bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of envelope domain III-based single chimeric tetravalent antigen and monovalent antigen mixtures for the detection of anti-dengue antibodies in human sera
Authors: Batra Gaurav , Nemani Satish K , Tyagi Poornima , Swaminathan Sathyamangalam , Khanna Navin
Published: March 2011

Background

Flavivirus cross-reactive antibodies in human sera interfere with the definitive identification of dengue virus (DENV) infections especially in areas with multiple co-circulating flaviviruses. Use of DENV envelope domain-III (EDIII) can partially resolve the problem. This study has examined the effect of (i) incorporating the EDIIIs of four DENV serotypes into a single chimeric antigen, and (ii) immobilizing the antigen through specific interaction on the sensitivity and specificity of anti-DENV antibody detection.

Methods

A sera panel (n = 164) was assembled and characterized using commercial kits for infection by DENV and a host of other pathogens. Anti-DENV antibodies of both IgM and IgG classes in this panel were detected in indirect ELISAs using a mixture of monovalent EDIIIs, a chimeric EDIII-based tetravalent antigen, EDIII-T, and a biotinylated version of the latter as coating antigens. The sensitivity and specificity of these assays were compared to those obtained using the PanBio Dengue IgG/IgM ELISAs.

Results

The performance of dengue IgG and IgM indirect ELISAs, using either a physical mixture of four EDIIIs or the single chimeric EDIII-T antigen, were comparable. Coating of a biotinylated version of the tetravalent antigen on streptavidin plates enhanced sensitivity without compromising specificity.

Conclusions

The incorporation of the EDIIIs of the four DENV serotypes into a single chimeric antigen did not adversely affect assay outcome in indirect ELISAs. Oriented, rather than random, immobilization of the tetravalent antigen enhanced sensitivity of detection of anti-DENV antibodies with retention of 100% specificity.
Severe pneumococcal pneumonia: impact of new quinolones on prognosis
Authors: Olive David , Georges Hugues , Devos Patrick , Boussekey Nicolas , Chiche Arnaud , Meybeck Agnes , Alfandari Serge , Leroy Olivier
Published: March 2011

Background

Most guidelines have been proposing, for more than 15 years, a β-lactam combined with either a quinolone or a macrolide as empirical, first-line therapy of severe community acquired pneumonia (CAP) requiring ICU admission. Our goal was to evaluate the outcome of patients with severe CAP, focusing on the impact of new rather than old fluoroquinolones combined with β-lactam in the empirical antimicrobial treatments.

Methods

Retrospective study of consecutive patients admitted in a 16-bed general intensive care unit (ICU), between January 1996 and January 2009, for severe (Pneumonia Severity Index > or = 4) community-acquired pneumonia due to non penicillin-resistant Streptococcus pneumoniae and treated with a β-lactam combined with a fluoroquinolone.

Results

We included 70 patients of whom 38 received a β-lactam combined with ofloxacin or ciprofloxacin and 32 combined with levofloxacin. Twenty six patients (37.1%) died in the ICU. Three independent factors associated with decreased survival in ICU were identified: septic shock on ICU admission (AOR = 10.6; 95% CI 2.87-39.3; p = 0.0004), age > 70 yrs. (AOR = 4.88; 95% CI 1.41-16.9; p = 0.01) and initial treatment with a β-lactam combined with ofloxacin or ciprofloxacin (AOR = 4.1; 95% CI 1.13-15.13; p = 0.03).

Conclusion

Our results suggest that, when combined to a β-lactam, levofloxacin is associated with lower mortality than ofloxacin or ciprofloxacin in severe pneumococcal community-acquired pneumonia.
Central modulation in cluster headache patients treated with occipital nerve stimulation: an FDG-PET study
Authors: Magis Delphine , Bruno Marie-Aurélie , Fumal Arnaud , Gérardy Pierre-Yves , Hustinx Roland , Laureys Steven , Schoenen Jean
Published: March 2011

Background

Occipital nerve stimulation (ONS) has raised new hope for drug-resistant chronic cluster headache (drCCH), a devastating condition. However its mode of action remains elusive. Since the long delay to meaningful effect suggests that ONS induces slow neuromodulation, we have searched for changes in central pain-control areas using metabolic neuroimaging.

Methods

Ten drCCH patients underwent an 18FDG-PET scan after ONS, at delays varying between 0 and 30 months. All were scanned with ongoing ONS (ON) and with the stimulator switched OFF.

Results

After 6-30 months of ONS, 3 patients were pain free and 4 had a ≥ 90% reduction of attack frequency (responders). In all patients compared to controls, several areas of the pain matrix showed hypermetabolism: ipsilateral hypothalamus, midbrain and ipsilateral lower pons. All normalized after ONS, except for the hypothalamus. Switching the stimulator ON or OFF had little influence on brain glucose metabolism. The perigenual anterior cingulate cortex (PACC) was hyperactive in ONS responders compared to non-responders.

Conclusions

Metabolic normalization in the pain neuromatrix and lack of short-term changes induced by the stimulation might support the hypothesis that ONS acts in drCCH through slow neuromodulatory processes. Selective activation in responders of PACC, a pivotal structure in the endogenous opioid system, suggests that ONS could restore balance within dysfunctioning pain control centres. That ONS is nothing but a symptomatic treatment might be illustrated by the persistent hypothalamic hypermetabolism, which could explain why autonomic attacks may persist despite pain relief and why cluster attacks recur shortly after stimulator arrest. PET studies on larger samples are warranted to confirm these first results.
Pv RON2, a new Plasmodium vivax rhoptry neck antigen
Authors: Arévalo-Pinzón Gabriela , Curtidor Hernando , Patiño Liliana C , Patarroyo Manuel A
Published: March 2011

Background

Rhoptries are specialized organelles from parasites belonging to the phylumApicomplexa; they secrete their protein content during invasion of host target cells and are sorted into discrete subcompartments within rhoptry neck or bulb. This distribution is associated with these proteins' role in tight junction (TJ) and parasitophorous vacuole (PV) formation, respectively.

Methods

Plasmodium falciparumRON2 amino acid sequence was used as bait for screening the codifying gene for the homologous protein in thePlasmodium vivaxgenome. Gene synteny, as well as identity and similarity values, were determined forron2and its flanking genes amongP. falciparum,P. vivaxand other malarial parasite genomes available at PlasmoDB and Sanger Institute databases.Pvron2gene transcription was determined by RT-PCR of cDNA obtained from theP. vivaxVCG-1 strain. Protein expression and localization were assessed by Western blot and immunofluorescence using polyclonal anti-PvRON2 antibodies. Co-localization was confirmed using antibodies directed towards specific microneme and rhoptry neck proteins.

Results and discussion

The firstP. vivaxrhoptry neck protein (named herePvRON2) has been identified in this study.PvRON2 is a 2,204 residue-long protein encoded by a single 6,615 bp exon containing a hydrophobic signal sequence towards the amino-terminus, a transmembrane domain towards the carboxy-terminus and two coiled coil α-helical motifs; these are characteristic features of several previously described vaccine candidates against malaria. This protein also contains two tandem repeats within the interspecies variable sequence possibly involved in evading a host's immune system.PvRON2 is expressed in late schizonts and localized in rhoptry necks similar to what has been reported forPfRON2, which suggests its participation during target cell invasion.

Conclusions

The identification and partial characterization of the firstP. vivaxrhoptry neck protein are described in the present study. This protein is homologous toPfRON2 which has previously been shown to be associated withPfAMA-1, suggesting a similar role forPvRON2.
Enzymatic- and temperature-sensitive controlled release of ultrasmall superparamagnetic iron oxides (USPIOs)
Authors: Yu Shann S , Scherer Randy L , Ortega Ryan A , Bell Charleson S , O'Neil Conlin P , Hubbell Jeffrey A , Giorgio Todd D
Published: March 2011

Background

Drug and contrast agent delivery systems that achieve controlled release in the presence of enzymatic activity are becoming increasingly important, as enzymatic activity is a hallmark of a wide array of diseases, including cancer and atherosclerosis. Here, we have synthesized clusters of ultrasmall superparamagnetic iron oxides (USPIOs) that sense enzymatic activity for applications in magnetic resonance imaging (MRI). To achieve this goal, we utilize amphiphilic poly(propylene sulfide)-bl-poly(ethylene glycol) (PPS-b-PEG) copolymers, which are known to have excellent properties for smart delivery of drug and siRNA.

Results

Monodisperse PPS polymers were synthesized by anionic ring opening polymerization of propylene sulfide, and were sequentially reacted with commercially available heterobifunctional PEG reagents and then ssDNA sequences to fashion biofunctional PPS-bl-PEG copolymers. They were then combined with hydrophobic 12 nm USPIO cores in the thin-film hydration method to produce ssDNA-displaying USPIO micelles. Micelle populations displaying complementary ssDNA sequences were mixed to induce crosslinking of the USPIO micelles. By design, these crosslinking sequences contained an EcoRV cleavage site. Treatment of the clusters with EcoRV results in a loss of R2 negative contrast in the system. Further, the USPIO clusters demonstrate temperature sensitivity as evidenced by their reversible dispersion at ~75°C and re-clustering following return to room temperature.

Conclusions

This work demonstrates proof of concept of an enzymatically-actuatable and thermoresponsive system for dynamic biosensing applications. The platform exhibits controlled release of nanoparticles leading to changes in magnetic relaxation, enabling detection of enzymatic activity. Further, the presented functionalization scheme extends the scope of potential applications for PPS-b-PEG. Combined with previous findings using this polymer platform that demonstrate controlled drug release in oxidative environments, smart theranostic applications combining drug delivery with imaging of platform localization are within reach. The modular design of these USPIO nanoclusters enables future development of platforms for imaging and drug delivery targeted towards proteolytic activity in tumors and in advanced atherosclerotic plaques.
Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study
Authors: Gubbels Jessica S , Kremers Stef PJ , Stafleu Annette , de Vries Sanne I , Goldbohm R Alexandra , Dagnelie Pieter C , de Vries Nanne K , van Buuren Stef , Thijs Carel
Published: March 2011

Background

Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development.

Methods

Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics.

Results

Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI.

Conclusion

Although most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child.
Integrated sensitive on-chip ion field effect transistors based on wrinkled InGaAs nanomembranes
Authors: Harazim Stefan M , Feng Ping , Sanchez Samuel , Deneke Christoph , Mei Yongfeng , Schmidt Oliver G
Published: March 2011

Self-organized wrinkling of pre-strained nanomembranes into nanochannels is used to fabricate a fully integrated nanofluidic device for the development of ion field effect transistors (IFETs). Constrained by the structure and shape of the membrane, the deterministic wrinkling process leads to a versatile variation of channel types such as straight two-way channels, three-way branched channels, or even four-way intersection channels. The fabrication of straight channels is well controllable and offers the opportunity to integrate multiple IFET devices into a single chip. Thus, several IFETs are fabricated on a single chip using a III-V semiconductor substrate to control the ion separation and to measure the ion current of a diluted potassium chloride electrolyte solution.
Pool boiling of water-Al2O3 and water-Cu nanofluids on horizontal smooth tubes
Authors: Cieslinski Janusz T , Kaczmarczyk Tomasz Z
Published: March 2011

Experimental investigation of heat transfer during pool boiling of two nanofluids, i.e., water-Al2O3 and water-Cu has been carried out. Nanoparticles were tested at the concentration of 0.01%, 0.1%, and 1% by weight. The horizontal smooth copper and stainless steel tubes having 10 mm OD and 0.6 mm wall thickness formed test heater. The experiments have been performed to establish the influence of nanofluids concentration as well as tube surface material on heat transfer characteristics at atmospheric pressure. The results indicate that independent of concentration nanoparticle material (Al2O3 and Cu) has almost no influence on heat transfer coefficient while boiling of water-Al2O3 or water-Cu nanofluids on smooth copper tube. It seems that heater material did not affect the boiling heat transfer in 0.1 wt.% water-Cu nanofluid, nevertheless independent of concentration, distinctly higher heat transfer coefficient was recorded for stainless steel tube than for copper tube for the same heat flux density.
Structural and optical properties of germanium nanostructures on Si(100) and embedded in high-k oxides
Authors: Ray Samit K , Das Samaresh , Singha Raj K , Manna Santanu , Dhar Achintya
Published: March 2011

The structural and optical properties of Ge quantum dots (QDs) grown on Si(001) for mid-infrared photodetector and Ge nanocrystals embedded in oxide matrices for floating gate memory devices are presented. The infrared photoluminescence (PL) signal from Ge islands has been studied at a low temperature. The temperature- and bias-dependent photocurrent spectra of a capped Si/SiGe/Si(001) QDs infrared photodetector device are presented. The properties of Ge nanocrystals of different size and density embedded in high-k matrices grown using radio frequency magnetron sputtering have been studied. Transmission electron micrographs have revealed the formation of isolated spherical Ge nanocrystals in high-k oxide matrix of sizes ranging from 4 to 18 nm. Embedded nanocrystals in high band gap oxides have been found to act as discrete trapping sites for exchanging charge carriers with the conduction channel by direct tunneling that is desired for applications in floating gate memory devices.
A simple and efficient method for isolating small RNAs from different plant species
Authors: Rosas-Cárdenas FlordeFátima , Durán-Figueroa Noé , Vielle-Calzada Jean-Philippe , Cruz-Hernández Andrés , Marsch-Martínez Nayelli , de Folter Stefan
Published: March 2011

Background

Small RNAs emerged over the last decade as key regulators in diverse biological processes in eukaryotic organisms. To identify and study small RNAs, good and efficient protocols are necessary to isolate them, which sometimes may be challenging due to the composition of specific tissues of certain plant species. Here we describe a simple and efficient method to isolate small RNAs from different plant species.

Results

We developed a simple and efficient method to isolate small RNAs from different plant species by first comparing different total RNA extraction protocols, followed by streamlining the best one, finally resulting in a small RNA extraction method that has no need of first total RNA extraction and is not based on the commercially available TRIzol® Reagent or columns. This small RNA extraction method not only works well for plant tissues with high polysaccharide content, like cactus, agave, banana, and tomato, but also for plant species like Arabidopsis or tobacco. Furthermore, the obtained small RNA samples were successfully used in northern blot assays.

Conclusion

Here we provide a simple and efficient method to isolate small RNAs from different plant species, such as cactus, agave, banana, tomato, Arabidopsis, and tobacco, and the small RNAs from this simplified and low cost method is suitable for downstream handling like northern blot assays.
Perforation and abscess formation after radiological placement of a retrievable plastic biliary stent
Authors: Papadopoulou Ioanna , Fotiadis Nicos I , Ahmed Irfan , Thurley Peter , Hutchins Robert R , Fotheringham Tim
Published: March 2011

Introduction

Retrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting.

Case presentation

A 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week.

Conclusion

Late retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.
Relationships between the Foot Posture Index and foot kinematics during gait in individuals with and without patellofemoral pain syndrome
Authors: Barton Christian J , Levinger Pazit , Crossley Kay M , Webster Kate E , Menz Hylton B
Published: March 2011

Background

Foot posture assessment is commonly undertaken in clinical practice for the evaluation of individuals with patellofemoral pain syndrome (PFPS), particularly when considering prescription of foot orthoses. However, the validity of static assessment to provide insight into dynamic function in individuals with PFPS is unclear. This study was designed to evaluate the extent to which a static foot posture measurement tool (the Foot Posture Index ‐ FPI) can provide insight into kinematic variables associated with foot pronation during level walking in individuals with PFPS and asymptomatic controls.

Methods

Twenty‐six individuals (5 males, 21 females) with PFPS aged 25.1 ± 4.6 years and 20 control participants (4 males, 16 females) aged 23.4 ± 2.3 years were recruited into the study. Each participant underwent clinical evaluation of the FPI and kinematic analysis of the rearfoot and forefoot during walking using a three‐dimensional motion analysis system. The association of the FPI score with rearfoot eversion, forefoot dorsiflexion, and forefoot abduction kinematic variables (magnitude, timing of peak and range of motion) were evaluated using partial correlation coefficient statistics with gait velocity entered as a covariate.

Results

A more pronated foot type as measured by the FPI was associated with greater peak forefoot abduction (r = 0.502, p = 0.013) and earlier peak rearfoot eversion relative to the laboratory (r = ‐0.440, p = 0.031) in the PFPS group, and greater rearfoot eversion range of motion relative to the laboratory (r = 0.614, p = 0.009) in the control group.

Conclusion

In both individuals with and without PFPS, there was fair to moderate association between the FPI and some parameters of dynamic foot function. Inconsistent findings between the PFPS and control groups indicate that pathology may play a role in the relationship between static foot posture and dynamic function. The fair association between pronated foot posture as indicated by the FPI and earlier peak rearfoot eversion relative to the laboratory observed exclusively in those with PFPS is consistent with the biomechanical model of PFPS development. However, prospective studies are required to determine whether this relationship is causal.
New clinical score to diagnose nonalcoholic steatohepatitis in obese patients
Authors: Pulzi Fernanda BU , Cisternas Raul , Melo Murilo R , Ribeiro Cristiane MF , Malheiros Carlos A , Salles João E
Published: March 2011

Background

Nonalcoholic fatty liver disease (NAFLD) is the most frequent disease associated with abnormal liver tests that is characterized by a wide spectrum of liver damage, ranging from simple macro vesicular steatosis to steatohepatitis (NASH), cirrhosis or liver carcinoma. Liver biopsy is the most precise test to differentiate NASH from other stages of NAFLD, but it is an invasive and expensive method. This study aimed to create a clinical laboratory score capable of identify individual with NASH in severely obese patients submitted to bariatric surgery.

Methods

The medical records from 66 patients submitted to gastroplasty were reviewed. Their chemistry profile, abdominal ultrasound (US) and liver biopsy done during the surgical procedure were analyzed. Patients were classified into 2 groups according to liver biopsy: Non-NASH group - those patients without NAFLD or with grade I, II or III steatosis; and NASH group - those with steatohepatitis or fibrosis. The t-test was used to compare each variable with normal distribution between NASH and Non-NASH groups. When comparing proportions of categorical variables, we used chi-square or z-test, where appropriate. A p-value < 0.05 was considered statistically significant.

Results

83% of patients with obesity grades II or III showed NAFLD, and the majority was asymptomatic. Total Cholesterol (TC)≥200 mg/dL, alanine aminotransferase (ALT) ≥30, AST/ALT ratio (AAR)≤ 1, gammaglutaril-transferase (γGT)≥30 U/L and abdominal US, compatible with steatosis, showed association with NASH group. We proposed 2 scores: Complete score (TC, ALT, AAR, γGT and US) and the simplified score, where US was not included. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH (sensitivity 70%, specificity 88.6%, NPV 91.2%, PPV 63. 6%).

Conclusion

Alterations in TC, ALT, AAR, γGT and US are related to the most risk for NASH. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH. Additionally, negative final scores exclude the presence of an advanced illness. Using this score, the severity of fatty liver infiltration would be predicted without the risks associated with hepatic biopsy.
Intellectual Property
Authors: Walker David A.
Published: March 2011

The Intellectual Property department in each issue of Geophysics provides U.S. patent abstracts, published patent abstracts of U.S. patent applications, and published abstracts filed under the Patent Cooperation Treaty (PCT).
An Audit of the Management of Melanoma Patients at Glasgow Royal Infirmary 1998-2003
Authors: Macdonald A , Berry C , Holmes S
Published: March 2011

Background

Melanoma is an important cause of morbidity and mortality. Recently published Scottish Intercollegiate Guideline Network (SIGN) guidelines outline standard management for melanoma patients in Scotland.

Methods

We audited the management of consecutive patients diagnosed with melanoma in Glasgow Royal Infirmary (1998-2003), using the SIGN guidelines as a gold standard.

Results

Of 102 patients, 41% were male and 59% were female. The mean ages of men and women were 58 and 50 years respectively. Fifty five per cent of all patients had a superficial spreading melanoma, and the median Breslow thickness was 0.64 mm. The most commonly affected site was the head and neck (29%). Most patients (87%) were referred by their general practitioner, but only 30% were marked as urgent by the referrer, and accordingly the median time to first appointment varied between 20 days (1998) and 52 days (2001). The most frequently noted suspicious feature was irregular pigmentation. The median time to biopsy was 6 days. Seventy-one per cent of patients had an excision biopsy, and of those who did not, most (71%) had lesions on the head and neck. There was poor recording of surgical margins (13%) and histological margins were used to determine the need for re-excision. The SIGN guidelines for re-excision and sentinel lymph node biopsy were closely followed.

Conclusion

The SIGN guidelines for melanoma have been adhered to in our department, although time to first appointment exceeded national recommendations.
Changing Prevalences of Overweight and Obesity in Primary School Children - a Glimmer of Hope?
Authors: Mcdougall C M , Crum J E
Published: March 2011

Background

The current epidemic of childhood obesity is a growing public health concern. Estimates of the prevalence of obesity are necessary so that secular trends can be monitored and the need for preventative measures assessed.

Aims

To establish the prevalences of overweight and obesity in Aberdeen primary schoolchildren and to investigate how children have been changing with respect to body fatness during their primary school years. Methods: Retrospective study of two cohorts of school entrants, using height and weight data from school nurse records.

Results

Data were collected on 1018 children. The prevalence of overweight among children in primary year 1 decreased from 28.7% in 1997/98 to 21.5% in 2001/02 (P<0.01). The mean BMI SD score also significantly decreased in boys from 0.51 in 1997/98 to 0.32 in 2001/02. For the 1997/98 school entrants, the prevalences of overweight and obesity did not change between school entry and the end of primary school. The mean BMI SD score decreased significantly during primary school in boys but not in girls.

Conclusion

Although childhood overweight and obesity remain major public health concerns, we report a slight improvement in measures of obesity over time, particularly in boys.
A Rare Case of Cardiac Tamponade Due to Metastatic Cancer of the Prostate
Authors: Shariff N , Karthik S , Sissons MCJ , Li Kam Wa E
Published: March 2011

Cardiac tamponade is a potentially life-threatening condition that is not uncommon in the oncology setting. Massive pericardial effusion occurring due to metastatic prostatic carcinoma is very rare and only a handful of cases have been reported in literature till date. We report one such case, review literature and stress on keeping this rare diagnosis as one of cause of breathlessness in patients with prostate cancer.
The dangers of alternative medicine: An unusual cause of winging of the scapula. A case report and review of the literature
Authors: Banaszkiewicz P.A. , Ledingham K.Szalai W.M.
Published: March 2011

This is a case report of a 30-year-old man who presented with winging of his scapula secondary to acupuncture treatment for chronic neck pain. This complication has never previously been described and would be classified as a major adverse event following acupuncture use.
The Case of the Septic Fitness Instructor: Exercise Immunology in Action?
Authors: Witherspoon P. , Tatarkowska N , Reid F , Anderson JR
Published: March 2011

A 20 year old fitness instructor was admitted with abdominal pain and rapidly developed severe systemic inflammatory response syndrome and multi-organ dysfunction requiring ventilation and inotropic support. The cause was a histologically early appendicitis. Investigations excluded any underlying immunological or connective tissue disorder.

Intense exercise is known to cause changes in the physiology and function of the immune system. Innate and adaptive immune function, both in cellular numbers and function, has been shown to be impaired. An acute phase response similar to that seen with physical stressors such as sepsis and trauma has also been observed with elevation of pro-inflammatory and anti-inflammatory cytokines. This has led to the ‘open window’ theory of transient immunosuppresion following intense exercise. In this case presented, regular vigorous aerobic exercise was being performed whilst the patient was symptomatic up until 4 hours prior to admission. We propose that exercise induced immunosuppresion and priming of the inflammatory response led to a florid systemic inflammatory response developing and contributed to the rapid progression towards multi-organ dysfunction syndrome.
Intraperitoneal haemorrhage following thombolysis for acute myocardial infarction
Authors: Al-Nammari S , Yae-Eun SUH , Roberton BJ
Published: March 2011

A major complication of thrombolytic therapy is haemorrhage. A case of intraperitoneal haemorrhage necessitating three laparotomies is described in a patient following thrombolysis. This is the only documented case of a non-hepatic intraperitoneal haemorrhage occurring post thrombolysis in a patient without risk factors and without a hepatic source being identified. Retroperitoneal haemorrhage1 and intraperitoneal haemorrhage from a hepatic source have previously been described2,3,4.
Hypokalaemia and severe acute power loss: An unusual presentation of Sjögren's Syndrome
Authors: Henriksen P A , King M
Published: March 2011

Acute paralysis in the context of hypokalaemia is the presenting feature of a rare group of heterogeneous disorders including the familial periodic paralyses and renal tubular acidosis. Hypokalaemic paralysis has previously been described as the presenting feature of Sjögren's Syndrome. In this report we present a patient with hypokalaemic paralysis, distal renal tubular acidosis and features suggestive of Sjögren's Syndrome.
Hepatitis C Virus Infection in Scotland: Epidemiological Review and Public Health Challenges
Authors: Hutchinson SJ , Roy KM , Wadd S , Bird SM , Taylor A , Anderson E , Shaw L , Codere G , Goldberg DJ
Published: March 2011

Introduction

In 2004, Scotland's Health Minister stated that the hepatitis C virus (HCV) “is one of the most serious and significant public health risks of our generation”

Methods

To appreciate the prevention and care challenges posed by HCV in Scotland, we reviewed all country-specific data on i) the prevalence of infection among different populations, ii) the numbers infected with HCV, and iii) the current and future HCV disease burden

Results

An estimated 1% of Scotland's population has HCV; 85-90% of those infected were injecting drug users (IDUs). Reductions in HCV prevalence among young IDUs during the early 1990s suggest that the incidence of HCV had decreased; since then, the absence of further reductions highlight that existing prevention measures are insufficient. Two-thirds of the estimated 37,500 chronically HCV-infected individuals in Scotland remain undiagnosed and two-thirds of this group are former IDUs. An estimated 9,000 former IDUs were living with either moderate or severe HCV disease in 2004; if the current uptake of antiviral therapy continues, this number was estimated to double by 2016. Approximately 1,200 HCV-infected IDUs had developed liver failure by 2004; this figure was predicted to increase to 3,200 by 2020.

Conclusions

Scotland faces three principal public health challenges: i) the prevention of HCV among current IDUs, ii) the diagnosis of HCV-infected persons, particularly those most in need of therapy to prevent severe HCV disease, and iii) the current and future provision of adequate resources to ensure that the movement of patients through the diagnostic and clinical care pathway is optimal
Cost Savings and Quality Improvement - Single-Use Suture Instruments?
Authors: Harden JL , Hiscox JA
Published: March 2011

Aim

To determine if the instruments found in single-use suture kits are of satisfactory quality when compared with re-useable instruments and to determine the cost implications of changing to these kits.

Methods

Audit of established practice, followed by trial of new suture kits and their introduction to the department. The new practice was then audited. A cost analysis was conducted.

Results

The audit showed numerous problems with the traditional suture kits (instruments were breaking or no longer suitable for suturing wounds). A trial of single-use instruments demonstrated them to be high quality and provided new instruments each time. A repeat audit at one year post-introduction demonstrated no identifiable problem with the new suture kits. The subjective impression of staff was of an improvement compared to the old kits. Costs of sterilising suture instruments were determined and it was found that single use suture kits were cost effective. Assuming an average usage of 150 kits per month, at £4.45 each cost for sterilisation, and a total cost of £3.05 each for a single-use suture kit plus dressing pack per patient, this yielded a projected cost saving of £2520.00 per annum. The actual cost saving was £1981.00 that year. The shortfall was due to overestimation of average usage. Conclusion - Single use instruments would appear to be safe and cost effective in the emergency department setting.
Outcome Using a Conservative Tracheostomy Strategy in Intensive Care
Authors: Khanna R , Beynon Ja , Ure Ds
Published: March 2011

Background and aims

We have a conservative approach to tracheostomy in intensive care, in that every patient considered for tracheostomy in our unit is discussed at a clinical meeting to evaluate potential benefit and harm from the procedure. This study examined tracheostomy numbers, complications and outcome of patients who had tracheostomy in comparison to our general intensive care population and to Scottish national data.

Methods

We collected prospective data on all patients having a tracheostomy over a three year period. Data included included time to tracheostomy, type of procedure (open or percutaneous), ventilator settings immediately before tracheostomy, peri- and post-operative complications and mortality.

Results

The number of tracheostomies was low (27 of 692 patients, 4%) and time to tracheostomy high (mean, 18 days) in comparison to published data. Patients who had a tracheostomy had a hospital mortality that was greater than predicted by the APACHE II scoring system (55% actual mortality vs. 44% predicted). Standardised mortality ratio (SMR) was 1.29 for tracheostomy patients and 0.89 for patients who did not have a tracheostomy. Length of stay and mortality were similar to national figures. One patient in the tracheostomy group developed tracheal stenosis that needed surgical intervention. There were no cases of symptomatic tracheal stenosis in the much larger group managed with orotracheal intubation alone.

Conclusions

We found that a conservative approach to performing tracheostomy reduced the number of procedures performed without affecting overall unit outcomes.
The Prevalence of Alcohol Misuse Among Acute Admissions: Current Experience and Historical Comparisons
Authors: Cameron A , Morris Jm , Forrest Eh
Published: March 2011

Background

Over the last 25 years there has been a large increase in alcohol related deaths in Scotland. Medical patients who misuse alcohol may have overt alcohol related disease, but may also present with other unrelated illness.

Aim

We examined alcohol misuse amongst acute medical admissions to compare this with other similar studies at the same hospital since 1974.

Patients and Methods

850 consecutive admissions to the medical receiving unit of Victoria Infirmary were assessed. They were assessed using the modified Michigan Alcohol Screening Test (MAST) and also by a medical consultant. 414 patients also had their blood ethanol levels measured on admission.

Results

18.6% admissions had a MAST greater than 5 and were considered to misuse alcohol (24.8% male and 12.2% female; p<0.0001). Patients from socio-economic group V and patients presenting with gastro-intestinal haemorrhage or self-poisoning were more likely to misuse alcohol. The sensitivity and specificity of consultant opinion regarding alcohol misuse were 0.55 and 0.97 compared with the MAST. There was an increase in the alcohol misuse amongst women admitted (12.2%) compared to 1977 (5.5%; p=0.0026) and 1981/2 (6.3%; p=0.004).

Conclusion

Alcohol misuse is common amongst acute medical admissions. Since 1979, there has been a particular increase in female medical admissions who misuse alcohol. Medical opinion regarding alcohol misuse lacks sensitivity in identifying at risk individuals compared with a validated questionnaire.
Rate of Referral of Breech Infants for Hip Ultrasound: An Audit Cycle
Authors: Dryden C , White Mp
Published: March 2011

Background

Infants with risk factors for developmental dysplasia of the hip (DDH) should have hip ultrasounds performed shortly after birth to detect and treat the condition at an early stage. Breech presentation is associated with increased risk of DDH. We embarked on an audit cycle to assess and improve our rate of referral of breech infants for hip ultrasound.

Methods

Two retrospective audits (phases I & II) were carried out before, and after, the introduction of a new pro-forma which encouraged recognition of breech presentation at the time of the routine neonatal examination. Breech infants were identified from labour ward records. Multiple births and infants < 35 weeks gestation were excluded. Infants were considered to have been referred for ultrasound if the computer system at our affiliated children's hospital held a record of an ultrasound appointment.

Results and Conclusions

In phase I 56% of breech infants born in our hospital had been referred for hip ultrasound. In phase II the referral rate had risen to 76% (p = 0.034). We conclude that the change in practice was effective. Further improvement might be achieved by increasing staff awareness of risk factors for DDH and by enlisting the help of advanced neonatal nurse practitioners (ANNPs) in routine neonatal examinations.
Recurrent Anaphylactic Shock To Radiocontrast Media
Authors: Cayir K. , Bilici M. , Tekin S Basol
Published: March 2011

Radiocontrast media (RCM) is used commonly in clinical practice, and can be associated with significant adverse effects. Since non-ionic RCM's have been introduced to radiological investigation, the incidence of adverse reactions has been significantly reduced in comparison to ionic compounds. However, acute anaphylactoid reactions with heterogeneous symptoms within minutes after intravenous administration of RCM are still a life-threatening risk of investigations with RCM. We report a patient who underwent two anaphylactic reactions (acute and delayed) after intravenous administration of RCM.
Are we giving General Practitioners what they want from Psychiatric out-patient review letters?
Authors: Davey C. , Desai A. B. , Shajahan P. M.
Published: March 2011

We aimed to assess the quality of out-patient clinic letters in relation to GPs expectations. A questionnaire was devised and sent to 65 GPs to ascertain what they felt to be important in a psychiatric out-patient clinic letter. We examined 250 out-patient clinic letters comprising both a formatted and unformatted pattern. We compared whether one particular type of letter was more successful at providing the information specifically requested by GPs. Fifty seven per cent of GPs responded to the questionnaire. Letters following a pre-determined formatted template, although slightly longer, consistently conveyed more relevant information. Conclusion: The use of formatted letters is a means of enhancing communication between psychiatrists and GPs and within secondary psychiatry services.
Lack of Knowledge of Osteoporosis: A Multi-Centre, Observational Study
Authors: Spencer SJ
Published: March 2011

Background and Aim

Osteoporosis poses a significant health problem. As the population ages, its incidence increases. Effective prevention requires good awareness of the disease among the general public. The aim of this study was to assess the level and source of osteoporosis knowledge in a group of patients attending for Dual Emission X-ray Absorpitometry (DEXA) scanning.

Methods

A questionnaire was devised to assess knowledge of the osteoporosis risk factors, risk-reducing measures and signs/symptoms. Questionnaires were completed by 176 patients in two centres; Glasgow Royal Infirmary, UK (120 patients), and Christchurch Public Hosp, New Zealand (56 patients).

Results

Overall knowledge of osteoporosis was poor. In terms of risk factors 31.8% (n=56/176) knew no risk factors at all, 19.3% (n=34/176) knew no risk reducing measures and 39.2% (n=69/176) knew no signs or symptoms of osteoporosis.

Conclusion

Knowledge of osteoporosis, despite this cohort being a group of patients attending for DEXA scanning, was poor. There is a need for the public to to be made more aware of osteoporosis, thereby enabling them to be more actively involved in preventive measures. National campaigns are required to increase awareness. Furthermore, increasing health professionals' awareness of the considerable limitations which exist in public knowledge of the disease, leading to a new realisation of the need for them to discuss osteoporosis with their patients, could provide a highly effective means of increasing awareness of the disease.
“Do Unto Others As…” - Which Treatments do Psychiatrists Prefer?
Authors: Taylor M , Brown T
Published: March 2011

We undertook an independent national survey of psychiatrists' treatment preferences should they become mentally ill. The response rate was 59% from 921 individuals. For psychosis, atypical antipsychotics were generally favoured with risperidone receiving most votes. Psychotherapy and antidepressants were both endorsed as treatments for mild-tomoderate depression, and citalopram, fluoxetine and venlafaxine were the three preferred antidepressants. ECT received the backing of a large majority of psychiatrists, particularly for severe mood disorder.
Epidemiological Aspects of Referral to TIA Clinics in Glasgow
Authors: Murray S , Bashir K , Lees KR , Muir K , MacAlpine C , Roberts M , Langhorne P
Published: March 2011

A retrospective cohort study was carried out of new referrals to transient ischaemic attack (TIA) clinics in Glasgow. The aims of the study were to describe the profile of referrals and to assess the odds ratios for TIA, minor stroke or amaurosis fugax of both cardiovascular risk factors and clinical features.

In total, data were collected for 813 new referrals in a period of six months. Thirteen point eight percent of referrals were from other Health Boards. The overall referral rate among residents of Greater Glasgow NHS Board was 165.6 per 100,000 per year. About 20% of referrals were made by clinicians in secondary care. The specialties from which referrals were most commonly made were accident and emergency, general medicine, ophthalmology and geriatric assessment. The most common risk factors in patients referred were hypertension (52.9%), smoking (31.7%), ischaemic heart disease (22.7%) and former smokers (22.4%). The most common clinical features were hemiparesis (13.3%), weakness of an upper limb (8.7%), vertigo (7.9%) and dysphasia (7.3%). In 48.7% of cases, a non-cerebrovascular diagnosis was made.

Separate multivariate models were established for risk factors and clinical features. In the model for risk factors, five factors were significant for risk of TIA, stroke or amaurosis fugax. These were hyperlipidaemia, age over 64 years, hypertension, smoking and ex-smoking. In the model for clinical features, five factors were also significant. These were visual field defect, speech defact, facial weakness and hemiparesis.
Multiple pulmonary emboli despite the presence of a caval filter – a literature review
Authors: McGuire BB , Kelly C
Published: March 2011

Introduction

Acute pulmonary embolism is a serious life-threatening phenomenon. When anticoagulation is contraindicated, treatment poses a challenge.

Background

We describe the case of a young girl with recurrent pulmonary emboli despite the presence of a caval filter and explore the different treatment options available in this situation. The placement of an intra-caval filter often provides a feeling of protection against further pulmonary emboli, however the incidence of filter thrombosis is surprisingly quite high. Subsequent pulmonary embolus can occur in up to a third of these patients which is potentially life threatening.

Conclusion

We examine the different filters that are commercially available, and the incidence of thrombosis and embolism associated with them. Following this, we look at the treatment options available in managing filter thrombosis and the safety of such intervention.
Acute thermal injury associated with cerebral protection in the surgical management of aortic dissection
Authors: Hussey K , Jeffrey R
Published: March 2011

A 53 year old male presented with a type I acute aortic dissection managed surgically, with placement of a tube graft and aortic valve re-suspension procedure. We present a complication associated with the adjunct cerebral protection employed, in the form of an acute cold injury in the right occipital region secondary to packing the head in ice.
Primary Cerebral Lymphoma presenting with Parkinsonism
Authors: Foy JM , Primrose WR , Mackenzie JM
Published: March 2011

Brain tumour is a rare cause of Parkinsonism with cerebral lymphoma seldom reported as a cause. However, the incidence of this tumour is increasing and we report one such case, which presented with a parkinsonian syndrome and did not respond to medication. The diagnosis of cerebral lymphoma was made at postmortem.