Mirizzi syndrome complicated by type IV cholecystobiliary fistula to the right hepatic duct

Mirizzi syndrome is a rare complication of long-term chronic cholecystitis, characterized by extrinsic compression of the common hepatic duct that may progress to development of cholecystobiliary fistula.Here we report a case of a 38-year-old female patient who underwent laparoscopic cholecystectomy with intraoperative cholangiogram for acute cholecystitis and choledocholithiasis. Intraoperatively, the patient was found to have a Mirizzi syndrome complicated by cholecystobiliary fistula to the right hepatic duct. The gallbladder was successfully removed, cholelithiasis cleared and a ureteral stent was used in reconstruction. The patient was discharged on postoperative two and was doing well on routine follow-up. Ultimately, Mirizzi syndrome is a rare clinical entity that requires careful consideration during preoperative workup and a high suspicion when abnormal anatomy is encountered intraoperatively.

Physico-chemical properties and antibacterial drug performance of amoxicillin from streets in Bamenda, Cameroon

Background: The advent of microbial drug resistance creates a concern about the quality of anti-infective drugs. The rise in some microbial resistance to therapy has urged us to investigate physico-chemical properties and antibacterial performance of amoxicillin from streets in Bamenda, Cameroon.Methods: Amoxicillin samples were purchased from street vendors in Bamenda. Cameroon. Visual inspection was done for defects and signs of discoloration, deterioration or other physical disfiguration. Weight uniformity test for each sample of antibiotic tablet was carried out. The time for drug disintegration for each sample of amoxicillin was evaluated. Microbial antibiotic susceptibility tests were done using both the agar disc diffusion and micro well broth dilution methods to check drug performance. Data analysis was done and comparison checked with Student-Newman-Keuls at p<0.05.Results: The mean weight of amoxicillin drugs ranged from 632.00±11.5 to 748.06±17.9 mg. Tablets from Austria had a significant decrease in weight compared to those from Germany and Nigeria. This was similar with the capsules from India and China. Average disintegration varied significantly from as small as 2.2 to 14.4 minutes. All the amoxicillin samples were active against the tested bacteria with mean zones of inhibitions ranging from 8.33±0.57 to 39.33±0.57 mm. The MICs and MBCs values range from 1 to 64 µg/ml. For the same bacterium the growth inhibitory effects of the various drugs were not all similar.Conclusions: Some of the amoxicillin samples studied in this paper showed significant differences in their weights and performances (antibacterial activities). Probably the required amount of API was not respected.

Degradation of xenobiotic compounds by lignin-degrading white-rot fungi: enzymology and mechanisms involved.

White-rot fungi (WRF) are ubiquitous in nature with their natural ability to compete and survive. WRF are the only organisms known to have the ability to degrade and mineralize recalcitrant plant polymer lignin. Their potential to degrade second most abundant carbon reserve material lignin on the earth make them important link in global carbon cycle. WRF degrade lignin by its unique ligninolytic enzymatic machinery including lignin peroxidase, manganese peroxidase, laccase, cellobiose dehydrogenase, H2O2-generating enzymes, etc. The ligninolytic enzymes system is non-specific, extracellular and free radical based that allows them to degrade structurally diverse range of xenobiotic compounds. Lignin peroxidase and manganese peroxidase carry out direct and indirect oxidation as well as reduction of xenobiotic compounds. Indirect reactions involved redox mediators such as veratryl alcohol and Mn2+. Reduction reactions are carried out by carboxyl, superoxide and semiquinone radicals, etc. Methylation is used as detoxification mechanism by WRF. Highly oxidized chemicals are reduced by transmembrane redox potential. Degradation of a number of environmental pollutants by ligninolytic system of white rot fungi is described in the present review.

Desejo de informação e participação nas decisões terapêuticas em caso de doenças graves em pacientes atendidos em um hospital universitário / Desire of information and participation in therapeutic decisions concerning severe diseases, in patients of a University Hospital

OBJETIVO: Avaliar o desejo de pacientes serem informados sobre diagnóstico de doenças graves, de informação às suas famílias e de participação nas decisões terapêuticas. MÉTODOS: 363 pessoas atendidas no ambulatório ou internadas na enfermaria de um serviço universitário de Clínica Geral foram entrevistadas. O questionário continha perguntas sobre desejo de ser informado e de que familiares também fossem informados em casos de diagnósticos de câncer e síndrome da imunodeficiência adquirida (Aids) e de ser informado e participar de decisões terapêuticas em caso de tumores abdominais. RESULTADOS: Homens (96,1 por cento) e mulheres (92,6 por cento) mostraram desejo de serem informados do diagnóstico de câncer e 87,7 por cento dos homens e 84,2 por cento das mulheres desejaram que sua família também fosse informada; 94,2 por cento dos homens e 91 por cento das mulheres afirmaram querer saber do diagnóstico de Aids. Enquanto 86 por cento das mulheres e 76,6 por cento dos homens mostraram desejo de serem informados das opções terapêuticas em caso de tumor abdominal, apenas 58,5 por cento das mulheres e 39,6 por cento dos homens desejaram opinar sobre o tratamento. O desejo de participar das decisões terapêuticas foi menor nos homens, nas pessoas com mais de 60 anos e em quem estava internado (p<0.05). CONCLUSÕES: A grande maioria da população que procura um hospital universitário deseja ser informada sobre suas condições de saúde, incluindo eventuais diagnósticos de doenças graves. Por outro lado, existem vínculos familiares intensos, sendo que os pacientes desejam, também, que suas famílias sejam informadas.