Impalement injury to the heart.

Cardiac impalement injury is rare and one of the most severe penetrating chest injuries, often fatal. The management of penetrating cardiac injuries is a challenging one. The success in management of impaling cardiac trauma requires stabilization of the impaling object, expeditious transfer to a facility for open heart surgery, rapid imaging, access to blood and blood products and a ready surgical team. We report a case of impalement injury to the heart by a stick, transfixing the right ventricle and its successful treatment.

CTLA4 -1661A/G and 3'UTR long repeat polymorphisms are associated with ulcerative colitis and influence CTLA4 mRNA and protein expression.

Reduced cytotoxic T-lymphocyte antigen 4 (CTLA4) expression has been proposed as a risk for autoimmunity. CTLA4 polymorphisms have been associated with several autoimmune diseases, including ulcerative colitis (UC). In this study, we performed genotyping for CTLA4 -1661A/G, -1722T/C and 3' untranslated region (AT)n repeat polymorphisms in 300 Chinese UC patients and in 700 healthy controls, and evaluated the effects of polymorphisms on full-length (flCTLA4) and soluble CTLA4 (sCTLA4) expression in UC patients. The frequency of the -1661G allele was higher in UC patients than in healthy controls (16.5 vs 11.4%, P=0.003, odds ratio (OR)=1.53, 95% confidence interval (95% CI): 1.17-2.01). The prevalence of (AT)n repeats of the CTLA4 gene carrying long alleles (≥116 bp) was more common in UC patients than in healthy controls (22.0 vs 6.3%, P<0.001, OR=4.21, 95% CI: 2.79-6.33), and was associated with extensive colitis (P=0.008). Among UC patients, long-allele carriers expressed lower levels of flCTLA4 and sCTLA4 mRNA and sCTLA4 protein than did short-allele carriers (P<0.001, P<0.001, P<0.001, respectively). CTLA4 gene -1661A/G and long 3' untranslated region (AT)n repeat polymorphisms are associated with UC in Central China. This is likely from decreased expressions of sCTLA4 mRNA and sCTLA4 protein. Our study suggests that CTLA4 has an important role in susceptibility for UC in Central China.

Ruptured aneurysm of extracranial carotid artery.

Aneurysm of extracranial carotid artery is an uncommon clinical disease and that presenting as a ruptured aneurysm is extremely rare. This entity represents a challenge to treatment strategy. A 54 year old hypertensive male presented with painful, pulsatile mass in left neck. Duplex scan revealed the ruptured left carotid artery at its bifurcation. Angiogram depicted clear picture of ruptured carotid artery aneurysm. Resection of aneurysm was performed with placement of external carotid shunt. Continuity was maintained with interposition of Dacron graft.

The prevalence of hypertension and diabetes defined by fasting and 2-h plasma glucose criteria in urban Nepal.

AIMS: To determine the prevalence of diabetes, impaired fasting glucose and impaired glucose tolerance (IGT) in people aged >/= 40 years in urban communities of Nepal, comparing the fasting and 2-h plasma glucose (PG) criteria for diagnosis of diabetes and to relate the prevalence to age, gender and hypertension. METHODS: Field surveys of fasting and 2-h PG and blood pressure (BP) were done by cluster sampling in seven urban populations of Nepal. Of 1180 eligible individuals invited, 1012 (85.7%) aged >/= 40 years participated. RESULT: The age and sex standardized prevalence of diabetes (known and newly diagnosed), IGT and impaired fasting glycaemia (IFG) were 19.0%, 10.6% and 9.9%, respectively. Of the total population, 30.5% (37.8% of men and 25.3% of women) had some abnormality of glucose tolerance. Of all diabetic individuals, 54.4% (53.8% of men and 55.1% of women) were undiagnosed. The prevalence of diabetes increased with age until the age of 75 years. The prevalence of diabetes was higher in men than in women (P < 0.001). The sensitivity of the fasting plasma glucose (FPG) criterion compared with either FPG or 2-h PG or both criteria for the diagnosis of diabetes was 70.5%[95% confidence interval (CI) 60.7, 78.8] and the corresponding sensitivity of 2-h PG criterion was 79% (95% CI 69.8, 86.1). The age- and sex-standardized prevalence of hypertension (BP >/= 140/90 mmHg) was 22.7%. Hypertension was less common in subjects with normal plasma glucose than in those with diabetes (18.8% vs. 36.7%). Similarly, of all subjects with hypertension, 29.1% had diabetes (known or newly diagnosed) and 43.0% had glucose intolerance of some form. CONCLUSIONS: Our study shows that diabetes and hypertension are common and related problems in people aged >/= 40 years in urban Nepal. The overall sensitivity of the 2-h PG criteria was greater than that of the FPG criteria for diagnosing diabetes, except in subjects aged >/= 60 years.

Prevalence of rheumatic fever and rheumatic heart disease in school children in a rural community of the hill region of Nepal.

A survey of school children aged 5 to 16 years living in a rural community of the hill region of Nepal, situated about 15-22 km outside Kathmandu city, was conducted to determine the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD). Of the 4,816 eligible children enrolled in the selected schools, 4,452 (92.4%) were examined. WHO expert committee criteria (1966) was used for the diagnosis and classification of rheumatic fever. Chest x-ray, electro-cardiography, echocardiography and Doppler study were done in all suspected cases of rheumatic heart disease. Six cases of RHD (1 pure mitral stenosis, 3 mitral regurgitation and 2 combined mitral stenosis and regurgitation) were identified giving overall prevalence rate of 1.35 per thousand. No case with active rheumatic fever could be identified. This is the first study on prevalence of RF/RHD in Nepal. The prevalence rate is lower than that reported from neighbouring countries.