A multidisciplinary approach: Case report of an abdominal aortic aneurysm with type IIIA endoleak in the setting of cholangitis.

Endoleaks are a common complication of endovascular aortic aneurysm repair and often lead to aneurysm rupture. We report a complex case of a Type IIIA endoleak in a patient with suspected cholangitis. Immediate surgical measures to manage both the cholangitis and endoleak were performed while minimizing the risk of graft infection.

The role of miRNA in somatic embryogenesis.

Somatic embryogenesis (SEG) is one of the best techniques for mass production of economically important plants. It is also used for the study of morphology, anatomy, physiology, genetics and molecular mechanism of embryo development. Somatic Embryos (SE) are bipolar structures that develop from a cell other than a gamete or zygote. SEG reflects the unique developmental potential of plant somatic cells, resulting in the transition of the differentiated somatic cells to embryogenic cells to follow the zygotic embryo stages. There are several biochemical and physiological processes that transformed a single somatic cell to a whole plant. SE studies provide insight into cell mechanisms governing the totipotency process in plants. Previously, in vitro studies have suggested the role of various regulatory genes in embryogenic transition that are triggered by plant hormones in response to stress. The omic studies identify the specific genes, transcripts, and proteins required for somatic embryogenesis development. MicroRNAs (miRNAs) are small, 19-24 nucleotides (nt), non-coding small RNA regulatory molecules controlling a large number of biological processes. In addition to their role in SEG, miRNAs play vital role in plant development, secondary metabolite synthesis and metabolism of macromolecules, hormone signal transduction, and tolerance of plants to biotic and abiotic stresses. During last decade several types of miRNAs involved in SEG have been reported. Among these miRNAs, miR156, miR162, miR166a, miR167, miR168, miR171a/b, miR171c, miR393, miR397 and miR398 played very active role during various stages of SEG. In this review, we highlighted the role of these as well as other miRNAs in some economically important plants.

"Can community level interventions have an impact on equity and utilization of maternal health care" - evidence from rural Bangladesh.

BACKGROUND: Evidence from low and middle income countries (LMICs) suggests that maternal mortality is more prevalent among the poor whereas access to maternal health services is concentrated among the rich. In Bangladesh substantial inequities exist both in the use of facility-based basic obstetric care and for home births attended by skilled birth attendant. BRAC initiated an intervention on Improving Maternal, Neonatal, and Child Survival (IMNCS) in the rural areas of Bangladesh in 2008. One of the objectives of the intervention is to improve the utilization of maternal and child health care services among the poor. This study aimed to look at the impact of the intervention on utilization and also on equity of access to maternal health services. METHODS: A quasi-experimental pre-post comparison study was conducted in rural areas of five districts comprising three intervention (Gaibandha, Rangpur and Mymensingh) and two comparison districts (Netrokona and Naogaon). Data on health seeking behaviour for maternal health were collected from a repeated cross sectional household survey conducted in 2008 and 2010. RESULTS: Results show that the intervention appears to cause an increase in the utilization of antenatal care. The concentration index (CI) shows that this has become pro-poor over time (from CI: 0.30 to CI: 0.04) in the intervention areas. In contrast the use of ANC from medically trained providers has become pro-rich (from, CI: 0.18 to CI: 0.22). There was a significant increase in the utilisation of trained attendants for home delivery in the intervention areas compared to the comparison areas and the change was found to be pro-poor. Use of postnatal care cervices was also found to be pro-poor (from CI: 0.37 to CI: 0.14). Utilization of ANC services provided by medically trained provider did not improve in the intervention area. However, where the intervention had a positive effect on utilization it also seemed to have had a positive effect on equity. CONCLUSIONS: To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers.

Does the added benefit of ondansetron over dexamethasone, to control post-operative nausea and vomiting, justify the added cost in patients undergoing tonsillectomy and adenotonsillectomy?

OBJECTIVE: To investigate comparative effectiveness of ondansteron and dexamethasone in prophylaxis of PONV in tonsillectomy and adenotonsillectomy patients. METHODS: The study was conducted at Shifa International Hospital Islamabad from 1st January to 30th June 2009, on 60 patients undergoing tonsillectomy or adenotonsillectomy, with their consent. After consecutive alternate sampling, patients were divided into two groups containing 30 patients each. Ondansteron was given in one group, and Dexamethasone in the other group, as anti emetic, at the time of induction. Episodes of PONV were recorded at three specified intervals, i.e., immediate postoperative, 6 hours after surgery and 12 hours after surgery. Data was entered on a pre-designed performa. The data was analyzed in SPSS Version 13.0. RESULTS: Ondansteron Group had a mean age of 12.7 +/- 9.54 years (5-36 years). There were 22 (73.3%) males and 8 (26.7%) females. Dexamethasone Group had a mean age of 14.8 +/- 8.4 years (5-35 years) of whom 18 (60.0%) were males and 12 (40.0%) were females. Overall 6 patients who received ondansetron had PONV compared to 7 patients in the dexamethasone group. This difference was statistically insignificant (p > 0.05). CONCLUSION: Dexamethasone was equally effective in controlling PONV in tonsillectomy and adenotonsillectomy patients. The improved benefit of using ondansetron over dexamethasone, on a regular basis, does not justify the added cost.

The predictors of difficult tracheal intubations in patients undergoing thyroid surgery for euthyroid goitre.

OBJECTIVE: To evaluate the influence of goitre on anatomic features and the correlation of these changes with difficulty in intubation. METHODS: A questionnaire was employed to assess 139 patients scheduled for elective surgery of euthyroid goitre to predict the potential of difficult intubation. These measurements were later correlated with the patients who eventually had difficult intubations. Neck circumference, mouth width, lip test, sternomental distance, thymomental distance, Mallampati score and laryngeal palpation were evaluated. RESULTS: All predictors were found to be significant as single predictors but on logistic regression analysis it was found that the circumference of the neck alone, was the independent predictor for difficult intubation. CONCLUSION: Neck thickness in patients with goitre is a significant predictor of difficult intubation and should be used in preoperative assessment to anticipate difficult intubations.

Gibberellic acid mediated co-ordination of calcium and magnesium ameliorate physiological activities, seed yield and fibre yield of Linum usitatissimum L.-a dual-purpose crop.

Commercial cultivation of linseed for both seed and fibre is not keeping pace with increasing demand for linseed products. Although, different strategies are being adopted to produce a dual-purpose linseed crop with good yield of seed and fibre, little progress has been achieved. The present study was carried out to investigate whether application of gibberellic acid (GA3) along with CaCl2 and/or MgSO4 could ameliorate the seed yield in three linseed genotypes 'Parvati', 'Shekhar' and 'Shubhra' without compromising the fibre production. Before sowing the seeds of linseed genotypes were soaked for 8 h in 10(-6) M GA3. Forty days after sowing (DAS), the plants were sprayed with 10(-6) M GA3 along with 2 kg Ca/ha (Ca2) and/or 0.5 kg Mg/ha (Mg0.5). Treatments comprised of (1) 10(-6) M GA3 + Ca0Mg0 (control, T0); (2) 10(-6) M GA3 + Ca2Mg0 (T1); (3) 10(-6) M GA3 + Ca0Mg0.5 (T2) and (4) 10(-6) M GA3 + Ca2Mg0.5 (T3). Performance of the crop was assessed in terms of growth characteristics, physiological and biochemical parameters at 60 and 75 DAS and yield and quality attributes at harvest. Treatment T3 proved best, it enhanced dry weight per plant by 38.2 and 20.6%, P N by 20.7 and 19.1% and gs by 18.2 and 8.8% at 60 and 75 DAS, respectively and seed yield by 39.6%, oil yield by 46.9% and fibre yield by 36.9% at harvest. Further, a decrease in lodging by 13.9% was recorded. Of the three genotypes tested, all exhibited significant difference for all the parameters studied, except for leaf-N content, biological yield and iodine value which showed no difference. However, 'Shubhra' performed better than 'Parvati'.