of costs, undertaking extensive motivational and awareness programs and publicity, regular consultation of tea garden workers with the health specialists, and vector control staff of concerned utilities as well as an integrated water supply, sanitation, and hygiene promotion programs should be considered as the priority in order to improve the deteriorated sanitary conditions in two tea gardens.