ZIKV infection regulates inflammasomes pathway for replication in monocytes.

ZIKV causes microcephaly by crossing the placental barrier, however, the mechanism of trans-placental dissemination of ZIKV remains unknown. Here, we sought to determine whether monocytes, which can cross tissue barriers, assist ZIKV dissemination to the fetus. We determined this by infecting monocytes with two strains of ZIKV: South American (PRVABC59) and Nigerian (IBH30656) and analyzing viral replication. We found that ZIKV infects and replicates in monocytes and macrophages, which results in the modulation of a large number of cellular genes. Analysis of these genes identified multiple pathways including inflammasome to be targeted by ZIKV, which was confirmed by analyzing the transcript levels of the proteins of inflammasome pathways, NLRP3, ASC, caspase 1, IL-1 and IL-18. Interestingly, IFNα and the IFN inducible gene, MxA were not enhanced, suggesting prevention of innate antiviral defense by ZIKV. Also, inhibition of inflammasome led to an increased transcriptional activity of IFNα, MxA and CXCL10. Based on these results we suggest that ZIKV transcription is regulated by inflammasomes.

Sonographically detected caesarean section scar defects and menstrual irregularity.

The purpose of this study was to estimate the frequency of post-caesarean section scar defects (PCSD) on transvaginal ultrasound and to correlate these with the presence of abnormal menstrual bleeding. We reviewed the pelvic ultrasound images of 318 women referred for a gynaecological scan in a private women's ultrasound clinic. The incidence of defects at the expected location of a caesarean scar was evaluated and then correlated with patient responses to a questionnaire on abnormal menstrual bleeding. Of the 318 patients, 71 had a history of caesarean section and technically adequate pelvic ultrasound images. Fluid-filled defects in the hysterotomy incision were noted in 29 (40%). The presence of a PCSD was significantly associated with patients reporting prolonged periods or post-menstrual spotting. The larger the defect, the higher was the incidence of abnormal vaginal bleeding.

Ultrasonographic visualization of balloon placement for uterine tamponade in massive primary postpartum hemorrhage.

This case report is the first documentation of ultrasonographic confirmation of positioning of a Sengstaken-Blakemore balloon catheter (SBEC) in the management of massive postpartum hemorrhage. The sonongraphic position, while incorrect according to conventional use of uterine balloon catheters, raises the possibility of an alternative mechanism of action of the balloon: not uterine cavity tamponade but hydrostatic pressure directly around the uterine arteries, a mechanism akin to mechanical uterine artery embolization or ligation. If this hypothesis is correct, it not only elucidates how balloon tamponade works but also challenges current thinking on how postpartum hemorrhage should be managed effectively. Future studies are required to corroborate this hypothesis and we believe that sonographic confirmation of balloon catheter location should be an integral part of uterine balloon tamponade in women with massive primary postpartum hemorrhage.

Tc-99m glucoheptonate brain scintigraphy: a clinical comparison between one- and two-hour delayed images: concise communication.

Sixteen patients with known cerebral disease had one- and two-hour delayed brain scans following intravenous injection of 15 mCi of technetium-99m glucoheptonate. No abnormalities were seen on the two-hour images that were not detected on the one-hour delayed scan. There were two false negative scans. Of the 14 true positives, 10 were visualized equally well in the one-and two-hour delayed images, two were better seen on two-hour images, and two were better on one-hour scans. As no difference in lesion detection was found, consideration of reducing the post-dose delay time two hours to one seems warranted.

Opium administration to infants in Peshawar region of Pakistan.

Use of opium for sedating infants in the North-West Frontier Province of Pakistan causes a grave public health problem. Among the infants hospitalized for opium overdosage, 22 were studied in detail, and their major clinical picture is presented in this paper. The effect of opium use on the nutritional status of these infants, or the relation of infant opium use to addiction in adult life, have not been assessed. It is, however, pointed out that opium overdosage of infants contributed to infant mortality. Despite emergency treatment, the lethality rate of opium overdosed infants was 40 per cent. It is emphasized that a preventive programme should be undertaken to educate parents who are ignorant of the dangers of opium administration to infants.

Redux testis: a potential pitfall in testicular imaging.

The use of radionuclide testicular imaging to assess testicular perfusion has been shown to be a valuable diagnostic procedure in the evaluation of the acute scrotum. However, if images are not evaluated in conjunction with physical findings falsely negative examinations can occur. A case of torsion of a retractile testicle (redux testis) is presented to demonstrate this potential limitation. To our knowledge this has not been reported previously.