Atrioventricular valve plane displacement in healthy persons. An echocardiographic study

A method of measuring the displacement of the atrioventricular (AV) of the left ventricle plane during the cardiac cycle in 71 healthy persons is described. An echocardiographic equipment with two cursors was used. Measurements were performed from four sites in the AV plane situated about 90 degrees apart and corresponding to the septal, anterior, lateral and posterior myocardial walls. The mean displacement during systole was 16 mm towards the apex. There was no significant difference in the recordings from the four sites. The study population was divided into three groups with mean ages 28, 42 and 60 years (group I, II and III). The displacement was significantly smaller in group III compared with groups I and II. Fractional shortening, however, could not demonstrate such a difference. The determination of displacement of the AV plane may imply the introduction of a new and simple method in assessment of left ventricular function.

The clinical implications (or lack thereof) of vegetations detected by echocardiography in patients not thought to have endocarditis

BACKGROUND

The clinical impact of echocardiographic demonstration of a vegetation (Veg) in patients in whom infective endocarditis (IE) is not suspected has not previously been analyzed.

HYPOTHESIS

In this study, an echocardiographic database was interrogated to test whether discovery of a vegetation by echocardiography should result in treatment for endocarditis if IE is not suspected.

METHODS

In all, 2,750 serial transthoracic echocardiograms (TTE) were reviewed to generate a list of reports containing the word Veg or thickening (Thk). A chart review of cases identified the impact the report had on patient management. To analyze reader bias due to echocardiographic requests, stating "rule out Veg or IE" as the reason for the study, an additional 1,000 serial TTE requests were segregated into two groups with and without this term. The incidence of the terms Veg or Thk in TTE reports of these groups was tabulated.

RESULTS

Of 2,750 reports, 20 contained the word Veg. Blood cultures were drawn in 16 of 20, with 7 of 16 being positive. Therapy for IE was initiated in 5 of 7 patients with positive cultures. Of 1,000 requests reviewed in the second phase, 24% of those with rule out Veg as the indication for TTE (n = 29) had Veg and 7% had Thk, while in 971 cases with other indications for TTE 0.2% had Veg and 9.3% had Thk.

CONCLUSIONS

Clinicians disregard TTE demonstration of Veg if clinical suspicion for IE is low. It is not clear whether the initial echo request biases the interpretation.

PCR for mecA gene of methicillin resistant Staphylococcus aureus

The study was under taken to detect mecA gene of methicillin resistant Staphylococcus aureus (MRSA) by PCR. It was carried out in the department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh between the periods from July 2006 to June 2007. A total of 40 S. aureus strains were used in this study. Isolates of S. aureus were identified by standard microbiology technique and their antimicrobial susceptibility test was done by disk diffusion method according to NCCLS. Minimum inhibitory concentration (MIC) of oxacillin was determined for all isolates by standard agar plate dilution method. All strains were tested for mecA gene by PCR. Out of 40 S. aureus strains 15(37.5%) were detected as MRSA by disk diffusion and agar dilution method but 10(25%) yielded mecA gene by PCR. Detection rate of MRSA by disk diffusion and agar dilution test showed significant difference to that by PCR (p<0.001).

Comparison between DOT EIA IgM and Widal Test as early diagnosis of typhoid fever

A recently developed DOT enzyme immunoassay known as "Typhidot" for detecting IgM antibody against 50 KDa OMP antigen of Salmonella typhi, was evaluated on 100 clinically suspected typhoid fever cases and 40 age-sex matched controls, in the Department of Microbiology, Mymensingh Medical College during, the period from June 2006 to July 2007. Blood culture, Widal test, and DOT EIA for IgM test were performed in all patients. Among 100 clinically suspected typhoid fever cases, 35 were subsequently confirmed on the basis of positive blood culture for S. typhi and/or significant rising titre of Widal test. The DOT EIA IgM test could produce results within 1 hour. The result of the DOT EIA IgM test showed a good diagnostic value for typhoid fever. The sensitivity, specificity, positive and negative predictive value of the test was found as 91.42%, 90.00%, 88.88% and 92.30% respectively. On the other hand corresponding values for Widal test were of 42.85%, 85.00%, 71.42% and 62.96% respectively. Thus, The DOT EIA IgM seems to be a practical alternative to Widal test for early diagnosis of typhoid fever.

Analysis of Carica papaya Telomeres and Telomere-Associated Proteins: Insights into the Evolution of Telomere Maintenance in Brassicales

Telomeres are terminal regions of linear eukaryotic chromosomes that are critical for genome stability and continued cell proliferation. The draft assembly of the papaya genome provides an opportunity to analyze and compare the evolution of telomeric DNA sequence composition and telomere maintenance machinery in this and other organisms of the Brassicales Order, which includes Arabidopsis. Here we investigate telomere size and sequence variation at papaya chromosome ends. As with most other plant species, papaya telomeres consist of TTTAGGG repeats. However, in contrast to members of the closely related Brassicaceae family, telomeres in papaya are ~10-fold longer. Sequence analysis reveals that many centromereproximal telomere repeats in papaya harbor nucleotide substitutions and insertions of Gs and Ts. In contrast, we found very few N-to-C substitutions, and even fewer instances of nucleotide deletion, suggesting that a six-nucleotide telomere repeat is not well tolerated. The papaya genome encodes single-copy sequence homologues of several genes involved in telomere maintenance and chromosome end protection, including the Telomerase Reverse Transcriptase (TERT) and Protection Of Telomeres (POT1). Notably, unlike Arabidopsis, which encodes six Telomere Repeat binding Factor-like (TRFL) proteins that bind double-stranded telomere DNA, papaya appears to encode only two such proteins. Thus, the more streamlined genome of papaya will provide an excellent resource for comparative and functional analysis of telomeres in plants.

Occurrence of a Clover Proliferation (16SrVI) Group Phytoplasma Associated with Little Leaf Disease of Portulaca grandiflora in India

Portulaca grandiflora (family Portulacaceae), commonly known as moss rose purslane, is a popular ornamental plant widely grown in temperate climates because it blooms all summer. Portulaca is also used for medicinal purposes since it is rich in vitamins A, B1, and C and has antimicrobial and cytotoxic activity. Since March 2005, 30 to 50% of P. grandiflora plants in the ornamental gardens as well as in pots at the Central Institute of Medicinal and Aromatic Plants, Lucknow, India have displayed symptoms resembling phytoplasma infection. Disease symptoms start as a typical bud proliferation, downward curling, and diminishing size of leaves, followed by overall stunted growth and yellowing of the whole plant from April to June. Some plants also formed rosettes and a proliferation of axillary shoots resulting in a witches'-broom appearance. Typical pleomorphic bodies, mostly spherical to oval, ranging from 340 to 1,100 nm were observed only in sieve elements of infected plants by transmission electron microscopy (TEM). On the basis of symptoms, TEM observations, PCR, and response to antibiotic treatment, the causal organism was identified as phytoplasma (1). Total genomic DNA from healthy and infected plants was extracted with the CTAB buffer method (2). Of 27 suspected samples screened by PCR, 23 were phytoplasma positive. Presence of phytoplasmas in plants was demonstrated by a nested PCR assay employing primer pair P1/P6 followed by R16F2n/R16R2 that generated rDNA products of 1.5 and 1.2 kb, respectively, only from symptomatic plants. No differences among phytoplasmas in Portulaca plants were detected by restriction fragment length polymorphism (RFLP) analysis of nested rDNA (1.2 kb) products using endonucleases BamHI, RsaI, AluI, HpaII, and EcoRI. Comparative analysis of RFLP patterns with those derived from reference phytoplasmas tentatively identified the Portulaca little leaf (PLL) phytoplasma as a member of 16S rDNA RFLP group 16SrVI (3). A nested PCR product (1.25 kb) was cloned with a TOPO TA cloning kit (Invitrogen, Carlsbad, CA) and sequenced. The sequence was deposited in the GenBank database (Accession No. EF651786). Sequence analysis revealed the PLL phytoplasma to be most similar (98%) to Indian brinjal little leaf (Accession No. EF186820) and 'Candidatus Phytoplasma trifolii' (Accession No. AY390261), two 16SrVI group phytoplasmas previously reported from India and Canada, respectively. The status of PLL (EF651786) was also verified by in silico RFLP analysis (4) of the F2n/R2 sequence of six closely related strains (Accession Nos. AF228052, AY390261, AY270156, AY409070, AY409069, and EF186820) of the 16SrVI group using 17 restriction enzymes (AluI, BamHI, BfaI, BsfUI, DraI, EcoRI, HaeIII, HhaI, HinfI, HpaI, HpaII, KpnI, MseI, Sau3AI, RsaI, SspI, and TaqI). In silico restriction digestion and virtual gel plotting showed similar patterns for all enzymes. To our knowledge, this is the first report of a 16SrVI group phytoplasma infecting Portulaca plants in India. References: (1) P. V. Ajayakumar et al. Aust. Plant Dis. Notes 2:67, 2007. (2) S. P. S. Khanuja et al. Plant Mol. Biol. Rep. 17:74, 1999. (3) I.-M. Lee et al. Int. J. Syst. Bacteriol. 48:1153, 1998. (4) W. Wei et al. Int. J. Syst. Evol. Mic. 57:1855, 2007.

Antigen detection from urine of Kala-azar cases by latex agglutination test

A recently developed Latex agglutination method known as "KATEX" for detecting leishmanial antigen in urine of Kala-azar patients was evaluated on 97 Kala-azar cases and 35 controls in the department of Microbiology, Mymensingh Medical College during the period from March' 2004 to February' 2005. The method yielded sensitivity as 100% and 82.8% in 33 confirmed and 64 ICT positive cases respectively. Since 8.6% controls showed antigen positive results, so specificity of KATEX was calculated as 91.4%. KATEX methods for antigen detection in urine should be used as an early immuno-diagnostic test as it has yielded high sensitivity. But interpretation of a positive test must be made cautiously having correlation with clinical findings as because it becomes false positive in Kala-azar free person. Further elucidation of KATEX method including larger population from community giving particular emphasis on its prognostic use was strongly recommended.

A step towards being EWTD compliant: a single institution study of the cardiothoracic surgery experience

The introduction of the European Working Time Directive has led to intensive debate regarding the working conditions, training and service delivery of Non Consultant Hospital Doctors. Surgical specialties are especially affected by the directive as they have always been associated with long working hours. These have been defended on the basis that these were required to achieve surgical competence. This study aims to survey the working hours and examine the activity of cardiothoracic surgery trainees, who traditionally worked long hours, in a single institution. Arising from the survey results, a novel working model is proposed.

Destructive deformation of the digits with auto-amputation: a review of pseudo-ainhum

Pseudo-ainhum is an auto-amputation of the digits. Although extremely rare, it is a traumatic and painful experience that can be alleviated with early recognition and intervention. The scientific literature is filled with reports of this interesting but unfortunate phenomenon. To date, a firm causative aetiology has not yet been established. Although reports on this phenomenon have attempted to further our understanding of pseudo-ainhum, a clear understanding has been complicated by the interchangeable use of terms describing this auto-amputation. In this review, we discuss the current understanding, diagnostic criteria, and management of pseudo-ainhum. Furthermore, the nomenclature of pseudo-ainhum is clarified. Ideally, this will allow for more efficient exploration of pseudo-ainhum, its causes, and therapeutic approaches.

Acute facial paralysis due to primary squamous cell carcinoma of the parotid gland

The incidence of primary squamous cell carcinoma in salivary gland tumours is rare. The first presenting symptom of a salivary gland tumour is usually a painless lump. Acute facial paralysis is uncommon to be the initial presentation. This case report describes a patient of acute facial paralysis due to primary squamous cell carcinoma of parotid gland who was initially incorrectly labelled as a case of Bell's palsy. He was managed successfully with total parotidectomy, neck dissection, facial nerve sacrifice with immediate cable graft reconstruction and fascia lata sling followed by postoperative radiotherapy. The sacrifice of the extra-temporal part of the facial nerve in rare cases can be unavoidable during parotid resections for malignancy when the nerve is grossly involved by the tumour. It is important in this situation that some form of nerve repair and/or facial rejuvenation is undertaken to avoid the unpleasant sequele of facial paralysis. His postoperative facial symmetry improved at rest and one year later he regained satisfactory eye closure and smile. Not all facial paralysis is Bell's palsy. All patients who are labelled as Idiopathic facial paralysis or Bell's palsy should have adequate clinical evaluation with detailed history and proper physical examination.

Multiply antibiotic-resistant Vibrio cholerae O1 biotype El Tor strains emerge during cholera outbreaks in Zambia

Antibiotic resistance data, made available from laboratory records during eight cholera outbreaks between 1990 and 2004 showed Vibrio cholerae serogroup O1 to have a low level of resistance (2-3%) to tetracycline during 1990-1991. Resistance increased for tetracycline (95%), chloramphenicol (78%), doxycycline (70%) and trimethoprim-sulphamethoxazole (97%) in subsequent outbreaks. A significant drop in resistance to tetracycline and chloramphenicol followed the adoption of a national policy to replace tetracycline with erythromycin for treating cholera. Sixty-nine strains from cholera outbreaks in Zambia between 1996 and 2004, were examined for antibiotic resistance and basic molecular traits. A 140 MDa conjugative, multidrug-resistant plasmid was found to encode tetracycline resistance in strains from 1996/1997 whereas strains from 2003/2004 were resistant to furazolidone, but susceptible to tetracycline, and lacked this plasmid. PCR revealed 25 of 27 strains from 1996/1997 harboured the intl1 class 1 integron but lacked SXT, a conjugative transposon element. Similar screening of 42 strains from 2003/2004 revealed all carried SXT but not the intl1 class 1 integron. All 69 strains, except two, one lacking ctxA and the other rstR and thus presumably truncated in the CTX prophage region, were positive for important epidemic markers namely rfbO1, ctxA, rstR2, and tcpA of El Tor biotype. Effective cholera management is dependent on updated reports on culture and sensitivity to inform the choice of antibiotic. Since the emergence of antibiotic resistance may significantly influence strategies for controlling cholera, continuous monitoring of epidemic strains is crucial.

Use of cutaneous lasers and light sources: appropriate training and delegation

In recent years, there has been increasing concern among physicians, patient advocacy groups, and media watchdogs that laser, light, and cosmetic surgery are being practiced by poorly trained professionals, with resulting preventable injuries to patients. In response, several professional organizations have developed guidelines for the delegation of laser services to nonphysician providers. These guidelines delineate appropriate qualifications for delegating physicians and nonphysician providers, and also describe the circumstances and settings in which delegation is appropriate.

Treatment of acne scarring

Acne scarring is common but surprisingly difficult to treat. Scars can involve textural change in the superficial and deep dermis, and can also be associated with erythema, and less often, pigmentary change. In general, treatment of acne scarring is a multistep procedure. First, examination of the patient is necessary to classify the subtypes of scarring that are present. Then, the patient's primary concerns are elicited, and the patient is offered a menu of procedures that may address the various components of the scarring process. It is important to emphasize to the patient that acne scarring can be improved but never entirely reversed.

Fractional Laser treatment for pigmentation and texture improvement

Fractional laser treatment with the 1,550 nm erbium fiber laser (Fraxel Laser, Reliant Technologies) has bridged the gap between the ablative and nonablative laser modalities used to treat the epidermal and dermal signs of skin aging. By targeting water as its chromophore, the laser induces a dense array of microscopic, columnar thermal zones of tissue injury that do not perforate or impair the function of the epidermis. The significant skin remodeling that ensues can be used to treat, with limited downtime, epidermal pigmentation, melasma, and rhytides, as well as textural abnormalities that include acne-related and surgical scars.