An evaluation of current shigellosis treatment

Shigellosis or bacillary dysentery, characterised by the passage of frequent loose stools mixed with blood and mucous, is caused by Shigella spp. which can be subdivided into four serotypes, namely, S. sonnei, S. boydii, S. flexneri and S. dysenteriae. S. dysenteriae type 1 produces severe dysentery and may be associated with many complications like leukaemoid reaction and haemolytic-ureamic syndrome. It is known to produce protracted epidemics and pandemics and is usually multi-drug resistant. Antibiotics are the mainstay of therapy of all cases of shigellosis. Antibiotics such as tetracycline, ampicillin and co-trimoxazole, were previously highly effective. Newer fluoroquinolones such as norfloxacin, ciprofloxacin, ofloxacin, azithromycin and ceftriaxone are effective. Although single dose of norfloxacin 800 mg and ciprofloxacin 1 g have been shown to be effective, they are currently less effective against S. dysenteriae type 1 infection. Oral rehydration salt should be given concurrently to prevent or correct dehydration. Antimotility agents are contraindicated. Feeding during and after shigellosis is emphasised. Hand-washing practices with plenty of water and soap help to prevent the transmission of infection from person to person. A search is on for an effective vaccine against shigella.     

Perivascular epithelioid cell tumor (PEComa) of falciform ligament — an extremely rare tumor

Primary tumor of falciform ligament is exceedingly uncommon. So far, seven cases of Perivascular Epithelioid Cell tumor (PECom), a recently described histological entity with characteristic perivascular tumor cell arrangement and expression of muscle and melanocytic marker by the cells, have been reported in literature. Here, we report a case of PEComa of falciform ligament, which presented with a huge abdominal lump. Pre-surgical CT scan of abdomen was uninformative regarding the nature and organ of origin of the tumor. On laparotomy, it was surprisingly found to arise from the falciform ligament, and this was easily removed. Histopathological diagnosis confirmed PEComa. There was no recurrence of disease after two years of follow up.     

Open port placement through the umbilical cicatrix

Peritoneal access and creation of pneumoperitoneum are the key initial steps of laparoscopic surgery. This is commonly achieved by either introducing Veress needle or by gradual dissection of all the layers of the abdominal wall and then introducing a port under direct vision. The two techniques are extremely safe, but large outcome studies have found slightly increased complications with the Veress needle. Randomized trials do not support such finding and both techniques continue to have their enthusiasts. We hereby describe an open method of initial port placement, wherein the port is introduced through the umbilical cicatrix under direct vision.     

Adjunctive high-frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) was not effective in obsessive–compulsive disorder but improved secondary depression

BackgroundThere is preliminary evidence that repetitive transcranial magnetic stimulation (rTMS) may be useful in obsessive–compulsive disorder (OCD) patients.MethodsOur objective was to examine efficacy of adjunctive right prefrontal high-frequency (rapid) rTMS treatment in OCD patients. 42 patients with OCD were randomly assigned to 10 sessions of add-on high-frequency right prefrontal active rTMS (10 Hz, 110% of motor threshold, 4 s per train, 20 trains per session) or sham stimulation. They were rated on Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A) and Clinical Global Impression-Severity of Illness (CGI-S) at baseline, day 14 and day 28. The dose of antiobsessive drug was kept constant throughout the period of assessment.ResultsFor YBOCS scores, repeated measures ANOVA showed significant main effect of treatment, but no effect of treatment over time (Pillai's Trace F = 1.39, p = .262). However, significant effect of treatment over time as shown by interaction effect for both HAM-D (Pillai's Trace F = 3.67, p = .035, η² = .158) and HAM-A scores (Pillai's Trace F = 5.22, p = .01, η² = .211) were seen.ConclusionAdjunctive high-frequency right prefrontal rTMS does not have any significant effect in the treatment of OCD. However, it is modestly effective in the treatment of comorbid depressive symptoms in patients with OCD.     

The immunoregulatory role of dopamine: An update

The neurotransmitter dopamine (DA) is an important molecule bridging the nervous and immune systems. DA through autocrine/paracrine manner modulates the functions of immune effector cells by acting through its receptors present in these cells. DA also has unique and opposite effects on T cell functions. Although DA activates naïve or resting T cells, but it inhibits activated T cells. In addition, changes in the expression of DA receptors and their signaling pathways especially in T cells are associated with altered immune functions in disorders like schizophrenia and Parkinson’s disease. These results suggest an immunoregulatory role of DA. Therefore, targeting DA receptors and their signaling pathways in these cells by using DA receptor agonists and antagonists may be useful for the treatment of diseases where DA induced altered immunity play a pathogenic role.     

Rapid monitoring of iron-chelating therapy in thalassemia major by a new cardiovascular MR measure: the reduced transverse relaxation rate

In iron overload, almost all the excess iron is stored intracellularly as rapidly mobilizable ferritin iron and slowly exchangeable hemosiderin iron. Increases in cytosolic iron may produce oxidative damage that ultimately results in cardiomyocyte dysfunction. Because intracellular ferritin iron is evidently in equilibrium with the low-molecular-weight cytosolic iron pool, measurements of ferritin iron potentially provide a clinically useful indicator of changes in cytosolic iron. The cardiovascular magnetic resonance (CMR) index of cardiac iron used clinically, the effective transverse relaxation rate (R(2)*), is principally influenced by hemosiderin iron and changes only slowly over several months, even with intensive iron-chelating therapy. Another conventional CMR index of cardiac iron, the transverse relaxation rate (R(2)), is sensitive to both hemosiderin iron and ferritin iron. We have developed a new MRI measure, the 'reduced transverse relaxation rate' (RR(2)), and have proposed in previous studies that this measure is primarily sensitive to ferritin iron and largely independent of hemosiderin iron in phantoms mimicking ferritin iron and human liver explants. We hypothesized that RR(2) could detect changes produced by 1 week of iron-chelating therapy in patients with transfusion-dependent thalassemia. We imaged 10 patients with thalassemia major at 1.5 T in mid-ventricular short-axis planes of the heart, initially after suspending iron-chelating therapy for 1 week and subsequently after resuming oral deferasirox. After resuming iron-chelating therapy, significant decreases were observed in the mean myocardial RR(2) (7.8%, p < 0.01) and R(2) (5.5%, p < 0.05), but not in R(2)* (1.7%, p > 0.90). Although the difference between changes in RR(2) and R(2) was not significant (p > 0.3), RR(2) was consistently more sensitive than R(2) (and R(2)*) to the resumption of iron-chelating therapy, as judged by the effect sizes of relaxation rate differences detected. Although further studies are needed, myocardial RR(2) may be a promising investigational method for the rapid assessment of the effects of iron-chelating therapy in the heart.     

Application of the Extended Technology Acceptance Model in predicting pharmacists’ intention to use personal digital assistants

ObjectiveTo evaluate pharmacists’ behavioral intention to use personal digital assistants (PDAs) in their profession, by means of the Extended Technology Acceptance Model (ETAM).DesignProspective cross-sectional study.SettingHospital and community pharmacies in Houston, TX, in 2004.ParticipantsConvenience sample of 295 practicing pharmacists.InterventionA prevalidated survey containing 30 items, evaluated on a 5-point Likert scale (1, strongly disagree, to 5, strongly agree), which measured the ETAM variables.Main outcome measuresPredictors of intention to use PDA for pharmacists owning the device.ResultsAmong the surveyed population, 49% of pharmacists owned PDAs. Overall, the ETAM constructs showed fairly good reliability. Stepwise regression analysis showed that the ETAM explained 69% of the variance in intention to use PDAs for pharmacists owning the device. Result demonstrability (β = 0.53), subjective norm (β = 0.25), and voluntariness (β = –0.10) were significant (P < 0.05) predictors of pharmacists’ intention to use PDAs.ConclusionETAM proved useful in predicting pharmacists’ behavior in using PDAs. With improvements in technology, PDAs be an effective tool for pharmacists in providing better patient care.