Processing movement related cortical potentials in EEG signals for identification of slow and fast movements

The extraction of intended kinetic information from an EEG signal can have several applications related to the rehabilitation for subjects with various neurological disorders. However, the task is mainly constrained by the low signal-to-noise ratio for the EEG signals. It is well known that the cortical activity takes place at a very low frequency since it is characterized by the dropping of movement related cortical potential (MRCP) across the sampled EEG signal. The strong variations in the MRCP is indicative of the noise due to various sources. The aim of this work is to remove this noise from the EEG signals using empirical mode decomposition, which decomposes a signal into harmonics (intrinsic mode functions--IMF) of various frequencies. The IMFs pertaining to small frequencies are later used for features extraction where we extract the spatial and spectral features from the selected IMFs. The features are later used for classification using support vector machines (SVM). Our experiments show superior results to the benchmark method for the underlying dataset that has been used in this research.

Effect of environmental air pollution on type 2 diabetes mellitus

OBJECTIVE

Air pollution is a novel risk factor for insulin resistance and occurrence of type 2 diabetes mellitus (T2DM), but the evidence is limited and diverse. Therefore, the aim of this study was to assess the effect of environmental air pollution on incidence of type 2 diabetes mellitus.

METHODS

In this study, we identified 102 published studies through a systematic data base search including ISI-Web of Science, EMBASE and PubMed. We searched the related literature by using the key terms including diabetes mellitus, air pollution, occupational and environmental pollution, gaseous, NO2, particulate matter pollutants PM2.5, and PM10. Studies in which diabetes mellitus, insulin resistance, air pollution, occupational and environmental pollution was discussed were included in the study. No confines on publication status, study design or language of publication were considered. Descriptive and quantitative information were extracted from the selected literature. Finally we included 21 publications and remaining studies were excluded.

RESULTS

Air pollution is a leading cause of insulin resistance and incidence of type 2 diabetes mellitus. The association between air pollution and diabetes is stronger for traffic associated pollutants, gaseous, nitrogen dioxide, tobacco smoke and particulate matter.

CONCLUSIONS

Exposure to air pollutants is significantly associated with increased risk of type 2 diabetes mellitus. It is suggested that, environmental protection officials must take high priority steps to minimize the air pollution, hence to decrease the incidence of type 2 diabetes mellitus.

Chemical vapour deposition of Ir-based coatings: chemistry, processes and applications

Iridium-based film precursor chemistry, nucleation and growth at CVD/ALD are reviewed with numerical characterization of the growth features in 3D objects.

Diabetes during Ramadan: underestimated, under-investigated, needs more attention

OBJECTIVE

In Ramadan, Muslims adults fast from sunrise to sunset for a period of a month. Due to paucity of data it seems that, diabetes mellitus during Ramadan is underestimated and the statistics are not a reflection of the actual reality. The aim this study is to highlight the staggering demographics in the diabetic Muslim population and emphasize its ramifications on fasting during Ramadan.

METHODS

In this study, we identified 37 published studies through a systematic database searches including ISI-Web of Science and PubMed. We searched the related literature by using the key words Diabetes Mellitus, Ramadan Fasting, Ramadan Fasting complications. Studies in which Diabetes Mellitus, Ramadan Fasting was discussed were included in the study. No limitations on publication status, study design or language of publication were obligatory. Finally we included 19 publications and remaining 18 were excluded.

RESULTS

Today's emerging diabetes hotspots in Muslim majority countries are the Middle East, Western Pacific, Sub-Saharan Africa and South-East Asia. Poverty, lack of education, poor healthcare, minimum available data and inappropriate guidance for the diabetic patients are the major risk factors resulting in serious complication during fasting in the month of Ramadan.

CONCLUSIONS

Still there are big gaps in the management of diabetic patients during Ramadan, the care of diabetic patients is fragmented and it is felt that diabetes during Ramadan is underestimated, under-investigated and needs more attention. It is vital to empower the healthcare workers and the patients in the frontlines with the appropriate information about Ramadan fasting in diabetic patients. Diabetic patients who fast during Ramadan should be adequately investigated and engaged in a structured Ramadan-focused diabetes education to undertake the fast safely.

Phylogenetic analysis of human metapneumovirus among children with acute respiratory infections in Kuala Lumpur, Malaysia

Human metapneumovirus (HMPV) is a recently discovered cause of viral respiratory infections. We describe clinical and molecular epidemiology of HMPV cases diagnosed in children with respiratory infection at University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The prevalence rate of HMPV between 2010 and 2012 was 1.1%, and HMPV contributed 6.5% of confirmed viral respiratory infections. The HMPV patients had a median age of 1.6 years, and a median hospital admission of 4 days. The most common clinical presentations were fever, rhinitis, pneumonia, vomiting/diarrhoea, and bronchiolitis. Based on the partial sequences of F fusion gene from 26 HMPV strains, 14 (54%) were subgenotype A2b, which was predominant in 2010; 11 (42%) were subgenotype B1, which was predominant in 2012; and 1 (4%) was subgenotype A2a. Knowledge of the circulating subgenotypes in Malaysia, and the displacement of predominant subgenotypes within 3 years, is useful data for future vaccine planning.

A case series of steroid-induced diabetes mellitus in Zaria, Nigeria

INTRODUCTION

New-onset diabetes Mellitus can occur in patients without documented hyperglycaemia before corticosteroid therapy, however hyperglycaemia has been reported as an adverse effect of steroids such as Prednisolone.This may be encountered in the management of haematologic disorders or malignancies when prolong administration or high dose prednisolone is used alone or as an adjuvantto cytotoxic agents

AIM

To report three adults who developed hyperglycaemia following an oral administration of prednisolone and to review the current literature on Steroid-induced diabetes mellitus. Method:We undertook a review of the case records of the three patients and an electronic MEDLINE as well as a manual library search of existing pertinent literature.

RESULT

Three male adults aged 55, 50 and 65 years old developed Diabetes Mellitus following the oral steroid administration. In the first case, oral Prednisolone (60mg/day) was used in combination to a cytotoxic agent Melphalan in the management of a plasma cell dyscrasia (Multiple Myeloma), the second case followed a one week course of same dose of prednisolone for Chronic lymphocytic leukaemia while the third case also had oral prednisolone administered alone for an Autoimmune Haemolytic anaemia. Aging, high body mass index and cumulative doses of steroids may be risk factors for the development of steroid-induced hyperglycaemia. The prevalence of this condition, possible pathogenesis and options for treatment are discussed.

CONCLUSION

Steroid-induced diabetes mellitus is an important clinical finding that, if recognized early, can be effectively treated. We propose Fasting blood sugar and Oral glucose tolerance test as part of the pretreatment investigation during the evaluation as well as in the course of management of middle aged and elderly patients on steroids.

Studies on Organophosphorus Insecticides II Distribution and metabolism of 32P-O, O-dimethyl-2,2,2-trichloro-l-methoxyethyl phosphonate in the adult larva of “Prodenia litura F“

The distribution of P32-labelled O,O-dimethyl-2,2,2-trichloro-1-methoxyethyl phosphonate (1) among different organs of adult larva of Prodenia litura F., showed that considerable radioactivity was translocated in hemolymph and gut. Significant accumulation of the P32-activity in the fat with time has been observed. The “in vivo” metabolic rate of I in Prodenia larvae was relatively small (12 — 16% of the applied dose during 20 hours). The major metabolite (75 — 85%) is produced by splitting of both O-methyl ester linkages and excreted as glucuronide. Monomethyl- (5 — 10%) and dimethyl phosphates (10 — 15%) were also identified as metabolic products.

I. Preparation of some Dipterex Analogues and stability of O,O-Dimethyl-2,2,2-Trichloro-1- Methoxyethyl Phosphonate

Dipterex and its homologues have been prepared by a single vessel reaction in good yields. The stability of O,O-dimethyl-2,2,2-trichloro-1-methoxyethyl phosphonate Ib towards temperature and pH variation has been studied using P32-labelled compounds. Compared with the parent substance (Dipterex), Ib is much more stable.

The anticholinesterase activity of Dipterex was found to be over 300 times higher than that of the methyl ether Ib; thus proving that the presence of the free hydroxyl group in Dipterex and its anticholinesterase activity are correlated.

Metabolism of organophosphorus insecticides: IV. Translocation and metabolism of 32P-labelled Dipterex in cotton plant

The uptake of 32P-labelled Dipterex by the cotton plant (Gossypium barbadense), has been studied following topical application on the leaf, as well as via root. The insecticide did not penetrate into the leaf cells, when applied topically, but is readily taken up by the root, when immersed in a solution of radioactive insecticide. Also the rate of respiration was found to increase significantly in plants treated with sublethal concentrations of Dipterex.

The metabolic fate of Dipterex within the plant tissues has been also investigated. Dimethylphosphate, monomethylphosphate and inorganic phosphate have been identified as degradation products of te insecticide.

Translocation and Degradation of 14C-Labelled Sevin in Cotton Plant

The distribution and metabolic fate of Sevin in cotton plant has been investigated using 14C-insecticide labelled at two different sites. Sevin is readily absorbed by the root system. Hydrolytic and nonhydrolytic mechanisms contribute almost equally to the metabolism of the insecticide. A specific esterase hydrolyzes the ester bond to produce 1-naphthol, methylamine and CO2 (24% of the absorbed dose). The liberated methylamine undergoes partly a process of oxidative degradation to CO2. A major metabolite possessing the skeleton CO-C (O) -N-C is probably produced by hydroxylation of the naphthalene ring

Cost-effectiveness of transcatheter aortic valve implantation (TAVI) for aortic stenosis in patients who are high risk or contraindicated for surgery: a model-based economic evaluation

BACKGROUND

Calcific aortic stenosis (AS) is a common valvular heart disease. Patients with severe symptomatic AS typically survive less than 3 years. In such patients, intervention with surgical aortic valve replacement (SAVR) may increase survival. However, in some patients SAVR is associated with a high operative risk and medical management is considered appropriate. Transcatheter aortic valve implantation (TAVI) is a relatively recent technique to avoid the invasiveness of open surgery. This procedure has been used for the treatment of patients with severe AS who are unsuitable for SAVR (because it is too high risk and/or for other reasons such as suffering from porcelain aorta) and is increasingly being considered for other patients.

OBJECTIVES

To determine the cost-effectiveness of TAVI being made available for patients who are high risk or contraindicated for SAVR through a review of existing economic evaluations and development of a model.

DATA SOURCES AND REVIEW METHODS

Bibliographic databases [MEDLINE, EMBASE, The Cochrane Library, Health Technology Assessment (HTA), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database (EED), Centre for Reviews and Dissemination HTA, DARE and NHS EED], guideline resources, current trials registers, websites/grey literature and manufacturers' websites, and consultation with clinical experts were used to identify studies for the review and information for the model. Databases were searched from 2007 to November 2010. A model was built to assess the cost-effectiveness of TAVI separately in patients suitable and unsuitable for SAVR, together with overall results for the effect of making TAVI available. Substantial deterministic sensitivity analysis was carried out together with probabilistic sensitivity analysis.

RESULTS

No fully published cost-effectiveness studies were found. Modelling patients not suitable for SAVR, the base-case results show TAVI as more costly but more effective than medical management, with an incremental cost-effectiveness ratio (ICER) of £12,900 per quality-adjusted life-year (QALY). The ICER was below £20,000 per QALY for over 99% of model runs in the probabilistic sensitivity analysis. For patients suitable for SAVR, the comparator with TAVI is a mixture of SAVR and medical management. TAVI is both more costly and less effective than this comparator assuming that most patients would receive SAVR in the absence of TAVI. This is robust to a number of assumption changes about the effects of treatment, but sensitive to assumptions about the proportion of patients receiving SAVR in the comparator. If the use of TAVI is extended to include more patients suitable for SAVR, the overall results from the model become less favourable for TAVI.

LIMITATIONS

The modelling involves extrapolation of short-term data and the comparison between TAVI and SAVR is not based on randomised data. More trial data on the latter have been published since the modelling was undertaken.

CONCLUSIONS

The results for TAVI compared with medical management in patients unsuitable for surgery are reasonably robust and suggest that TAVI is likely to be cost-effective. For patients suitable for SAVR, TAVI could be both more costly and less effective than SAVR. The overall results suggest that, if a very substantial majority of TAVI patients are those unsuitable for SAVR, the cost-effectiveness of a broad policy of introducing TAVI may fall below £20,000 per QALY. Future work required includes the incorporation of new data made available after completion of this work.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Do non-monetary incentives for pregnant women increase antenatal attendance among Ethiopian pastoralists?

In a pastoralist setting in Ethiopia, we assessed changes in attendance between the first and subsequent antenatal care (ANC) visits following the implementation of non-monetary incentives in a primary health care centre over a 3-year period from October 2009 to September 2012. Incentives included the provision of a bar of soap, a bucket, a mosquito net, sugar, cooking oil, a jerrycan and a delivery kit. The first ANC visits increased by 48% in the first year to 60% in the second. Subsequent visits did not show a similar pattern due to ruptures in incentive stocks. Incentives appear to increase ANC attendance; however, ruptures in stock should be avoided to sustain the effect.

Colour preference and light sensitivity in trilobite larvae of mangrove horseshoe crab, Carcinoscopius rotundicauda (Latreille, 1802)

The trilobite larvae of C. rotundicauda were tested to determine their colour preference and light sensitivity until their first moulting (25 days post hatching) under laboratory conditions. Maximum congregation size of the trilobite larvae was found in the white zone respectively where (n = 12) followed by yellow (n = 8) and orange (n = 8), which showed the larval preference for lighter zones. Morisita's index calculation showed a clumped/aggregated distribution (yellow, blue, orange and white) and uniform/hyper dispersed distribution (green, red and black) for various colours tested. Trilobite larvae showed least preference for brighter regions while tested in the experiment [black; (n = 4) and red; (n = 5)]. Experiments done to determine the light sensitivity of trilobite larvae showed that the larvae had more preference towards ultraviolet lights. The maximum congregation size of 38.8 and 40.7% of the larvae was encountered under ultraviolet light, when the light sources were kept horizontal and vertical, respectively. Overall, results suggested that the trilobite larvae of C. rotundicauda, preferred light source of shorter wavelengths (UV light) and colours of lighter zone (white, yellow, orange), which might be due to their adaptation to their natural habitat for predator avoidance, prey selection and water quality.

Central nervous system–immune reconstitution inflammatory syndrome presenting as varicella zoster virus-mediated vasculitis causing stroke

Varicella zoster virus (VZV)-mediated vasculitis is a rare cause of stroke, but should be considered in HIV patients where vasculitis can occur in association with central nervous system – immune reconstitution inflammatory syndrome (CNS-IRIS). A literature search revealed 7 reports of VZV vasculitis over the years with no unifying management strategy, highlighting the difficulty in managing rare conditions in the absence of clear guidelines. This is the first documented case of VZV-mediated vasculitis presenting as stroke in the United Kingdom. Our patient made a full recovery with multidisciplinary input from HIV, neurology and radiology specialists.

Prevalence of erectile dysfunction among Saudi type 2 diabetic patients

OBJECTIVES

The present study aimed to determine the prevalence and etiology of erectile dysfunction in Saudi type 2 diabetic patients.

PATIENTS AND METHODS

429 Saudi type 2 diabetic male patients aged more than 30 years were recruited. Total and bio-available serum testosterone, sex hormone binding globulin and free testosterone levels were measured by ELISA-IBL GMBH Germany.

RESULTS

47 (12.6%) subjects had hypogonadism with total testosterone < 8 nmol/l and 109 (29.3%) had possible hypogonadism with a total testosterone between 8 and 12 nmol/l. Similarly, using bioavailable levels, 30 (8%) men had overt hypogonadism with bioavailable testosterone < 2.5 nmol/l and 89 (33.9%) men had possible hypogonadism with bioavailable testosterone between 2.5-4 nmol/l; while 266 (71.6%) patients with free testosterone < 0.255 nmol/l had hypogonadism. BMI and waist circumference were both significantly negatively correlated with testosterone levels in Saudi type 2 diabetic men.

CONCLUSIONS

Testosterone levels are frequently low in Saudi men with type 2 diabetes and majority of these patients have symptoms of hypogonadism. The prevalence of erectile dysfunction (ED) was 86.7% in diabetic men with low testosterone level of 8-12 nmol/L. Obesity is an associated factor with low testosterone levels and ED in Saudi type 2 diabetic patients.

Diabetes during Ramadan - PRE-approach model: presentation, risk stratification, education

OBJECTIVE

Fasting (Sawm) during Ramadan is one of the five pillars of Islam and mandatory for all Muslim healthy adults. Most of the Muslim diabetic patients insist on fasting in Ramadan despite their exemption. Due to paucity of literature, diabetes during Ramadan is underestimated and the statistics are not reflecting the actual reality. The aim of this study is to highlight the demographics in diabetic Muslim population and emphasize its ramifications on Ramadan fasting.

METHODS

In this study, we developed a 3 step PRE-approach model based on Presentation, Risk stratification, Education in diabetics who fast during Ramadan. For the establishment of this model we identified 40 published studies in database searches including ISI-web of science and pub-med. We searched the related literature by using the key words including diabetes mellitus, Ramadan fasting. All studies in which diabetes and fasting in Ramadan was investigated were included. There was no limitation on publication status, design or language. Finally, we included 35 publications and remaining 5 were excluded from the study.

RESULTS

The diabetic patients who fast are at risk of severe hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, thrombosis, strokes and retinal artery occlusion. Lack of education, poor healthcare and no structured guidance cause adeverse health consequences.

CONCLUSIONS

It is vital to empower the healthcare workers and the patients in the frontlines with appropriate information. To preempt and minimize the problems faced by the diabetic patients who fast, available resources should be mobilized to efficiently and effectively reach out these patients. Diabetic patient educational guidelines about Ramadan fasting should be disseminated and translated into major regional languages to minimize the complications. Diabetic patients who are stable, free of deteriorating complications and able to manage can be allowed to fast.

Research progress and prospects of Saudi Arabia in global medical sciences

OBJECTIVES

Since last decade, Saudi Arabia has been swiftly moving ahead to promote an education and research in the country. This study aimed to investigate the research outcome of Saudi Arabia in medical sciences during the period 1996-2012.

MATERIAL AND METHODS

In this study, the research papers published in various global science journals during the period 1996-2012 were accessed. We recorded the total number of research documents having an affiliation with Saudi Arabia. The main source for information was Institute of Scientific Information (ISI) Web of Science, Thomson Reuters and SCI-mago/Scopus.

RESULTS

In global science data base, Saudi Arabia contributed 103804 documents in all science and social sciences. In medicine the total number of research papers from Saudi Arabia are 16196, citable documents 14732, total citations 102827, citations per documents 6.36 and Hirsch index (h-index) is 92. However, in combined medical and allied health sciences the total number of research papers are 27246, citable documents 25416, total citations 181999, mean citations per documents 7.07 and mean h-index is 41.44. Furthermore, Saudi Arabia contributed 40797 research documents in ISI indexed journals only and also 151 research documents in highly reputable and towering science journals.

CONCLUSIONS

Saudi Arabia's research performance in global medical sciences has markedly increased during the period 2006-2012. The research publications are continuously on mounting path; however, the number of citations has decreased. The country improved its regional as well as international research rankings and graded 45 in the world in year 2012.

Triorchidism: two case reports

In this study, two cases of triorchidism are reported. The first case (29 years) had two right discrete ovoid nontender, firm, mobile lumps with testicular sensation. The second case (32 years) had two left discrete ovoid nontender, firm, mobile lumps with normal testicular sensation. They were subjected to the estimation of serum follicle-stimulating hormone, luteinising hormone, free and total testosterone, alpha-fetoprotein, prostate-specific antigen, karyotyping and semen analysis. Imaging included ultrasonography, transrectal ultrasound, magnetic resonance imaging and intravenous pyelography. The first case had two testes in the right side. Each one had an epididymis where one vas deferens was palpated. The second case had two left testes with normal testicular sensation. The lower left lump represented normal-sized testis attached to its epididymis and a single palpated vas deferens. Diagnosis of the first case was triorchidism associated with left varicocele (grade I) with oligoasthenoteratozoospermic semen profile. Intracytoplasmic sperm injection was carried out resulting in a twin. Diagnosis of the second case was triorchidism with accessory testis on the left side associated with left varicocele (grade I) and asthenozoospermic semen profile that was submitted to medical treatment. It is concluded that triorchidism is an uncommon congenital anomaly that should be not overlooked in diagnosing scrotal masses.

The Effect of TMPTMA Addition on Electron-beam Irradiated LDPE, EVA and Blend Properties

In this work low density polyethylene (LDPE) and ethylene vinyl acetate (EVA) were blended in the presence of trimethylol propane trimethylacrylate (TMPTMA) (0 to 6 phr). The resultant blends were irradiated with a 3 MeV electron-beam resulting in dosages of 0 to 240 kGy using a rhodotron accelerator system. The effect of radiation exposure on the LDPE/EVA/TMPTMA blend properties were investigated with respect to gel content, tensile strength and elongation up to breakage of the blends. The findings indicate that increasing EVA and TMPTMA content yield tighter network structures through enhanced blend crosslinking, which is a direct consequence of irradiation. For pure EVA significant tensile strength improvements are evident as irradiation increases up to 210 kGy. Irradiated blends exhibit improved tensile strength and elongation at breakage with respect to pure LDPE and EVA. Volume resistivity (VR) and dielectric constant (DC) of the blends were also studied as a function of EVA content, TMPTMA content and radiation dosage. Increasing EVA and TMPTMA content enhances DC and VR values, whereas, increasing irradiation dosage only effects VR values of the blends. The maximum VR value attained in this work corresponds to a radiation dosage of 170 kGy and a blend comprising of 30 wt% of EVA.

Flammability and Thermal Characterization of Aluminum Hydroxide Filled with LDPE

Aluminum hydroxide (ATH), a non-toxic and environmentally friendly flame retardant, was characterized using thermogravimetric analysis (TGA) and differential thermal analysis (DTA). The effect of ATH content on flammability properties of LDPE was also determined using limiting oxygen index (LOI) and smoke density test. The thermal characterization studies showed that the effective temperature range for ATH as a flame retardant is 200 to 350°C. In water release test, it was determined that the release of the water by ATH degradation in ATH increased with increasing temperature. The LOI test showed that the flame retardancy of LDPE increased with increasing ATH content and decreasing ATH particle size. The smoke density test proved that addition of ATH reduced effectively the smoke density of a burning LDPE. It was studied in this paper the effect of ATH particle size on thermal, flammability and viscosity of ATH filled with LDPE.

X-linked inhibitor of apoptosis (XIAP) deficiency: the spectrum of presenting manifestations beyond hemophagocytic lymphohistiocytosis

X-linked inhibitor of apoptosis (XIAP) deficiency caused by mutations in BIRC4 was initially described in patients with X-linked lymphoproliferative syndrome (XLP) who had no mutations in SH2D1A. In the initial reports, EBV-associated hemophagocytic lymphohistiocytosis (HLH) was the predominant clinical phenotype. Among 25 symptomatic patients diagnosed with XIAP deficiency, we identified 17 patients who initially presented with manifestations other than HLH. These included Crohn-like bowel disease (n=6), severe infectious mononucleosis (n=4), isolated splenomegaly (n=3), uveitis (n=1), periodic fever (n=1), fistulating skin abscesses (n=1) and severe Giardia enteritis (n=1). Subsequent manifestations included celiac-like disease, antibody deficiency, splenomegaly and partial HLH. Screening by flow cytometry identified 14 of 17 patients in our cohort. However, neither genotype nor protein expression nor results from cell death studies were clearly associated with the clinical phenotype. Only mutation analysis can reliably identify affected patients. XIAP deficiency must be considered in a wide range of clinical presentations.

Laparoscopic repair of perforated peptic ulcer: patch versus simple closure

BACKGROUND

Laparoscopic correction of perforated peptic ulcer (PPU) has become an accepted way of management. Patch omentoplasty stayed for decades the main method of repair. The goal of the present study was to evaluate whether laparoscopic simple repair of PPU is as safe as patch omentoplasty.

METHODS

Since June 2005, 179 consecutive patients of PPU were treated by laparoscopic repair at our centers. We conducted a retrospective chart review in December 2012. Group I (patch group) included patients who were treated with standard patch omentoplasty. Group II (non-patch group) included patients who received simple repair without patch.

RESULTS

From June 2007 to Dec. 2012, 179 consecutive patients of PPU who were treated by laparoscopic repair at our centers were enrolled in this multi-center retrospective study. 108 patients belong to patch group. While 71 patients were treated with laparoscopic simple repair. Operative time was significantly shorter in group II (non patch) (p = 0.01). No patient was converted to laparotomy. There was no difference in age, gender, ASA score, surgical risk (Boey's) score, and incidence of co-morbidities. Both groups were comparable in terms of hospital stay, time to resume oral intake, postoperative complications and surgical outcomes.

CONCLUSION

Laparoscopic simple repair of PPU is a safe procedure compared with the traditional patch omentoplasty in presence of certain selection criteria.

Severe antibody-mediated rejection following IVIG infusion in a kidney transplant recipient with BK-virus nephropathy

Intravenous immune-globulin (IVIG) use in renal transplantation has increased, with common uses including desensitization, treatment of antibody mediated rejection and adjunctive therapy for BK virus nephropathy. Although considered generally safe, potential side effects can occur in up to 23% of patients including acute kidney injury. We present a case of an unexpected cause of acute kidney injury in a renal transplant recipient following IVIG infusion. A 48-year-old nonsensitized female with end stage renal disease secondary to polycystic kidney disease received a deceased donor kidney transplant. The initial post-transplant period was unremarkable however at three years post-transplant the patient develops BK virus nephropathy. Despite a reduction in immunosuppression, graft function worsened and IVIG infusion was commenced. Immediately following the IVIG infusion, the patient develops anuric acute kidney injury necessitating hemodialysis. Renal transplant biopsy performed before and after the IVIG infusion revealed the de novo development of acute antibody mediated rejection and donor specific antibodies in the serum. Anti-HLA and donor-specific antibodies were also confirmed in a diluted sample of the IVIG preparation. We argue that the anti-HLA antibodies present in the IVIG caused an acute antibody mediated rejection in this previously nonsensitized female.

A phytotoxin Solanapyrone-A downregulates calcium-dependent protein kinase activity in potato

We previously demonstrated that alternaric acid, a host-specific toxin produced by the plant pathogenic fungus Alternaria solani, in the presence of Ca(2+) and Mg(2+), stimulated in vitro phosphorylation of His-tagged calcium-dependent protein kinase 2 from potato cultivar Rishiri (RiCDPK2). Herein, we report that Solanapyrone-A (SpA), a non-host-specific toxin produced by A. solani, inhibited the phosphorylation of RiCDPK2 in the presence of Ca(2+) and Mg(2+). However, SpA stimulated RiCDPK2 phosphorylation in the absence of these cations. Based on the current findings, we suggest that RiCDPK2 may mediate SpA-induced signaling independent of Ca(2+) and Mg(2+), leading to a compatible interaction between potato and A. solani.

Clozapine as a potential treatment for refractory impulsive, compulsive, and punding behaviors in Parkinson's disease

There have been emerging cases of medication refractory obsessions, impulsivity, compulsivity, and/or punding in Parkinson's disease. These cases have proven difficult to treat, even for the experienced clinician. We report several medication refractory cases with a positive response to treatment with clozapine.