Non traumatic coma

Objective: To study the etiology and clinical profile of non-traumatic coma in children and to determine the clinical signs predictive of outcome.Methods: 100 consecutive cases of nontraumatic coma between 2 months to 12 years. Clinical signs studied were temperature, pulse, heart rate, blood pressure, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupillary and corneal reflex, extra ocular movements, motor patterns, seizure types and fundus picture. These were recoded at admission and after 48 hours of hospital stay. Etiology of coma was determined on basis of clinical history, examination and relevant laboratory investigations by the treating physician. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Chi-square test and logistic regression analysis were done to determine predictors of outcome.Results: Etiology of coma in 60% cases was CNS infection (tubercular meningitis19, encephalitis18, bacterial meningitis16, others7); other causes were toxic-metabolic conditions (19%), status epilepticus (10%), intracranial bleed (7%), and miscellaneous (4%). 65 children survived, 11 were normal, 14 had mild disability, 21 had moderate disability and 14 were severely disabled and dependent. Survival was significantly better in patients with CNS infection (63%) as compared to those with toxic-metabolic causes (27%) and intracranial bleed (43%, P < 0.05). On bivariate analysis age <-3 years, poor pulse volume, abnormal respiratory pattern and apnoea, abnormal pupillary size and reaction, abnormal extra ocular movements, absent corneal reflex, abnormal motor muscle tone at admission or 48 hours correlated significantly with mortality. Survival was better with increasing GCS (Spearman rho =. 32, P < 0.001). On logistic regression age < 3 years, poor pulse volume, absent extraocular movements and papilloedema at admission and 48 hours after admission were independent significant predictors of death.Conclusion: CNS infections were the most common cause of non-traumatic coma in childhood. Simple clinical signs were good predictors of outcome     

Predictive value of electroencephalography and computed tomography in childhood non-traumatic coma

Objectives: To study value of electroencephalogram (EEG) and computed tomography (CT Scan) in predicting outcome of non-traumatic coma in children.Methods: 100 consecutive children, between 2 months to 12 years, with nontraumatic coma, (Glasgow Coma Scale score <-8). Demographic and clinical data was recorded at admission. EEG and CT scan were done within 24 hours of admission. Etiologic diagnosis was assigned on basis of clinical data and relevant laboratory investigations. The outcome was recorded as survived and died. Among survivors it was graded as no disability, or mild, moderate, or severe disability. Odds ratio and/or relative risk (RR) with 95% confidence interval (CI) were calculated.Results: EEG could be done in 60 patients (43 survived; 7 were normal, 8 had mild, 17 moderate and 11 severe disability) CT scan in 93 patients (60 survived; 11 were normal, 14 had mild, 21 moderate and 14 severe disability). A normal/borderline EEG was associated with good outcome (P = 0.001); 11 of 12 survived and of survivors 55% had no or mild disability. Electrocerebral silence on EEG was a predictor of death (OR = 44; 95% CI -1.5-7372; P =0.01). An abnormal EEG was associated with significant increase in risk of disability among survivors (RR=2.6, 95% CI= 1.2–5.4, P=0.03). Among CT abnormalities intracranial bleed suggested increased risk of death (RR = 2.1; 95% CI-0.8-5.3; P = 0.058), while, hydrocephalus was associated with better survival (RR = 0.7; 95% CI-0.5 to 0.96; P = 0.029). However, hydrocephalus when compared with other abnormal CT scan findings, was associated with higher risk of moderate and severe disability among survivors (P= 0.046)Conclusion: A normal CT scan and EEG, and some of the specific findings could be helpful in predicting outcome in children with non-traumatic coma. EEG and CT scan should be done at admission in all patients with non-traumatic coma if feasible     

Real‐time multi‐directional flow MRI using model‐based reconstructions of undersampled radial FLASH – A feasibility study

The purpose of this work was to develop an acquisition and reconstruction technique for two‐ and three‐directional (2d and 3d) phase‐contrast flow MRI in real time. A previous real‐time MRI technique for one‐directional (1d) through‐plane flow was extended to 2d and 3d flow MRI by introducing in‐plane flow sensitivity. The method employs highly undersampled radial FLASH sequences with sequential acquisitions of two or three flow‐encoding datasets and one flow‐compensated dataset. Echo times are minimized by merging the waveforms of flow‐encoding and radial imaging gradients. For each velocity direction individually, model‐based reconstructions by regularized nonlinear inversion jointly estimate an anatomical image, a set of coil sensitivities and a phase‐contrast velocity map directly. The reconstructions take advantage of a dynamic phase reference obtained by interpolating consecutive flow‐compensated acquisitions. Validations include pulsatile flow phantoms as well as in vivo studies of the human aorta at 3 T. The proposed method offers cross‐sectional 2d and 3d flow MRI of the human aortic arch at 53 and 67 ms resolution, respectively, without ECG synchronization and during free breathing. The in‐plane resolution was 1.5 × 1.5 mm² and the slice thickness 6 mm. In conclusion, real‐time multi‐directional flow MRI offers new opportunities to study complex human blood flow without the risk of combining differential phase (i.e., velocity) information from multiple heartbeats as for ECG‐gated data. The method would benefit from a further reduction of acquisition time and accelerated computing to allow for extended clinical trials.     

An animal model of PDH deficiency using AAV8-siRNA vector-mediated knockdown of pyruvate dehydrogenase E1α

We evaluated the feasibility of self-complementary adeno-associated virus (scAAV) vector-mediated knockdown of the pyruvate dehydrogenase complex using small interfering RNAs directed against the E1α subunit gene (PDHA1). AAV serotype 8 was used to stereotaxically deliver scAAV8-si3-PDHA1-Enhanced Green Fluorescent Protein (knockdown) or scAAV8-EGFP (control) vectors into the right striatum and substantia nigra of rats. Rotational asymmetry was employed to quantify abnormal rotation following neurodegeneration in the nigrostriatal system. By 20 weeks after surgery, the siRNA-injected rats exhibited higher contralateral rotation during the first 10 min following amphetamine administration and lower 90-min total rotations (p ≤ 0.05). Expression of PDC E1α, E1β and E2 subunits in striatum was decreased (p ≤ 0.05) in the siRNA-injected striatum after 14 weeks. By week 25, both PDC activity and expression of E1α were lower (p ≤ 0.05) in siRNA-injected striata compared to controls. E1α expression was associated with PDC activity (R² = 0.48; p = 0.006) and modestly associated with counterclockwise rotation (R² = 0.51;p = 0.07). The use of tyrosine-mutant scAAV8 vectors resulted in ~ 17-fold increase in transduction efficiency of rat striatal neurons in vivo. We conclude that scAAV8-siRNA vector-mediated knockdown of PDC E1α in brain regions typically affected in humans with PDC deficiency results in a reproducible biochemical and clinical phenotype in rats that may be further enhanced with the use of tyrosine-mutant vectors.     

Hepatocellular carcinoma presenting as an isolated sphenoid sinus lesion: a case report

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.     

Characterization and Antibiotic Sensitivity Profile of Bacteria in Orofacial Abscesses of Odontogenic Origin

Background

Odontogenic infections range from peripheral abscess to superficial and deep infections leading to severe infections in head and neck region. This study was aimed to assess bacterial isolates responsible for orofacial infection of odontogenic origin and their drug susceptibility patterns so as to provide better perceptive for the management of odontogenic infections.

Methods

The study was made in a selected cohort of patients, irrespective of age and gender having moderate and severe orofacial infections of odontogenic origin admitted to Yenepoya University Hospital. Pus samples were collected and identification of bacteria was performed by 16S rRNA gene sequencing. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method.

Result

A total of 37 study subjects were included, with bacterial isolation rate of 31 (83.7 %). The mean age presented of all patients was 40.62. Of all, 24 (64.9 %) were males. Staphylococcus aureus, Enterobacter claocae subsp. dissolvens, Klebsiella quasipneumoniae subsp. similipneumoniae, Staphylococcus aureus subsp. anaerobius and Klebsiella pneumoniae subsp. ozaenae were the most prevalent isolates. Result showed that 58.6 % of the isolates were resistant to gentamicin, 52.5 % for ampicillin, 51.3 % for piperacillin; least resistant being 18.9 % for azithromycin.

Conclusion

High prevalence of bacterial isolates was found, Staphylococcus aureus being the dominant. Most of the bacteria were resistant to different classes of antibiotics. Appropriate antibiotics should be given based on the bacterial isolates, culture sensitivity and clinical course of the disease.

     

A Robust Method for Ventriculomegaly Detection from Neonatal Brain Ultrasound Images

Ventriculomegaly is the most commonly detected abnormality in neonatal brain. It can be defined as a condition when the human brain ventricle system becomes dilated. This in turn increases the intracranial pressure inside the skull resulting in progressive enlargement of the head. Sometimes it may also cause mental disability or death. For these reasons early detection of ventriculomegaly has become an important task. In order to identify ventriculomegaly from neonatal brain ultrasound images, we propose an automated image processing based approach that measures the anterior horn width as the distance between medial wall and floor of the lateral ventricle at the widest point. Measurement is done in the plane of the scan at the level of the intraventricular foramina. Our study is based on neonatal brain ultrasound images in the midline coronal view. In addition to ventriculomegaly detection, this work also includes both cross sectional and longitudinal study of anterior horn width of lateral ventricles. Experiments were carried out on brain ultrasound images of 96 neonates with gestational age ranging from 26 to 39 weeks and results have been verified with the ground truth provided by doctors. Accuracy of the proposed scheme is quite promising.     

Serum uric acid level in newly diagnosed essential hypertension in a Nepalese population: A hospital based cross sectional study

Objective

To develop the missing link between hyperuricemia and hypertension.

Methods

The study was conducted in Department of Biochemistry in collaboration with Nephrology Unit of Internal Medicine Department. Hypertension was defined according to blood pressure readings by definitions of the Seventh Report of the Joint National Committee. Totally 205 newly diagnosed and untreated essential hypertensive cases and age-sex matched normotensive controls were enrolled in the study. The potential confounding factors of hyperuricemia and hypertension in both cases and controls were controlled. Uric acid levels in all participants were analyzed.

Results

Renal function between newly diagnosed hypertensive cases and normotensive healthy controls were adjusted. The mean serum uric acid observed in newly diagnosed hypertensive cases and in normotensive healthy controls were (290.05±87.05) µmol/L and (245.24±99.38) µmol/L respectively. A total of 59 (28.8%) participants of cases and 28 (13.7%) participants of controls had hyperuricemia (odds ratio 2.555 (95% CI: 1.549-4.213), P<0.001).

Conclusions

The mean serum uric acid levels and number of hyperuricemic subjects were found to be significantly higher in cases when compared to controls.     

Simulating Staffing Needs for Surgical Instrument Distribution in Hospitals

Timely and accurate delivery of surgical instruments to operating rooms is critical for success in surgical operations in hospitals. The National Hospital of Singapore was facing several problems in the process of surgical instrument distribution on ad hoc orders from operating rooms. To solve the problems, the Hospital management considered adopting a new process of surgical instrument distribution on ad hoc orders that involves staffing new healthcare assistants for delivery of surgical instruments to operating rooms. Using computer simulation, this study assessed the efficiency of the new process and recommended the optimal number of healthcare assistants needed for delivery of surgical instruments on ad hoc orders, at which healthcare assistants as well as surgical instruments could be most efficiently utilized. The results show that computer simulation is an effective tool supporting decisions on staffing needs for surgical instrument distribution in hospitals.     

Spectral Clustering for Unsupervised Segmentation of Lower Extremity Wound Beds Using Optical Images

Chronic lower extremity wound is a complicated disease condition of localized injury to skin and its tissues which have plagued many elders worldwide. The ulcer assessment and management is expensive and is burden on health establishment. Currently accurate wound evaluation remains a tedious task as it rely on visual inspection. This paper propose a new method for wound-area detection, using images digitally captured by a hand-held, optical camera. The strategy proposed involves spectral approach for clustering, based on the affinity matrix. The spectral clustering (SC) involves construction of similarity matrix of Laplacian based on Ng-Jorden-Weiss algorithm. Starting with a quadratic method, wound photographs were pre-processed for color homogenization. The first-order statistics filter was then applied to extract spurious regions. The filter was selected based on the performance, evaluated on four quality metrics. Then, the spectral method was used on the filtered images for effective segmentation. The segmented regions were post-processed using morphological operators. The performance of spectral segmentation was confirmed by ground-truth pictures labeled by dermatologists. The SC results were additionally compared with the results of k-means and Fuzzy C-Means (FCM) clustering algorithms. The SC approach on a set of 105 images, effectively delineated targeted wound beds yielding a segmentation accuracy of 86.73 %, positive predictive values of 91.80 %, and a sensitivity of 89.54 %. This approach shows the robustness of tool for ulcer perimeter measurement and healing progression. The article elucidates its potential to be incorporated in patient facing medical systems targeting a rapid clinical assistance.