Computed tomography of pediatric blunt abdominal trauma

Computed tomography (CT) is the imaging method of choice in the evaluation of hemodynamically stable children after blunt abdominal trauma. Evaluation with CT will show whether intraperitoneal fluid or blood is present and whether the liver, spleen, kidneys, and pancreas are intact. Although the principal role of CT after blunt abdominal trauma is the assessment of solid viscus injury, an unintended consequence of the increased utilization of CT in this setting is that an increased number of children with hollow viscus injury are being evaluated. CT can reliably depict injury to these hollow viscera, although the diagnosis of such injury is not as straightforward as with solid viscus injury. This essay reviews indications for CT, technique for the performance of CT, and CT findings associated with hollow and solid viscus injury and posttraumatic shock.     

Mitoxantrone in the treatment of acute leukemia

Summary Forty-six patients with acute leukemia were treated with mitoxantrone as a single agent. Twenty-nine patients had relapsed and/or refractory acute leukemia. Seventeen patients with acute non-lymphatic leukemia had received no prior treatment. Twelve mg/m² of mitoxantrone was given intravenous on five consecutive days. Treatment related side effects included bone marrow suppression, mucositis, alopecia, nausea, vomiting and infection. Cardiotoxicity was documented in 7 patients. This study reconfirms that mitoxantrone is an active agent in acute leukemia with complete response documented in 10 of 29 patients with relapsed and/or refractory acute leukemia (34% response rate, 95% confidence limits 18–53%) and complete response documented in 11 of 17 patients (65% response rate, 95% confidence limits 38–87%) with previously untreated acute non-lymphatic leukemia.     

Surveillance technology for HIV-1 subtype C in Ethiopia: an env-based NASBA molecular beacon assay to discriminate between subcluster C and C'

Forty-nine samples with known C2V3 sequences were used for the evaluation of an env-based molecular beacon assay to distinguish between the two genetic subclusters C and C′ which characterize the HIV-1 epidemic in Ethiopia. Two subcluster C and two subcluster C′ beacons targeting two different loci in the C2V3 region were developed. Using a three beacon-based (2C and 1C′ = C prime), isothermal amplification assay, concordance with DNA sequencing was achieved for 43 (87.8%) samples. Sensitivity was 81.8% and specificity 97.4% for subcluster C beacons. For the subcluster C′ beacon, a sensitivity of 97% and a specificity of 87.5% was achieved. Five samples were ambiguous by sequencing of which two samples were subcluster C′ by the beacon assay and one subcluster C. Two of the samples remained ambiguous with different beacon-pair combinations as well. From samples with a clear C or C′ phylogeny by sequencing, three were undetected by the first-line beacon genotyping assay. Genotype ambiguity was resolved in the three samples using beacon pair combinations restricted to each targeted locus. The beacons were evaluated further in a panel including all HIV-1 subtypes. Four of five subtype C isolates were identified correctly, and no cross-reactivity was observed with other subtypes.     

Environmental health outcomes and exposure risks among at-risk communities living in the Upper Olifants River Catchment,South Africa

Potential exposure to water and air pollution and associated health impacts of three low-income communities in the Upper Olifants River Catchment, South Africa, was investigated through a cross-sectional epidemiological study comprising a household survey. Water samples were collected and analysed for microbial indicators and pathogens. Ambient air-monitoring included some of the criteria pollutants, as well as mercury and manganese. Associations between environmental exposure and health outcomes were analysed by means of logistic regression. Despite poor water and air quality episodes, the communities’ self-perceived health was good with relatively low prevalence of reported health outcomes. Hygiene practices with respect to water collection and storage were often poor, and most likely contributed to the regularly contaminated water storage containers. Community proximity to the polluted stream was associated with increased prevalence in adverse health outcomes. This paper reports on preliminary results and additional multivariate analyses are necessary to further understand study results.     

Ethnic differences in C-peptide secretion but not in non-esterified fatty acid metabolism in pre-menopausal women with and without abdominal obesity

The present study aimed to reveal racial differences in the metabolic pattern of C-peptide and non-esterified fatty acids (NEFA), and in their associations with cardiovascular measures in healthy urban African (102) and Caucasian women (115) from South Africa. An oral glucose tolerance test was performed with measurements before and at 30, 60, 90 and 120min. Various cardiovascular parameters and blood lipids were assessed. Statistical analyses were done in a sub-sample of pre-menopausal women. Fasting C-peptide and hepatic insulin extraction were significantly higher in lean African women compared to their Caucasian counterparts, with no racial differences between women with abdominal obesity. Postchallenge C-peptide response and hepatic insulin extraction were significantly higher in Caucasians with abdominal obesity. There were no racial differences in insulin sensitivity and resistance. Despite different associations of C-peptide and NEFA with cardiovascular measures between the ethnicities both showed significant positive correlations with triglycerides. Increased fasting C-peptide levels and unfavorable associations of C-peptide and NEFA with triglycerides and cardiovascular measures implicate a higher cardiovascular risk in lean African women only. This may be of importance for the development of hypertension in this population group.     

Virtual autopsy: two- and three-dimensional multidetector CT findings in drowning with autopsy comparison

PURPOSE: To retrospectively determine the multidetector computed tomographic (CT) virtual autopsy findings of death by drowning in comparison with autopsy findings. MATERIALS AND METHODS: The institutional review board of the Armed Forces Institute of Pathology approved this HIPAA-compliant study and did not require informed consent by the next of kin. Total-body multidetector CT was performed, immediately prior to routine autopsy, in 28 consecutive male subjects (mean age, 24.2 years) who died of drowning and a control group of 12 consecutive male subjects (mean age, 50.8 years) who died of sudden death from atherosclerotic coronary artery disease. Images were evaluated for the presence of fluid and sediment in the paranasal sinuses and airways, mastoid air cell fluid, frothy fluid in the airways, pulmonary opacity (ground-glass opacity or airspace consolidation), interlobular septal thickening, and gastric distention and contents (fluid or sediment). Image findings were compared with findings from autopsy reports and photographs. RESULTS: All drowning subjects had fluid in the paranasal sinuses and mastoid air cells and had ground-glass opacity within the lungs. Twenty-six subjects (93%) had fluid in the subglottic trachea and main bronchi. Fourteen subjects (50%) had high-attenuation sediment in the subglottic airways. Frothy fluid in the airways was present in six subjects (21%). Twenty-five (89%) of the drowning subjects had pulmonary ground-glass opacity with septal lines, which was mild with apical and perihilar distribution in 12 subjects, severe and diffuse in nine, posterior and basilar in three, and limited to the apices in one (not assessed in three of 28 subjects because of decomposition). Control subjects showed mastoid cell fluid (25%), sinus fluid (83%), subglottic airway fluid (92%), and pulmonary ground-glass opacity (100%) but did not have evidence of frothy airway fluid or high-attenuation sediment in the airways. CONCLUSION: The multidetector CT finding of frothy airway fluid or high-attenuation airway sediment is highly suggestive of drowning; multidetector CT findings of pan sinus fluid, mastoid cell fluid, subglottic tracheal and bronchial fluid, and ground-glass opacity within the lung at multidetector CT are supportive of drowning in the appropriate scenario.     

Timing of the introduction into Ethiopia of subcluster C' of HIV type 1 subtype C

Viruses circulating in Ethiopia during the 1990s cluster with main subtype C, but a significant subcluster, C', was noted in multiple analyses. This subcluster of subtype C(C') was in a fifty-fifty equilibrium with the main subtype C (Abebe et al., AIDS Res Hum Retroviruses 2000;16:1909-1914). To analyze genetic diversification within the subcluster of HIV-1 subtype C designated C' in the course of the epidemic in Ethiopia, we analyzed 165 env gp120 V3 sequences obtained between 1988 and 1999. We observed a highly significant positive correlation between sampling years of individual sequences and their synonymous distances to the reconstructed common ancestor of the HIV-1 subtype C' subcluster. The extrapolation of the regression line of synonymous distances back to the date when no synonymous heterogeneity was present among the Ethiopian HIV-1 C' population allowed us to estimate 1982 (95% CI, 1980-1983) as the year of the onset of HIV-1 C' genetic diversification and expansion in Ethiopia. These results are in agreement with retrospective epidemiological and serological data, which demonstrated the absence of an HIV-1 epidemic in the Ethiopian population before the 1980s.     

Timing of the HIV-1 subtype C epidemic in Ethiopia based on early virus strains and subsequent virus diversification

OBJECTIVE: To trace the introduction of HIV-1 subtype C into Ethiopia based on virus diversification during the epidemic. DESIGN: A set of 474 serum samples obtained in Ethiopia in 1982-1985 was tested for HIV-1. HIV-1 env gp120 V3 and gag or pol regions were sequenced and analysed together with sequences from later stages of the epidemic. RESULTS: None of 98 samples from 1982-1983, one of 193 samples from 1984, and one of 183 samples from 1985 were HIV-1 positive. Phylogenetic analysis of virus sequences from positive samples revealed that they belong to the Ethiopian C, and not the C', cluster. Analysis of 81 Ethiopian C V3 sequences from 1984-1997 revealed that the consensus sequence of the Ethiopian epidemic has been stable over time. Both the 1984 and 1985 V3 sequences, in contrast with three out of 27 (11%) of the 1988 and none out of 51 of the 1992-1997 sequences, had no synonymous substitutions compared to the reconstructed common ancestor of the Ethiopian C viruses. A highly significant correlation between sampling years of the V3 sequences and their synonymous distances to the common ancestor was demonstrated. CONCLUSIONS: The increasing genetic heterogeneity together with stable consensus sequence of the Ethiopian HIV-1 C population demonstrates that evolution of the virus population is characterized by an unbiased expansion around a stationary consensus. Based on the rate of synonymous diversification of HIV-1 strains within the Ethiopian population, we were able to estimate 1983 (95% confidence interval, 1980-1984) as the year of HIV-1 C introduction into Ethiopia.