Non Dysraphic Intramedullary Spinal Cord Lipoma.

Among all intramedullary spinal cord lesions, intramedullary spinal cord lipomas account less than 1%. Non-dysraphic intramedullary lipoma is very rare. It is most commonly seen in cervicodorsal region followed by cervico bulbar, lumbar and sometimes multiple. Here we present a 17-year-old female who underwent MRI due to upper dorsal pain followed by progressive bilateral lower limb weakness which showed intramedullary lesion extending from T1-T9, involving eight vertebral segments with distal syrinx and features suggestive of lipoma. Patient underwent surgical decompression of lipoma. Patient had an uneventful post-operative period. Diagnosis confirmed by histopathology.

Surgical Catastrophic Health Expenditure and Risk Factors for Out-of-Pocket Expenditure at a South African Public Sector Hospital.

BACKGROUND: Worldwide, 3.7 billion people risk financial catastrophe if they require surgery, mostly affecting the poorest populations. Surgical care associated with catastrophic health expenditure (CHE) has not been well-described in the South African context. The objectives of this study were to determine: (1) the proportion of surgical patients at a South African hospital who experienced CHE and impoverishing health expenditure (IHE); and (2) the risk factors for out-of-pocket (OOP) payments. METHODS: A cross-sectional prospective questionnaire was administered to participants admitted for a surgical procedure at New Somerset Hospital, Cape Town. CHE was defined in three ways: (1) 40% or more of capacity-to-pay, (2) 25% of annual household expenditure, or (3) 10% of annual household expenditure. IHE was described as the number of participants who experienced new or worsening impoverishment after surgery. RESULTS: Two hundred and seventy-four participants were interviewed, and 263 were included in the analysis (4% attrition rate). Two (0.8%) participants experienced CHE. 98.5% of participants spent less than 10% of their annual household expenditure and 43 participants (16.7%) experienced IHE. Risk factors for OOP expenditure were cancer diagnosis (p = 0.0386), an elective procedure (p = 0.0001), and having a limited health insurance plan (p = 0.0492). DISCUSSION: Most participants undergoing a surgical procedure did not experience CHE. Participants were relatively protected from financial catastrophe owing to subsidized user fees and the provision of transport. However, 17% of patients experienced IHE, suggesting even small payments resulted in impoverishment. Ensuring low financial vulnerabilities around surgical care is an important consideration for national surgical planning in South Africa.

Surgery in South Africa - challenges and barriers.

BACKGROUND: Sustaining a surgical career can be challenging and there are numerous barriers to pursuing a career in surgery. These barriers and challenges are well reported in international literature, but there is a lack of knowledge on how this affects surgeons in South Africa. This study aimed to determine the barriers and challenges that South African surgeons face in their training and careers. METHODS: A 15-item questionnaire was designed and distributed via the Research Electronic Database Capturing software from 1 February-3 April 2020. Data were analysed in Stata 15 SE. All responses were anonymised. RESULTS: One hundred and twenty-nine participants responded to the questionnaire, 33 (26%) of whom were female. The majority were specialist surgeons (n = 87; 71%). One hundred and eleven participants (90%) reported they did not regret pursuing surgery. Barriers to pursuing surgery included limited personal time (n = 98; 76%), heavy surgical workload (n = 92; 71%), and difficulty taking leave of absence (n = 64; 50%), limited postgraduate training (n = 34; 26%), and verbal discouragement (n = 22; 17%). Challenges included difficulty maintaining work-life balance (n = 74; 56%), racial discrimination (n = 29; 23%) and gender discrimination (n = 15; 12%). Fifty-three per cent of participants experienced burnout. CONCLUSION: Despite high career satisfaction, South African surgeons face numerous barriers to pursuing and challenges in sustaining a career in surgery and often experience burnout. These barriers and challenges disproportionately affect female surgeons and can be mitigated through formalised mentorship programmes, flexible work schedules, funding for postgraduate training, and training in diversity and discrimination.

Surgery in South Africa - the attitudes toward mentorship in facilitating general surgical training.

BACKGROUND: There are many barriers to pursuing a surgical career in South Africa, some of which are unique to females. Mentorship has been proposed as a solution to mitigate these barriers. The value of mentorship has not been formally assessed among South African general surgeons and trainees. METHODS: The study was part of a larger study designed to assess barriers to pursuing a career in surgery, including the value of mentorship. A 15-item questionnaire was designed and distributed via the Research Electronic Database Capture from 1 February 2020-3 April 2020. Data were analysed using Stata 15 SE. All responses were anonymised. RESULTS: One hundred and twenty-nine (13.5%) of 955 potential participants responded to the survey of which 26% (33/129) were female. Sixty-seven per cent of respondents were specialist surgeons (87/129). Seventy per cent (90/129) of participants reported having a role model in surgery, however, 66% (86/129) reported they had no mentor in surgery. 107/129 (83%) participants reported the importance of mentorship. The need for a formalised mentorship programme to facilitate surgical training was recorded by 60% (78/129) of participants, while 18% (23/129) reported the need for a mentorship group specifically for females. CONCLUSION: Eighty-three per cent of participants reported the importance of mentorship however two-thirds lacked a mentor. Most participants advocated for a mentorship group to facilitate surgical training. Establishing formalised mentorship programmes could mitigate the barriers to pursuing a surgical career.

District hospital surgical capacity in Western Cape Province, South Africa: A cross-sectional survey.

BACKGROUND: The role of the district hospital (DH) in surgical care has been undervalued. However, decentralised surgical services at DHs have been identified as a key component of universal health coverage. Surgical capacity at DHs in Western Cape (WC) Province, South Africa, has not been described. OBJECTIVES: To describe DH surgical capacity in WC and identify barriers to scaling up surgical capacity at these facilities. METHODS: This was a cross-sectional survey of 33 DHs using the World Health Organization surgical situational analysis tool administered to hospital staff from June to December 2019. The survey addressed the following domains: general services and financing; service delivery and surgical volume; surgical workforce; hospital and operating theatre (OT) infrastructure, equipment and medication; and barriers to scaling up surgical care. RESULTS: Seven of 33 DHs (21%) did not have a functional OT. Of the 28 World Bank DH procedures, small WC DHs performed up to 22 (79%) and medium/large DHs up to 26 (93%). Only medium/large DHs performed all three bellwether procedures. Five DHs (15%) had a full-time surgeon, anaesthetist or obstetrician (SAO). Of DHs without any SAO specialists, 14 (50%) had family physicians (FPs). These DHs performed more operative procedures than those without FPs (p=0.005). Lack of finances dedicated for surgical care and lack of surgical providers were the most reported barriers to providing and expanding surgical services. CONCLUSIONS: WC DH surgical capacity varied by hospital size. However, FPs could play an essential role in surgery at DHs with appropriate training, oversight and support from SAO specialists. Strategies to scale up surgical capacity include dedicated financial and human resources.

Multiplex real-time PCR assays for the prediction of cephalosporin, ciprofloxacin and azithromycin antimicrobial susceptibility of positive Neisseria gonorrhoeae nucleic acid amplification test samples.

BACKGROUND: The incidence of antimicrobial-resistant Neisseria gonorrhoeae (GC) is rising in Canada; however, antimicrobial resistance (AMR) surveillance data are unavailable for infections diagnosed directly from clinical specimens by nucleic acid amplification tests (NAATs), representing over 80% of diagnoses. We developed a set of 10 improved molecular assays for surveillance of GC-AMR and prediction of susceptibilities in NAAT specimens. METHODS: Multiplex real-time PCR (RT-PCR) assays were developed to detect SNPs associated with cephalosporin (ponA, porB, mtrR -35delA, penA A311V, penA A501, N513Y, G545S), ciprofloxacin (gyrA S91, parC D86/S87/S88) and azithromycin [23S (A2059G, C2611T), mtrR meningitidis-like promoter] resistance. The assays were validated on 127 gonococcal isolates, 51 non-gonococcal isolates and 50 NAATs with matched culture isolates. SNPs determined from the assay were compared with SNPs determined from in silico analysis of WGS data. MICs were determined for culture isolates using the agar dilution method. RESULTS: SNP analysis of the 50 NAAT specimens had 96% agreement with the matched culture RT-PCR analysis. When compared with MICs, presence of penA A311V or penA A501 and two or more other SNPs correlated with decreased susceptibility and presence of three or more other SNPs correlated with intermediate susceptibility to cephalosporins; presence of any associated SNP correlated with ciprofloxacin or azithromycin resistance. NAAT-AMR predictions correlated with matched-culture cephalosporin, ciprofloxacin and azithromycin MICs at 94%, 100% and 98%, respectively. CONCLUSIONS: We expanded molecular tests for N. gonorrhoeae AMR prediction by adding new loci and multiplexing reactions to improve surveillance where culture isolates are unavailable.

Epidural blood patch for spontaneous intracranial hypotension (SIH): a report of two cases.

One of the latest diagnoses that need to be considered when evaluating patients with persistent headache is spontaneous (postural) intracranial hypotension (SIH). The diagnosis can be clinched by magnetic resonance imaging (MRI) findings of subdural collections, meningeal enhancement and tonsillar descent. Cerebrospinal fluid leak has been postulated as the cause, and both medical and surgical treatment options have been documented. The treatment of choice is, however, an epidural blood patch. Here we discuss two cases of SIH treated successfully with epidural blood patch.

Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae in Canada, 2012-2016.

BACKGROUND: Neisseria gonorrhoeae have acquired resistance to many antimicrobials, including third generation cephalosporins and azithromycin, which are the current gonococcal combination therapy recommended by the Canadian Guidelines on Sexually Transmitted Infections. OBJECTIVE: To describe antimicrobial susceptibilities for N. gonorrhoeae circulating in Canada between 2012 and 2016. METHODS: Antimicrobial resistance profiles were determined using agar dilution of N. gonorrhoeae isolated in Canada 2012-2016 (n=10,167) following Clinical Laboratory Standards Institute guidelines. Data were analyzed by applying multidrug-resistant gonococci (MDR-GC) and extensively drug-resistant gonococci (XDR-GC) definitions. RESULTS: Between 2012 and 2016, the proportion of MDR-GC increased from 6.2% to 8.9% and a total of 19 cases of XDR-GC were identified in Canada (0.1%, 19/18,768). The proportion of isolates with decreased susceptibility to cephalosporins declined between 2012 and 2016 from 5.9% to 2.0% while azithromycin resistance increased from 0.8% to 7.2% in the same period. CONCLUSION: While XDR-GC are currently rare in Canada, MDR-GC have increased over the last five years. Azithromycin resistance in N. gonorrhoeae is established and spreading in Canada, exceeding the 5% level at which the World Health Organization states an antimicrobial should be reviewed as an appropriate treatment. Continued surveillance of antimicrobial susceptibilities of N. gonorrhoeae is necessary to inform treatment guidelines and mitigate the impact of resistant gonorrhea.

Burden of community-onset bloodstream infections, Western Interior, British Columbia, Canada.

Although community-onset bloodstream infection (BSI) is recognized as a major cause of morbidity and mortality, its epidemiology has not been well defined in non-selected populations. We conducted population-based surveillance in the Interior Health West region of British Columbia, Canada in order to determine the burden associated with community-onset BSI. A total of 1088 episodes were identified for an overall annual incidence of 117·8/100 000 of which 639 (58·7%) were healthcare-associated (HA) and 449 (41·3%) were community-associated (CA) BSIs for incidences of 69·2 and 48·6/100 000, respectively. The incidence of community-onset BSI varied by age and gender and elderly males were at the highest risk. Overall 964 (88·6%) episodes resulted in hospital admission for a median length of stay of 8 days; the total days of acute hospitalization associated with community-onset BSI was 13 530 days or 1465 days/100 000 population per year. The in-hospital mortality rate was 10·6% (102/964) and this was higher for HA-BSI (72/569, 12·7%) compared to CA-BSI (30/395, 7·6%, P = 0·014) episodes. Community-onset BSI, especially HA-BSI, is associated with a major burden of illness.

Enabling dual cellular destinations of polymeric nanoparticles for treatment following partial injury to the central nervous system.

Following neurotrauma, oxidative stress is spread via the astrocytic syncytium and is associated with increased aquaporin 4 (AQP4), inflammatory cell infiltration, loss of neurons and glia and functional deficits. Herein we evaluate multimodal polymeric nanoparticles functionalized with an antibody to an extracellular epitope of AQP4, for targeted delivery of an anti-oxidant as a therapeutic strategy following partial optic nerve transection. Using fluorescence microscopy, spectrophotometry, correlative nanoscale secondary ion mass spectrometry (NanoSIMS) and transmission electron microscopy, in vitro and in vivo, we demonstrate that functionalized nanoparticles are coated with serum proteins such as albumin and enter both macrophages and astrocytes when administered to the site of a partial optic nerve transection in rat. Antibody functionalized nanoparticles synthesized to deliver the antioxidant resveratrol are effective in reducing oxidative damage to DNA, AQP4 immunoreactivity and preserving visual function. Non-functionalized nanoparticles evade macrophages more effectively and are found more diffusely, including in astrocytes, however they do not preserve the optic nerve from oxidative damage or functional loss following injury. Our study highlights the need to comprehensively investigate nanoparticle location, interactions and effects, both in vitro and in vivo, in order to fully understand functional outcomes.

Reductive Alkylation of α-Keto Imines Catalyzed by PTSA/FeCl3: Synthesis of Indoles and 2,3'-Biindoles.

A simple and efficient method for the synthesis of highly functionalized indoles and biindoles was developed. In the reaction protocol, three components were used in one pot and products were obtained in high yield in an easy workup procedure. The reaction occurred via initial reductive alkylation of α-keto imines, followed by a cyclization process in the presence of PTSA/FeCl3 as catalyst.

Iodine-catalyzed sp³ C-H bond activation by selenium dioxide: synthesis of diindolylmethanes and di(3-indolyl)selanides.

An efficient reaction protocol was developed for the synthesis of several diindolylmethane derivatives via the [Formula: see text] C-H bond activation of aryl methyl ketones by [Formula: see text] and indoles in the presence of catalytic amounts of [Formula: see text] at 80 [Formula: see text] using dioxane as solvent. Unexpectedly, an interesting class of di(3-indolyl)selenide compounds was isolated when the reaction was carried out at room temperature.

Microwave-assisted one-pot multi-component reaction: synthesis of novel and highly functionalized 3-(pyranyl)- and 3-(dihydropyridinyl)indole derivatives.

One-pot multi-component reaction of 3-cyanoacetyl indole, aromatic aldehydes and ethyl acetoacetate in the presence of InCl(3)/NH(4)OAc under microwave irradiation for 2-7 min afforded novel and highly functionalized 3-(pyranyl)- and 3-(dihydropyridinyl)indole derivatives, respectively, in good yield.

Synthesis of N-homobicyclic dideoxynucleoside analogues.

Syntheses of six N-homobicyclic dideoxynucleoside analogues are described. The reaction of mannose diacetonide with trimethylsulfoxonium iodide gave a mixture of diastereomeric hydroxymethyl mannose diacetonides in a ratio of 2:5, which was separated by fractional crystallization. The two stereoisomers were converted to bicyclic furanolactols each of which was coupled with three nucleoside bases. Further debenzylations gave the six target N-homobicyclic dideoxynucleosides.

Synthesis of 5-alkylated barbituric acids and 3-alkylated indoles via microwave-assisted three-component reactions in solvent-free conditions using Hantzsch 1,4-dihydropyridines as reducing agents.

Reaction of barbituric acids with aldehydes and dihydropyridines in one pot under microwave (MW) irradiation in the absence of solvent, affords 55­82% of the 5-benzylated barbituric acids. Use of alkyl nitriles or barbituric acids with indole-3-aldehyde and dihydropyridine (DHP) afforded 3-alkylated indoles in 57­76 % yield. In each case DHPs are converted to pyridines.

Multiple thoracolithiasis: An incidental finding.

Thoracoliths are rare benign intrapleural fibrotic structures with a necrotic fat core. There are 19 previous reported cases in the literature. This case report presents for the first time, a patient with two thoracoliths within the same hemithorax. Both lesions were identified incidentally in the left hemithorax by computed tomography and remained in the same position on repeat imaging. The lesions were removed by a video-assisted thoracic surgery approach. Histology revealed a 20mm and a 14mm lesion, with a fibrotic dense collagen shell surrounding a non-viable necrotic fat core. This case demonstrates that thoracolithiasis is a rare differential diagnosis for incidental multiple non-mobile lesions within the thorax.

Treatment of crown dilaceration: an interdisciplinary approach.

Trauma to primary teeth can result in a wide range of disturbances to the underlying permanent teeth, such as dilaceration. Root dilacerations occur more commonly than crown dilacerations. This paper is a report of an 11-year-old girl with a missing maxillary left anterior tooth. Past history revealed premature loss of primary maxillary anterior teeth due to trauma. Radiographic examination revealed crown dilaceration of permanent maxillary left central incisor. An interdisciplinary approach in the management of this child is presented herewith.

The case for the development of novel analgesic agents targeting both fatty acid amide hydrolase and either cyclooxygenase or TRPV1.

Although the dominant approach to drug development is the design of compounds selective for a given target, compounds targeting more than one biological process may have superior efficacy, or alternatively a better safety profile than standard selective compounds. Here, this possibility has been explored with respect to the endocannabinoid system and pain. Compounds inhibiting the enzyme fatty acid amide hydrolase (FAAH), by increasing local endocannabinoid tone, produce potentially useful effects in models of inflammatory and possibly neuropathic pain. Local increases in levels of the endocannabinoid anandamide potentiate the actions of cyclooxygenase inhibitors, raising the possibility that compounds inhibiting both FAAH and cyclooxygenase can be as effective as non-steroidal anti-inflammatory drugs but with a reduced cyclooxygenase inhibitory 'load'. An ibuprofen analogue active in models of visceral pain and with FAAH and cyclooxygenase inhibitory properties has been identified. Another approach, built in to the experimental analgesic compound N-arachidonoylserotonin, is the combination of FAAH inhibitory and transient receptor potential vanilloid type 1 antagonist properties. Although finding the right balance of actions upon the two targets is a key to success, it is hoped that dual-action compounds of the types illustrated in this review will prove to be useful analgesic drugs.

Protective effect of quercetin against ICV colchicine-induced cognitive dysfunctions and oxidative damage in rats.

Intracerebroventricular (i.c.v.) administration of colchicine, a microtubule-disrupting agent, causes cognitive dysfunction and oxidative stress. The present study was designed to investigate the protective effects of quercetin against colchicine-induced memory impairment and oxidative damage in rats. An i.c.v. cannula was implanted in the lateral ventricle of male Wistar rats. Colchicine was administered at dose of 15 microg/rat. Morris water maze and plus-maze performance tests were used to assess memory tasks. Various biochemical parameters such as lipid peroxidation, reduced glutathione, nitrite level, acetylcholinesterase and proteins were also assessed. Central administration of colchicine (15 microg/rat) showed poor retention of memory. Chronic treatment with quercetin (20 and 40 mg/kg, p.o.) twice daily for a period of 25 days beginning 4 days prior to colchicine injection significantly improved the colchicine-induced cognitive impairment. Biochemical analysis revealed that i.c.v. colchicine injection significantly increased lipid peroxidation, nitrite and depleted reduced glutathione activity in the brains of rats. Chronic administration of quercetin significantly attenuated elevated lipid peroxidation and restored the depleted reduced glutathione, acetylcholinesterase activity and nitrite activity. The results of the present study clearly indicated that quercetin has a neuroprotective effect against colchicine-induced cognitive dysfunctions and oxidative damage. This article was published online on 3 November 2008. An error was subsequently identified. This notice is included in the online and print version to indicate that both have been corrected.