Short course <Emphasis Type="Italic">versus</Emphasis> 7-day course of intravenous antibiotics for probable neonatal septicemia: <Emphasis Type="Italic">A pilot,open-label,randomized controlled trial</Emphasis>

Objective  

To compare a short course of antibiotics (48 to 96 hours) and a standard course of antibiotics (7 days) for probable neonatal sepsis.     

Improved, atraumatic access to digits with severe flexor contractures: surgical tape and suture modification of the lead hand

We present a modification to the widely used lead hand retraction system that allows for improved surgical access to a digit with a severe flexor contracture. A simple construct using surgical adhesive tape and a silk suture can be made and applied to the digit and lead hand. Our technique is simple and inexpensive to use, and we recommend its use to improve surgical access without causing unnecessary trauma to the digit.     

Inadvertent transvenous left ventricular pacing through an unsuspected atrial septal defect

A 65-year-old male patient with a long standing history of chronic obstructive lung disease had permanent pacemaker implantation for symptomatic atrioventricular nodal blocks. Preoperative echocardiography showed dilated right heart chambers and moderate pulmonary arterial hypertension without any demonstrable intracardiac shunt. Postoperative twelve-lead ECG showed right bundle branch block configuration of paced complexes. This suggested left ventricular pacing which was confirmed by transthoracic echocardiography. Later, transoesophageal echocardiography showed the lead entering into left atrium from right atrium through a sinus venosus type of atrial septal defect. The patient refused any further intervention and continues to remain asymptomatic with stable pacing on aspirin-anticoagulant therapy at end of four years.     

Haemangioma of Cheek Different Presentation and Management

Though haemangioma of cheek is not a very uncommon entity, here we are presenting a case series of four such cases of haemangioma cheek of completely different presentation. One of which is classical maxillary haemangioma and the rest of the others have different and unusual presentations. They all have different radiological features and were managed successfully by different surgical approaches without any recurrence.     

Antiplasmodial activity of [(aryl)arylsulfanylmethyl]Pyridine

A series of [(aryl)arylsufanylmethyl]pyridines (AASMP) have been synthesized. These compounds inhibited hemozoin formation, formed complexes (K(D) = 12 to 20 muM) with free heme (ferriprotoporphyrin IX) at a pH close to the pH of the parasite food vacuole, and exhibited antimalarial activity in vitro. The inhibition of hemozoin formation may develop oxidative stress in Plasmodium falciparum due to the accumulation of free heme. Interestingly, AASMP developed oxidative stress in the parasite, as evident from the decreased level of glutathione and increased formation of lipid peroxide, H(2)O(2), and hydroxyl radical (.OH) in P. falciparum. AASMP also caused mitochondrial dysfunction by decreasing mitochondrial potential (DeltaPsim) in malaria parasite, as measured by both flow cytometry and fluorescence microscopy. Furthermore, the generation of .OH may be mainly responsible for the antimalarial effect of AASMP since .OH scavengers such as mannitol, as well as spin trap alpha-phenyl-n-tertbutylnitrone, significantly protected P. falciparum from AASMP-mediated growth inhibition. Cytotoxicity testing of the active compounds showed selective activity against malaria parasite with selectivity indices greater than 100. AASMP also exhibited profound antimalarial activity in vivo against chloroquine resistant P. yoelii. Thus, AASMP represents a novel class of antimalarial.     

Mapping quantitative trait loci in humans: achievements and limitations

Recent advances in statistical methods and genomic technologies have ushered in a new era in mapping clinically important quantitative traits. However, many refinements and novel statistical approaches are required to enable greater successes in this mapping. The possible impact of recent findings pertaining to the structure of the human genome on efforts to map quantitative traits is yet unclear.     

The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery

INTRODUCTION

With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during ‘awake surgery’, in particular of which aspects of the process may be distressing.

METHODS

Seventy patients undergoing day case plastic surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients.

RESULTS

Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as ‘knife’ and ‘scalpel’ provoke considerable anxiety in the conscious patient. This varied according to age and sex with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving.

CONCLUSIONS

Technical jargon used by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.