Systematic review of fever, febrile convulsions and serious adverse events following administration of inactivated trivalent influenza vaccines in children

In 2010, increased febrile convulsions (FC) occurred after administration of inactivated trivalent influenza vaccine (TIV) in Australia. We systematically reviewed the rates of fever, FC and serious adverse events (SAEs) after TIV, focussing on published and unpublished clinical trial data from 2005 to 2012, and performed meta-analysis of fever rates. From 4,372 records in electronic databases, 18 randomised controlled trials (RCTs), 14 non-randomised clinical trials, six observational studies and 12 registered trials (five RCTs and seven non-randomised) were identified. In published RCTs, fever ≥ 38 °C rates after first dose of non-adjuvanted TIV were 6.7% and 6.9% for children aged 6–35 months and ≥ 3 years, respectively. Analysis of RCTs by vaccine manufacturer showed pooled fever estimates up to 5.1% with Sanofi or GlaxoSmithKline vaccines; bioCSL vaccines were used in two non-randomised clinical trials and one unpublished RCT and were associated with fever in 22.5–37.1% for children aged 6–35 months. In RCTs, FCs occurred at a rate of 1.1 per 1,000 vaccinated children. While most TIVs induced acceptably low fever rates, bioCSL influenza vaccines were associated with much higher rates of fever in young children. Future standardised study methodology and access to individual level data would be illuminating.

Middle East respiratory syndrome coronavirus "MERS-CoV": current knowledge gaps

The Middle East respiratory syndrome coronavirus (MERS-CoV) that causes a severe lower respiratory tract infection in humans is now considered a pandemic threat to the Gulf region. Since its discovery in 2012, MERS-CoV has reached 23 countries affecting about 1100 people, including a dozen children, and claiming over 400 lives. Compared to SARS (severe acute respiratory syndrome), MERS-CoV appears to kill more people (40% versus 10%), more quickly, and is especially more severe in those with pre-existing medical conditions. Most MERS-CoV cases (>85%) reported thus far have a history of residence in, or travel to the Middle East. The current epidemiology is characterised by slow and sustained transmission with occasional sparks. The dromedary camel is the intermediate host of MERS-CoV, but the transmission cycle is not fully understood. In this current review, we have briefly summarised the latest information on the epidemiology, clinical features, diagnosis, treatment and prevention of MERS-CoV especially highlighting the knowledge gaps in its transmission dynamics, diagnosis and preventive strategy.

Australian Hajj pilgrims' knowledge, attitude and perception about Ebola, November 2014 to February 2015

Upon return from Hajj 2014, 150 Australian pilgrims were interviewed about their understanding of the Ebola epidemic. Most (89%, 134/150) knew of the epidemic before travelling and 60% (80/134) of those knew Ebola transmits through body fluids. Pilgrims who received pre-travel health advice were more conscious of Ebola (69% vs 31%, p = 0.01) and adhered better to hand hygiene after touching an ill person (68% vs 31%, p < 0.01). Mass media was the main information source (78%).

Vaccinations against respiratory tract infections at Hajj

The transmission of respiratory tract infections (RTIs) is very high among the Hajj congregation in Mecca, Saudi Arabia. Despite recommendations for vaccinations, pilgrims remain at increased risk of RTIs. In this paper we systematically reviewed available studies assessing the uptake and effectiveness of vaccinations against RTIs among Hajj pilgrims and enumerated important demographic factors, if described, associated with vaccine uptake. Of the 42 included studies, 29 reported on the uptake and effectiveness of influenza vaccine among pilgrims, eight studies reported the uptake of other vaccines, notably pneumococcal, diphtheria and bacillus Calmette-Guérin vaccines, and the remaining five studies described both influenza and non-influenza vaccines. The uptake of seasonal influenza vaccine ranged from 0.7% to 100% across the study populations, with coverage highest in the elderly and those with pre-existing co-morbidities. The effectiveness of influenza vaccine was variable across studies but was significantly effective against laboratory-confirmed influenza (risk ratio 0.56; 95% CI 0.41-0.75; p <0.001) in pooled metadata from six studies. Uptake of diphtheria and pneumococcal vaccines was low, and the only study reporting pertussis among Hajj pilgrims found the presence of pre-Hajj immunity to be significantly protective against disease. Despite favourable evidence of effectiveness, our review shows variable uptake of vaccines across a number of studies with few data available on the uptake of non-influenza vaccines. Mixed-method studies are needed to gauge knowledge, attitudes and practices of Hajj pilgrims regarding vaccination, and randomized controlled trials are required to confirm the efficacy of vaccines and improve uptake in this vulnerable travelling population.

Comparison of efficacy of labetalol and fentanyl for attenuating reflex responses to laryngoscopy and intubation

Stress response due to laryngoscopy and intubation has been universally recognized phenomenon resulting in increase in heart rate, arterial, intracranial, and intraocular pressure. Various pharmacological approaches have been used to blunt or attenuate such pressure responses. This prospective, randomized, placebo controlled, double blinded study was designed to compare the efficacy of bolus dose of Labetalol and Fentanyl for attenuating reflex responses to laryngoscopy and intubation. Ninety patients with physical status of ASA I and II were scheduled for elective surgery under standard protocol of general anaesthesia, randomly allocated into three groups, consisting of 30 patients in each group, assigned as C (Control), L (Labetalol), and F (Fentanyl). In control group 10ml of 0.9% saline, in Labetalol group 0.25 mg/kg Labetalol and in Fentanyl group 2μgm/kg of Fentanyl were given intravenously at 3 minutes prior to laryngoscopy and intubation. Pulse rate, systolic, diastolic, mean arterial pressure and rate pressure products (RPP) were recorded before and after premedication, after administration of study drugs and at 1, 3, 5, 10 and 15 minutes after intubation. For statistical analysis of data, ANOVA tests were performed for comparison between groups. There were an increase in heart rate, systolic, diastolic, mean arterial pressures and rate pressure product in all the three groups after intubation in comparison to base line value. But the rise was minimum in L and F group as compared to C group which is statistically significant and also minimum in L group as compared to F group. So Labetalol is better agent for attenuation of laryngoscopic and intubation reflex.

Pathogenic Bacteria, Pesticide Residues and Metal Content in Giant Fresh Water Prawn, Macrobrachium Rosenbergii (De Man) Sold in Local Markets

The giant fresh water prawn, Macrobrachium rosenbergii (de Man), a leading export item of Bangladesh was studied in terms of pathogenic bacteria, pesticide residues and metal contents. In microbiological analysis, total viable bacteria, total coliform, total faecal coliform, total Salmonella and total Vibrio count were ranged from 6.8 × 104 to 1.6 × 106, 1.5 × 102 to 1.8 × 105, 0.0 to 5.0 × 102, 0.0 to 1.8 × 102 and 0.0 to 3.6 × 102 cfu/gm, respectively. Pesticide residue was analyzed by HPLC. Out of six samples studied, one was found to be contaminated with Quinalphos and another with Cypermethrin, where the concentrations were 0.03 and 0.56 ppm, respectively, below the maximum residue limit set by joint FAO/WHO expert committee. Copper (Cu), cadmium (Cd) and lead (Pb) concentrations were measured by atomic absorption spectrophotometer. The range found for Cu and Cd was from 0.01 to 0.11 ppm and 0.01 to 0.06 ppm, respectively, which is below the maximum residue limit set by joint FAO/WHO expert committee (10 ppm for Cu and 0.2 ppm for Cd). Relatively high microbial load and presence of pathogens in all the tested samples, collected from local market revealed that the samples had exposure to an unhealthy environment.DOI: http://dx.doi.org/10.3329/jbas.v35i1.7974Journal of Bangladesh Academy of Sciences, Vol.35, No.1, 91-97, 2011

Preoperative use of granisetron plus dexamethasone and granisetron alone in prevention of post operative nausea and vomiting in tonsillectomy

This prospective study was done for to see the efficacy of preoperative use of granisetron plus dexamethasone (Group A) & granisetron (Group B) alone for the postoperative prevention of nausea & vomiting after tonsillectomy operation. One hundred patients undergoing tonsillectomy & adenoidectomy operation under general anaesthesia who were admitted in the Mymensingh Medical College Hospital during the period from July 2008 to June 2009 with American Society of Anaesthesiologists (ASA) grade I & II with age 3-40 years, body weight 10-60 kgs, were studied. Observation of this study was analyzed in the light of comparison between the two groups. All results were expressed as mean±SEM. Age in Group A 15.98±1.028 & Group B 17.18±0.961 years; Weight in Group A 38.40±1.492 & Group B 39.76±1.561 kgs and operational duration in Group A 52.60±0.786 & Group B 52.70±0.823 minutes. The studied groups were statistically matched for age, weight, duration of surgery. We observed that the effects of combination of granisetron & dexamthasone are more than granisetron alone in prevention of nausea & vomiting after tonsillectomy operation. The frequency of vomiting was 4% in combination & 16% in single therapy which is statically significant (p<0.05).

Germ cell degeneration in high-temperature treated pufferfish, Takifugu rubripes

Exogenous factors such as temperature, social behavior, and salinity play a crucial role during the critical sensitive period of sex differentiation in many vertebrates. In fishes, amphibians, and reptiles temperature treatment is known to induce all-male (or female) individuals, and genes related to sex differentiation have been studied. The Japanese pufferfish, Takifugu rubripes, possesses the most compact genome among vertebrates and has immense potential for studies focusing on comparative genome analysis. In this study, we describe gonadal morphology and vasa (germ cell marker) and dmrt1 (Sertoli cell marker) expression on a molecular level in relation to the development of temperature-treated pufferfish. To investigate the relationship between temperature and gonadal development, pufferfish were exposed to high-temperature conditions (32 degrees C) during early gonadal development. Morphological observations showed that this high-temperature treatment did not influence sexual differentiation as determined by ovarian cavity characteristics; however, high-temperature treatment induces gonadal degeneration that is devoid of germ cells. RT-PCR results revealed no vasa expression within germ cell-degenerated gonads. In situ hybridization results showed that dmrt1 was expressed in somatic cells of germ cell-degenerated ovaries. These results suggest that high-temperature treatment during early gonadal development induces germ cell degeneration and masculinization of ovarian somatic cells in pufferfish.

Development and performance analysis of a standard orifice flow calibration system

An orifice flow system has been developed indigenously which is a primary standard for the calibration of high vacuum gauges in the range of 10(-3)-10(-6) mbar. It consists of a constant-volume flow meter, designed to generate a known flow rate of a particular gas to the vacuum chamber. This chamber is partitioned into two parts by a plate with an orifice of calculable conductance. The pressures, generated by this standard system, are compared with those of secondary standard, namely, spinning rotor gauge. Different uncertainties and correction factors are calculated. The maximum percentage deviation is from 1.16% to 0.97%. The combined uncertainties over the entire calibration range of the standard system are in the range of 4.0 x 10(-6) mbar.

Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach

BACKGROUND

Diabetic patients are more likely to develop critical leg ischaemia (CLI) and subsequently major amputation than the general population. Major amputation rate in this group is reported to be high compared with non-diabetic patients with a devastating outcome.

AIM

The aim of this study was to assess the impact of a multidisciplinary approach on the major amputation rate in diabetic patients with CLI suitable for surgical or radiological revascularisation.

METHODS

A retrospective analysis of data of all diabetic patients with CLI presenting to a one-stop multidisciplinary clinic between December 2003 and May 2006 was performed. The multidisciplinary team included a vascular surgeon, diabetologist, podiatrist, tissue viability nurse, interventional radiologist and a radiology coordinator. Peripheral vascular disease was assessed by history taking, clinical examination, ankle brachial pressure index, Doppler arterial waveform analysis and transcutaneous oxygen tension. Duplex scan and magnetic resonance angiography were performed in selected patients. Based on the available information, suitable patients were offered percutaneous transluminal angioplasty (PTA), surgical arterial reconstruction (SAR) or both (hybrid arterial reconstruction).

RESULTS

Three hundred and twelve diabetic patients with CLI were suitable for revascularisation. Eighty-two per cent underwent PTA while 18% underwent SAR. Thirteen threatened grafts were detected during follow-up and early intervention was performed as required. Major amputation rate among the study group was 4.1%.

CONCLUSION

Multidisciplinary approach improves the care of diabetic patients with CLI. Close follow-up and early intervention in dedicated centres improve limb salvage rates in this group of high-risk patients.

Histopathological changes of pancreas in patients with fibrocalculous pancreatopathy

A total of 20 pancreatic biopsy samples taken from Fibrocalculous Pancreatopathy previously known as Fibro Calculus Pancreatic Diabetes (FCPD) patients, a variant of Malnutrition Related Diabetes Mellitus (MRDM) or under 30 young diabetes attending hepatobiliary, surgical and out patient department of Bangladesh Diabetes, Endocrine and Metabolic (BIRDEM) hospital were processed for light microscopic examination. Four samples were subjected to Immunohistochemistry (IHC) staining using antibodies to T cell marker (CD3), B cell marker (CD20), anti apoptotic markers (bcl-2) and tumour suppressor gene marker p53. Light microscopic findings and IHC indicate an immune mediated injury of pancreatic tissue and increased evidence of apoptosis which possibly results in the development of diabetes in these patients.

Lymphoma masquerading as a recurrent brachial artery aneurysm

Malignant lymphoma infiltrating the brachial artery in a renal transplant patient has not been documented previously. We report an angiodestructive B-cell lymphoma in a 64-year-old post-renal transplant recipient. Improved longevity post-transplantation has been associated with an increased incidence of cancer which means that we will be seeing such patients more frequently in the future.

Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims

A high incidence of respiratory infection, including influenza, has been reported at the Hajj in Mecca, Saudi Arabia. Reported rates of influenza have been higher among UK than among domestic pilgrims, but this could be explained by methodological differences among studies. Accordingly, the present study compared the frequencies of respiratory viruses among UK and Saudi pilgrims using the same study design. Pilgrims with upper respiratory tract symptoms were recruited from Mecca and the neighbouring valley Mina during the Hajj 2006. Nasal swabs were used for point-of-care influenza testing and real-time RT-PCR (rtRT-PCR) tests for influenza virus, rhinovirus, parainfluenza virus, adenovirus, human metapneumovirus and respiratory syncytial virus. Of 260 pilgrims investigated, 150 were from the UK and 110 were Saudi; of these, 38 (25%) UK pilgrims and 14 (13%) Saudi pilgrims had respiratory infections detectable by rtRT-PCR (p 0.01). In the UK group, there were 19 (13%) cases of rhinovirus infection, 15 (10%) cases of influenza virus infection, two (1%) cases of dual infections with influenza virus and rhinovirus, one (3%) case of parainfluenza virus infection, and one (1%) case of respiratory syncytial virus infection. Fifty-six (37%) UK pilgrims had been vaccinated against influenza virus, with the rates of influenza in the vaccinated and unvaccinated group being 7% and 14%, respectively (p 0.19). In the Saudi group, there were three (3%) cases of rhinovirus infection and 11 (10%) cases of influenza. Only four (4%) Saudi pilgrims had been vaccinated against influenza virus, and none of these was infected with influenza virus. Overall, a significantly higher proportion of the UK pilgrims had detectable respiratory infections (25% vs. 13%, p 0.01). Influenza rates were similar in both groups, but the reported rates of influenza vaccination differed.

Fugu (Takifugu rubripes) sexual differentiation: CYP19 regulation and aromatase inhibitor induced testicular development

In order to assess the involvement of aromatase CYP19 isoforms and endogenous sex steroids in gonadal sex differentiation and development of the Japanese fugu (Takifugu rubripes), an aromatase inhibitor (AI, fadrozole) was administered to developing fishes from the 'first feeding' till the 100th day after hatching. It was observed that ovarian cavity formation was inhibited by fadrozole at doses of 500 and 1000 microg/g diet, which was followed by testicular differentiation in all treated fugu. In the non-treated fugu, CYP19A was predominantly expressed in the ovary and CYP19B in the brain (in both sexes), although both were expressed interchangeably at low levels. An exceptionally high expression of CYP19B was also evident in testis throughout the study period. Both forms of CYP19 mRNA showed low levels of expression in brain and gonad with no significant differences between the two AI treatments. AI treatment inhibited CYP19A mRNA in trunk during the crucial period of ovarian cavity formation and CYP19B in gonad and brain by the end of gonadal sex differentiation. An elevation of testosterone and 11-ketotestosterone was observed which can be associated with the down-regulation of the circulating 17beta-estradiol production during the AI treatment period. After stopping AI treatment, both circulating estrogen and androgen were normalized. The current results suggest that suppression of CYP19A before and during morphological sex differentiation inhibits ovarian cavity formation in fugu. Furthermore, non-detectable limits of 17beta-estradiol and high testosterone levels by the end of the gonadal differentiation period can be ascribed to inhibition of CYP19B, suggesting that conversion of 17beta-estradiol from testosterone is plausibly regulated by CYP19B, and that this factor (CYP19B) may play an important role in AI-induced testicular development after gonadal sex differentiation through regulation of the testosterone-17beta-estradiol balance in fugu.

Influenza and respiratory syncytial virus infections in British Hajj pilgrims

Viral respiratory infections including influenza and respiratory syncytial virus (RSV) have been reported during the Hajj among international pilgrims. To help establish the burden of these infections at the Hajj, we set up a study to confirm these diagnoses in symptomatic British pilgrims who attended the 2005 Hajj. UK pilgrims with symptoms of upper respiratory tract infection (URTI) were invited to participate; after taking medical history, nasal swabs were collected for point-of-care testing (PoCT) of influenza and for subsequent PCR analysis for influenza and RSV. Of the 205 patients recruited, 37 (18%) were positive for either influenza or RSV. Influenza A (H3) accounted for 54% (20/37) of the virus-positive samples, followed by RSV 24% (9/37), influenza B 19% (7/37), and influenza A (H1) 3% (1/37). Of the influenza-positive cases, 29% (8/28) had recently had a flu immunisation. Influenza was more common in those who gave a history of contact with a pilgrim with a respiratory illness than those who did not (17 versus 9%). The overall rate of RSV was 4% (9/202). This study confirms that influenza and RSV cause acute respiratory infections in British Hajj pilgrims. Continuing surveillance and a programme of interventions to contain the spread of infection are needed at the Hajj, particularly when the world is preparing for an influenza pandemic.

Evaluation of stentangioplasty in university cardiac center

In this ongoing prospective study conducted in University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2004 to January 2006. Fifty (50) patients (mean age 56+/-7.2 years) underwent stentangioplasty were evaluated. The study group of 50 patients consisted of 42 (84%) men and 08 (16%) women. The aim of this study was to evaluate in-hospital success, failure and complications during the procedures. About risk factors 19(38%) had hypertension, 13(26%) were smoker, 11(22%) suffered from diabetes mellitus, 05(10%) had family history of ischaemic heart disease. Average left ventricular ejection fraction was 54+/-7. Target vessel percutaneous coronary angioplasty (PTCA) were done in 61 vessel, intracoronary stent implanted in 58 vessels, direct stenting were done in 35 cases, failed PTCA were in 03(6%) cases and two had dissection. The native vessels had a mean reference diameter of 2.91 mm and their luminal diameter increased significantly after percutaneous coronary intervention (PCI). All the patients were discharged by one to three days of the procedure with improvement of their clinical condition. In conclusion, intracoronary stent deployment in coronary artery stenosis following balloon angioplasty is a valid and beneficial strategy with good in-hospital results.

Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort

OBJECTIVES

Traditionally secondary post-tonsillectomy haemorrhage has been thought to be due to post-operative infection and as such is treated with broad-spectrum antibiotics. The aim of this study was to identify clinical evidence of infection in patients with secondary post-tonsillectomy haemorrhage that might justify the use of antibiotics in these patients.

DESIGN

Prospective data collection.

SETTING

Tertiary University Teaching Hospital.

PARTICIPANTS

Adult patients admitted with post-tonsillectomy haemorrhage over a 2-year period.

MAIN OUTCOME MEASURES

Temperature, white cell count, Neutrophil count and C-reactive protein.

RESULTS

47 patients were admitted with secondary post-tonsillectomy haemorrhage. Fifteen out of 47 patients (32%) had an elevated white cell count but in them the other indicators of temperature and C-reactive protein were extremely variable: none of these 15 patients was pyrexial (> 37.6 C). An elevated C-reactive protein was found in 55% of patients but none had an elevated white cell count. The elevated C-reactive protein may have been influenced by the recent surgery rather than infection. Overall there was no clear interrelation between the indicators of infection in the patients and none had the three main indicators of infection (pyrexia, increased white cell count and elevated C-reactive protein).

CONCLUSIONS

Our results suggest that clinical signs of infection are lacking in patients with secondary tonsillectomy bleeding. Correspondingly the routine use of antibiotics should be questioned for secondary tonsillectomy haemorrhage.

Invos Cerebral Oximeter compared with the transcranial Doppler for monitoring adequacy of cerebral perfusion in patients undergoing carotid endarterectomy

AIM

The aim of this prospective study was to assess the correlation between signals obtained during carotid endarterectomy (CEA) under local (LA) or general anesthesia from the Somanetics Invos cerebral oximeter (CO) and transcranial Doppler (TCD).

METHODS

Forty patients were enrolled in the study. The percentages fall in TCD mean flow velocity (FVm) and CO regional oxygen saturation (rSO2) on the ipsilateral side following clamping were recorded and the correlation coefficient and Spearman's coefficient of rank correlation were calculated.

RESULTS

Fourteen patients were not included in the statistical analysis because either no TCD window or reliable TCD signal was obtained. The remaining 26 patients had a fall in either FVm, rSO2 or both during carotid clamping. There was a highly statistically significant correlation between the percentage fall in FVm and rSO2 with a correlation coefficient of 0.73, P<0.0001, with a 95% confidence interval (CI) for r=0.48 to 0.87; Spearman's coefficient of rank correlation (rho) =0.67, P=0.0008, with a 95% CI for rho=0.384 to 0.84. A significant decline in both TCD and rSO2 was noted in 3 patients under LA out of which 2 required shunts for alteration in conscious level. In 2 LA patients there was a significant decline in TCD but not in rSO2 and the endarterectomy was completed without a shunt.

CONCLUSIONS

Regional oxygen saturation correlates well with FVm during carotid clamping. However, the inability to obtain reliable TCD FVm readings in 35% of patients is a serious disadvantage for this monitor. It appears that CO is a satisfactory and possibly superior device for monitoring adequacy of cerebral perfusion and oxygenation during CEA in comparison with the TCD.

An integrated care pathway to save the critically ischaemic diabetic foot

This prospective study describes and evaluates the efficacy of an integrated care pathway for the management of the critically ischaemic diabetic foot patients by a multidisciplinary team. A weekly joint diabetes/vascular/podiatry ward round and outpatient clinic was established where patients were assessed within 7 days of referral by clinical examination, ankle-brachial-index-pressures, duplex angiogram and transcutaneous oxygen pressures. An angiogram +/- angioplasty or alternatively a magnetic resonance angiography prior to surgical revascularisation was performed in patients deemed not suitable for angioplasty based on the above vascular assessment. Between January 2002 and June 2003(18 months), 128 diabetic patients with lower limb ischaemia were seen. Thirty-four (26.6%) patients received medical treatment alone, and 18 (14.1%) were deemed 'palliative' due to their significant co-morbidities. The remaining 76 (59.4%) patients underwent either angioplasty (n = 56), surgical reconstruction (n = 18), primary major amputation (n = 2) or secondary amputation after surgical revascularisation (n = 1). Minor toe amputations were required in 35 patients. The mortality in the intervention group was 14% (11/76). This integrated multidisciplinary approach offers a consistent and equitable service to diabetic patients with critically ischaemic feet and appears to have a beneficial major/minor amputation ratio.

Emergence of multidrug-resistant Salmonella enterica serotype Typhi with decreased ciprofloxacin susceptibility in Bangladesh

During 1989-2002, we studied the antimicrobial resistance of 3928 blood culture isolates of Salmonella enterica serotype Typhi (S. Typhi) in Dhaka, Bangladesh. Overall 32% (1270) of the strains were multidrug-resistant (MDR, resistant to chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole); first detected in 1990 (rate of 8%), increased in 1994 (44%), declined in 1996 (22%, P<0.01 compared to 1994) and re-emerged in 2001 (36%) and 2002 (42%, P<0.01 compared to 1996). An increased MIC of ciprofloxacin (0.25 microg/ml) indicating decreased susceptibility to ciprofloxacin was detected in 24 (18.2%) out of 132 randomly selected strains during 1990-2002; more frequently in MDR than susceptible strains (46.3% vs. 5.5%, P<0.001), and the proportion of them rose to 47% in 2002 from 8% in 2000 (P<0.01). Ciprofloxacin (5 microg) disk diffusion zone diameters of < or =24 mm as break-point had 98% sensitivity and 100% specificity when compared with a ciprofloxacin MIC of 0.25 microg/ml as break-point for decreased susceptibility; being a useful and easy screen test. All strains were susceptible to ceftriaxone. The emergence of MDR S. Typhi with decreased ciprofloxacin susceptibility will further complicate the therapy of typhoid fever because of the lack of optimum treatment guidelines.

Association of malignant disease with critical leg ischaemia

BACKGROUND

The aim of the study was to determine the prevalence of malignant disease in patients with critical leg ischaemia (CLI).

METHODS

: Data for all patients with CLI presenting to a tertiary vascular unit over an 18-month interval were collected prospectively. Patients with clinical, laboratory or radiological features suggestive of malignancy were evaluated further.

RESULTS

Of 192 patients admitted with CLI, 22 (11.5 per cent) were found to have an associated malignancy; ten had lung cancer. Fifteen were anaemic on presentation. The prevalence of occult malignancy in patients with acute leg ischaemia was 16 per cent (ten of 62) compared with 9.2 per cent (12 of 130) in those with chronic CLI. Eleven of 22 of patients with CLI and malignancy died within 6 months, compared with 35 (20.6 per cent) of 170 patients with no evidence of malignancy.

CONCLUSION

A high prevalence of occult cancer was found in patients presenting with CLI; this was associated with a significantly increased mortality rate at 6 months.

Radiation processed hydrogel of poly (vinyl alcohol) with biodegradable polysaccharides

Poly(vinyl alcohol) (PVA) can be modified to polymer hydrogels by radiation crosslinking and can be used in different biomedical applications. A study was done on the optimization of ingredients concentration for preparing good quality PVA hydrogels with natural polysaccharides. The synthesized hydrogels were also characterized by measuring the different physical properties e.g. gel fraction, swelling and absorption rate. Besides these, sterility test were also performed. Good quality hydrogels were obtained from PVA and natural polysaccharides solutions with 27 kGy radiation dose. There is an influence of natural polysaccharides on the gel fraction of hydrogel. The increase in the amount of polysaccharide causes a decrease in gel fraction that is decrease in the crosslinking density of PVA hydrogel network. The prepared hydrogels were found to be sterile.

Infrasellar craniopharyngioma presenting as epistaxis, excised via Denker's medial maxillectomy approach

Infrasellar craniopharyngioma is an uncommon neoplasm. Rarely, it presents with epistaxis. To date, 39 cases of infrasellar craniopharyngioma have been reported in the world literature. Involvement of the maxillary sinus has only been reported once. We report a second case exclusively involving the nasal cavity, ethmoid sinus and maxillary sinus. Excision was performed using a Denker's medial maxillectomy approach.

Sensory hypoinnervation in club foot

We have compared the density of nerve fibres in the synovium in club foot with that of specimens obtained from the synovium of the hip at operations for developmental dysplasia. The study focused on the sensory neuropeptides substance P; calcitonin gene-related peptide; protein gene product 9.5, a general marker for mature peripheral nerve fibres; and growth associated protein 43, a neuronal marker for new or regenerating nerve fibres. In order to establish whether there might be any inherent difference we analysed the density of calcitonin gene-related peptide-positive nerve fibres in the hip and ankle joints in young rats. Semi-quantitative analysis showed a significant reduction in the number of sensory and mature nerve fibres in the synovium in club foot compared with the control hips. Calcitonin gene-related peptide (CGRP) positive fibres were reduced by 28%, substance P-positive fibres by 36% and protein gene product 9.5-positive fibres by 52% in club foot. The growth associated protein 43-positive fibres also seemed to be less in six samples of club foot. No difference in the density of CGRP-positive nerve fibres was observed in the synovium between ankle and hip joints in rats. The lack of sensory input may be responsible for the fibrosis and soft-tissue contractures associated with idiopathic club foot.

Depression, cognitive impairment and function in Alzheimer's disease

Depression is very common in patients with dementia but the relationship is very complex. Depression is regarded as a cause of excess disability in persons with dementia and contributes to their functional decline. The assessment of depression in dementia patients, however, has been difficult in that the validity of self-reported depression in patients with dementia has been questioned. This study was done to investigate whether self-reported depression by persons with dementia (using the GDS) is related to their functional abilities as rated by a family caregiver (using the IADL scale) above and beyond demographic variables. This study was conducted at the Detroit Satellite of the Michigan Alzheimer's Disease Research Center. There were 141 participants, 67% were African American and 33% were European American. Statistical analyses included a correlational and multiple regression approach to determine the predictive relationships of cognitive and depressive symptoms above and beyond the influence of demographic variables and cognition. The results of the study further support the notion that depression in dementia is significantly related to functional decline but, more importantly, that self-reported depression in patients with dementia can be valuable information in understanding patients' functioning.