Delayed presentation of intraperitoneal bladder rupture following domestic violence in pregnancy

Trauma during pregnancy can present a unique challenge because of care for the mother and the fetus. About 6-7% of all pregnant patients are exposed to some sort of trauma, especially during the third trimester, with 0.3-0.4% requiring hospitalization. Although mostly accidental, injuries are sometimes caused by intentional violence. There is no published report on bladder rupture following trauma in pregnancy. We report a case of bladder injury following abdominal trauma in a pregnant woman.     

Laser Treatment of a Tracheal Inflammatory Myofibroblastic Tumor

Background

Inflammatory myofibroblastic tumors of the trachea are rare childhood quasi-neoplastic lesions.

Case characteristics

7-year-old boy with recurrent episodes of cough, breathing difficulty and wheeze, initially treated as asthma.

Intervention

CT chest and flexible bronchoscopy revealed a mass lesion of the trachea, which was excised by diode laser through the ventilating bronchoscope. Histopathology confirmed it as the inflammatory myofibroblastic tumor.

Message

Use of laser ensured complete endotracheal excision of the tumor.

     

Risk factors for post-induction hypotension in children presenting for surgery

Background

Preoperative factors have been correlated with pre-incision hypotension (PIH) in children undergoing surgery, suggesting that PIH can be predicted through preoperative screening. We studied blood pressure (BP) changes in the 12 min following the induction of anesthesia to study the incidence of post-induction hypotension and to assess the feasibility of predicting PIH in low-risk children without preoperative hypotension or comorbid features.

Methods

We retrospectively evaluated 200 patients ranging in age from 2 to 8 years with American Society of Anesthesiologists’ (ASA) physical status I or II, undergoing non-cardiac surgery. Patients were excluded if they had preoperative (baseline) hypotension (systolic blood pressure (SBP)?<?5th percentile for age). BP and heart rate (HR) were recorded at 3 min intervals for 12 min after the induction of anesthesia. Pre-incision hypotension (PIH) was initially defined as SBP?<?5th percentile for age: (1) at any timepoint within 12 min of induction; (2) for the median SBP obtained during the 12 min study period; or (3) at 2 or more timepoints including the final point at 12 min after the induction of anesthesia (sustained hypotension). In addition, we examined PIH defined as >?20% decrease in SBP from baseline: (4) at any timepoint within 12 min of the induction of anesthesia; (5) for the median SBP obtained during the 12 min study period; or (6) at two or more timepoints including the final point at 12 min after the induction of anesthesia. Agreement among the six definitions was analyzed, in addition to the effects of age, gender, type of anesthetic induction, use of premedication, preoperative BP, preoperative HR, and body mass index on the incidence of PIH according to each definition.

Results

Five patients were excluded due to baseline hypotension and six were excluded for missing data. In the remaining cohort, estimated PIH prevalence ranged from 4% [definition (Stewart et al., in Paediatr Anaesth 26:844–851, 2016), sustained PIH according to SBP percentile-for-age] to 57% [definition (Task Force on Blood Pressure Control in Children, in Pediatrics 79:1–25, 1987), at least one timepoint where SBP was >?20% lower than baseline]. Pairwise agreement among the six definitions ranged from 49 to 91% agreement. No sequelae of PIH were noted during subsequent anesthetic or postoperative care. On multivariable analysis, no covariates were consistently associated with PIH risk across all six definitions of PIH.

Conclusion

The present study describes the incidence and prediction of PIH in a cohort of relatively healthy children. In this setting, accurate prediction of PIH appears to be hampered by lack of agreement between definitions of PIH. Overall, there was a low PIH incidence when the threshold of SBP?<?5th percentile for age was used.

Level of evidence

II.

     

Effects of benzo(a)pyrene on intra-testicular function in F-344 rats

The objective of this study was to evaluate the reproductive risk associated with exposure of adult male Fisher-344 (F-344) rats to inhaled benzo(a)pyrene (BaP), a ubiquitous environmental toxicant present in cigarette smoke, automobile exhaust fumes and industrial emissions. Rats were assigned randomly to a treatment or control group. Treatment consisted of exposure of rats via nose-only inhalation to 75 microg BaP/m3, 4 hours daily for 60 days, while control animals were unexposed (UNC). Blood samples were collected immediately on day 60 of exposures (time 0) and subsequently at 24, 48, and 72 hours, to assess the effect of exposures to BaP on plasma testosterone and luteinizing hormone (LH) concentrations. Mean testis weight, total weight of tubules and total tubular length per paired testes were reduced 33% (P < 0.025), 27% (P < 0.01) and 39%, respectively in exposed rats (P < 0.01) compared with UNC rats. The number of homogenization -resistant spermatids was significantly reduced in BaP-exposed versus UNC rats. Plasma testosterone and intra-testicular testosterone (ITT) concentrations were significantly decreased by BaP compared with those of UNC rats. The decreases in circulating plasma testosterone were accompanied by concomitant increases in plasma LH concentrations in BaP-exposed versus control rats (P < 0.05). These data suggest that 60 days exposure to inhaled BaP contribute to reduced testicular endocrine and spermatogenic functions in exposed rats.     

Human health problems associated with current agricultural food production

Scientific and technological developments in the agricultural sectors in the recent past has resulted in increased food production and at the same time led to certain public health concerns. Unseasonal rains at the time of harvest and improper post harvest technology often results in agricultural commodities being contaminated with certain fungi and results in the production of mycotoxins. Consumption of such commodities has resulted in human disease outbreaks. Naturally occurring toxins, inherently present in foods and either consumed as such or mixed up with grains, had been responsible for disease outbreaks. Other possible causes of health concern include the application of various agrochemicals such as pesticides and the use of antibiotics in aquaculture and veterinary practices. Foodborne pathogens entering the food chain during both traditional and organic agriculture pose a challenge to public health. Modern biotechnology, producing genetically modified foods, if not regulated appropriately could pose dangers to human health. Use of various integrated food management systems like the Hazard Analysis and critical control system approach for risk prevention, monitoring and control of food hazards are being emphasized with globalization to minimise the danger posed to human health from improper agricultural practices.