Clinics in diagnostic imaging (184). Fat embolism syndrome (FES)

A 23-year-old Indian man presented with shortness of breath and new-onset confusion along with a rash on his chest on Postoperative Day 2, following internal fixation of his femur fracture. Although computed tomography pulmonary angiography was negative for filling defects in the pulmonary vasculature, it showed mosaic attenuation changes with some interlobular septal thickening. Magnetic resonance imaging of the brain showed patchy signal abnormalities, predominantly in the grey-white matter junction region with extensive susceptibility artefacts, consistent with petechial haemorrhages. The laboratory work-up showed thrombocytopenia and anaemia. A diagnosis of fat embolism syndrome was established, based on the clinical presentation combined with laboratory and imaging findings. The clinical and imaging features of fat embolism syndrome are discussed.

Radiofrequency Microtenotomy with Concurrent Gastrocnemius Recession Improves Postoperative Vitality Scores in the Treatment of Recalcitrant Plantar Fasciitis

INTRODUCTION@#Gastrocnemius recession and radiofrequency microtenotomy treat plantar fascia via different mechanisms. While studies have shown additive effects in performing plantar fasciotomy in conjunction with gastrocnemius recession, no such study exists examining the effects of performing radiofrequency microtenotomy with gastrocnemius recession. We hypothesised that performing both gastrocnemius recession and radiofrequency microtenotomy concurrently for recalcitrant plantar fasciitis is more effective than performing either procedure individually.@*MATERIALS AND METHODS@#We analysed all patients who underwent either a radiofrequency microtenotomy, a gastrocnemius recession, or both procedures concurrently between 2007 and 2014. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the SF-36 Health Survey, and 2 questions regarding patient satisfaction and met expectations were assessed preoperatively and postoperatively up to 1-year.@*RESULTS@#Patients who underwent both procedures concurrently had significantly higher vitality scores on the SF-36 Health Survey at 1-year postoperatively compared to patients who underwent either procedure individually. Type of intervention offered and preoperative factors were not predictive for patient outcomes.@*CONCLUSION@#Combining radiofrequency microtenotomy and gastrocnemius recession in patients with recalcitrant plantar fasciitis and an underlying gastrocnemius contracture shows favourable medium- term outcomes compared to performing either procedure in isolation.

Using PCR-PIRA based genotyping for identifying complex vertebral malformation allele in Frieswal young bulls in India

Complex vertebral malformation [CVM] has considerable economic impact on dairy cattle breeding due to extensive use of artificial insemination [AI]. Identifying the carrier is an important factor to reduce the incidence of the genetic disorder. The study was conducted to identify the carriers of CVM in Frieswal cattle by polymerase chain reaction-primer-introduced restriction analysis [PCR-PIRA] method, which was further confirmed by sequencing. Carrier prevalence of 1% was observed in the Frieswal cattle. The results of the study clearly demonstrated the existence of carriers of CVM among Frieswal bull calves. Due to the widespread use of AI it is recommended to screen young bulls at early stages for this defective allele in order to avoid its rapid spread within the population

Clinics in diagnostic imaging (162). Meckel's diverticulum

A 28-year-old Chinese man presented with acute bleeding per rectum. Computed tomography showed a posterior outpouching arising from the distal ileum. The outpouching had hyperaemic walls, but no active contrast extravasation was detected. Technetium-99m pertechnetate scintigraphy showed focal areas of abnormal uptake in the right side of the pelvis, superior and posterior to the urinary bladder. These areas of uptake appeared simultaneously with the gastric uptake and demonstrated gradual increase in intensity on subsequent images. The diagnosis of Meckel's diverticulum was confirmed on surgery and the lesion was resected. The clinical and imaging features of Meckel's diverticulum are discussed.

Comparison of histopathology and PCR based assay for detection of experimentally induced toxoplasmosis in murine model

OBJECTIVE@#To compare histopathology and PCR based detection in diagnosis of experimentally induced toxoplasmosis of RH human strain of the parasite in murine models.@*METHODS@#A comparison of histopathology and PCR based detection was done to diagnose experimentally induced toxoplasmosis in ten inbred swiss albino mice after intraperitoneal inoculation of 100 tachyzoites of laboratory mantained human RH strain of the parasite. Tissue samples from lung, liver, spleen, brain, heart and kidney were taken and processed for histopathological examination while all the samples also were subjected to PCR, using primers directed to the multicopy of SAG 3 gene, in dublicates.@*RESULTS@#Histopathology revealed presence of tachyzoites only in liver while along with lung, liver, spleen and brain tissue yielded desired positive PCR amplicons.@*CONCLUSIONS@#The SAG 3 based PCR is able to diagnose toxoplasmosis in those tissues which are declared negative by histopathological assay.

Level of awareness of lung cancer risk factors, signs, symptoms and safe practices among college teachers of different states in India: do awareness programmes have an impact on adoption of safe practices?

Introduction: Lung cancer is the one of the most common cause of cancer mortality among men in India where incidence rates are increasing although they are largely preventable diseases. In India, late presentation is generally responsible for high mortality and morbidity rates and early detection is one of the best ways to control it. The purpose of this study is to measure the level of awareness on lung cancer among women represented by a sample of college teachers in India and the impact of awareness programs in changing or adopting safer practices and the prevention and early detection of the disease

Material and methods: The assessment was conducted during a Pink Chain Campaign on cancer awareness in 2011 in various women colleges in India. Pre-test related to lung cancer was followed by awareness programs. Post-test using the same questionnaire was conducted at the end of interactive session, at 1 year and 6 months

Results: A total of 156 out of 182 teachers participated in the study [overall response rate was 85.7%]. Mean age of the study population was 42.4 years [range- 28-59 yrs]. There was a significant increase in level of knowledge regarding lung cancer at 6 months and this was sustained at 1 year. Magazines and newspapers were the primary source for information regarding risk factors, signs and symptoms of lung cancer in more than 60% of teachers whereas more than 30% teachers were educated by doctors. At post-awareness after 1 year and 6 months, there was a significant change in alcohol and smoking habits. The main reasons for not undergoing screening tests are: ignorance [50%], lethargic attitude [44.8%] and lack of time [34.6%]

Conclusion: Knowledge about lung cancer was very low among teachers. Overall awareness of risk factors, signs and symptoms, and screening modalities of lung cancer have improved after 1 year along with practices related to smoking and alcohol consumption. There was a significant improvement in people undergoing regular check-up's. Improved means of communication, access to information and effective warnings about cigarette smoking are necessary to increase public awareness. To ensure the adoption of safe practices in the lifestyle of people who smoke and consume alcohol, awareness programmes such as the pink chain campaign should be conducted regularly, frequently and more widely in various areas of India

Stewart-Treves syndrome: a rare entity.

Stewart-Treves syndrome is a rare, deadly cutaneous angiosarcoma that develops in long - standing chronic lymphedema. Most commonly, this tumor is a result of lymphedema induced by radical mastectomy to treat breast cancer. Stewart-Treves syndrome occurs in 0.5% of patients, who survive mastectomy for more than 5 years. The mean age at appearance of the angiosarcoma is 62 years, and the mean interval between mastectomy and the appearance of the tumor is 10.5 years. The exact pathogenesis is not known so far. On histopathology, vascular channels infiltrate the normal structures in a disorganized fashion, as if trying to line every available tissue space with a layer of endothelial cells. The prognosis is poor as it is very aggressive. Only early diagnosis and prompt radical excision with or without adjuvant radiotherapy, can promote survival.

Genetic polymorphism and association of kappa-casein gene with milk production traits among Frieswal [HF x Sahiwal] cross breed of Indian origin

The aim of the present study was to screen the genotype profile of bovine kappa-casein gene among Frieswal [HF x Sahiwal] crossbred cattle developed in India. A total number of two hundred Frieswal cows were evaluated for Hinfl RFLP based genotyping of kappa-casein gene. We observed that only two genotypes [AA and AB] exist among the studied population with the genotype frequency of 0.58 [n=117] and 0.42 [n=83], respectively. The calculated allele frequency for A and B was 0.79 and 0.21, respectively. Association of genotypes with certain milk production traits revealed that AB had significant [P<0.05] effect on total milk yield, peak yield, yield at 300 days and SNF% as compared to AA

Clinics in diagnostic imaging (150)

Spontaneous spinal epidural haematoma is a rarely encountered cause of back pain. It often leads to cauda equina syndrome, necessitating emergency spinal surgery. We report the case of a 19-year-old Chinese man who presented with pain in the lower back, which started after he had carried some heavy boxes. He denied a history of fall or trauma. Magnetic resonance (MR) imaging showed a hyperintense biconvex-shaped lesion in the posterior epidural space on both T1- and T2-weighted sequences, diagnostic of a spinal epidural haematoma. The patient, who was admitted and managed conservatively, had gradual resolution of his pain. No neurological deficit was detected on discharge or on follow-up. Repeat MR imaging showed total resolution of the lumbar spinal epidural haematoma. The clinical characteristics, MR imaging features, diagnosis and management of spontaneous spinal epidural haematoma are discussed.

Audit of state-funded antiviral treatment for chronic hepatitis C in Qatar

Hepatitis C virus [HCV] infection is a major public health problem in the Middle East. A database of 400 patients with chronic HCV in Qatar was retrospectively analysed: 242 patients underwent antiviral treatment, of whom 212 [87.6%] were naive to treatment. The response to treatment and the predictors of response were studied. The largest group of patients were of Egyptian origin. The rate of sustained virological response [SVR] varied significantly between patients with HCV genotypes 2 or 3 [79.6%] and genotype 1 [45.6%] and 4 [the predominant genotype] [51.0%]. Multivariate analysis showed that the independent predictors of SVR were age < 45 years, infection with genotypes 2 or 3, low fibrosis score on liver biopsy and naive treatment status

Factors influencing rehabilitation outcome in adult traumatic brain injury in Qatar

To analyze the factors influencing outcome in Traumatic Brain Injury [TBI] rehabilitation in Qatar medical records, we reviewed 50 patients with TBI who were seen between January 2004 and Sep 2007 in the Rehabilitation Unit of Rumailah Hospital [RH], Hamad Medical Corporation. Demographic and clinical variables included age at admission, length of stay in acute care [LOSa], length of stay in rehabilitation [LOSr], Rancho Level [RLA], Glasgow Coma Scale [GCS]. Functional Outcomes were functional independence measure on admission [FIMa] and functional independence measure on discharge [FIMd]. There was a significant positive correlation of FlMd with FIMa and Rancho level [r=0.69, p=0.00 and r=0.70, p=0.00] respectively, where there was no correlation between FlMd and GCS score. Negative correlation was observed between FIMd and age as well as LOSa [r=-0.47, p=0.01] and [r=-0.49, p=0.00] respectively. Multivariate regression analysis was performed taking age, Rancho, FIMa, mobility, GCS and LOSa variables as independent and FIMd as the dependent variable. The model could explain 70% of variation. It was concluded that the Rancho level of cognitive functioning, FIMa and mobility variables were the most influential factors in determining the functional outcome

Endometrial ablation in the women's Hospital, HMC, Doha, Qatar: a retrospective cohort

To study the outcome of various methods of endometrial ablation as a treatment of heavy vaginal bleeding, the records and post-operative histories were reviewed of 122 women with a mean age of 47 years who attended the Women's Hospital, Doha, Qatar, between January 2002 and December2005. Post-operative amenorrhea, oligomenorrhea, or a normal flow plus a satisfied patient were considered evidence of success; a need for further medical or surgical intervention was considered failure. Fifty-eight women [47.5%] had Thermachoice Balloon Ablation with a success rate of 83%; 37[30%] had Microwave Endometrial Ablation [MEA] with 71% success; and 27[22%] had Transcervical Resection of Endometrium [TCRE] with 74% success. Apart from the duration of the procedures there were no statistically significant differences in age, parity, pre-operative haemoglobin and platelets, presence of fibroids, pre-operative endometrial preparation by hormones, or final satisfaction level. It is concluded that Balloon Thermal Ablation, MEA and TCRE are equally effective for the treatment of abnormal vaginal bleeding

En-plaque meningioma completely encircling the cervical cord: case report

Meningioma particularly the intradural subtype is one of the common spinal tumors, which usually occurs as a round to oval broad based lesion. We report an unusual case of en-plaque meningioma in which the lesion completely encircled the cervical spinal cord. En-plaque meningiomas remain a surgical challenge. Although early recognition and combined strategy of surgery and radiosurgery have shown promising results, these lesions can still be associated with poorer prognosis particularly when the lesions are complex in nature and the resources are limited

Sorption isotherms and kinetics of chromium uptake from wastewater using natural sorbent material

Chromium [VI] which exists in many industrial wastewater is considered highly toxic. The aim of the present investigation was to study the reduction of chromium [VI] to chromium [III] and then removing it with the help of weathered basalt andesite products. Reduction of the chromium [VI] to chromium [III] by hydrazinium sulfate was investigated. The influence of hydronium ion concentration, contact time, hydrazinium sulphate dosage and temperature has been tested in batch runs. The process was found to be acid, temperature and concentration dependent. The suitability of weathered basalt andesite products as a potential sorbent was assessed for the removal of chromium [III] following batch mode of operation. The effect of various parameters such as hydronium ion concentration, shaking time, sorbent dose, initial metal ion concentration and temperature on the removal of chromium [III] from aqueous solution was studied. Thermodynamic parameters [DH° DS° and DG°] for the sorption process were evaluated. Analysis of sorption obtained results showed that the sorption pattern followed the Freundlich, Langmuir and Dubinin-Kaganer-Radushkevich isotherms. The process follows pseudo second order rate and surface diffusion is identified as the predominating mechanism. The sorption process was shown to be reversible by the recovery of sorbed chromium [III] upon extraction with 0.5 M nitric acid. The sorbent, before and after sorption, was characterized by fourier transform infrared spectrometer, X-ray diffraction, scanning electron microscope, transmision electron microscope and thermo-gravimetric analyse methodes. An increase in crystallanity after sorption of chromium was observed. An industrial effluent was successfully treated with the same sorbent with convincing results

Theoretical studies of different tautomers of anti cancer drug: Dichloroacetate

The structure and relative energies of the tautomers of dichloroacetate are predicted using Hartree Fock method. The infrared spectra of two dominant tautomers are calculated in the density functional theory. Good agreement between calculated [DFT] and experimental harmonic vibrational frequencies is found. Assuming Cs point symmetry, vibrational assignments for the observed frequencies have been proposed. The spectra exhibit distinct features originating from low frequency vibrational modes caused by inter-molecular motion. Energy is minimum for DCA-2 tautomer. Dipole moment is large for DCA-1 tautomer and polar surface area is somewhat larger in caso of DCA-2. Local ionization potential map and lowest-unoccupied molecular orbital [LUMO] map has been drawn and analyzed. Linear regression data for both the tautomers has also been calculated, so clearly DCA1 is more correlated to experimental wavenumbers

Comparison of extractability of Cd, Cu, Pb, and Zn with sequential extraction in contaminated and non-contaminated soils

Various extraction procedures were employed for measuring extractable concentrations of potential toxic elements in soil. The extractability of Cd, Cu, Pb and Zn in four contaminated and four non-contaminated soils of Japan, was compared by single extraction [CaCl2, DTPA, NH4Cl, 0.1 M HCl and 1 M HCl] and sequential extraction procedures [[six operationally defined chemical phases, viz. water soluble [F1], exchangeable [F2], carbonate [F3], oxide [F4], organic [F5] and residual [F6] fractions]]. Extractability of metals from soils samples varied depending on metals and/or extractants used. Among the extractants, 1 M HCl extracted the largest proportion of Cd [79 to 96% of total], Cu [61 to 83%], Pb [51 to 99%] and Zn [23 to 52%] from soils followed by 0.1 M HCl, NH4Cl, DTPA and CaCl2. In all the extractants, the proportion of extractability of metals was higher in the contaminated soils than the non-contaminated soils. Regardless of soils and extractants, relative extractability was higher for Cd as compared to other three metals. The use of 1 M HCl may be recommended for first-level screening of soil contamination with heavy metals. The other four weak extractants are believed to provide a better assessment of bioavailable/mobile metals content in soils than 1 M HCl extractant. However, 0.1 M HCl mobilized all four metals irrespective of soil types, therefore, might be the best choice if only one extractant is to be used. The sequential extraction procedures showed 22 to 64% of total Cd was in the mobile fraction [sum of F1 to F3], while the corresponding values for Cu, Pb and Zn in this fractions were 2 to 23% suggesting higher mobility of Cd than other three metals. The single extraction procedures are simple and easy to perform and obtained results are comparable with sequential extraction procedure

Hepatities-B vaccine uptake and obstacles among medical staff and students

Across sectional analysis of 400 medical care staff and students conducted in Benghazi to assess hepatitis B vaccine uptake rates and associated factors. The hepatitis B vaccine uptake was found complete for 52.5%, incomplete or absent in 47.5% the uptake was higher for those 20-39 years of age, for males, for doctors and technicians, for singles and for non-Libyans. The factors for non-uptake were attitudinal in 40.9%, situational in 24.5%, knowledge related in 20.9% and medical in 13.6%. The main reasons cited in the descending order of frequency for incomplete uptake were inertia, pressure of work or forgetfulness, and being in the process of completing the vaccination course: whereas for non uptake were confidence in precautionary measures, pressure of work or unsuitability of time, fear of side effects, unawareness of risk or necessity. The study conclude that vaccination programme at Benghazi should be redesigned which could offer the vaccine to all those workers at their respective places of work. Computerised records of all health care staff and students should be maintained for their immune status, exposure events, and surveillance

[Effect of herbal hypoglycemic agents on antioxidant enzymes and metal ions in streptozotocin induced diabetic rats]

Background: up to know many herbal medicines with different oral formulations have been recommended for diabetes. The aim of this study was to investigate the effect of 4 herbal hypoglycemic agents include garlic [Allium sativum] neem [Azadirachta indica], tulsi [Ocimum sanctum] and bitter gourd [Momordica charantia] on blood glucose, antioxidant enzymes and metal ions in diabetics

Methods: crude extracts of herbal agents was prepared and each one was given to one group of diabetic rats. Two group of diabetic rats received insulin and glibenclamide. As controls, two groups of healthy and diabetic rats received saline. Body weight, fasting blood glucose, antioxidant enzymes and metal ions were measured before and after the study

Results: all agents including herbal preparations, insulin and glibenclamide reduced the levels of blood sugar and lipid peroxide when compared with diabetic control. These agents also increased levels of antioxidant enzymes in diabetic rats. Antioxidant enzymes decreased significantly in diabetic controls. Metal ions increased in diabetic rats treated with herbal agents, insulin and glibenclamide but decreased in diabetic controls

Conclusion: above mentioned herbal plants may be useful in the treatment of diabetes as they not only have hypoglycemic effect but they also protect rats from free radical mediated cellular injury by improving the activity of antioxidant enzymes. They also improve the levels of metal ions which are associated with antioxidant enzymes

Cancer mortality in Benghazi, Libyan Arab Jamahiriya, 1991-96

We present a descriptive study of 1221 cancer deaths among Libyans in Benghazi for the period 1991-96. The cancer mortality rates per 10[5] person-years at risk for males, females and both sexes were 39.8, 26.5 and 33.3 respectively. The age-standardized cancer death rate per 10[5] standard world population was 91.5, 60.0 and 76.5 respectively. The 10 most common cancer deaths by site [comprising 67.7% of the total], in descending order of frequency, were: trachea, bronchus and lung, blood [leukaemia], colon/rectum, other lymphatic and haemo-poietic tissue [lymphomas], stomach, breast, prostate, liver, bladder, and larynx. The results point to the necessity for conducting comprehensive prospective studies, initiating a cancer registry and establishing a national cancer control programme