Staphylococcus aureus endocarditis associated with injecting new psychoactive substances.

BACKGROUND: Staphylococcus aureus infective endocarditis (IE) associated with injection of new psychoactive substances (NPS) in Edinburgh from 2014 to 2016 was observed. We compared these infections with a series of S. aureus IE cases in a non-injecting population within Edinburgh. METHODS: NPS-associated S. aureus IE diagnosed between 1 January 2014 and 31 May 2016 in persons who inject drugs (PWID) were compared with a series of S. aureus IE cases from non-PWID. RESULTS: There was a fourfold increase in the annual incidence of S. aureus IE, mainly due to NPS use in PWID. A larger vegetation diameter was seen on echocardiogram in PWID vs non-PWID (median 1.7 cm vs 0.65 cm; p = 0.009) with more embolic complications in PWID (15 PWID vs 1 non-PWID; p = 2.1 x 10-7) but no difference in 90-day mortality (2 PWID vs 4 non-PWID; p = 0.39). CONCLUSIONS: NPS-associated S. aureus IE correlated with complications, such as deep organ embolic abscesses, that were different from non-PWID S. aureus IE. The alarming increase in incidence resolved with targeted public health and legislative measures.

Morphological study of fossa ovalis and its clinical relevance.

AIMS: Patent foramen ovale (PFO) has been implicated in the etiology of a number of different pathologies, including cryptogenic stroke, decompression sickness in divers, etc. It can act as a channel for paradoxical embolism. PFO is not an uncommon condition, with a probe-patency in 15-35% population. The fossa ovalis (FOv) varies in size and shape from heart to heart; the prominence of annulus FOv also varies. The entire FOv may be redundant and aneurysmal. The anatomico-functional characterization of interatrial septum seems to be of paramount importance for both atrial septal defect (ASD) and PFO, not only for the device selection, but also for the evaluation of the outcome of this procedure. METHOD: This study was conducted in 50 apparently normal hearts available in Department of Anatomy. After opening the right atrium, the shape of FOv was observed. The size was measured with the digital vernier caliper; the prominence and extent of limbus, and the redundancy or otherwise of FOv were noted; probe patency was confirmed. RESULTS: In the majority, FOv was oval (82%); average transverse diameter was 14.53mm and vertical 12.60mm. In 90%, the rim of the annulus was raised; in 20%, a recess was found deep to the margin of the annulus; and 18% showed probe patency. CONCLUSION: As no study of this nature has been carried out in the Indian population, this provides pertinent information on the morphology of FOv, which may be useful for device selection in treating ASD and PFO.

Increased fragmentation of sleep-wake cycles in the 5XFAD mouse model of Alzheimer's disease.

Sleep perturbations including fragmented sleep with frequent night-time awakenings and daytime naps are common in patients with Alzheimer's disease (AD), and these daily disruptions are a major factor for institutionalization. The objective of this study was to investigate if sleep-wake patterns are altered in 5XFAD mice, a well-characterized double transgenic mouse model of AD which exhibits an early onset of robust AD pathology and memory deficits. These mice have five distinct human mutations in two genes, the amyloid precursor protein (APP) and Presenilin1 (PS1) engineered into two transgenes driven by a neuron-specific promoter (Thy1), and thus develop severe amyloid deposition by 4 months of age. Age-matched (4-6.5 months old) male and female 5XFAD mice were monitored and compared to wild-type littermate controls for multiple sleep traits using a non-invasive, high throughput, automated piezoelectric system which detects breathing and gross body movements to characterize sleep and wake. Sleep-wake patterns were recorded continuously under baseline conditions (undisturbed) for 3 days and after sleep deprivation of 4h, which in mice produces a significant sleep debt and challenge to sleep homeostasis. Under baseline conditions, 5XFAD mice exhibited shorter bout lengths (14% lower values for males and 26% for females) as compared to controls (p<0.001). In females, the 5XFAD mice also showed 12% less total sleep than WT (p<0.01). Bout length reductions were greater during the night (the active phase for mice) than during the day, which does not model the human condition of disrupted sleep at night (the inactive period). However, the overall decrease in bout length suggests increased fragmentation and disruption in sleep consolidation that may be relevant to human sleep. The 5XFAD mice may serve as a useful model for testing therapeutic strategies to improve sleep consolidation in AD patients.

Smoking accelerates pancreatic cancer progression by promoting differentiation of MDSCs and inducing HB-EGF expression in macrophages.

Smoking is an established risk factor for pancreatic cancer (PC), but late diagnosis limits the evaluation of its mechanistic role in the progression of PC. We used a well-established genetically engineered mouse model (LSL-K-ras(G12D)) of PC to elucidate the role of smoking during initiation and development of pancreatic intraepithelial neoplasia (PanIN). The 10-week-old floxed mice (K-ras(G12D); Pdx-1cre) and their control unfloxed (LSL-K-ras(G12D)) littermates were exposed to cigarette smoke (total suspended particles: 150 mg/m(3)) for 20 weeks. Smoke exposure significantly accelerated the development of PanIN lesions in the floxed mice, which correlated with tenfold increase in the expression of cytokeratin19. The systemic accumulation of myeloid-derived suppressor cells (MDSCs) decreased significantly in floxed mice compared with unfloxed controls (P<0.01) after the smoke exposure with the concurrent increase in the macrophage (P<0.05) and dendritic cell (DCs) (P<0.01) population. Further, smoking-induced inflammation (IFN-γ, CXCL2; P<0.05) was accompanied by enhanced activation of pancreatic stellate cells and elevated levels of serum retinoic acid-binding protein 4, indicating increased bioavailability of retinoic acid which contributes to differentiation of MDSCs to tumor-associated macrophages (TAMs) and DCs. TAMs predominantly contribute to the increased expression of heparin-binding epidermal growth factor-like growth factor (EGFR ligand) in pre-neoplastic lesions in smoke-exposed floxed mice that facilitate acinar-to-ductal metaplasia (ADM). Further, smoke exposure also resulted in partial suppression of the immune system early during PC progression. Overall, the present study provides a novel mechanism of smoking-induced increase in ADM in the presence of constitutively active K-ras mutation.

Morphology of the bicipital aponeurosis: a cadaveric study.

The bicipital aponeurosis (BA) is a fascial expansion which arises from the tendon of biceps brachii and dissipates some of the force away from its enthesis. It helps in dual action of biceps brachii as supinator and flexor of forearm. The aim of the present work was to study the morphology of BA. Thirty cadavericupper limbs (16 right and 14 left side limbs) were dissected and dimensions ofthe BA were noted. The average width of aponeurosis at its commencement on the right was 15.74 mm while on the left it was 17.57 mm. The average angle between tendon and aponeurosis on the right was 21.16° and on the left it was 21.78°. The fibres from the short head of the biceps brachii contributed to the formation of proximal part of aponeurosis. Fascial sheath over the tendon oflong head of biceps brachii was seen to form the distal part of the aponeurosis. In 5 cases, large fat globules were present between the sheath and the tendon. Histologically: The aponeurosis showed presence of thick collagen bundles. Fascials heath covering the tendon of long head extended towards the aponeurosis and passed superficial to the tendon of biceps. Blood vessels and adipose tissue were found to be present between fascial sheath and the tendon. This morphological description of BA may be helpful 1) in elucidating the dynamic role that BA plays in normal functioning and 2) to the surgeons in the repair of ruptured biceps brachii tendon.

Nephron sparing surgery for unilateral non-syndromic wilms tumor.

The initial therapy for most children with Wilms tumor is radical nephrectomy. Several centers, have explored the role of Nephron-sparing procedures in children with unilateral non-syndromic Wilms tumors. The primary motivation for this approach is concern about late occurrence of renal dysfunction after unilateral nephrectomy. We report our experience with NSS for unilateral non-syndromic Wilms tumor. We reviewed the records of nine children who underwent nephron sparing surgery for unilateral, nonsyndromic Wilms tumors at our Hospital between Jan 2000 through Jan 2012. All patients received preoperative chemotherapy with two drugs (vincristine, and dactinomycin) following which patients underwent tumor resection. Subsequent renal function was assessed by estimating the glomerular filtration rate using creatinine clearance and other measures of long-term renal function assessment included blood pressure evaluation and the need for antihypertensive medications. During the study period nine children with a mean age 19.66 ± 14.37 months at diagnosis and presenting with unilateral non-syndromic Wilms tumor underwent nephron sparing surgery. In all the nine children, the renal plane of resection showed a tumor-free margin. Post-operative serum creatinine repeated at the end of 3 months revealed maintenance of good renal function in all children. Nephron sparing surgery is a safe and effective option in the management of early stage unilateral non-syndromic Wilms tumor. It is oncologically safe and does not lead to decreased local tumor control. The function of the kidney remnant remains rather well.

Lumbosacral actinomycosis in an immunocompetent individual: An extremely rare case.

Actinomycosis is a gram positive commensal bacteria. In predisposed individuals like immunocompromised patients, it can cause myriad lesions involving virtually any organ of the body. Involvement of spinal cord with its compression is rare though. We are reporting here a case of 30-year-old immunocompetent male who presented with weakness of left lower limb. Radiologically differential diagnosis was tuberculosis or lymphoma of spinal cord. Histopathology showed actinomycotic colonies that were periodic Schiff (PAS) positive and revealed gram positive filamentous bacteria.

The morphology of lumbar sympathetic trunk in humans: a cadaveric study.

The vasospastic diseases and chronic pain related to lower limb have been successfully treated by surgical ablation of lumbar sympathetic trunk for last 80 years.Precise knowledge of anatomy of lumbar sympathetic trunk and its adjoining structures is mandatory for safe and uncomplicated lumbar and spinal surgeries.We aim to study the detailed anatomy of entry and exit of lumbar sympathetic trunk, the number, dimensions and location of lumbar ganglia in relation to lumbar vertebra. Thorough dissection was carried out in 30 formalin embalmed cadavers available in the Department of Anatomy, Pravara Institute of Medical Sciences (PIMS), Rural Medical College (RMC), Loni, Maharashtra. A total of 238 ganglia were observed in 60 lumbar sympathetic trunks. The sympathetic trunk traversed dorsal to the crus of diaphragm in 72.6% and in 13.3% it entered dorsal to the medial arcuate ligament. The most common site of the location of lumbar ganglia was in relation to the second lumbar vertebra, sometimes extending up to the L2-L3 vertebral disc. There was a medial shift of sympathetic trunk in lumbar region and it coursed over sacral promontory to reach the pelvic region in 96% of specimens. These variations should be kept in mind in order to prevent hazardous complications like accidental avulsion of first lumbar ganglia and genitofemoral neuritis.

Transcultural diabetes nutrition therapy algorithm: the Asian Indian application.

India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India-coupled with a sedentary lifestyle and specific socioeconomic pressures-has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant India-specific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs.

The thyroid gland and its variations: a cadaveric study.

The size and shape of the thyroid gland is subject to much variation, as stated by Wood Jones. Literature is replete with a large number of variations of the gland. By utilizing various techniques like gross dissection, histology, developmental anatomy, and recently thyroid scans and scintigraphy, some common and certain rare anomalies of the thyroid with their possible developmental bases are described in the literature. An attempt has been made to study the thyroid glands in 90 male cadavers available in our department, with ages ranging from 60 to 75 years with mean height of 5'4". The parameters that were observed included the length and width of lobes, presence or absence of pyramidal lobe, levator glandulae thyroideae, and isthmus with its relation to the tracheal rings. The average length of the right lobe was 4.32 cm, and the left lobe was 4.22 cm. The thickness of the right lobe was 1.13 cm, and the left lobe was 1.18 cm. Pyramidal lobe was present in 34 (37.77%) cases, frequently arising from the left lobe, while the levator glandulae thyroideae was present in 27 (30%) instances, mostly attached superiorly to the body of the hyoid bone. The isthmus was absent in 15 (16.66%) cases; its relation with the tracheal rings greatly varied from the cricoid cartilage to the fourth tracheal ring. Knowledge of variations of the thyroid assumes significance as this has relevance in the resection of thyroid, tumours, and tracheostomy.

Feathered fibres of human soleus muscle / Fibras penniformes del músculo sóleo humano

The large size of superficial group of muscles of back of leg is a characteristic feature of the musculature of man being related directly to its erect posture and mode of progression. Triceps surae is one of the powerful muscles of the body after Gluteus maximus and Quadriceps femoris. To make the muscle more powerful nature has devised a unique method of packing the fibers in a small space by pennation. There exists a bipenniform mass as a peculiarly human feature. Its feathered fasciculi arise from the deep (anterior) surface of the soleus muscle. Most of the textbooks of Anatomy and the available literature on the triceps surae or the tendoachillis do not appreciate and describe this fascinating aspect of the muscle. It was Schafer et al. (1923) who gave a detailed account of this muscle. Standring et al. (2005) have also described this muscle in great detail. We have studied the unique features of this part of soleus muscle. Bipennate arrangement was seen in 86 percent (right-83 percent; left-89 percent); and its maximum width was found to be 3.63 cm (Rt-3.71cm; Lt-3.55cm). Median tendinous septum was directed backwards and medially. Thus this muscle will further increase the power of contraction of soleus, which is so very important for a bipedal gait.

El gran tamaño de los grupos musculares superficiales de la parte posterior de la pierna es un rasgo característico de la musculatura del hombre siendo relacionado directamente con su postura erguida y el modo de progresión. El músculo tríceps sural es uno de los músculos más potentes del cuerpo después de los músculos glúteo magno y cuadríceps femoral. Para hacer al músculo más potente, la naturaleza ha ideado un método único de empaquetamiento de las fibras en un pequeño espacio por pennación. Existe una masa bipenniforme como una característica peculiarmente humana. Los fascículos pennados surgen desde la superficie profunda (anterior) del músculo sóleo. La mayoría de los textos de Anatomía y la literatura disponible sobre el músculo tríceps sural o el tendón de Aquiles no se aprecia ni se describe este aspecto fascinante que tienen los músculos. Fue Schafer (1923) quien dió una detallada descripción del músculo sóleo y posteriormente, Standring et al. (2005) también describieron detalladamente al músculo. Estudiamos las características únicas de esta parte del músculo sóleo, observando una disposición bipenniforme en el 86 por ciento de los casos (derecha 83 por ciento; izquierda 89 por ciento). El ancho máximo del músculo fue de 3,63 cm (derecha 3,71cm; izquierda 3,55cm). El septo tendinoso mediano se dirigió hacia posterior y medial, aumentando así aún más el poder de contracción del músculo sóleo, el cual es muy importante para la bipedestación.

Some interesting observations on the surface features of the liver and their clinical implications.

INTRODUCTION: A sound knowledge of the normal and variant liver anatomy is a prerequisite to having a favourable surgical outcome. Knowledge of the commonly-occurring variations assumes even more significance in the era of diagnostic imaging and minimally-invasive surgical approaches. Although the segmental anatomy of the liver has been extensively researched, very few studies have dealt with the surface variations of the liver. METHODS: 90 formalin-fixed livers were utilised for the study. Variations regarding the shapes of the caudate and the quadrate lobes as well as the normal fissures were observed. The presence of the accessory fissures and any other variations on the surface of the livers were noted. RESULTS: Varied shapes of the caudate and the quadrate lobes were encountered. Notching along the inferior border of the caudate lobe was seen in 18 percent of livers, a vertical fissure was observed in 30 percent, and prominent papillary process was seen in 32 percent. Accessory fissures and grooves were more common in the right lobe. Multiple prominent vertical grooves were observed on the anterosuperior surface of the liver in six percent of livers. Quadrate lobe was absent in four percent, and in two cases, it was found to be deeply buried. Presence of a pons hepatis, bridging the left and the quadrate lobes, was observed in 30 percent of the livers examined. CONCLUSION: Our study is expected to serve as a guide for proper interpretations of liver images using various imaging modalities. It will also be useful to the operating surgeons to be aware of the frequently-occurring morphological variations on the liver surface.

Influence of biomass and gold salt concentration on nanoparticle synthesis by the tropical marine yeast Yarrowia lipolytica NCIM 3589.

Cell-associated gold nanoparticles and nanoplates were produced when varying number of Yarrowia lipolytica cells were incubated with different concentrations of chloroauric acid (HAuCl(4)) at pH 4.5. With 10(9)cells ml(-1) and 0.5 or 1.0 mM of the gold salt, the reaction mixtures developed a purple or golden red colour, respectively, and gold nanoparticles were synthesized. Nanoparticles of varying sizes were produced when 10(10)cells ml(-1) were incubated with 0.5, 1.0 or 2.0 mM chloroauric acid salt. With 3.0, 4.0 or 5.0 mM HAuCl(4), nanoplates were also observed. With 10(11)cells ml(-1) nanoparticles were synthesized with almost all the gold salt concentrations. The cell-associated particles were released outside when nanoparticle-loaded cells were incubated at low temperature (20 degrees C) for 48 h. With increasing salt concentrations and a fixed number of cells, the size of the nanoparticles progressively increased. On the other hand, with increasing cell numbers and a constant gold salt concentration, the size of nanoparticles decreased. These results indicate that by varying the number of cells and the gold salt concentration, a variety of nanoparticles and nanoplates can be synthesized. Fourier transform infrared (FTIR) spectroscopy revealed the possible involvement of carboxyl, hydroxyl and amide groups on the cell surfaces in nanoparticle synthesis.

Anatomy of retrohepatic segment of inferior vena cava and termination of hepatic veins.

BACKGROUND: Information on anatomy of intrahepatic inferior vena cava (IVC) and hepatic vein openings in it is limited. METHODS: We studied the retrohepatic segment of IVC and hepatic vein openings in it in 69 livers obtained from cadavers. The retrohepatic portion of the IVC was opened posteriorly by a vertical cut, the exposed surface was divided into 12 quadrants and the position, size, and septation of ostia of hepatic veins and any accessory openings were charted; measurements were made using Vernier calipers. RESULTS: The median length of the intrahepatic IVC was 5.7 (range 3.3-8.2) cm and its median diameter was 2.3 (range 1.5-3.0) cm. The superior (major) set of hepatic veins comprised of two veins (right and left-middle) in 45 (65%) cases, three veins (right, middle, and left) in 23 (33%) and four veins in one (2%) case. Median diameter of the right hepatic vein was 1.5 (range 0.8-2.7) cm and that of left hepatic vein was 1.2 (0.7-2.6) cm. Middle hepatic vein, when separate, had a median diameter of 1.1 (range 0.5-1.5) cm. The inferior (minor) set of hepatic veins had two to 16 (median 7) veins. CONCLUSIONS: Our data provide information on number, size, position, and septation of hepatic vein openings into the IVC. This information may be useful to hepatologists, hepatic surgeons while planning segmental resection of the liver, and to radiologists planning diagnostic and interventional procedures on hepatic venous system.

Endoscopic management is the preferred treatment modality for a Grade III vesicoureteric reflux with breakthrough infections in a young girl.

Endoscopic injection treatment for VUR appears to have less success rate than open surgical treatment, even in Gr 3 VUR. Economics of use of deflux injection and its success rate do not suit Indian milieu. To achieve high success rate of Atlanta group in endoscopic injection treatmnent , requires a longer learning curve and yet it has not achieved success rate of 96-98% achieved by open surgical techniques. Recent addition of modified extravesical reimplantation technique has reduced significantly the post operative pain and patient can be discharged within 2 days from the hospital.

Bone disease in preterm.

The survival rate of premature infants has significantly increased during the last few decades. As a consequence, new disorders such as osteopenia of prematurity have been emerging. We report 6 month evolution from diagnosis to recovery of a patient with metabolic bone disease of prematurity who showed a remarkable improvement on therapy with phosphate, calcium and vitamin D.

Morphology of peroneus tertius muscle.

Peroneus tertius (PT) muscle is peculiar to man, and man is the only member among the primates in whom this muscle occurs. The muscle is variable in its development and attachment. Because of functional demands of bipedal gait and plantigrade foot, part of extensor digitorum brevis (EDB) has migrated upwards into the leg from the dorsum of foot. PT is a muscle that evolution is rendering more important. In a total of 110 cadavers, extensor compartment of leg and dorsum of foot were dissected in both the lower limbs and extensor digitorum longus (EDL), and PT muscles were dissected and displayed. PT was found to be absent in 10.5% limbs, the incidence being greater on the right side. The remaining limbs in which the PT muscle was present had a very extensive origin from lower 3/4th of extensor surface of fibula (20% on right and in 17% on left), and the EDL was very much reduced in size. In approximately 12%, the tendon of PT was thick or even thicker than the tendon of EDL. In 4%, the tendon extended beyond fifth metatarsal up to metatarsophalangeal joint of fifth toe, and in 1.5%, it extended up to the proximal phalanx of little toe. In two cases (both on the right side), where PT was absent, it was replaced by a slip from lateral margin of EDL. We conclude that PT, which is preeminently human, is extending its purchase both proximally and distally.