Krill's disease: a newer management option

Purpose: To report a case of a young female who presented with scotoma in the right eye for few days. Case Report: Krill's disease or acute retinal pigment epithelitis (ARPE) is a self-limiting retinal disease with no specific treatment. Typical clinical and imaging features helped us to diagnose her with ARPE. Intravenous methylprednisolone (IVMP), which gives a rapid anti-inflammatory response, was advised. An SD-OCT scan post-injection showed a reduction in hyperreflectivity and height of lesion at day 3 and near total resolution by day 5. Conclusion: This case suggests rapid resolution of ARPE with the use of IVMP.

Comparison of safety and analgesic efficacy of diclofenac sodium with etodolac after surgical extraction of third molars: a randomized, double-blind, double-dummy, parallel-group study

BACKGROUND: Surgical extraction of third molars is associated with postoperative pain and swelling at the extraction site. Pain is commonly managed using non-steroidal anti-inflammatory drugs (NSAIDs). Postoperative pain is usually moderate to severe in the first 12 h postoperatively and lasts for 3–5 days. However, with NSAIDs, these symptoms usually subside within 24 h. Diclofenac sodium and etodolac are NSAIDs, more selectively cyclooxygenase-2 inhibitors, with good analgesic efficacies.METHODS: We compared the safety and analgesic efficacy of diclofenac sodium with etodolac peroral after surgical extraction of third molars in a double-blind, double-dummy, parallel-group study. The subjective pain improvement and pain relief after 2, 6, 24, 48, and 72 h using the visual analogue scale were measured as the study outcome.RESULTS: Etodolac was equivalent to diclofenac sodium in pain alleviation at all postoperative time periods. No significant differences were found between diclofenac sodium and etodolac groups (P > 0.05). Both study medications were well tolerated and safe with mild adverse effects in only a few participants.CONCLUSION: Diclofenac sodium and etodolac are comparable in terms of analgesic efficacy and safety after surgical removal of third molars.

What's new in alcoholic hepatitis / 临床肝胆病杂志

@#Alcoholic hepatitis is an important type of alcohol-associated liver disease characterized by acute liver inflammation caused by prolonged heavy alcohol use.In the present article,the pathogenesis,clinical characteristics,diagnosis,current therapies aud future treatment strategies of alcoholic hepatitis are summarized and reviewed in order to help the hepatologists to better understand this kind of disease in clinical practice.

The Use of MR Perfusion Imaging in the Evaluation of Tumor Progression in Gliomas

OBJECTIVE: Diagnosing tumor progression and pseudoprogression remains challenging for many clinicians. Accurate recognition of these findings remains paramount given necessity of prompt treatment. However, no consensus has been reached on the optimal technique to discriminate tumor progression. We sought to investigate the role of magnetic resonance perfusion (MRP) to evaluate tumor progression in glioma patients. METHODS: An institutional retrospective review of glioma patients undergoing MRP with concurrent clinical follow up visit was performed. MRP was evaluated in its ability to predict tumor progression, defined clinically or radiographically, at concurrent clinical visit and at follow up visit. The data was then analyzed based on glioma grade and subtype. RESULTS: A total of 337 scans and associated clinical visits were reviewed from 64 patients. Sensitivity, specificity, positive and negative predictive value were reported for each tumor subtype and grade. The sensitivity and specificity for high-grade glioma were 60.8% and 87.8% respectively, compared to low-grade glioma which were 85.7% and 89.0% respectively. The value of MRP to assess future tumor progression within 90 days was 46.9% (sensitivity) and 85.0% (specificity). CONCLUSION: Based on our retrospective review, we concluded that adjunct imaging modalities such as MRP are necessary to help diagnose clinical disease progression. However, there is no clear role for stand-alone surveillance MRP imaging in glioma patients especially to predict future tumor progression. It is best used as an adjunctive measure in patients in whom progression is suspected either clinically or radiographically.

Clinico-pathological findings of Clostridium perfringens type D enterotoxaemia in goats and its hemolytic activity in different erythrocytes

The present investigation was conducted to study the effects of experimental Clostridium perfringens type D enterotoxaemia in teddy goats. Clinical signs started to appear after 30 min of experimental infection like anorexia, diarrhea, dehydration, frothing and dyspnea. Gross lesions consisted of severe congestion in tissues of varying intensity with enlarged mesenteric lymph nodes while histological examination revealed edema of lungs, kidney, and lymph nodes and to some extent in brain along with hemorrhages in lungs and intestines. Clostridium perfringens type D carrying alpha and epsilon toxin genes were amplified with amplicon size about 247 bp and 665 bp, respectively. Human erythrocytes showed the highest hemolysis, 68%, followed by mice, 57%, against culture supernatants. The percentage of hemolysis was significantly higher at 37[degree]C as compared to 25[degree]C except for rabbit and dog

Managing alcoholic liver disease

Alcoholic liver disease continues to be a significant cause of liver-related morbidity and mortality throughout the world. A number of diagnostic and prognostic models have been developed in the management of this condition, although specific roles for liver biopsy still remain particularly in the setting of alcoholic hepatitis. Despite a large number of recent treatment trials, the ideal pharmacotherapy approach remains undefined. Most essential is the supportive care and focus on abstinence and nutrition. Owing in part to a great deal of attention from governmental funding sources, a number of new treatment approaches are undergoing rigorous evaluation, hopefully providing future treatment options in this very severe condition.

[Conversancy with oxygen and its production instrument in military aviation and seafaring]

The most important qualification of aviation at flight altitude over tenthousand feet and sub aquatic seafaring [in all deeps] are the effective oxygen production instruments which have the worthwhile role in prevention of hypoxia and hyperventilation. These systems were used invention in First World War and greatly improved since this century. Informed about this systems and their introduction, function and probable failures are very necessary. This study documents collected based on any books, articles and knowledge about marine. Oxygen generator systems produce this gas as a shape of gas, liquid and chemical compounds. All the oxygen generators consist of two major sources: main source and back up source which help on emergency situations. Function of this system was based on two methods: automatic and manual operation. Relative appurtenants such as connecting pips, regulators, air dilution systems and masks have accurate points depend on their facilities. Best part of their functions are air dilution ability, generation of 100% oxygen, positive pressure breathing and suitable oxygen temperature. Progressive development of aviation and seafaring technology and up to date investigations implicate enough flight and sea crew orientation about oxygen and its equipments for hypoxia and hyperventilation prevention

Idiopathic adult ileoileal and ileocolic intussusception in situs inversus totalis: a rare coincidence

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature

Serum ferritin levels in non-scarring alopecia of women: a case-control study

Iron deficiency in the etiology of hair loss has been studied for more than 45 years. However, contradictory reports have been published and almost all the studies conducted so far are based on observational methodology. To find out if any real association exists between the iron deficiency and alopecia. One hundred consecutive, clinically typical female patients [14-54 years] with nonscarring alopecia i.e. alopecia areata, androgenetic alopecia and telogen effluvium and an equal number of age- and sex-matched controls were included in the study. Both groups were evaluated for serum ferritin and other important parameters of iron status. Mean serum ferritin value of cases was significantly lower than that of the controls [p=0.005]. Patients with alopecia areata and androgenetic alopecia had significantly lower values of serum ferritin [p=0.011 and 0.015, respectively], but there was no significant difference in telogen effluvium cases and controls [p=0.348]. The values of hemoglobin, hematocrit, MCV, MCH and transferring-saturation were significantly lower in cases but had significantly higher TIBC values than controls. There is a definite association of decreased serum ferritin levels and nonscarring alopecia in women. The iron stores of female patients with nonscarring alopecias should be built for the optimum response to treatment as the proposed triggering factor can be abolished

The role of gut-liver axis in the pathogenesis of liver cirrhosis and portal hypertension

Because of the anatomical position and its unique vascular system, the liver is susceptible to the exposure to the microbial products from the gut. Although large amount of microbes colonize in the gut, translocation of the microbes or microbial products into the liver and systemic circulation is prevented by gut epithelial barrier function and cleansing and detoxifying functions of the liver in healthy subjects. However, when the intestinal barrier function is disrupted, large amount of bacterial products can enter into the liver and systemic circulation and induce inflammation through their receptors. Nowadays, there have been various reports suggesting the role of gut flora and bacterial translocation in the pathogenesis of chronic liver disease and portal hypertension. This review summarizes the current knowledge about bacterial translocation and its contribution to the pathogenesis of chronic liver diseases and portal hypertension.

Carcinoma thyroid in multi and uninodular goiter

To determine the frequency and profile of carcinoma in multi-nodular goiter and solitary thyroid nodule. Case series. Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Center, Karachi, from January 1999 to January 2009. Cases with solitary thyroid nodules and multi-nodular goiter were included. Patients under 12 years of age, cystic benign lesion in solitary thyroid nodules or those multi-nodular goiters, which were not causing pressure symptoms, cosmetic problems or sign of malignancy were excluded. In solitary thyroid nodule, hemithyroidectomy was done and if histopathology examination revealed carcinoma thyroid then completion thyroidectomyw as done. In multi-nodular goiter sub-total thyroidectomy done. Results were described as frequency percentages and mean. Out of 379 patients of multi-nodular goiter only one patient was found to be papillary carcinoma [0.25%]. In 220 patients of solitary thyroid nodules, 93 patients were diagnosed as carcinoma of thyroid [42.27%]. Others diagnosed in solitary thyrid nodule were thyroid adenoma, colloid goiter, thyroiditis and multi-nodular goiter. The frequency of papillary carcinoma in 65.95% occurring females of 12-30 years of age and being multifocal in 6.45% follicular carcinoma in 23.49%, medullary carcinoma in 7.44%, analplastic carcinoma in 2.12% and lymphoma in 1.01%. Female were predominantly involved and papillary carcinoma was common in 12-30 years of age [7.63%] and follicular was common in 30-40 years of age [68.18%. 6.45% of papillary carcinoma was found to be multifocal in nature. Frequency of carcinoma of thyroid is very high in solitary thyroid nodule [42.27%], but markedly low in multi-nodular goiter. Papillary carcinoma is the most common variety, most of in younger female

Cross - infection control in dentistry: a review

The dental environment is associated with significant amount of risk for exposure to various micro-organisms. Infection control is one of the prime elements of a successful dental practice. There are many infectious diseases that can be transmitted in a dental environment. New diseases with serious consequences and a high rate of transmission have evolved in the recent past. Infection control is directed at prevention to exposure of such infections and also to prevent it being transferred from person to person. The universal infection control policy considers that 'Every patient should be considered Infectious'. This review article presents various aspects of cross-infection control in dental environment

Systemic amyloidosis presenting as mucocutaneous bullous lesions

A 65-year-old male presented with hemorrhagic bullous skin lesions with purpura and ecchymoses. There was increased skin fragility with a strongly positive Nikolsky sign. Histopathology of the skin revealed large amounts of amyloid deposits in the dermis with a positive Congo Red staining around the dermal vessels. Examination and tests in this patient also revealed anemia, hepatomegaly, infiltrative cardiomyopathy, polyneuropathy and immunoglobulin lamda deposition, favoring a diagnosis of primary amyloidosis [AL type]. The present case is reported in view of the rarity of the bullous variant of primary systemic amyloidosis as well as presence of mucosal lesions and a positive Nikolsky sign

Intrinsic electromagnetic noise in living cells in vitro and its spectroscopy

Living cell membranes, even in the absence of any ambient or applied electric fields, are known to have associated with them weak intrinsic noise, generated as a result of various biochemical and physiological processes taking place in and around the plasma membrane bilayer. This paper presents the theoretical backgroupd and details of a biophysical study in the measurement of intrinsic membrane electromagnetic noise within living cells in vitro, on the basis of which a spectroscopy technique is, defined. Initial studies have been carried out with cultured yeast cells [Saccharomyces cerevisiae]. A number of successful recordings of intrinsic noise from aerobic cells have been carried out, demonstrating the presence of intrinsic fields in living and aerobically-respiring cells in an electromagnetically-shielded environment. Our studies also reveal the effect of aerobioc respiration on the studied cells, whereby conspicuously higher magnitude noise spectra were seen with aerobically-respiring active yeast cells, as compared to anaerobic cells. The recorded noise had spectral region within the range of Extremely-Low-frequency [ELF] part of the spectrum

Thrombotic thrombocytopenic purpura, at a tertiary care centre in lahore, Pakistan

Thrombotic thrombocytopenic purpura is a syndrome, characterized by microangiopathic hae-molytic anaemia, thrombocytopaenia, neurological symptoms, renal disease and fever. Commonly considered rare, but actually it is one of the most under diagnosed disorders. This study was aimed at evaluating the clinical features, course, prognostic factors and treatment outcome in 17 patients diagnosed as having thrombotic thrombocytopaenic purpura [TTP]. It was a cross-sectional descriptive study at Shaikh Zayed Hospital Lahore. This study includes patients diagnosed as having TTP by the department of haematology from January 2005 to December 2007. Eight of 17 patients were treated with plasma exchange. Six of these 8 patients survived. Plasma infusions were performed in 9 patiejits, 5 of them recovered. Overall 65% patients recovered and mortality was 35%

usefulness of carotid and femoral artery intimal-medial thickness as non-invasive predictors of coronary artery disease

Background: B-mode ultrasonography has shown that measurements of the intima-media thickness of carotid artery [CIMT] is useful in studying atherosclerosis, while study of femoral artery has received little attension

Objective: studying the predictive value of carotid intimal-medial thickness [CIMT] and femoral artery intimal medical thickness [FIMT] for coronary artery disease [CAD] and the relation to risk factors

Methods: Measurement of CIMT and FIMT was performed, utilizing B-mode ultrasonography, for 120 patients [84 males and 36 females] refered for coronary angiography. Biochemical studies included: lipid profile, microalbuminurea, fasting and postprandial blood sugar. Patients were classified into two groups: group l [18 patients] with normal coronary angiography [c. angio] and group 11[102 patients] with abnormal c. angio

Results: CIMT and FIMT were significantly increased in patients with CAD compared to those with normal angiography [P<0.01]. The CIMT and FIMT showed a significant correlation with the extent of CAD [P<0.03 and <0.01], the sensitivity, specificity, positive [ppv] and negative [npv] predictive values of CIMT for CAD were [73.5%, 60.6%, 92.5% and 30%] respectively. While that of FIMT were [88.2%, 88.8%, 97.8% and 57.5%] respectively. Using the univariante analysis: the following parameters were independent risk for CAD: age, DM, hypertension, dyslipidemia, CIMT and FIMT

Conclusion: The CIMT and FIMT can be considered as independent predictors of the presence and extent of CAD, and these non-invasive tests can be used in evaluation and screening for subclinical CAD in high risk population

Development of a monoclonal antibody-based co-agglutination test to detect enterotoxigenic Escherichia coli isolated from diarrheic neonatal calves

Escherichia coli (E. coli) strains were collected from young diarrheic calves in farms and field. Strains that expressed the K99 (F5) antigen were identified by agglutination tests using reference antibodies to K99 antigen and electron microscopy. The K99 antigen from a selected field strain (SAR-14) was heat-extracted and fractionated on a Sepharose CL-4B column. Further purification was carried out by sodium deoxycholate treatment and/or ion-exchange chromatography. Monoclonal antibodies to purified K99 antigen were produced by the hybridoma technique, and a specific clone, NEK99-5.6.12, was selected for propagation in tissue culture. The antibodies, thus obtained, were affinity-purified, characterized and coated onto Giemsastained Cowan-I strain of Staphylococcus aureus (S. aureus). The antibody-coated S. aureus were used in a coagglutination test to detect K99+ E. coli isolated from feces of diarrheic calves. The specificity of the test was validated against reference monoclonal antibodies used in co-agglutination tests, as well as in ELISA. Specificity of the monoclonal antibodies was also tested against various Gram negative bacteria. The developed antibodies specifically detected purified K99 antigen in immunoblots, as well as K99+ E. coli in ELISA and co-agglutination tests. The co-agglutination test was specific and convenient for large-scale screening of K99+ E. coli isolates.

Role of magnesium sulphate in ischaemic stroke

To evaluate the role of magnesium sulphate in patients presenting with ischaemic stroke. This experimental type of interventional study was carried out at Mayo Hospital, Lahore. Within 24 hours of onset of clinically diagnosed stroke, which was later confirmed by CT scan, patients were randomized to receive either magnesium sulphate [16mmol IV over 15 minutes and 65mmol over 24 hours] or placebo. Their disability was measured by Barthel score at presentation and outcome measured after three months by death and disability and the results were compared between the two groups. Those patients who had a Barthel score of = 12 at three months were considered independent and those with a score of < 12 were considered disabled. The results were analyzed by SPSS. Fifty patients were recruited in the study. 25 patients were randomized to receive MgSO[4] and 25 received placebo. The Barthel score improved from 5.1 +/- 3.3 at presentation to 13.5 +/- 3.4 after three months in all the patients so the re was improvement whether MgSO[4] was given or not. Patients who were randomized to receive MgSO[4] had a lower Barthel score of 4.2 +/- 2.9 as compared to controls 5.9 +/- 3.5, but after three months they improved more than the controls gaining a score of 15.7 +/- 1.9 versus 11.3 +/- 3.2 [p=0.000]. The mortality rate was not statistically different in the two groups. 88% patients had a Barthel score of > 12 at three months in the MgSO[4] and 30% in the control/placebo group. Combined death and disability was 8% in MgSO[4] group and 60% in the control group. Moreover MgSO[4] was well tolerated. Magnesium sulphate therapy was safe in patients presenting with ischaemic stroke irrespective of the site of infarct. It improves prognosis regarding Barthel score at three months as well as the difference in the Barthel score at presentation and at three months. A greater percentage of magnesium treated patients led independent lives after three months

Complications of streptokinase during infusion in acute myocardial infarction

Myocardial infarction is one of the most common causes of death worldwide. The cornerstone of therapy is thrombolytic therapy. Coronary thrombolysis helps restore coronary patency, preserves left ventricular function and improves survival. The most common thrombolytic agent used is streptokinase. But thrombolytic therapy is at times associated with some complications. This comparative study was aimed to find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction in Mayo Hospital, Lahore. Two hundred patients with definite diagnosis of acute myocardial infraction, who presented to East Medical Ward, Mayo Hospital, Lahore, were included in this study. All patients presenting with AMI were considered for SK therapy. Those who were actually given SK constituted the SK group and those who were not fit for SK, but otherwise SK was indicated, constituted the control group. In SK group 100 patients were given standard t reatment of acute myocardial infarction including streptokinase. In control group 100 patients were given standard treatment of acute myocardial infarction except streptokinase due to non-eligibility. Patients with typical chest pain of at least 30 minutes duration, serial ECG changes and serial cardiac enzyme changes were entered in the study. Comparative / interventional Post SK changes in blood pressure were significant [p= 0.011]. There was post SK hypotension in 48 [24%] and post SK hypertension in 20 [10%] patients. Allergic reaction was present in 4 [2%] only [p=0.044]. Arrhythmias were significantly less prominent in SK group [p=0.000]. Post SK bleeding occurred in 3 [1.5%] only [p=0.082]. 37 patients died [18.5%] in total, out of which 5 [2.55] patients died in SK group and 32 in control group [p=0.000]. CVA occurred in 1 SK group patient only, which was found to be hemorrhagic on CT scan [p= 0.31]. Early administration of SK lowers in-hospital mortality [p= 0.00 0]. Major complications during SK therapy are Hypotension [p= 0.011], Arrhythmias [p= 0.000], Allergic reactions [p= 0.044]