Off pump bidirectional Glenn performed through a thoracotomy

Introduction The bidirectional Glenn shunt has become an accepted method of palliation for single ventricle physiology and an intermediate step prior to the Fontan type operations. Attempts have been made to perform this operation without the use of cardiopulmonary bypass thereby eliminating its deleterious effects. The aim of this study was to review our experience with bidirectional Glenn shunt performed via thoracotomy without cardiopulmonary bypass. Methods Aretrospective review of fifteen patients (11 males) with ages ranging from 30 to 120 months (mean 44±5.2 months) who underwent off pump bidirectional glenn via thoracotomy. Results There were two deaths in the study patients due to septicemia and acute renal failure. None of the patients had any seizure or focal or global neurologic deficit. All patients who were discharged had a patent Glenn shunt on echocardiography. Conclusion Off pump bi-directional Glenn can be safely performed by an experienced surgeon in selected patients. The thoracotomy approach in properly selected patients gives good exposure and would reduce adhesions during future Fontan operation.     

Trace element-based food value evaluation in soft and hard shelled mud crabs

Concentrations of 10 elements were studied from the pre-moult hard shelled and newly moulted (soft shelled) crabs (Scylla serrata) by the (Energy Dispersive X-ray Fluorescence) EDXRF technique. The study evaluated the composition of all 10 elements from the body tissues and the exuvium of soft shelled and the carapace of pre-moulted hard-shelled crabs in order to evaluate the food value from nutritional and safety point of view for human consumption. The essential elements like K, Ca, Mn, Cu, etc., get reabsorbed from the carapace to the body tissues in order to meet the further requirement in the soft shelled crabs and are also utilized to some extent during the formation of new carapace, toxic element like Pb gets excreted during exuviation and element like Zn gets regulated, as and when become higher in bioavailable form. This study gives evidence that, the freshly moulted soft shelled crabs are more safe and nutritious than the hard-shelled crabs.     

Correlation between CD4 counts of HIV patients and enteric protozoan in different seasons – An experience of a tertiary care hospital in Varanasi (India)

Background  

Protozoan infections are the most serious among all the superimposed infections in HIV patients and claim a number of lives every year. The line of treatment being different for diverse parasites necessitates a definitive diagnosis of the etiological agents to avoid empirical treatment. Thus, the present study has been aimed to elucidate the associations between diarrhoea and CD4 counts and to study the effect of HAART along with management of diarrhoea in HIV positive patients. This study is the first of its kind in this area where an attempt was made to correlate seasonal variation and intestinal protozoan infestations.     

Is Regular Probiotic Practice Safe for Management of Sepsis?

For decades,the gut has been thought to play an important role in sepsis pathogenesis.Sepsis is a serious life-threatening,chronic condition of an infection caused by dysregulated host immune response in most of the intensive care unit patients.Probiotics have dual roles in polymicrobial sepsis i.e.probiotics may induce sepsis in many cases and may prevent its prognosis in many cases.Experimental evidence from both pre-clinical and clinical studies have demonstrated that probiotic therapy ameliorates various inflammatory mediators such as tumor necrosis factor,interleukin-10(IL-10),IL-6,etc.,in septicemia.In addition,probiotic use was also found to reduce the severity of pathological conditions associated with irritable bowel disorder and prevent development of endocarditis in septicemia.On contrary,probiotic therapy in neonatal and athymic adult mice fail to provide any beneficial effects on mortality and sepsis-induced inflammation.Importantly,in few clinical trials probiotic use was found to aggravate sepsis by promoting inflammatory cascade rather than suppressing it.This review discusses various studies regarding the beneficial or harmful effects associated with probiotic therapy in sepsis.     

Diagnostic assays developed for the control of foot-andmouth disease in India

Foot-and-mouth disease(FMD) is a highly contagious and economically devastating disease of livestock, primarily affecting cattle, buffalo and pigs. FMD virus serotypes O, A and Asia1 are prevalent in India and systematic efforts are on to control and eventually eradicate the disease from the country. FMD epidemiology is complex due to factors like co-circulation, extinction, emergence and re-emergence of genotypes/lineages within the three serotypes, animal movement, diverse farm practices and large number of susceptible livestock in the country. Systematic vaccination, prompt diagnosis, strict biosecurity measures, and regular monitoring of vaccinal immunity and surveillance of virus circulation are indispensible features for the effective implementation of the control measures. Availability of suitable companion diagnostic tests is very important in this endeavour. In this review, the diagnostic assays developed and validated in India and their contribution in FMD control programme is presented.     

Primary pediatric mid-brain lymphoma: Report of a rare pediatric tumor in a rare location

Primary central nervous system lymphoma (PCNSL) is a rare disease in pediatric age group. A thirteen-year-old male child presented with complaints of headache for six months, vomiting and diplopia for three days. Magnetic resonance imaging of the brain showed a single lesion of 1.7 cm × 1.6 cm × 1.6 cm in the mid brain and tectum. He underwent a gross total resection of the tumor. The histopathological evaluation revealed B cell high grade non Hodgkin lymphoma. The patient was treated with High dose methotrexate and cranio spinal radiation. The patient was alive without disease 12 mo after completion of treatment. This case highlights importance of keeping PCNSL as differential in brain stem lesions of pediatric patients also. Radiation and chemotherapy remains the most important treatment for such patients.     

Primary oral tuberculosis on the tongue mimicking squamous cell carcinoma

Tuberculosis is chronic granulomatous disease with rare oral manifestations. But if so are overlooked by most of the health care professionals. Clinically, most of the times, a tuberculous ulcer may mimic an ulcer of malignant origin and may be misdiagnosed. So, keeping in mind the etiology and the nature of the ulcer, it should be differentially diagnosed and a histopathological examination should only confirm the final diagnosis of the ulcer.     

Polycythemia vera presenting with bilateral papilledema: a rare case report

A 45-year-old male patient presented with gradual onset of headache, vomiting and blurring of vision of 28 days duration. Ophthalmological examination revealed normal anterior segment and pupillary reflex. No abnormality was detected in the vitreous. Optic disc showed features of advanced papilledema with normal macula and retinal periphery in both eyes. Visual acuity was 20/200 in the right eye and counting fingers close range in the left eye. Non-contrast computed tomography of brain was normal and magnetic resonance imaging showed sagittal sinus thrombosis without any evidence of venous infarction or intracranial mass. Routine hematological investigations revealed increased hemoglobin level, packed cell volume and leucocytosis. Further investigation revealed increased Vitamin B12 and decreased serum erythropoietin. A diagnosis of polycythemia vera was made from the above findings. This case is being presented for the rarity of association of polycythemia vera with bilateral advanced papilledema due to sagittal sinus thrombosis.     

Isolated and silent spinal neurocysticercosis associated with pseudotumor cerebri

Incidence of spinal neurocysticercosis (NCC) is rare. Isolated spinal NCC is still rarer. We present here a case report where a young lady presented with all the clinical features of pseudotumor cerebri (PTC), where medical treatment for PTC failed and the presence of cysticercous in spinal canal was detected only on the operation table, while doing a lumbo-peritoneal shunt (LP shunt) to save her vision. Diagnosis could be confirmed only after the histopathology report was received. She did not have any direct evidence of spinal involvement, thereby eluding correct diagnosis. In English literature, we could not find any report of isolated and silent spinal NCC associated with PTC. In addition, we could not find any report of recovery of cysticercous larva through the Touhey's needle injury, although this was an incidental finding. In endemic areas, isolated spinal NCC should be suspected in patients presenting with PTC.