Delaying Cholecystectomy for Complicated Gallstone Disease in Pregnancy is Associated with Recurrent Postpartum Symptoms

Introduction

Pregnancy is a risk factor for gallstone disease; in some patients, cholecystectomy may be delayed to the postpartum period. Our aim was to examine the effect of antepartum interventions on postpartum outcomes in complicated gallstone disease (CGD) during pregnancy.

Material and Methods

Retrospective analysis of patients seeking medical care for CGD (cholecystitis, choledocholithiasis, or gallstone pancreatitis) during pregnancy at a single tertiary care institution over a 10-year period (2002–2012). Patients were contacted via standardized telephone survey to account for outside hospitalizations.

Results and Discussion

We identified 56 patients with CGD during pregnancy, 42.9 % initially presenting during the second trimester. Choledocholithiasis was the most common diagnosis (n?=?30). Antepartum cholecystectomy was performed in 17.9 %. Seventeen patients did not follow up postpartum and did not complete telephone survey. Of the remaining 29 patients, 58.6 % had recurrent postpartum symptoms, 35.3 % recurred within 1 month, and 82.4 % within 3 months of delivery. Antepartum ERCP with biliary sphincterotomy decreased postpartum symptom recurrence (38.5 vs. 75.0 %, p?=?0.07).

Conclusions

The majority of patients with CGD who do not undergo antepartum cholecystectomy have recurrent postpartum symptoms often within 3 months postpartum. When appropriate, physicians should advocate for antepartum or early postpartum cholecystectomy to minimize symptom recurrence and unplanned hospitalizations.     

Transcatheter Aortic Valve Implantation in Surgically Repaired Double Outlet Right Ventricle

A 52‐year‐old male patient, with a medical history of surgically repaired double outlet right ventricle presented with severe aortic stenosis (AS) and hepatitis C with cirrhosis, presented with New York Heart Association Class IV heart failure. During evaluation for a liver transplant, he was deemed a poor surgical candidate due to his aortic valve disease and cirrhosis with model for end‐stage liver disease score of 14. Transthoracic echocardiogram showed severe AS with a mean gradient of 62 mm Hg and calculated aortic valve area of 0.74 cm² with a normal ejection fraction of 65%. The patient underwent transfemoral implantation of a 23‐mm Edwards Sapien commercial heart valve with significant mean gradient reduction across the aortic valve from 62 to 13 mm Hg. The patient was observed in the coronary care unit and discharged home 2 days postprocedure with his clinical symptoms greatly improved.     

Prevalence of zygomatic air cell defect in adults--a retrospective panoramic radiographic analysis

Objectives

This research involved retrospectively evaluating panoramic radiographs of patients from India with the intention of assessing the prevalence of Zygomatic Air Cell Defect (ZACD) and establishing its dominant location and type.

Methods

Seven thousand seven hundred and fifty-five panoramic radiographs of routine outpatients aged between 19 and 91 years were concomitantly evaluated by four investigators for estimating the prevalence and characteristics of the Zygomatic Air Cell Defect.

Results

The prevalence of ZACD was noted to be 1.82%, with male preponderance. Unilateralality and multilocular appearance of ZACD were the dominant patterns observed.

Conclusion

The frequency of ZACD amongst Indian population is in harmony with most of the similar studies conducted on various geographic populations.     

Emerging organisms in a tertiary healthcare set up

Background

One-tenth of all infectious diseases are attributable to emerging organisms. As emerging organisms sporadically affect a relatively small percentage of population they are not studied at large. This study was aimed at studying the characteristics of emerging organisms encountered from various clinical samples in an apex tertiary care multispeciality teaching and research hospital.

Methods

16,918 positive isolates obtained from 66,323 culture samples processed in the clinical microbiology lab of an apex multispeciality hospital during 2011–2012 were included after a pilot study. Both manual and automated systems were used for identification and antimicrobial susceptibility. The frequency of isolation, sources, referring centers, resistance and susceptibility profiles, phenotypic characteristics and number of reports in PubMed were studied.

Results

Out of 16,918 isolates, 13,498 (79.78%) were Gram negative bacteria, 3254 (19.23%) were Gram positive bacteria and 166 (0.98%) were yeasts. A total of 483 (2.85%, 95% CI 2.6%–3.1%) emerging organisms including 116 (0.69%, 95% CI 0.57%–0.81%) emerging species were identified comprising 54 genera.

Conclusion

Emerging organisms are likely to evade routine identification or be disregarded as non-contributory. Astute efforts directed at identification of emerging isolates, decisions by clinical microbiologists and treating physicians and containment of infection are required.     

Pharmacokinetic and Target Engagement Measures of ANX007, an Anti-C1q Antibody Fragment,Following Intravitreal Administration in Nonhuman Primates

PurposeC1q and the classical complement cascade are key regulators of synaptic pruning, and their aberrant activation has been implicated in neurodegenerative ophthalmic diseases including geographic atrophy and glaucoma. The antigen-binding fragment antibody ANX007 specifically recognizes globular head groups of C1q to block substrate binding and functionally inhibit classical complement cascade activation. ANX007 was assessed in nonclinical studies of biodistribution and C1q target engagement in the eye following intravitreal (IVT) administration in cynomolgus monkeys.MethodsFemale juvenile cynomolgus monkeys (n = 12) received a single bilateral dose of 1 or 5 mg ANX007/eye, with vitreous and non-perfused tissue samples collected approximately 4 weeks later. In a separate study, male (n = 6/5) and female (n = 6/5) animals received repeat bilateral dosing of 1, 2.5, or 5 mg ANX007/eye on days 1 and 29, with aqueous and vitreous collections on day 44 or day 59. Tissues from the 5 mg/eye repeat-dose group were perfused, and retina, choroid, and optic nerve samples were collected approximately 2 and 4 weeks post-last dose.ResultsFollowing a single dose of ANX007, vitreous levels of free drug were measurable through 4 weeks at both the 1 and 5 mg dose levels, with approximately 3-day half-life. With repeat dose of 5 mg/eye, free-ANX007 was measurable 4 weeks post-last dose in perfused retina and choroid and up to approximately 2 weeks post-last dose in optic nerve. There was a strong correlation between C1q target engagement and free drug levels in aqueous and vitreous humors and retinal tissue.ConclusionsFollowing IVT administration, ANX007 distributes to sites within the retina that are relevant to neurodegenerative ophthalmic disease with clear evidence of C1q target engagement. Based on its mechanism of action inhibiting C1q and its downstream activity, ANX007 is predicted to mitigate tissue damage driven by classical complement activation in the retina. These data support further clinical evaluation of ANX007.     

The Quality of Care for Gastroesophageal Reflux Disease

Improving the quality of healthcare delivery is a cornerstone of modern medical care shared between all stakeholders. However, effectively improving quality requires both an understanding of the tenets of healthcare quality and how they relate to an individual disease process. This is especially important for common diseases, such as gastroesophageal reflux disease (GERD), where wide variations in practice exist. The high prevalence of GERD coupled with wide variation in clinical approach results in significant economic burden and poor quality of care. Thus, GERD serves as a useful framework to highlight the opportunities and current challenges of delivering high-quality care. In this article, we identify quality metrics in GERD and the areas in need of research to improve the quality of the management of GERD. Additionally, we suggest strategies for improvement as it relates to the proper diagnostic testing utilization and the decision-making process.     

Evaluation of E and EAC rosette-forming cells in patients with thermal injuries

Thermal injuries lead to changes in both the cell-mediated and humoral responses of the patient. This study was undertaken to assess these responses in the post-burn period and also to see if bacterial infection altered these responses. It has been concluded that alterations in the cell-mediated and humoral immune responses following thermal injuries are altered by infection and consequently are also important in the healing process.     

A study of humoral factors in carcinoma cervix.

Serum immunoglobulins, circulating immune-complexes and blocking effect of patients' sera on normal T lymphocytes were studied in 10 patients with chronic cervicitis, 25 with carcinoma cervix and 20 age matched healthy women. No significant difference was observed between the healthy controls and chronic cervicitis. In carcinoma, there was a significant increase in IgG and IgA in stage I, IgG and IgM in stage II and in all the three immunoglobulins in stage III as compared to chronic cervicitis. Circulating immune-complexes and T cell depression were also found to be increased and stage related. After radiotherapy, both these parameters and IgG were found to be significantly reduced. The study of these immune parameters seems to be a promising aid in the diagnosis and prognosis of patients with carcinoma cervix.