Post-operative Fat Embolism Syndrome: A case report and review of literature

Fat embolism occurs in all patients with long bone fractures and intra-medullary reaming of long bone but is usually asymptomatic. A few patients will have pulmonary, cerebral and dermal dysfunction; this triad is called fat embolism syndrome (FES). We report a case of FES developed after intramedullary nailing of both femurs that was successfully managed in our surgical intensive care unit (SICU).

Tumors in the lung--morphologic features and the challenge of integrating biomarker signatures into diagnostics

In the last decade, pathologic approaches concerning diagnosis and treatment of lung carcinomas have increasingly moved towards the implementation of molecular methods into the process of decision. In this study, an overview is given referring to the variety of tumors in the lung including common primary lung neoplasms and secondary tumors, and a modus operandi is presented which integrates immunology as well as molecular pathology within the process of finding correct diagnoses. Besides the conventional and approved methods and techniques leading to appropriate treatment including so-called targeted therapies, pathologist's work meanwhile depends on both histologic and molecular results. Since molecular techniques have increasingly entered the field of routine diagnostics, challenges and possibilities have changed and are still rapidly developing. The proceeding integration of molecular-biologic investigations into the process of diagnosing has changed the nature of diagnostics and will continuously grow in the near future. Only by obtaining a proper diagnosis, the optimal treatment of a patient can be assured, whereupon the knowledge of gene mutations and/or altered protein expression is crucial. By identifying those novel molecular target structures, the therapeutic spectrum is tremendously enlarged and will finally improve the patient's prognosis by personalized targeted therapies.

Synthesis, docking studies and anti-inflammatory activity of some 2-amino-5,6,7,8-tetrahydroquinoline-3-carbonitriles and related compounds

A series of 2-amino-5,6,7,8-tetrahydroquinoline-3-carbonitriles 4a-c has been synthesized and reacted with various reagents. Docking studies into the catalytic site of p38 mitogen activated protein kinase (MAPK) were used to identify potential anti-inflammatory lead compounds. The anticipated lead derivative 2-(pyridin-3-yl)-5-(4-methoxyphenyl)-6,7,8,9-tetrahydropyrimido[4,5-b]quinolin-4-amine 9b was endowed with good binding energy. Also, the obtained products were evaluated for their in vivo antiinflammatory activity as prostaglandin inhibitiors (% inhibition of edema and % inhibition of plasma PGE2 at the two dose levels were determined). The tested compounds exhibited significant anti-inflammatory activity and minor ulcerogenic effects, when compared to the reference standard indomethacin, with product 9b being of particular interest.

Prognostic values of lung resistance protein (LRP) and P53 in patients with multiple myeloma (MM)

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Background: This study was undertaken to assess the significance of lung-resistance related protein (LRP) expression and p53 mutations in plasma cells from untreated multiple myeloma (MM) patients and to determine whether LRP expression and p53 deletions was associated with a poor response and survival in patients treated with a conventional dose of melphalan. Methods: We have studied LRP expression by immunocytochemistry and p53 deletions by interphase fluorescence in situ hybridization (FISH) with a DNA probe specific for the p53 locus at 17p13 in bone marrow plasma cells from 38 untreated patients with MM received conventional oral dose melphalan (0.25 mg/kg, day 1 to 4) combined with prednisone (MP). We also studied their association with both response to chemotherapy and survival of the patients. Results: By FISH, deletions of p53, were detected in 31.5% of patients and LRP was found positive in 36.8%. Patients with a p53 deletion were predominantly at stage III (p53 deletion in 83.4% of stage III patients vs. 8.3% of patients at stages I and II respectively; P = 0.04). Both p53 deletion and LRP expression were correlated with other laboratory and clinical parameters. The overall response rate of all of the evaluable patients was 63.2%. The response rate was 79.2% for patients without LRP expression but only 35.7% for patients with LRP expression (P = 0.01). Among the 12 patients with a p53 deletion by FISH, 25% responded compared with 75% of patients without p53 deletion (P = 0.001). With the exception of LRP expression and p53 deletions, there was no other prognostic variable sharing any correlation with response. The median survival of LRP-positive patients was 11 months (95%-Cl: 9 to 24), whereas the median survival duration of LRP negative patients was not reached (Cl: 26 to 82; P < .002; hazard ratio [HR] = 2.9 (1.4–5.7). Patients with and without p53 deletions had significantly different overall survival times (median 13.9 months, 95%-CI: 8 to 26 and median not reached, CI: 24 to84, respectively; P < .0001; hazard ratio [HR] = 2.6). Conclusions: For patients with MM who were treated with conventional-dose chemotherapy, LRP expression and p53 deletions provides prognostically relevant information in addition to that provided by standard prognostic factors.

No significant financial relationships to disclose.

Pattern of haematological diseases diagnosed by bone marrow examination in Yemen: a developing country experience

There is lack of information about the relative prevalence of haematological disorders in Yemen and other Middle East countries. The aim of this study was to evaluate the pattern of haematological diseases diagnosed by bone marrow examination in Yemen considering the limited diagnostic facilities. At the referral haematology centre in Yemen, between November 1999 and November 2005, 785 patients >14 years old were evaluated by bone marrow examination. Relevant investigations were performed when needed. A total of 627 patients had haematological disorders other than lymphoma, and their data were analysed. There were 273 females and 354 males. A total of 159 patients had Acute myeloid leukaemia, 75 had acute lymphocytic leukaemia, 87 had chronic myeloid leukaemia, 36 chronic lymphocytic leukaemia, eight had multiple myeloma, 13 myelodysplastic syndromes, seven myelofibrosis, seven polycythaemia vera, three primary thrombocythaemia, two hairy cell leukaemia, two metastases, 36 aplastic anaemia, 29 immune thrombocytopenic purpura (ITP), nine autoimmune haemolytic anaemia, three pernicious anaemia, 65 iron deficiency anaemia, 57 megaloblastic anaemia and malaria, 18 mixed deficiencies, and 11 patients had visceral leishmaniasis. Sex- and age-related distribution of the various disorders was also presented. In conclusion, the leukaemias were the most frequently encountered diagnosis followed by iron deficiency anaemia, megaloblastic anaemia and malaria, aplastic anaemia and ITP respectively. The other haematological disorders were less common. These findings are comparable with that seen in other developing and developed countries.

Evaluation of the use of rapid urease test: Pronto Dry to detect H pylori in patients with dyspepsia in several cities in Indonesia

AIM: To evaluate Pronto Dry examination in patients with dyspepsia.

METHODS: The study was conducted in patients with dyspepsia who underwent endoscopic examination in several endoscopic centers of several cities in Indonesia from January 2003 until April 2004. Biopsies for histopathologic examination were fixed with formalin and sent to Histopathologic Department to be analyzed and confirm the presence of H pylori infection. If H pylori was found positive, the density was calculated semi quantitatively. Histopathologic examination from gastric biopsy samples was interpreted based on the updated Sydney system classification.

RESULTS: Of 550 patients, 309 (56%) were male and 241 (44%) were female with ages ranging from 15 to 82 years. Mean age was 44.98 ± 14.46 years. Mean age of male patients was 44.35 ± 13.85 years and mean age of female patients was 45.78 ± 15.19 years. Evaluation of endoscopic results showed gastric ulcer in 36 cases (6.5%) and duodenal ulcer in 20 cases (3.6%). Normal endoscopic finding was found in 45 cases (8.2%) and minimal disorder of gastritis and duodenitis were found in 246 cases (44.7%). One case of gastric cancer was identified. Of 56 cases which were positive based on the criteria used, 39 patients were positive with Pronto Dry and 17 patients were negative with Pronto Dry. Overall sensitivity and specificity of Pronto Dry were 69.7% and 95.7% respectively. Positive predictive value was 66.1% and negative predictive value was 96.4% and overall accurate rate was 92.9%.

CONCLUSION: Pronto Dry seems promising as a diagnostic tool to detect H pylori more rapidly and accurately.

Making EmOC a reality--CARE's experiences in areas of high maternal mortality in Africa

OBJECTIVE

This paper describes the package of interventions undertaken by the CARE/AMDD program collaboration to increase the availability and quality of emergency obstetric care for 3 high maternal mortality countries in Africa.

METHODS

Project implementation over 4 years focused on enhancing the capacity of 10 district hospitals in 3 countries - Tanzania, Rwanda and Ethiopia. Interventions were designed to create functional health facilities with trained and competent staff, working in an enabling environment supporting EmOC service delivery.

RESULTS

By keeping a clear focus on EmOC, the project achieved modest improvements in services, even in the face of the considerable constraints of rural district hospitals. Availability and utilization of EmOC increased in Tanzania; the met need for EmOC increased slightly from 14% in year 1 to 19% in year 4, while in Rwanda it increased from 16% to 25% over 4 years. Case fatality rates (CFR) declined by 30-50% in all 3 countries. While still well below UN recommendations, in all 3 countries there was also a progressive increase in the cesarean section rates, a life saving obstetric intervention.

CONCLUSIONS

The increases in met need and decreases in case fatality suggest that project interventions improved the quality and use of EmOC, a critical component for saving women's lives.

Epidemiology of epilepsy in Pakistan: review of literature

OBJECTIVE

To review literature pertinent to the epidemiology of epilepsy in developing countries with special reference to Pakistan.

METHODS

All the studies published in medical journals related to epilepsy in Pakistan were systematically reviewed. Important findings from various studies are summarized.

RESULTS

Overall prevalence of epilepsy in Pakistan is estimated to be 9.99 per 1000 population. Highest prevalence is seen in people younger than 30 years of age. A slight decrease in prevalence is noted between the ages of 40 and 59. Higher prevalence is observed in rural population. Etiology of epilepsy is more commonly identified in pediatric population. Epilepsy was considered idiopathic in 21 to 76% cases. Only 27.5% epileptic persons in urban areas and 1.9% in the rural areas were treated with AEDs. The burden of epilepsy is not fully evaluated and understood. Generalized seizures were the most common seizure type noted. Knowledge about epilepsy and its care is extremely low.

CONCLUSION

Epilepsy is a common medical problem in Paksitan, more prevalent is rural population. The majority of people with epilepsy are treated inadequately or inappropriately.

Pancreatitis in primary hyperparathyroidism

The cause and effect relationship between acute pancreatitis and primary hyperparathyroidism (pHPT) still evokes controversy. Our paper reviews the debate in the medical literature. In this controversy we add a case of a 49-year old non-alcoholic man presenting with recurrent attacks of acute pancreatitis. His raised serum calcium was realized rather late. Eventually, high intact parathyroid hormone levels led to open neck exploration and finding of a solitary parathyroid adenoma. Post-surgery, serum calcium returned to normal and abdominal symptoms disappeared. The case report and the accompanying literature review support our belief, that acute pancreatitis is one of the symptoms of pHPT often caused by a parathyroid adenoma and curable by its excision.

Nutrient digestibility of broiler feeds containing different levels of variously processed rice bran stored for different periods

Nutrient digestibility of broiler feeds containing different levels of variously processed rice bran stored for varying periods was determined. A total of 444 Hubbard male chicks were used to conduct four trials. Each trial was carried out on 111 chicks to determine digestibility of 36 different feeds. Chicks of 5 wk age were fed feeds containing raw, roasted, and extruded rice bran treated with antioxidant, Bianox Dry (0, 125, 250 g/ton), stored for a periods of 0, 4, 8, and 12 mo and used at levels of 0, 10, 20, and 30% in feeds. Digestibility coefficients for fat and fiber of feeds were determined. Increasing storage periods of rice bran significantly reduced the fat digestibility of feed, whereas no difference in fiber digestibility was observed. Processing of rice bran by extrusion cooking significantly increased digestibility of fat even used at higher levels in broiler feeds. Interaction of storage, processing, and levels was significant for fat digestibility. Treatments of rice bran by different levels of antioxidant had no effect on digestibility of fat and fiber when incorporated in broiler feed.

Congenital diaphragmatic hernia in a post-partum woman

Congenital diaphragmatic hernia (CDH) is rare in adults. We report a 24 year old woman presenting with shortness of breath, chest pain and nausea after the birth of her first baby. Clinical examination, plain radiography and a CT scan revealed herniation of abdominal contents into her left chest. Via a midline laparotomy, the contents were reduced and the defect repaired, using a mesh. She remains symptom-free three years since her surgery and even after a second childbirth. A brief review of the literature reporting adult diaphragmatic hernia of congenital origin accompanies this case report. We conclude that symptomatic CDH in adults usually presents as an emergency with gastrointestinal and occasionally respiratory complications. Early diagnosis and repair is essential to avoid subsequent morbidity and mortality.