Advances in alcoholic liver disease

Cytokines are mediators of cellular communication produced by multiple liver cell types. Cytokines can directly induce either necrosis or apoptosis. They can also recruit such cells as neutrophils and lymphocytes, which can mediate liver damage. Increased levels of hepatotoxic cytokines such as tumor necrosis factor-’are documented in alcoholic liver disease (ALD) and nonalcoholic steatohepatitis (NASH) and have been shown to play a mechanistic role in both of these disease processes. Transforming growth factor-βs a profibrotic cytokine that is critical in hepatic fibrosis. Beneficial cytokines, such as interleukin (IL)-10 and-6, also exist. Such beneficial cytokines as adiponectin are made outside the liver and appear to protect against ALD and NASH. This article reviews the relevance of cytokines in human and experimental forms of liver injury, focusing on modulation of cytokines and the use of beneficial cytokines in treatment and prevention of liver injury in ALD, NASH, and hepatitis C.     

Range of movements of lower limb joints in cross-legged sitting posture

Cross-legged sitting posture is integral to activities of daily living in Eastern and Asian cultures. This posture has not been studied or defined in any significant detail from an orthopedic view point. The movements of right lower limb joints were measured in cross-legged sitting posture in 44 volunteers from the Indian population with no prior history of problems related to the knee or hip joint. Flexion at the hip joint ranged from 82 degrees to 100 degrees , with a mean of 91 degrees . Abduction at the hip joint ranged from 19 degrees to 57 degrees , with a mean of 39 degrees . The external rotation ranged from 42 degrees to 58 degrees , with a mean of 49 degrees . Flexion at the knee ranged from 126 degrees to 142 degrees , with a mean of 135 degrees .Equinus at the ankle ranged from 17 degrees to 34 degrees , with a mean of 29 degrees . The resultant data would be useful in understanding kinematics of the knee and hip in the healthy and post-total joint arthroplasty population. The data could be used for design features of prosthetic joints, surgical technique, and rehabilitation protocols. Such data have not been available hitherto in any relevant published literature.     

Influence of Maternal Childhood Trauma on Perinatal Depression,Observed Mother–Infant Interactions,and Child Growth

Maternal and Child Health Journal - Mothers who have experienced childhood trauma may be at increased risk for disruptions in caregiving behavior, with potential consequences for early child...     

Infant feeding practices in a South African birth cohort—A longitudinal study

Childhood malnutrition is highly prevalent in low‐ and middle‐income countries. The choices of complementary foods, which are important in infant nutrition, are poorly described in this setting. We investigated infant feeding practices in a South African birth cohort, the Drakenstein Child Health Study. Longitudinal feeding data were collected from March 2012 to March 2015. Feeding practices at birth, 6–10 and 14 weeks and 6, 9, and 12 months, were investigated using food frequency questionnaires. Anthropometry was measured at birth and 12 months. The quality of the diet was analyzed using the World Health Organization infant and young child feeding indicators. Regression models were used to explore associations between feeding and growth outcomes at 1 year. Exclusive breastfeeding for 6 months was low (13%), and 19% of infants were introduced to solid foods before 4 months. There was high daily consumption of processed meat (56%) and inappropriate foods such as fruit juice (82%), soft drinks (54%), and refined sugary foods (51%) at 1 year. Dietary diversity and consumption of iron rich foods were low at 6 months (5% and 3%, respectively) but higher by 12 months (75% and 78%). Longer duration of exclusive breastfeeding was associated with a lower height‐for‐age z‐score at 1 year. Several dietary deficits and a rising trend in the consumption of inappropriate nutritionally poor foods were identified. These findings raise concern about poor dietary practices and the impact on child and long‐term health.     

Odontogenic myxoma: A review with report of an uncommon case with recurrence in the mandible of a teenage male

We describe a 13-year-old boy with recurrence of an odontogenic myxoma of the mandible. We review the existing published literature on the lesion, emphasizing the similarities and differences among lesions in the differential diagnosis. Odontogenic myxoma is an uncommon benign tumor that mainly affects the mandible, with a peak incidence in the second to fourth decades of life and predilection for the female sex. Clinical, radiological, and histopathological features should be considered when making a diagnosis. Several of these characteristics overlap with those of other benign and some malignant tumors. Odontogenic myxoma is known for recurrence. The treatment plan should consider the age and sex of the patient and the site and size of the lesion. Reconstructive surgery may be required, but should be delayed until after an adequate follow-up to rule out recurrence.     

Typhoid fever in Fiji: a reversible plague?

The country of Fiji, with a population of approximately 870 000 people, faces a growing burden of several communicable diseases including the bacterial infection typhoid fever. Surveillance data suggest that typhoid has become increasingly common in rural areas of Fiji and is more frequent amongst young adults. Transmission of the organisms that cause typhoid is facilitated by faecal contamination of food or water and may be influenced by local behavioural practices in Fiji. The Fijian Ministry of Health, with support from Australian Aid, hosted a meeting in August 2012 to develop comprehensive control and prevention strategies for typhoid fever in Fiji. International and local specialists were invited to share relevant data and discuss typhoid control options. The resultant recommendations focused on generating a clearer sense of the epidemiology of typhoid in Fiji and exploring the contribution of potential transmission pathways. Additionally, the panel suggested steps such as ensuring that recommended ciprofloxacin doses are appropriate to reduce the potential for relapse and reinfection in clinical cases, encouraging proper hand hygiene of food and drink handlers, working with water and sanitation agencies to review current sanitation practices and considering a vaccination policy targeting epidemiologically relevant populations.     

Endoscopic band ligation followed by sclerotherapy: Is it superior to sclerotherapy in children with extrahepatic portal venous obstruction?

Background and Aim: There is scarcity of data about children on a combination of endoscopic variceal ligation (EVL) and endoscopic sclerotherapy (EST). We assessed the efficacy of EVL followed by EST and EST alone in children with extrahepatic portal venous obstruction (EHPVO). Methods: From January 2000 to March 2007, 186 consecutive children (mean age 6.3 ± 4.2 years, 82% boys) with EHPVO with variceal bleeding were included. EVL followed by EST (Group I, n = 101) or EST alone (Group II, n = 60) was carried out at 3‐weekly intervals until eradication. Surveillance endoscopy was done at 3 to 6‐monthly intervals. In all cases, the number of sessions required to eradicate the esophageal varices, the volume of sclerosant, the complications and the endoscopic outcome on follow up were recorded. Results: Eradication was achieved in 158 of 161 (98%) children and 25 were lost to follow up. Group I required significantly fewer sessions (5.2 ± 1.8 vs 6.8 ± 2.8, P < 0.005), less sclerosant (13 ± 8.2 mL vs 30 ± 20 mL, P < 0.001) and had fewer complications (7% vs 28%, P < 0.001) as compared with Group II. On follow up (33 ± 17.6 months in Group I and 43 ± 16.7 months in Group II), there was a significant increase in the prevalence of portal hypertensive gastropathy as well as isolated gastric varices in both the groups. However, the prevalence of gastroesophageal varices decreased. Conclusions: EVL followed by EST is better than EST alone in children with EHPVO as it requires fewer sessions and has fewer complications. However, following eradication, evolution of gastric varices and portal hypertensive gastropathy was similar in the two groups.