Conditioning of ictal and interictal behaviors in rats by amygdala kindling: context as the conditional stimulus

The authors showed that conditional effects of the stimulation environment modulate both the ictal and interictal behaviors of rats subjected to amygdala kindling. Rats received 53 stimulations to the left basolateral amygdala in 1 conditional stimulus (CS) context (CS+) and 53 sham stimulations (the stimulation lead was attached but no current was delivered) in another context (CS-), quasirandomly over 54 days. Three kinds of conditional effects were observed. First, after several stimulations, less ambulatory activity, more freezing, and less rearing reliably occurred in the CS+ context than in the CS-context. Second, after 45 stimulations, all of the rats chose the CS- context over the CS+ context in a conditioned place preference test. Third, when the rats were finally stimulated in the CS- context, their motor seizures were less severe: Latencies were longer, motor seizures were shorter, convulsive patterns were of a lower class, and there were fewer falls.     

Anticoagulant-induced intramural hematoma of the jejunum

Background  

Spontaneous intramural intestinal hematoma in patients on oral anticoagulation therapy is rare.     

BILATERAL INFRAORBITAL NERVE BLOCK IS SUPERIOR TO PERI-INCISIONAL INFILTRATION FOR ANALGESIA AFTER REPAIR OF CLEFT LIP

Cleft lip repair is a common operation in infants and requires that the child is pain-free during the postoperative period so that handling does not affect the integrity of the delicate surgical site. This study was designed to compare the efficacy and duration of effect of 0.125% bupivacaine given preoperatively as a bilateral infraorbital nerve block with peri-incisional infiltration of the same local anaesthetic for postoperative analgesia in cleft lip repair. It was a randomised, double blind, prospective study in 30 children aged 4-20 months (ASA grade 1). After a standard induction, group A (n = 15) were given a bilateral infraorbital nerve block with 0.125% bupivacaine and group B (n = 15) had peri-incisional infiltration with the same solution. No additional systemic analgesics were given before or during the operation. Intraoperative monitoring comprised measurement of heart rate and blood pressure and postoperatively pain relief was recorded using a behavioural pain relief score. The heart rate, respiratory rate, and blood pressure were also monitored at 0, 1, 2, 4, 8, and 24 hours after tracheal extubation. The results showed that group A had significantly better pain relief (higher scores) than group B for eight hours postoperatively (p < 0.05). The analgesic requirement in group B became significant at two hours postoperatively, while group A had significant analgesic requirements only after eight hours. The significant rise in heart rate and blood pressure that accompanied tracheal intubation in both groups suggested that while both methods of analgesia may be adequate to prevent responses to skin incision, they do not substitute for adequate systemic analgesia during the operation. We conclude that infraorbital nerve block with 0.125% bupivacaine provides better and more prolonged analgesia than peri-incisional infiltration in cleft lip repair.     

BILE DUCT CYSTS: PRESENTATION IN ADULTS

Bile duct or choledochal cysts are rare congenital anomalies and presentation in adult is infrequent. Seven cases of type I/IV bile duct cysts presenting in adult life have been treated by the authors during the past 2 years. The diagnosis was made using a combination of ultrasound and cholangiography (endoscopic retrograde cholangiopancreatography/percutaneous transhepatic cholangiography). All cases underwent total cyst excision and Roux-en-Y hepaticojejunostomy. There were no operative complications and all patients were asymptomatic in the follow-up period, which ranged from 3 to 23 months.     

Haemangioma maxillary antrum

A case of haemangioma maxillary antrum is., reported. Since fatal cases are on record, it is suggested that the possibility of haemangioma of maxillary antrum should be kept in mind whenever there is no apparent lesion in nose and nasopharynx in case of recurrent unilateral epistaxis before undertaking any surgery.     

Dhat syndrome: A culture-bound sex neurosis of the orient

The Indian Dhat syndrome is a culture-bound symptom complex. The clinical picture includes severe anxiety and hypochondriasis. The patient is preoccupied with the excessive loss of semen by nocturnal emissions. There is a fear that semen is being lost. and mixed in urine. A study was carried out to investigate the cultural basis of the Dhat syndrome. One hundred and seven respondents from the general public were interviewed. A vignette describing an individual having nocturnal emissions was read aloud to the respondents. Attitudes toward nocturnal emission, its causes, and its management were investigated. A large segment of the general public from all socioeconomic classes believed that semen loss is harmful. Seminal fluid is considered an elixir of life both in the physical and in the mystical sense. Its preservation guarantees health, longevity, and supernatural powers. This belief is more frequent in lower socioeconomic classes. The susceptible individual reacts to the prevalent belief system and to the fears of semen loss. The symptoms usually disappear if the misconceptions about semen loss are effectively dealt with. It is expected that with increasing literacy and progress in sex knowledge the syndrome will become less common.     

Screening for HIV infection by health professionals in India

BACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.     

Major molecular markers in pancreatic ductal adenocarcinoma and their roles in screening, diagnosis, prognosis, and treatment

Pancreatic cancer is notorious for its late presentation, early and aggressive local invasion, metastatic potential, and poor outcome. It presents at a clinically advanced stage that precludes the possibility of surgical resection in most cases and shows constitutive resistance to chemotherapy and radiotherapy in others. As a result, mortality from this disease parallels its incidence rates.Recent breakthroughs in the molecular biology of pancreatic cancer have assisted in translational research, giving hope for individualized therapy and better disease management. Molecular biology tools are guiding early diagnosis, the assessment of prognosis, and isolation of novel, more effective therapeutic targets.This review discusses the signature mutations of pancreatic cancer, implications of these mutations to pancreatic cancer biology, their linked pathways, and recent advances in their understanding as biomarkers as diagnostic, prognostic, and therapeutic tools in dealing with this disease.