Persistent vegetative state after traumatic brain injury - a case report and review of the.

Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness. It cannot be diagnosed with certainty and misdiagnosis is very frequent. Its management has become one of the most controversial and emotive issues in medical ethics and medical law over the past few decades. The results of recent neuroimaging studies along with well-documented reports of significant late recovery of some PVS patients have challenged the long-held view that restoration of function in the severely traumatic brain injury (TBI) patients is not possible. Some clinicians believe that PVS is a misused term with the potential consequences of withdrawal and withholding of care, and tendency towards less aggressive management. Further naming these patients as “vegetative” has been misinterpreted by many groups that the patient is no more a human but “vegetable” like. Recently there has been an attempt to replace PVS by new, more appropriate name "Unresponsive Wakefulness Syndrome" (UWS). As opposed to brain death, PVS is not recognized by statute as death in any legal system. The context within which end of life decisions are being made for these patients has led to outrage especially if decisions were made to terminate hydration and nutrition. We present a case of young boy who is in a PVS following TBI with the aim to review some of the contemporary issues regarding their management.

Spinal anesthesia causing hearing loss: are we aware.

Sensorineural hearing loss can be attributed to many factors. Acoustic trauma, noisy environment, genetic syndromes, inner ear infection and tumors are the known wellestablished causes. Some of them are treatable but many of those are nonreversible. Recent literatures have shown some data that suggest this type of hearing loss also occurring post anesthesia, particularly in spinal anesthesia cases. Others claim that this hearing loss is temporary and clinically not significant.

Polymorphisms of UGT1A1*6, UGT1A1*27 & UGT1A1*28 in three major ethnic groups from Malaysia.

Background & objectives: Genetic polymorphisms of uridine diphosphate glucuronyltransferase 1A1 (UGT1A1) have been associated with a wide variation of responses among patients prescribed with irinotecan. Lack of this enzyme is known to be associated with a high incidence of severe toxicity. The objective of this study was to investigate the prevalence of three different variants of UGT1A1 (UGT1A1*6, UGT1A1*27 and UGT1A1*28), which are associated with reduced enzyme activity and increased irinotecan toxicity, in the three main ethnic groups in Malaysia (Malays, Chinese and Indians). Methods: A total of 306 healthy unrelated volunteers were screened for UGT1A1*28, UGT1A1*6 and UGT1A1*27. Blood samples (5 ml) were obtained from each subject and DNA was extracted. PCR based methods were designed and validated for detection of UGT1A1*6, UGT1A1*27 and UGT1A1*28. Direct DNA sequencing was performed to validate the results of randomly selected samples. Results: Malays and Indian have two-fold higher frequency of homozygous of UGT1A1*28 (7TA/7TA) which was 8 and 8.8 per cent, respectively compared to the Chinese (4.9%). However, the distribution of UGT1A1*6 and UGT1A1*27 showed no significant differences among them. UGT1A1*27 which has not been detected in Caucasian and African American population, was found in the Malaysian Malays (3.33%) and Malaysian Chinese (2.0%). Interpretation & conclusions: There was interethnic variability in the frequency of UGT1A1*28 in the Malaysian population. Our results suggest that genotyping of UGT1A1*6, UGT1A1*28 and UGT1A1*27 need to be performed before patients are prescribed with irinotecan due to their high prevalence of allelic variant which could lead to adverse drug reaction.

Epidural haemorrhage during embolisation: a rare complication of intra-arterial embolisation of vertebral metastases

Pre-operative embolisation of vertebral metastases has been known to effectively devascularise hypervascular vertebral tumours and to reduce intra-operative bleeding. However, the complications that occur during the procedure are rarely reported. This case study attempts to highlight one rare complication, which is epidural tumoural haemorrhage intra-procedure. It may occur due to the fragility of the tumour and presence of neovascularisation. A small arterial dissection may also have occurred due to a slightly higher pressure exerted during injection of embolising agent. Haemostasis was secured via injection of Histoacryl into the area of haemorrhage. The patient was able to undergo the decompression surgery and suffered no direct complication from the haemorrhage.

Otological problems among professional divers in Basrah

To determine the otological problems among professional divers in Basrah, and to study the risk factors which might be associated with diving. The retrospective cohort study carried out in Basrah Governorate from November 2002 to March 2003 to detect the otological problems among divers in comparison to non-divers group, and to determine the association between otological problems and some risk factors. The study involved 120 divers chosen randomly from Iraqi Military Navy and Iraqi Port Company, compared to 120 non-divers were matched to divers regarding age, education, residence and years of service chosen from the same units. Both groups were interviewed by the researcher using special questionnaire form designed for the study. Otological examination of the studied group was performed by E.N.T. specialist, while the audio-metric examination was done by audiologic technician. The study showed that 80.8% of divers had otological problems [otalgia 55.8%, itching 55.8%, hearing problems 45.8%, tinnitus 41.7%, vertigo 39.2% and discharge 26.7%]. Otoscopic examination showed abnormal findings in 60.8% of divers [otitis externa 28.3%, otitis media 19.2%, impacted wax 8.3% and retracted tympanic membrane 5.0%]. Audiometric examination showed that 44.2% of divers had some degree of hearing loss, presented as bilateral, mild, high frequency sensorineural hearing loss. The study showed that years of service was the most significant risk factor associated with otological problems. Maximum time spent under water was the second significant factor associated with sensrineural hearing loss. The prevalence of otological problems among studied divers was higher than that among non-divers with a ratio of 2.2

Effect of Nigella sativa on ingestion ability of mice peritoneal macrophages

This study was designed to examine the potential effect of Nigella sativa [the black seed or kammoun aswed] on ingestion of yeast cells by macrophages. The authentic Hadeeth of the Messenger of Allah on the Black seed my give a clue of the possible effect on the immune system. Therefore, the design of our study was based on this hint. A total of 84 white albino mice were used; 42 mice were tested by feeding with the black seed enriched food while another group of 42 mice were used as controls and were fed only normal food. Both groups of animals were challenged by intraperitoneal injection of dead candida albicans. There was a significant enhancement of ingestion in the tested mice with a mean +/- SD of 82.43 +/- 18.62 as compared to 60.81 +/- 11.59 in the control mice [P < 0.01] as shown by the higher percentage of peritoneal macrophages ingesting the organism. Electron microscopical studies showed no differences between macrophages of the two groups apart from the degree of ingestion ability