The Rare Presence of an Asymptomatic Os Sustentaculum in a Young Athlete.

The presence of an os sustentaculum bone is extremely rare. Given the scarcity of clinical literature reporting such a finding, the condition may be misdiagnosed as a fracture of the sustentaculum tali. We describe such an incident in a 16-year-old male athlete presenting for a recent ankle sprain with no other history of trauma or pain on the medial aspect of the ankle. The original computed tomographic scan reported a possible nonunion of a sustentaculum fracture, or peripherally corticated ossification in association with a possible talocalcaneal fibrocartilaginous coalition. Given no history of high-level trauma to the area, the clinical presentation, and the radiographic findings, the more likely diagnosis was confirmed to be an os sustentaculum. The goal of the authors of this article is to report such findings to raise awareness of a rare clinical presentation to avoid misdiagnosis.

Dermal Discoloration Secondary to Triamcinolone Acetonide Injection Observed in Patients with Autoimmune Disorders.

Triamcinolone acetonide is a synthetic glucocorticoid used to treat numerous acute and chronic inflammatory conditions. The various side effects of this drug from parenteral administration are well documented in the literature. In this study, three patients present with a rare side effect of violaceous dermal pigmentation. To the best of the authors' knowledge, this finding is rarely presented in the current literature. The purpose of this study is to provide awareness of a less-documented, delayed side effect from triamcinolone acetonide administration. Although all patients presenting in this study had a known history of autoimmune disease (eg, lupus, psoriatic arthritis) further research is needed to suggest a possible association between dermal violaceous change and the use of triamcinolone.

Atypical Vascularity Within a Schwannoma.

We report on the unusual presentation of a schwannoma. Aside from the aberrant dorsolateral anatomical presentation, ultrasonography revealed not only peripheral vascularity but also internal vascularity. Internal vascularity often suggests a malignant process as opposed to a benign one; however, in the presented case, the diagnosis of a benign lesion was confirmed with S100 immunohistochemical staining. In this study, we review the literature on this pathology and present an uncommon presentation of a benign nerve tumor.

Multiple Open Dislocations of the Lesser Interphalangeal JointsA Case Report.

We report on the rare case of multiple open interphalangeal dislocations. This uncommon pathologic condition results from dorsiflexion and axial loading of the digit. In the present patient, closed reduction was not possible. We review the literature on this pathologic condition and present a case of open irreducible dislocation of the lesser interphalangeal joints complicated by peripheral neuropathy and treated with resectional arthroplasty.

Child dysentery in the Limpopo Valley: a cohort study of water, sanitation and hygiene risk factors.

The objective of this cohort study was to assess risk factors for child dysentery and watery diarrhoea. The study participants consisted of 254 children aged 12-24 months in rural South Africa and Zimbabwe in households where drinking water was collected from communal sources. The main outcome measure was the most severe diarrhoea episode: dysentery, watery diarrhoea or none. For dysentery, drinking water from sources other than standpipes had a relative risk ratio of 3.8 (95% CI 1.5-9.8). Poor source water quality, as indicated by Escherichia coli counts of 10 or more cfu 100 ml(-1), increased risk by 2.9 (1.5-5.7). There were no other significant risk factors for dysentery and none for watery diarrhoea. In this study, endemic dysentery is associated only with faecal contamination of source water. Sources other than standpipes, including improved groundwater, are of greater risk. Remediation of water quality by treatment at source or in the household will be required to achieve access to safe drinking water in accordance with the 7th Millennium Development Goal.

Disease prevalence in the English population: a comparison of primary care registers and prevalence models.

The Quality and Outcomes Framework (QOF) is a UK system for monitoring general practitioner (GP) activity and performance, introduced in 2004. The objective of this paper is to explore the potential of QOF datasets as a basis for better understanding geographical variations in disease prevalence in England. In an ecological study, prevalence estimates for four common disease domains (coronary heart disease (CHD), asthma, hypertension and diabetes) were derived from the 2004-2005 QOF primary care disease registers for 354 English Local Authority Districts (LADs). These were compared with synthetic estimates from four prevalence models and with self-reported measures of general health from the 2001 census. Prevalence models were recalculated for LADs using demographic and deprivation data from the census. Results were mapped spatially and cross-tabulated against a national classification of local authorities. The four disease domains display different spatial distributions and different spatial relationships with the corresponding prevalence model. For example, the prevalence model for CHD under-estimated QOF cases in northern England, but this north-south pattern was not evident for the other disease domains. The census-derived health measures were strongly correlated with CHD, but not with the other disease domains. The relationship between modelled prevalence and QOF disease registers differs by disease domain, implying that there is no simple cross-domain effect of the QOF process on prevalence figures. Given reliable synthetic estimates of small area prevalence for the QOF disease domains, one potential application of the QOF dataset may be in assessing the geographical extent of under-diagnosis for each domain.

Use of ceramic water filtration in the prevention of diarrheal disease: a randomized controlled trial in rural South Africa and zimbabwe.

To determine the effectiveness of ceramic filters in reducing diarrhea, we conducted a randomized controlled trial in Zimbabwe and South Africa, in which 61 of 115 households received ceramic filters. Incidence of non-bloody and bloody diarrhea was recorded daily over 6 months using pictorial diaries for children 24-36 months of age. Poisson regression was used to compare incidence rates in intervention and control households. Adjusted for source quality, intervention household drinking water showed reduced Escherichia coli counts (relative risk, 0.67; 95% CI, 0.50-0.89). Zero E. coli were obtained for drinking water in 56.9% of intervention households. The incidence rate ratio for bloody diarrhea was 0.20 (95% CI, 0.09-0.43; P < 0.001) and for non-bloody diarrhea was 0.17 (95% CI, 0.08-0.38; P < 0.001), indicating much lower diarrhea incidence among filter users. The results suggest that ceramic filters are effective in reducing diarrheal disease incidence.

New directions for the Morita-Baylis-Hillman reaction; homologous aldol adducts via epoxide opening.

Under trialkylphosphine catalyzed Morita-Baylis-Hillman reaction conditions, epoxides react with enones to give rise to homologous aldol adducts.

Defining episodes of diarrhoea: results from a three-country study in Sub-Saharan Africa.

The study was conducted to assess the effect of definition of episode on diarrhoeal morbidity and to develop a means of adjusting estimates of morbidity for the definition of episode used. This paper reports on a cohort study of 374 children, aged 9-32 months, in three African countries, which recorded frequency and consistency of stool over a seven-month period. Different definitions of episode were applied to these data to assess their effect on annualized diarrhoeal morbidity. Adjustment factors were then derived that corrected morbidity for non-standard definitions of episode. Applying non-standard definitions of episode gave estimates of an annualized number of episodes between 38% and 137% of the internationally-accepted definition. Researchers should be encouraged to use the standard definition of episode of diarrhoea and to use appropriate field protocols. Where this is not possible, correction factors should be applied, particularly where estimates of diarrhoeal morbidity are pooled in systematic reviews.

Understanding variation in measles-mumps-rubella immunization coverage--a population-based study.

BACKGROUND: Coverage of the Measles-Mumps-Rubella combined vaccine (MMR) has declined in recent years in the UK, following adverse publicity about possible links between the vaccine, autism, and Crohn's disease. The objectives of this study were to assess geographical variation in trends in MMR coverage and to identify the factors affecting MMR uptake at population level. METHODS: We conducted an ecological study of immunization coverage by second birthday, based on routinely collected data from 1993-2004 for England. Trends in MMR uptake were assessed in 95 District Health Authorities in England over the study period. We investigated the relationship between MMR immunization uptake and deprivation, ethnicity, education, population density, rurality, and socioeconomic class. RESULTS: Since 2000, MMR coverage has declined significantly in virtually all areas of England. Population density and deprivation were both strongly correlated with low MMR uptake. The decline in coverage since 1993-94 was significantly related to the proportion of educated population and was greater in densely populated areas. CONCLUSION: Decline in MMR coverage now affects most areas of England. The lowest rates of MMR coverage remain in urban areas, particularly in inner cities, which also tend to show high levels of deprivation. Public health resources should continue to target inner city areas, as well as focus on the concerns of the better educated about vaccine safety.

Catalytic activity of dodecacarbonyltetracobalt in aqueous media: a "greening" of the Pauson-Khand reaction.

The unprecedented reactivity of Co(4)(CO)(12) with enynes under aqueous conditions, representing the development of a mild and simple aqueous-phase cobalt-catalyzed PK reaction protocol, is described herein.

Cobalt carbonyl-mediated carbocyclizations of enynes: generation of bicyclooctanones or monocyclic alkenes.

Depending on the thermolytic conditions, dicobalthexacarbonyl-complexed enynes underwent cyclizations to provide different carbocyclic frameworks. Bicyclopentanones were formed from enyne-Co2(CO)6 complexes, or from enynes that were treated with Co2(CO)8, or more effectively, with Co4(CO)12 in an alcoholic solvent under a H2 or N2 atmosphere. This transformation proceeded via a sequential cyclocarbonylation and 1,4-reduction and is the first account using the cobalt carbonyl cluster. Under these conditions a cobalt hydride was presumably generated, which mediated reduction of the enone to the saturated ketone. In contrast, thermolysis of dicobalthexacarbonyl-complexed enynes under a hydrogen atmosphere in toluene resulted in their reductive cyclization to form monocyclic alkenes in moderate yields, in addition to the bicyclopentenone product. In some cases, addition of a hydrosilane to the reaction induced a complete suppression of the bicyclopentenone formation. While the former results demonstrate a reaction that occurs after the cycloaddition, the latter depicts another example of an interruption of the normal route in the Pauson-Khand reaction pathway.