Investigation of tuberculosis clusters in Dehradun city of India

ObjectiveTo investigate the presence of statistically significant geographical clusters of tuberculosis (TB) using Geographical Information System and spatial scan statistics in Dehradun, India.MethodsThe spatial scan statistic implemented with a software program, SaTScan v6.1, was used to test the presence of statistically significant spatial clusters of TB and to identify their approximate locations (P< 0.05 for primary clusters and P<0.1 for secondary clusters). Geographical Information System was used for geographical analysis.ResultsSignificant high rate spatial clusters were identified in seven wards of the Dehradun Municipal area.ConclusionsThere is sufficient evidence about the existence of statistically significant TB clusters in seven wards of Dehradun, India. The purely spatial scan statistics methodology used in this study has a potential use in surveillance of TB for detecting the true clusters of the disease.     

Anti-inflammatory activity in the aqueous crude extract of the leaves of Nidularium procerum: A bromeliaceae from the Brazilian coastal rain forest

Nidularium procerum LINDMAN, a common bromeliaceae from the Brazilian flora, remains poorly studied regarding its chemical and pharmacological properties. We have recently published that N. procerum has potent analgesic and anti-inflammatory activities. In the present work, we have investigated potential mechanisms involved in the anti-inflammatory effects of N. procerum aqueous extract on lipopolysaccharide (LPS)-, platelet activating factor (PAF)- or formyl-methionyl-leucyl-phenylalanine (fMLP)-induced pleurisy models of inflammation. We found that the aqueous extract of N. procerum leaves (leaf aqueous extract; LAE) inhibits the neutrophil migration, production of inflammatory cytokines interleukin-1 and -6 (IL-1 and IL-6) and the generation of prostaglandin E2 (PGE2) in LPS-induced pleural inflammation in mice. Such inhibitory effect of N. procerum on PGE2 generation was tightly correlated to the inhibition of formation of new cytoplasmic lipid bodies within recruited leukocytes. N. procerum also blocked the in vivo neutrophil influx induced by injection of PAF or fMLP into the mouse pleural cavity and directly inhibited PAF-induced neutrophil chemotaxis in vitro. The data obtained in this study indicate that N. procerum LAE exerts its anti-inflammatory effects by interfering with the capacity of the host to respond to injury at different levels. Among the different functions affected by N. procerum LAE, lipid body formation, PGE2 and cytokine production and neutrophil chemotaxis are readily evidenced in relevant surrogate models. The N. procerum bioactive profile makes it an attractive candidate for future development as a drug or phytomedicine.     

Non surgical management of pseudoaneurysms

Background: The incidence of pseudoaneurysm has increased due to the large number of vascular procedures performed and the widespread use of anticoagulation therapy during procedures. Non-invasive methods for management of pseudoaneurysms comprise of ultrasound guided compression (USGC), thrombin therapy, arterial embolisation and endovascular stent graft insertion. We discuss our experience in the management of fourteen cases of pseudoaneurysms using non surgical techniques.     

Frequency and patterns of abnormality detected by iodine-123 amine emission CT after cerebral infarction

Single photon emission computed tomography (SPECT) was performed in 31 patients with cerebral infarction and 13 who had had transient ischemic attacks, using iodine-123-labeled N,N,N'-trimethyl-N'-(2-hydroxyl-3-methyl-5-iodobenzyl)-1,3-propanediamin e (I-123-HIPDM) as the radiopharmaceutical. SPECT scans were compared with computed tomographic (CT) scans. SPECT was as sensitive as CT in detecting cerebral infarction (94% vs. 84%). The abnormalities were larger on the SPECT scans than on the CT scans in 19 cases, equal in seven, and smaller in five (SPECT abnormalities greater than or equal to CT abnormalities in 86% of cases). Fifteen of 30 patients with hemispheric infarction had decreased perfusion (decreased uptake of I-123-HIPDM) to the cerebellar hemisphere contralateral to the cerebral hemisphere involved by the infarction (crossed cerebellar diaschisis). Nine of these 15 patients had major motor deficits, while only one of the 15 without crossed cerebellar diaschisis had a major motor deficit.     

Impact of Multidetector CT on 3D CT Angiography

3D Computed Tomographic Angiography (CTA) is a noninvasive volumetric imaging technique increasingly used for evaluation of vascular system. The introduction of Multidetector CT (MDCT) has increased scanning speed, allowing shorter acquisition time, greater volume coverage and decreased contrast requirement while diminishing respiratory motion artifacts. Thin-slice collimation protocols are routinely used which generate isotropic 3D voxels that improve image quality. The ideal CTA study requires scanning at peak vascular enhancement for optimal opacification of arteries with separation of arteries and veins. MDCT has enabled complete lower extremity inflow and runoff studies with a single injection, as well as thin-section CTA covering the entirety of the Carotid arteries and Circle of Willis. Sixteen row MDCT has increased scanning speed further facilitating the development of novel applications such as coronary CTA. CTA when perfomed with MDCT offers a “one scan – many views” option useful in imaging vascular diseases. CTA has important advantages over conventional angiography, such as reduced risk, diminished time and better patient acceptance. With MDCT, 3D CTA is crossing vessel tortuosity and evaluation of vessel fragility.Key Words: Multidetector CT, CT angiography, Volume Rendering     

Tracheotomy in a Canadian urban centre

Sixty-two patients requiring tracheotomy from 1998 to 2002 were followed for a mean length of 223.3 days. Outcomes were measured based on indications for ventilatory support, age, sex, length of intensive care unit (ICU) and hospital stay, and overall status at discharge. The overall mortality was 50%. Those who survived required a tracheotomy for an average of 41.6 days before decannulation; 41.2% of patients were discharged home. Information should assist families, intensivists, and physicians involved in the care of such critically ill patients. Ethical questions that arise in the care of these patients are addressed.