Search

In general, 5% of chronic hepatitis B (CHB) patients are also infected with HDV.[4] Chronic HDV coinfection is characterized by the development of decompensation and hepatocellular carcinoma (HCC) at a young age. With great interest, we read the article "Antiviral therapy does not improve outcomes of patients with HBV-related decompensated cirrhosis with undetectable DNA" by Lee Han Ah et al.[1] Adding anti-hepatitis B virus (HBV) therapy to a decompensated patient with undetectable HBV DNA is always a difficult decision for a physician. Though 13.7% of the patient had reactivation of HBV who were not on treatment and subsequently put on antiviral with similar outcome for patient on treatment, this needs to be validated in large cohort. [Extracted from the article]

Antimicrobial resistance is a major and growing public health threat. Recently, Health Canada introduced multiple regulatory changes to strengthen the oversight of antimicrobial drugs for veterinary use. These changes aim specifically at increasing control over importation of veterinary drugs and active pharmaceutical ingredients, mandatory reporting of antimicrobial sales data from manufacturers, importers and compounders and facilitating access to low risk veterinary health products. Additional policy changes under existing authorities are also being made to enhance veterinary supervision of antimicrobial use and to remove production claims for food animals from labels of medically important antimicrobial drugs. These important interlinked initiatives are aimed towards enhancing antimicrobial stewardship in Canada to preserve the effectiveness of existing antimicrobials and to protect the health of Canadians. [ABSTRACT FROM AUTHOR]

A rare case probably the first to be reported of pigmented squamous cell papilloma arising from the lower lid is presented.

A rare case of Warthin′s tumour, arising from the lid, is being presented. It is probably the first of its kind reported In literature.

Abstract: Introduction: Prostaglandins (PGs) can act on both hematopoietic and osteoblastic lineages to enhance osteoclast formation. Methods: We examined PGE2 stimulated osteoclastogenesis in RAW 264.7 cells and the role of endogenous PGE2 in lipopolysaccharide (LPS) stimulated osteoclastogenesis. Results: RANKL (1–100ng/ml) increased formation of osteoclasts, defined as tartrate resistant acid phosphatase multinucleated cells, with peak effects at 30ng/ml. Addition of PGE2 (0.01–1.0μM) to RANKL (30ng/ml) dose dependently increased osteoclast number 30–150%. Use of NS-398 (0.1μM) or indomethacin (Indo, 1.0μM) to block endogenous PG synthesis had little effect on the response to RANKL alone but significantly decreased the response to PGE2. Addition of LPS (100ng/ml) to RANKL increased osteoclast number 50%, and this response was significantly decreased by NS-398 and Indo. RANKL and PGE2 produced small, additive increases in COX-2 mRNA levels, while LPS produced a larger increase. PG release into the medium was not increased by RANKL and PGE2 but markedly increased by LPS. Conclusion: We conclude that RANKL stimulated osteoclastogenesis can be enhanced by PGE2 and LPS though direct effects on the hematopoietic cell lineage and that these effects may be mediated in part by induction of COX-2 and enhanced intracellular PG production. [Copyright &y& Elsevier]

Severely malnourished children (26), weight for age 55.27 +/- 3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P less than 0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea. [ABSTRACT FROM AUTHOR]

Thirty cases of viral hepatitis with and without coma and 15 normal healthy age and sex matched controls were studied for disseminated intravascular coagulopathy (DIC). Cases of viral hepatitis with coma showed strong evidence of DIC in the form of increased plasma FDP (240 ± 190.64 dilution), diminished fibrinogen half life (48.1 ± 15.3 hours) and increased fractional catabolic rate (46.13 ± 14.7% per day) with normal Euglobulin clot lysis time and reduced fibrinogen (147.33 ± 43.5%) and platelet count (1.27 ± 0.324 lakhs/cm.). The possible role of heparin in the reversal of coagulation abnormalities have been discussed. [ABSTRACT FROM AUTHOR]

The article reports on the significance of serum zinc in myocardial infarction. The exact mechanism of changes in serum zinc levels in cases of acute myocardial infarction has not been clearly understood. A highly significant degree of fall in serum zinc levels was observed in patients with acute myocardial infarction. Cases of myocardial infarction with cardiogenic shock had a greater degree of decrease as compared to cases of myocardial infarction with congestive heart failure and/or arrhythmias. Significant correlation was found between serial serum zinc changes, creatinine phosphokinase, and lactic dehydrogenase levels.

Complete heart block (CHB) developed in 10.3% of patients with acute myocardial infarction (MI). It was more frequent among patients with inferior myocardial infarction compared to anterior myocardial infarction, but the mortality was significantly high among patients with anterior MI who developed CHB. A new classification into primary (P) and secondary (S) CHB is suggested by the sequence of events. The incidence and mortality of SCHB was significantly high when compared to the incidence and mortality of PCHB. Wide QRS complexes, a heart rate of less than 60/min, and syncopal attacks were the grave prognostic signs. Progression from a lesser degree of AV block and regression of CHB to a lesser degree of AV Block were both observed in 25.8% cases. Circulatory failure in the form of shock, hypotension, congestive heart failure, and left ventricular failure, alone or in combination was a factor in 17 of the 22 patients who died. Four of 5 patients who underwent transvenous pacing also died. [ABSTRACT FROM AUTHOR]

The article discusses the incidence and significance of fascicular blocks in coronary care unit. These cases of acute myocardial infarction were continuously monitored at least for 72 hours. The diagnosis of myocardial infarction was based on strict electrocardiography criteria formulated by WHO. The diagnosis of bifascicular block involving right bundle branch and left anterior division was put forward. For diagnosing Right Bundle Branch Block with Left Inferior Hemiblock reliance was oriented to the right more than 90°.

The enzyme-linked immunosorbent assay (ELISA) was used to detect the presence or antibodies to muramyl dipeptide (MDP) in serum of patients with leprosy or tuberculosis. Using a conjugate of M DP lysine to horse radish peroxidase, no such antibodies could be detected in sera of either patients or controls. Antibodies to a sonicate antigen of Mycobacterium tuberculosis were found in sera of all individuals tested and the binding of these antibodies to the M. tuberculosis antigen could not be inhibited by MDP. On the other hand, binding of MDP to anti-MDP antibodies, raised in rabbits, was largely inhibited by free MDP, slightly inhibited by M. tuberculosis antigen and was not inhibited by the patients' sera. [ABSTRACT FROM AUTHOR]

In patients with high surgical risks, transcatheter mitral valve-in-valve replacement (VIV-TMVR) offers a less invasive alternative to open surgical approach for failing mitral bioprosthetic valves (1). Valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) in failing aortic valve bioprosthesis is already an established technique worldwide (2). Transesophageal echocardiography (TEE) plays a vital role in the intraoperative management of these cases. Here we describe the approach to TEE evaluation and guidance of VIV-TMVR. TEE is used for full assessment of the heart pre-procedurally as well as throughout the procedure to guide the placement of the new mitral valve and at the end to assess the integrity of the placement and to detect any complications.Both 2D B and color doppler modes as well as real-time, zoom and full volume 3D TEE modalities can be used to serve different purposes. Successful placement of an Edward Sapien S3 Valve (29 mm) under TEE guidance Pre-procedurally, severity and etiology of the bioprosthetic mitral valve disease should be confirmed using TEE (Fig 1A) as well as identification of factors that would contraindicate a VIV-TMVR such as infective endocarditis, severe paravalvular leak, bioprosthetic valve dehiscence or significant prosthesis-patient mismatch. It is also imperative to complete a baseline assessment of the right and left ventricular size and function, left atrial size and look for any pericardial effusion. During the procedure, TEE may rarely be used for guidewire placement into the IVC by the interventional cardiologists. Next, a combination of bicaval (90-110°) and aortic short axis (30-45°) views are used to guide the cardiologist to puncture the interatrial septum. The ideal site for puncture in these cases is determined in mid systole to be posterior and superior on the septum about 3-4 cm above the mitral annular plane. (Fig 1B) The puncture and passing of guidewire into the left atrium is followed by the passing of the valve deployment system, all of which are easily visible on TEE toggling between 2D and live 3D modes. (Fig 1C,D&E) Post-deployment TEE assessment include confirmation of the stability of the new valve as well as ensuring leaflets are moving freely with no or minimal mitral regurgitation, no paravalvular leaks and no flow restriction across the valve. (Fig 1F) The size, severity and directionality of the interatrial shunt created by the iatrogenic atrial septal puncture site should be assessed using color and spectral doppler, (Figure 1G) which may require placement of an Amplatzer ASD percutaneous closure device (Figure 1H). [ABSTRACT FROM AUTHOR]