Septic arthritis, osteomyelitis, and cellulitis in a neonate: A case report and discussion of diagnosis and management

INTRODUCTION

Septic arthritis, osteomyelitis, and cellulitis are rare but life-threatening conditions in neonates. This case report emphasizes the significance of early diagnosis and intervention in such cases.

PRESENTATION OF CASE

We present a case of a male neonate, who developed septic arthritis, osteomyelitis, and cellulitis following trauma from a fall. The patient presented with fever, swelling, and limited joint movement. Diagnosis was based on clinical evaluation, laboratory investigations, and imaging studies. Treatment involved intravenous antibiotics for three weeks, followed by oral antibiotics for two weeks, resulting in complete recovery.

DISCUSSION

Neonatal septic arthritis and osteomyelitis are challenging to diagnose due to nonspecific symptoms. Early initiation of antibiotics is crucial to prevent long-term complications. Surgical intervention may be required in cases of inadequate antibiotic response or significant joint effusion. This case underscores the importance of prompt recognition and tailored management.

CONCLUSION

Septic arthritis, osteomyelitis, and cellulitis pose serious threats to neonates. Timely diagnosis, appropriate antibiotics, and, if needed, surgical intervention are vital for favorable outcomes. Individualized treatment plans should consider clinical condition and local protocols.

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan

Background and Objectives

The Valsalva maneuver (VM) is the most effective measure that can be carried out to treat supraventricular tachycardia (SVT). Our objective was to compare the efficacy of postural modified VM with 20 ml syringe to standard VM for the emergency treatment of SVT.

Methods

This randomized control trial study was conducted at the Accident and Emergency Department, Pakistan ordinance factories hospital, Wah Cantt from July 2019 to September 2020. In the standard Valsalva group, fifty patients were placed at an angle of 45 with continuous monitoring of vitals and electrocardiogram. Patients blew into a 20ml syringe to generate 40 mmHg pressure for 15 seconds and remained in the same position for 45 seconds before a reassessment of cardiac rhythm at one-minute and three-minute intervals. In the modified Valsalva group same procedure was repeated with the other fifty patients, but immediately at the end of the strain, they were laid flat with their legs raised to 45° for 15 seconds. Participants returned to semi-recumbent position and cardiac rhythm was reassessed after 45 seconds and then at one and three minutes.

Results

In the standard Valsalva maneuver (SVM)20.0% of participants versus 58% of participants in the modified Valsalva maneuvers group(MVM) reverted to sinus rhythm at one min (odds ratio or 5.52, 95% CI 2.26-13.47; p<0.001) and time of stay in the emergency room was (odds ratio or 2.39, 95% CI 1.45- 3.93; p<0.0001).

Conclusion

Modified Valsalva by using a wide-bore syringe is more effective method than standard Valsalva in terminating SVT.

Evaluation of Early Renal Involvement in Essential Hypertension by Measuring Urinary Biomarkers

Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age >30 years, duration of hypertension <5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR >60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODμg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p<0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) μg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.

Burnout prevalence and associated factors in medical students in integrated modular curriculum: A cross-sectional study

Objectives:

The present study aimed to explore the prevalence of burnout syndrome and to find the association of burnout symptoms with sociodemographic factors in medical students.

Methods:

A cross-sectional study was conducted between September 2019 to January 2021 at Shifa College of Medicine, Islamabad. A total of 284 medical students from the first year to the fifth year participated in this cross-sectional study. After taking informed consent, students were asked to record responses on the Burnout Clinical Subtype Questionnaire BCSQ-12. In addition, a structured questionnaire was developed to obtain information about the sociodemographic status.

Results:

Prevalence of burnout was observed among day scholars, females, and students having a relatively sedentary lifestyle. Low family income showed a significant association of burnout in medical students (p=0.025). A significant association was found in the mean scores of neglect subtype of burnout with low family household income (p = 0.010). The mean scores of the overload subtype of burnout and daily duration of sleep also showed a significant association (p = 0.039).

Conclusion:

The prevalence of burnout was associated with low household income and sleep deprivation. Gender, academic year and physical activity did not have a significant association with burnout syndrome. The high prevalence of burnout syndrome necessitates appropriate interventions to identify and reduce the prevalence of burnout in medical students.

Dermatological surgery: an update on suture materials and techniques. Part 2

This is the second part of a two-part series summarizing the latest evidence related to suture materials and wound closure techniques in dermatological surgery. We critically appraised evidence focusing on the following consequences of suture choice: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases MEDLINE, PubMed and Embase using the keywords 'skin surgery', 'dermatological surgery', 'sutures', 'braided sutures', 'monofilament sutures' and 'antibacterial sutures' to identify relevant English-language articles. This part of the review assesses the evidence for different types of buried sutures, including braided vs. monofilament sutures, longer-absorbing sutures and antibacterial sutures. The majority of trials were noted to be of poor quality, single-centre (thus lacking external validity) and underpowered, which presents challenges in comparing suture techniques in skin surgery. Future large-scale, multicentre, randomized trials are needed, with both surgeon and patient-assessed validated outcomes.

Management zone delineation and spatial distribution of micronutrients in cold-arid region of India

The plant health is governed by many factors: soil playing a central role which exhibits huge variability in its characteristics. Micronutrients even though needed in small quantities by plants play an indispensable role in affecting the crop growth and development. The assessment of spatial variability of different soil parameters is incumbent for tackling the loss of crop productivity on account of non-receipt of desirable inputs. The present investigation centered on the spatial distribution of soil parameters and micronutrients was conducted to delineate management zones (MZs) in cold arid region (Kargil) of India for proficient micronutrient management. Overall 454 georeferenced representative soil samples at the depths of 0-15 cm were garnered. The soil samples were processed and analyzed for different soil parameters encompassing pH, EC (electrical conductivity), SOC (soil organic carbon), and available micro-nutrient (iron, manganese, zinc, copper and nickel) concentrations. The distinct variation in the soil properties including micronutrients was identified with coefficient of variation ranging as low as 5.62% to moderate (21.16 to 42.49%) and as high as 159.63%. Semivariogram analysis and ordinary kriging of soil variables under study revealed diverse spatial distribution exhibiting medium to high spatial dependence in the region. PCA (principal component analysis) and K-means clustering were expended for the delineation of MZs. Four principal components (PCs) having eigen values > 1 and accounting for 70% of the total variation were subjected to further analysis. The five potential MZs were demarcated on the basis of K-means cluster performance index, and heterogeneity in parameters was discerned. The results of study corroborate that the spatial variability analysis of different soil parameters for delineation/identification of MZs might be effectually employed for site-specific micronutrient management.

Dermatological surgery: an update on suture materials and techniques. Part 1

Significant variation exists in the surgical suture materials and techniques used for dermatological surgery. Many wound-closure techniques are now practised, including use of sutures, staples and topical adhesives. The focus of our review article is to summarize the latest evidence relating to suture materials and wound-closure techniques, considering the following areas: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases Medline, PubMed and Embase using the keywords 'skin surgery', 'dermatologic surgery', 'sutures', 'suture techniques', 'suturing techniques' and 'surgical techniques' to identify relevant English-language articles. Absorbable superficial sutures may be a preferred alternative to nonabsorbable sutures by both patients and surgeons. Subcuticular sutures may be preferable to simple interrupted sutures for superficial wound closure, and there may also be a role for skin staples in dermatological surgery, particularly on the scalp. However, there remains limited evidence specific to dermatological surgery supporting the use of particular suture materials and suturing techniques. Further high-quality research is required, including multicentre randomized trials with larger cohorts.

Next steps in dermatology training: choosing to enter higher speciality training and the transition from trainee to consultant dermatologist

BACKGROUND

Junior doctors are required to make career decisions at an early stage in their postgraduate training. Trainees also feel inadequately prepared for the transition to consultant roles.

AIM

To explore the key factors influencing the choice of dermatology as a postgraduate medical career and to identify the training needs required for transition from trainee to consultant.

METHODS

An online questionnaire was designed to identify (i) why trainees chose a postgraduate medical career in dermatology, and (ii) the training required for transition from trainee to consultant.

RESULTS

In total, 46 responses were received from trainees in their first to final years (ST3-6), of whom 89% had undertaken an undergraduate dermatology placement, with a median duration of 2 weeks. Dermatology was considered as a career during medical school by 61% of trainees, and 41% confirmed their decision to pursue a career in dermatology during foundation training. The most influential factors involved in speciality selection were first, enjoyment of the work, second, postgraduate experience and equal third, the variety of the speciality and the regularity of working hours (P < 0.05). Mentoring was pivotal to career decision-making. Significant numbers of trainees expressed a need for training in medical leadership, such as running an outpatient clinic and supervising clinical multidisciplinary teams. Although larger numbers of trainees had training in management of dermatology services, such as service improvement (52%) and local governance/National Health Service structures (43%), significant numbers of trainees had no training in writing job plans (89%) or business plans (85%). Training was significantly deficient for personal management and self-awareness.

CONCLUSION

Our study highlights important considerations in career decision-making for trainees. Training in medical leadership, management and self-awareness could be enhanced to ensure that trainees feel adequately equipped for consultant roles.

Agricultural soils a trigger to nitrous oxide: a persuasive greenhouse gas and its management

Agricultural soils form the backbone of the country's economic development. The increased population has not only reduced this treasure but also has affected the global climate at an alarming rate. Among the GHGs, emission of N₂O due to agricultural activities is nowadays a global concern. Agricultural industries have increased N₂O and CH₄ by 17% in the atmosphere since 1990, with an average emanation rate of around 60 MT CO₂ equivalents per year. Crop production accounts for approximately 50% of N₂O emissions stemming from the farming community and discharges of fertilizer-induced N₂O, for the time being estimated by IPCC at 1.24% of the N used ranging from 0.76% (rice) to 2.77% (maize). The concentration of atmospheric N₂O has increased (60 ppb) after the industrial revolution, at the pace of 0.73 ppb year^-1. Besides, soil structure, temperature, moisture, denitrifying microbial population, pH, C:N ratio, and relief are the factors which significantly enhance the N₂O levels into the atmosphere. N₂O as a GHG has more potential towards global warming than CO₂ and has a very long residence period (115 years) in the atmosphere. N₂O emission is nowadays a core issue which needs to be mitigated so as to decline the levels of its production in agricultural soils. However, priority should be given to the organic farming, management of soil chemistry, and phytoremediation to reduce the addition of N₂O into the ambient air. Furthermore, deployment of N₂O reductase in agricultural soils increases the efficiency of converting N₂O to inert N₂ which is a valuable strategy to reduce N₂O production.

A review of studies looking at quality of life and psychological impact in people with photodermatoses - skin diseases triggered by sunlight

Photodermatoses, or photosensitivity conditions, are a group of skin disorders caused by exposure to sunlight, overall affecting a large number of people. They cause a range of distressing symptoms including pain and burn, and can make the skin blister, flake and scar. The conditions themselves and the need for patients to avoid and protect themselves from sunlight may affect quality of life and psychological health. This study, from the U.K., aimed to find out what methods of assessment (tools) have been used to evaluate quality of life and psychological health in photodermatoses, and report what the impact is for patients. The authors reviewed relevant published English-language studies and summarised their findings. 20 studies were included: 19 assessing quality of life and three assessing psychological function. Six different tools had been used to assess quality of life, and four different tools to assess psychological health. It was shown that 31-39% of patients with photodermatoses experienced a very large impact on their quality of life. There was a particular impact on issues related to employment, social/leisure activities and clothing choices. Patients had around double the rates of anxiety and depression found in the general population, although few studies focussed on psychological health. The authors also noted that most available tools were not designed to address the unique impact of intermittent sunlight-induced skin conditions and suggested that development of more specific tools could be beneficial. In conclusion, this study confirmed that patients with photodermatoses experience substantial impact on their quality of life and that more research is needed. This is a summary of the study: Quality of life and psychological impact in the photodermatoses: a systematic review.

Effects of Recombinant Irisin on Body Mass Index, Serum Insulin, Luteinizing Hormone and Testosterone Levels in Obese Female BALB/c Mice

OBJECTIVE

To determine the effects of recombinant irisin on body mass index (BMI), serum insulin, luteinizing hormone (LH) and testosterone levels, and to correlate the serum insulin levels with serum luteinizing hormone and testosterone levels and to correlate the body mass index with serum insulin levels in obese female BALB/c mice.

STUDY DESIGN

Laboratory-based experimental study.

PLACE AND DURATION OF STUDY

Department of Physiology, Shifa College of Medicine, Islamabad in collaboration with Research Laboratory of Shifa College of Medicine, National Institute of Health (NIH) and Reproductive Physiology Laboratory, Quaid-e-Azam University, Islamabad, from March 2015 to September 2016.

METHODOLOGY

Ninety female BALB/c mice were divided into three equal groups. Group A which was the control group was fed with normal chow diet. Group B and Group C were fed with high fat-high sucrose (HF-HS) diet for five weeks to induce obesity. After four weeks group C was divided into two subgroups. Group C-low dose (LD) was injected with low dose irisin and group C-High dose (HD) was injected with high dose irisin for one week. After five weeks, the BMI, serum insulin, LH and testosterone levels were measured in all the groups. Data was analysed by SPSS version 21. P-value of <0.05 was considered significant.

RESULTS

Group B showed statistically significant elevation in BMI, serum insulin, LH and testosterone levels as compared to Group A (p <0.001, <0.001, 0.007 and 0.014, respectively). Group C-HD showed statistically significant decrease in BMI, serum insulin, and LH as compared to Group B (p <0.001, 0.013 and 0.028, respectively). Serum testosterone level was also decreased in group C-HD as compared to Group B, however the difference was not significant.

CONCLUSION

Obesity increases the serum insulin, LH and testosterone and irisin significantly lowers the elevated BMI, serum insulin and LH levels in female BALB/c mice. It also lowers the elevated testosterone levels, but not significantly.

Quality of life and psychological impact in the photodermatoses: a systematic review

BACKGROUND

The photodermatoses affect large proportions of the population but their impact on quality of life (QoL) and psychological health has not been reviewed. Several tools are available to evaluate QoL and psychological impacts.

OBJECTIVES

To systematically review current literature to identify tools used to assess QoL and psychological impacts in patients with photodermatoses, and to summarize the reported findings.

METHODS

A systematic search of PubMed, OVID Medline, PsycInfo and CINAHL was performed for articles investigating QoL and/or psychological impact in patients with photodermatoses, published between 1960 and September 2018.

RESULTS

Twenty studies were included: 19 incorporated QoL assessment while three evaluated psychological morbidity. Six QoL tools were found to be used: Dermatology Life Quality Index (DLQI), Children's DLQI, Family DLQI, Skindex (16- and 29-item versions), Erythropoietic Protoporphyria Quality of Life (EPP-QoL) and EuroQol. Between 31% and 39% of photosensitive patients reported a very large impact on QoL (DLQI > 10). Employment and education, social and leisure activities, and clothing choices were particularly affected. Only one tool was specifically designed for a photodermatosis (EPP-QoL). Four tools were used to evaluate psychological impact: the Hospital Anxiety and Depression Scale, Fear of Negative Evaluation, brief COPE and Illness Perception Questionnaire-Revised. Levels of anxiety and depression were approximately double British population data. Patients with facial involvement, female gender and younger age at onset showed more psychological morbidity.

CONCLUSIONS

Several tools have been used to assess QoL in the photodermatoses, and confirm substantial impact on QoL. Development of specific, validated QoL measures would address their unique impacts. Research delineating their psychological comorbidity is sparse and requires further exploration. What's already known about this topic? The photodermatoses negatively impact quality of life (QoL) and cause psychological distress, but no reviews of this area appear in the literature. What does this study add? Few studies have explored the psychological and social impacts of the photodermatoses. There are no fully validated QoL tools specific to the photodermatoses. Around one-third of adult and child patients with photosensitivity experience very or extremely large impact on QoL, with particular effect on clothing choices, employment and social and leisure activities. Studies suggest anxiety and depression levels in these patients are around double those in the U.K. general population. More attention is required on these 'hidden' conditions.

Effect of Kisspeptin on Serum Prolactin and Gonadotropins Levels in Balb-c Mice with Induced Chronic Stress

OBJECTIVE

To determine and compare effects of kisspeptin on serum prolactin, luteinizing hormone and follicle stimulating hormone levels in Balb-c mice with and without exposure to chronic restraint stress.

STUDY DESIGN

An animal experimental study.

PLACE AND DURATION OF STUDY

Shifa College of Medicine / Shifa International Hospital Islamabad, in collaboration with National Institute of Health, Islamabad and Centre for Research in Experimental and Applied Medicine Laboratory, Army Medical College, Rawalpindi, from April 2014 to June 2015.

METHODOLOGY

Mice divided into three groups, each containing 30 mice. Control group (group A) received intraperitoneal injection of saline, group B was administered with intraperitoneal injection of saline and restrained stress, and group C was administered with both stress and kisspeptin 100 ng daily for four weeks. Restraint stress was applied to groups B and C for three hours per day by immobilising individual mice in wire-mesh restrainers. At the end of four weeks blood sampling was done. Serum luteinizing hormones (LH), serum follicular stimulating hormone (FSH) and serum prolactin (PRL) were analysed by ELISA.

RESULTS

Serum prolactin level increased in group B (stressed) and group C (stressed + kisspeptin treated) as compared to control group; and decreased in group C as compared to group B. Serum LH and FSH in group B was decreased as compared to control, and it was increased in group C as compared to control and group B.

CONCLUSION

Administration of kisspeptin increases level of gonadotropins and reduces stress-induced hyperprolactinemia, which may improve fertility despite stress in animal.

Synchronization and collective swimming patterns in fish (Hemigrammus bleheri)

In this work, we address the case of red nose tetra fish Hemigrammus bleheri swimming in groups in a uniform flow, giving special attention to the basic interactions and cooperative swimming of a single pair of fish. We first bring evidence of synchronization of the two fish, where the swimming modes are dominated by 'out-phase' and 'in-phase' configurations. We show that the transition to this synchronization state is correlated with the swimming speed (i.e. the flow rate), and thus with the magnitude of the hydrodynamic pressure generated by the fish body during each swimming cycle. From a careful spatio-temporal analysis corresponding to those synchronized modes, we characterize the distances between the two individuals in a pair in the basic schooling pattern. We test the conclusions of the analysis of fish pairs with a second set of experiments using groups of three fish. By identifying the typical spatial configurations, we explain how the nearest neighbour interactions constitute the building blocks of collective fish swimming.

An evaluation of the male reproductive toxicity of cathinone

(-)-Cathinone is the major psychoactive component of khat plant (Catha edulis Forssk.). Khat has been shown to produce reproductive toxicity in human beings and experimental animals. However, the chemical constituents of khat leaves responsible for sexual dysfunction are not known. In the present study cathinone enantiomers have been investigated for their reproductive toxicity in rats. Cathinone produced a dose-dependent decrease in food consumption and suppressed the gain in body weight. There was a significant decrease in sperm count and motility and increase in the number of abnormal sperms in cathinone treated animals. Histopathological examination of testes revealed degeneration of interstitial tissue, cellular infiltration and atrophy of Sertoli and Leydig's cells in cathinone treated animals. Cathinone also produced a significant decrease in plasma testosterone levels of the rats. Although both enantiomers of cathinone produced deleterious effects on male reproductive system, (-)-cathinone was found to be more toxic. From this study it may be concluded that the cathinone content in khat may be partially or totally responsible for the reproductive toxicity in khat chewers.

Electron microscopic study of the effects of thallium poisoning on the rat cerebellum

Rats were given thallium acetate (5 mg elemental thallium/kg body weight) intra-peritoneally daily for 7 days. The brain was fixed by perfusion-fixation and small pieces of the cerebellum were processed for electron microscopy. Variegated mitochondrial profiles, increased incidence of electron--dense bodies and proliferation of Golgi zones were observed in the thallium--poisoned rat cerebellum. Multilamellar cytoplasmic bodies were discernible in the cerebellar cortex of the thallium-treated rats.