Sharp recanalization of central venous occlusions: a useful technique for haemodialysis line insertion

Central venous occlusions can be difficult to traverse using conventional catheter and wire techniques. We describe six procedures in five patients using a technique of "sharp" recanalization and subsequent line insertion. The technique was successful in all of the cases, with the line functional for a mean duration of 13 months. This technique can permit successful dialysis catheter placement in patients who have failed with traditional techniques.     

A dose response study of inhaled nitric oxide in hypoxic respiratory failure in preterm infants

BACKGROUND: Inhaled nitric oxide (iNO) is used widely in newborn infants with hypoxic respiratory failure, despite the known and theoretical toxicity of iNO, and a relative lack of information about appropriate doses. AIM: To determine whether a dose-response relationship existed for iNO in preterm infants. DESIGN: A four-period, four-dose, cross-over design was used with iNO given for 15 min in a randomised sequence in concentrations of 5, 10, 20 and 40 parts per million (ppm), with a minimum 5 min wash-out period. Data on ventilatory, blood gas and other physiological measurements were recorded before and at the end of each period. The relationship of clinical response with iNO dose and period was analysed using multivariate regression. SUBJECTS: Infants with gestational age < 34 weeks and < 28 days postnatal age with hypoxic respiratory failure were recruited. OUTCOME MEASURE: A clinically significant dose-response was defined as a rise in the post-ductal arterial oxygen tension (PaO(2)) of at least 3 kPa. RESULTS: Thirteen infants were recruited. At trial entry, ten were < 3 days of age; 11 were being treated with high frequency oscillatory ventilation; median (inter-quartile range) gestational age 27 (25-29) weeks; birthweight 983 (765-1120) g; oxygenation index 27.1 (21.8-28.8). Six infants (46%) showed a clinically significant response. After adjusting for period and patient effect, no evidence for an overall dose effect was identified (likelihood ratio test, p=0.34). CONCLUSION: No evidence of a dose-response relationship with iNO was found in this study of very preterm infants with respiratory failure.     

Insulin and C-peptide responses to glucose load in cystic fibrosis

Immunoreactive Insulin and C-peptide responses to glucose load were estimated in patients with cystic fibrosis and in controls. Both insulin and C-peptide responses were low in cystic fibrosis patients and the changes were more marked in those with glucose intolerance. There appears to be true pancreatic hyposecretion of insulin in patients with cystic fibrosis whereas the peripheral sensitivity of insulin seems to be normal or enhanced.     

Discharge or admit? Emergency department management of incidental pulmonary embolism in patients with cancer: a retrospective study

Background

Hospitalization and early anticoagulation therapy remain standard care for patients who present to the emergency department (ED) with pulmonary embolism (PE). For PEs discovered incidentally, however, optimal therapeutic strategies are less clear—and all the more so when the patient has cancer, which is associated with a hypercoagulable state that exacerbates the threat of PE.

Methods

We conducted a retrospective review of a historical cohort of patients with cancer and incidental PE who were referred for assessment to the ED in an institution whose standard of care is outpatient treatment of selected patients and use of low-molecular-weight heparin for anticoagulation. Eligible patients had received a diagnosis of incidental PE upon routine contrast enhanced chest CT for cancer staging. Survival data was collected at 30 days and 90 days from the date of ED presentation and at the end of the study.

Results

We identified 193 patients, 135 (70%) of whom were discharged and 58 (30%) of whom were admitted to the hospital. The 30-day survival rate was 92% overall, 99% for the discharged patients and 76% for admitted patients. Almost all (189 patients, 98%) commenced anticoagulation therapy in the ED; 170 (90%) of these received low-molecular-weight heparin. Patients with saddle pulmonary artery incidental PEs were more likely to die within 30 days (43%) than were those with main or lobar (11%), segmental (6%), or subsegmental (5%) incidental PEs. In multivariate analysis, Charlson comorbidity index (age unadjusted), hypoxemia, and incidental PE location (P?=?0.004, relative risk 33.5 (95% CI 3.1–357.4, comparing saddle versus subsegmental PE) were significantly associated with 30-day survival. Age, comorbidity, race, cancer stage, tachycardia, hypoxemia, and incidental PE location were significantly associated with hospital admission.

Conclusions

Selected cancer patients presenting to the ED with incidental PE can be treated with low-molecular-weight heparin anticoagulation and safely discharged. Avoidance of unnecessary hospitalization may decrease in-hospital infections and death, reduce healthcare costs, and improve patient quality of life. Because the natural history and optimal management of this condition is not well described, information supporting the creation of straightforward evidence-based practice guidelines for ED teams treating this specialized patient population is needed.

     

Multiple foreign bodies (open safety pins) in the oesophagus

Intra luminal hypopharyngeal and oesophageal foreign bodies are common. Among these the incidence of open safety pin is relatively uncommon and the occurrence of multiple open safety pins in the same ’ individual is a very rare phenomenon. Removal of one open safety pin itself is a surgical enigma, as inadvertant attempts at removal may cause the pointed end to get impacted submucosally or intramurally or may cause oesophageal tear and calls for the assistance of a thoracic surgeon. This article intends to highlight the occurrence of multiple open safety pins in the lumen of the oesophagus and its difficulty in successful retrieval.     

Newer trends in tubercular uveitis: a case series with systemic correlation

AIM: To determine the spectrum of uveitis, causes of visual loss in systemic tuberculosis, role of investigations and outcome after anti-tuberculosis treatment (ATT). METHODS: A retrospective study was conducted on 250 patients with systemic tuberculosis at a referral center in Chennai, South India from April 2016 to May 2019. Systemic workup comprised of Mantoux, chest X-ray, polymerase chain reaction (PCR) and QuantiFERON (QFT) TB Gold. Aqueous humor analysis by nested PCR or real time PCR (RT-PCR) and ancillary ophthalmic investigations such as fundus fluorescein angiography, optical coherence tomography were performed. RESULTS: Multifocal choroiditis and vasculitis were the most common manifestations and had a higher risk of recurrence. Pulmonary tuberculosis was more frequently associated with uveitis. Among those with extra-pulmonary tuberculosis miliary, bone and abdominal tuberculosis had uveitis. Complications such as cystoid macular edema, choroidal neovascular membranes and macular scarring caused visual loss. Aqueous humor analysis detected mycobacterium tuberculosis antigen. Collectively, systemic investigations such as chest X-ray, Mantoux test and those performed on blood samples such as PCR and QFT were positive in 39% of patients. In inconclusive patients, nested PCR and/or RT-PCR were done on aqueous humor samples and was diagnostic in 96%. A combination of tests was diagnostic in 92%. ATT in isolation in 71% and combined with corticosteroids in 29% was used for treatment of which signs of resolution and improvement in vision started as early as 6weeks in those who were started immediately on CS and ATT and longer than 3mo in those on ATT alone. Vision improved in 69%. Complete resolution occurred in 75% and worsening in 12%. CONCLUSION: A combination of investigations guided by clinical suspicion helps in precise diagnosis. In diagnostic dilemmas analysis of ocular samples is reliable and confirmatory. Prompt treatment with ATT and corticosteroids improved vision in 23% of our patients within 2mo. Vitritis with choroiditis causes cystoid macular oedema and requires longer duration of ATT. Screening all patients and a multidisciplinary approach in tuberculosis (active, healed or during treatment) is recommended.     

Antibiotic resistant Esherichia coli strains from seafood and its susceptibility to seaweed extracts

ObjectiveTo determine the prevalence and antibiotic resistance of Escherichia coli (E. coli), in seafood obtained from Cuddalore and Parangipettai fish landing centres. Also, to identify the susceptibility of E. coli against predominant seaweeds red alga Kappaphycus alvarezii (K. alvarezii) and brown alga Padina boergessenii (P. boergessenii) extracts as sulfated polysaccharides and polyphenols respectively.MethodsA total of 48 samples (Two stations Cuddalore and Parangipettai, Tamil Nadu, India). Sampling area are fish landing centre where fishes caught from sea and estuary, seafood processing plants (packing and ice packed fishes) and local fish markets (fish samples). After isolation totally 80 strains were analyzed for its antimicrobial resistance and sensitivity against commercially 10 antibiotics. The ampicillin resistant E. coli CE21 was identified through molecular techniques as 16S rDNA sequencing. Two seaweeds K. alvarezii and P. boergessenii were screened for antibacterial activity against 12 antibiotic resistant E. coli strains.ResultsTotally 48 swabbed samples from two different fish handling area were characterized for total bacterial and E. coli count. Mostly, the E. coli strains were isolated from fish local market and seafood processing plants before and after packaging process. In that maximum 56.25% strains were resistant to ampicillin and the minimum 2.5% strains were resistant to chloramphenicol. Therefore, the E. coli CE21 was identified through molecular techniques E. coli (GenBank accession number GU065251), The MIC value for polyphenol extract was slightly less than sulfated polysaccharides. E. coli strain isolated from Parangipettai was considerably increased MIC value that Cuddalore.ConclusionsThe polyphenol and sulfated polysaccharides showed promising inhibitory response against all antimicrobial resistant E. coli strains and in particular the inhibitory response of ampicillin resistant E. coli.     

Investigation on the effect of eclipta alba on animal models of learning and memory

Short and long term memory loss may result from deteriorating cerebral mechanisms due to varied causes which could have a tremendous impact on the quality of life. Herbs are being constantly explored to resolve cognitive deficits. Eclipta alba (Ea) commonly called as the trailing Eclipta is being examined for its memory enhancing quality as it is traditionally used for this purpose. The shade dried leaves of Eclipta alba was extracted with distilled water. The suspension of Ea containing 100 and 200 mg/kg was administered to rats to evaluate Transfer Latency (TL) on an elevated plus maze. TL was a measure of acquisition and retrieval learning. Mice were placed at the center of open field apparatus to assess spatial habitual learning, observed for 20 minutes for rearing and time spent during rearing using varied doses for 30 minutes, 24 hours and 96 hours and 144 hrs. The results revealed significant improvement of retrieval memory.