Ultrasound of tibialis anterior muscle and tendon: anatomy,technique of examination,normal and pathologic appearance

Lesions of the tibialis anterior muscle and tendon are not frequently reported in international literature although pathology is not rare. Pathology can be spontaneous, associated with arthropathy or more generalized conditions. Clinical assessment may not be sufficient for distinguishing conditions like tendinopathy, tears, bursitis, etc. Therefore, imaging studies are necessary to plan appropriate therapy. US has a number of advantages, including widespread availability, absence of contraindications and low cost. It can also be used for dynamic studies of the muscle during contraction and relaxation. This article reviews the anatomy of the tibialis anterior, normal variants, the technique used for standard US examination of this muscle and tendon, its normal appearance on US and the sonographic characteristics of the most common lesions that affect it including tips on US-guided injections used for treatment.     

The Society of Thoracic Surgeons (STS) Virtual Conference Taskforce: Recommendations for Hosting a Virtual Surgical Meeting

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Increased prevalence of indicator and pathogenic bacteria in Vembanadu Lake: a function of salt water regulator, along south west coast of India

Prevalence of faecal indicator bacteria, Escherichia coli and pathogenic bacteria, Vibrio cholerae, Vibrio parahaemolyticus and Salmonella were analysed in Vembanadu lake (9 degrees 35'N 76 degrees 25'E), along south west coast of India for a period of one year from ten stations on the southern and northern sides of a salt water regulator constructed in Vembanadu Lake in order to prevent incursion of seawater during certain periods of the year. While the northern side of the lake has a connection to the sea, the southern side is enclosed when the salt water regulator is closed. The results revealed the water body is polluted with high faecal coliform bacteria with mean MPN value ranging from 1718-7706/100 ml. E. coli, V. cholerae, V. parahaemolyticus and Salmonella serotypes such as S. paratyphi A, B, C and S. newport were isolated and this is the first report on the isolation of these Salmonella serovars from this lake. E. coli showed highest percentage of incidence (85.6-86.7%) followed by Salmonella (42-57%), V. choleare (40-45%) and V. parahaemolyticus (31.5-32%). The increased prevalence of indicator and pathogenic bacteria in the enclosed southern part of Vembanadu Lake may be resulting from the altered flow patterns due to the salt water regulator.     

Dorfman-Chanarin syndrome in two female siblings: a case report and discussion on approach and management

Dorfman-Chanarin syndrome (DCS) is a very rare disorder of lipid metabolism that exhibits an autosomal recessive pattern of inheritance. Besides ichthyosis, systemic manifestations may be present. We report two female siblings with DCS who presented with non-bullous ichthyosiform erythroderma (NBIE). A peripheral blood smear demonstrated Jordan anomaly. This case emphasizes the need for peripheral blood smear screening in patients with congenital ichthyosis. CASE REPORT: A 2?-year-old female child and her 1-month-old sibling presented with generalized erythema and scaling, which was suggestive of NBIE. Hepatomegaly and ectropion were seen in the older sibling. A peripheral blood smear of both the patients revealed Jordan anomaly. Serum biochemistry revealed abnormal liver function tests, abnormal lipid profile, and elevated muscle-derived enzymes. A diagnosis of Dorfman-Chanarin syndrome was made in both the siblings. Screening for Jordan anomaly in the family members including the parents and maternal and paternal grandmothers was negative. CONCLUSION: The peculiarities in our case include the presence of this disorder in both female siblings along with alopecia in the younger sibling. Hyperlipidemia, noted in one of our cases, is also not a common association. Diagnosing DCS is fairly simple and a high index of suspicion may lead to higher rates of detection of this rare disorder.     

The enteric microbiome in hepatobiliary health and disease

Increasing evidence points to the contribution of the intestinal microbiome as a potentially key determinant in the initiation and/or progression of hepatobiliary disease. While current understanding of this dynamic is incomplete, exciting insights are continually being made and more are expected given the developments in molecular and high‐throughput omics techniques. In this brief review, we provide a practical and updated synopsis of the interaction of the intestinal microbiome with the liver and its downstream impact on the initiation, progression and complications of hepatobiliary disease.     

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor, graft and recipient factors. Within the cohort of patients waiting for a transplant, better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation. A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age, gender, ethnicity, viral serology; graft factors such as size and quality, recipient factors such as age, size, gender and transplant factors such as major or minor blood group incompatibility and immunological factors. We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors’ clinical experience. Multiple donor and recipient factors impact graft survival after liver transplantation. Appropriate matching based on donor-organ-recipient variables, modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.