Fatal aortoesophageal fistula resulting from ingestion of chicken bone

A 22-year-old soldier was admitted in Combined Military Hospital, Attock, with dysphagia, chest pain and haemetemesis after swallowing a chicken bone during the dinner. The symptoms relieved spontaneously next day. The chest x-ray on the day of admission raised possibility of a radiopaque foreign body in the lower oesophagus. Repeat x-ray of chest and Barium swallow on next day did not reveal any radiopaque shadow, filling defect or leakage. He was discharged after 3 days of observation, during which, he remained asymptomatic. Nine days later, he was re-admitted in Combined Military Hospital, Multan, with massive haemetemesis. The endoscopy was inconclusive as stomach was full of blood clots. Laparotomy revealed triangular piece of chicken bone in the stomach associated with bleeding gastric erosions. The bleeding sites were stitched and cauterized. Postoperatively, he complained of pain in the left side of chest associated with breathlessness. X-ray of chest and ultrasound examination showed fluid collection in the pleural cavity. On chest intubation, 500 ml of blood stained fluid was drained. There was no haemetemesis in the postoperative period and gastric aspirate remained clear. One week later, he had massive haemetemesis, went into cardiac arrest and expired. Postmortem examination showed the cause of death to be aortoesophageal fistula.     

Anthelmintic,antimicrobial, antioxidant and cytotoxic activity of Caltha palustris var. alba Kashmir,India

The methanolic extract obtained from the root portion of Calthapalustris var. alba was evaluated for its anthelmintic efficacy against gastrointestinal nematodes of sheep under both in vitro and in vivo conditions using worm motility inhibition （WMI） assay and fecal egg count reduction （FECR） assay, respectively. The extract was subjected to antimicrobial activity using agar-well diffu- sion method against different bacterial strains. In addition the extract was evaluated for cytotoxic and antioxidant activity against cultured THP-l（Leukemia）, A-549 （Lung）, HCT-15 （Colon）, Cervix （HeLa） and PC-3（Prostrate） cell lines by SRB and DPPH radical scavenging assays. The extract used resulted in mean %WMI of 94.44%, as observed when the worms were put in lukewarm buffer for 30 min after exposure to different treatments. The mean mortality index of the sample was 0.95. The lethal concentration （LCs0）was 0.11 mg·mL ^-1. Cell lines were exposed to concentration of 100 μg·mL^-1 of extract for 48 h, which reduced the viability of these cell lines. The same plant extract also showed 55.58% DPPH radical scavenging activity.     

Optimisation of laboratory procedures for isolating human peripheral blood derived neutrophils

Functional analysis of neutrophils requires isolation of these cells in the laboratory. Current isolation procedures are time consuming and can potentially activate the resting neutrophils. Thus, in this present study, we have optimised an existing laboratory protocol for human neutrophil isolation from peripheral blood. Twenty ml of blood samples were subjected to optimised density gradient separation and dextran sedimentation to obtain a pure population of neutrophils. The efficacy of the optimised manual post isolation of neutrophils was compared with pre isolation count performed by an automated haematology analyzer. The recovery of neutrophils via our optimised methods was 65.5% in comparison with neutrophils counts at pre-isolation. The morphological analysis of isolated neutrophils indicated the purity level more than 95% using Leishman staining. Our optimised laboratory procedures for neutrophils isolation successfully harvested neutrophils with good viability, purity and post recovery yield. This procedure provides an ideal platform to separate neutrophils for in vitro studies.     

Synthesis and docking studies of N-(5-(alkylthio)-1,3,4-oxadiazol-2-yl)methyl)benzamide analogues as potential alkaline phosphatase inhibitors

A series of N-(5-(alkylthio)-1,3,4-oxadiazol-2-yl)methyl)benzamides 6a–i were synthesized as alkaline phosphatase inhibitors. The intermediate 5-substituted 1,3,4-oxadiazole-2-thione 4 was synthesized starting with hippuric acid. Hippuric acid in the first step was converted into corresponding methyl ester 2 which upon reaction with hydrazine hydrate furnished the formation of hydrazide 3 . The hippuric acid hydrazide was then cyclized into 5-substituted 1,3,4-oxadiazole-2-thione 4 . The intermediate 4 was then reacted with alkyl or aryl halides 5a–5i to afford the title compounds N-(5-(methylthio)-1,3,4-oxadiazol-2-yl)methyl)benzamides 6a–i . The bioassay results showed that compounds 6a–i exhibited good to excellent alkaline phosphatase inhibitory activity. The most potent activity was exhibited by the compound 6i having IC₅₀ value 0.420 μM, whereas IC₅₀ value of standard (KH₂PO₄) was 2.80 μM. Molecular docking studies was performed against alkaline phosphatase enzyme (PDBID 1EW2) to check binding affinity of the synthesized compounds 6a–i against target protein. The docking results showed that three compounds 6c , 6e , and 6i have maximum binding interactions with binding energy values of −8 kcal/mol. The compound 6i displayed the interactions of oxadiazole ring nitrogen with amino acid His265 having a binding distance 2.13 Ǻ. It was concluded from our results that synthesized compounds, especially compound 6i may serve as lead structure to design more potent inhibitors of human alkaline phosphatase.     

Core curriculum illustration: anterior process fracture of the calcaneus

This is the 28th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.aseronline.org/curriculum/toc.htm.     

Co-localization of c-Fos and neurotransmitter immunoreactivities in the cat brain stem after carotid sinus nerve stimulation

To reveal neurones in the cat medulla oblongata involved in carotid baroreceptor/chemoreceptor reflexes, the distribution of c-Fos oncoprotein immunoreactivity was studied following electrical stimulation of the right carotid sinus nerve. The neurochemistry of the activated neurones was investigated using antisera to tyrosine hydroxylase, neuropeptide Y, somatostatin, and glutamate. Nitric oxide containing neurones were identified using antiserum to nitric oxide synthase (NOS) and by the histochemical localization of nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase. Following sinus nerve stimulation numerous c-Fos-IR cells were detected both ipsilaterally and contralaterally in the nucleus tractus solitarii, the area postrema and throughout the ventrolateral medulla. Dual labelling studies revealed that 3.3% of c-Fos- immunoreactive cells in the nucleus tractus solitarii were also immunoreactive for tyrosine hydroxylase. The double labelled cells were scattered within the medial and ventrolateral subnuclei, predominantly rostral to obex. A higher proportion (10.3%) of c-Fos-IR cells in the ventrolateral medulla also showed tyrosine hydroxylase immunoreactivity. Caudal to obex, these were scattered in the reticular formation between the spinal trigeminal nucleus and the lateral reticular nucleus, while more rostrally they were found within the lateral reticular nucleus, the nucleus ambiguus and the lateral tegmental field. Cells expressing c-fos and reactive for glutamate, neuropeptide Y or NADPH-diaphorase (or NOS) were only rarely seen, and co-localization of c-Fos and somatostatin immunoreactivities was not seen. These results suggest that of the neurones forming pathways within the medulla activated on carotid sinus nerve stimulation, presumably mediating baro- and chemoreceptor reflexes, relatively few utilize catecholamines, glutamate, neuropeptide Y or nitric oxide as their transmitter substance.     

Causes of death from the randomized CoreValve US Pivotal High-Risk Trial

Objective

Explore causes and timing of death from the CoreValve US Pivotal High-Risk Trial.

Anti-hepatotoxic activity of cichotyboside, a sesquiterpene glycoside from the seeds of Cichorium intybus

The seeds of Cichorium intybus L. (Asteraceae) afforded a new guaianolide sesquiterpene glycoside, cichotyboside, which was characterized as 2alpha, 6beta, 7beta, 15-tetrahydroxy-1 (10), 4 (5)-diene-guaian-9alpha, 12-olide-7-O-beta-caffoyl-15-O-beta-D-glucoside (1) by means of spectral methods. Cichotyboside (1) exhibited a significant anti-hepatotoxic activity against CCl4 induced toxicity in Wistar rats, wherein it reduced the elevated levels of liver enzymes such as serum glutamate oxaloacetate transaminase (SGOT) by 52 units/ml; SGPT 38 units/ml; ALKP 24.97 units/ml and 7.54 g/dl, 5.48 g/dl increase in total protein and albumin, respectively. It was observed that cichotyboside (1) decreased the level of ALKP comparable with that of standard drug silymarin, exhibiting an 88% decrease in comparison to silymarin (92%) and increased the level of total albumin 85% in comparison to silymarin (89%) against intoxicated control. Whereas, the levels of SGOT and SGPT were also decreased considerably in comparison to standard and intoxicated control.