Should Cannabinoids Be Added to Multimodal Pain Regimens After Total Hip and Knee Arthroplasty?

Background

This study investigated the effects of dronabinol on pain, nausea, and length of stay following total joint arthroplasty (TJA).

Mutagenic and genotoxic assessment of atrazine-based herbicide to freshwater fish Channa punctatus (Bloch) using micronucleus test and single cell gel electrophoresis

The mutagenic and genotoxic effect of 'Rasayanzine', an atrazine herbicide, was carried out in fish Channa punctatus using micronucleus and single cell gel electrophoresis (SCGE) assays. Three sub-lethal concentrations of the test material viz., SL-I (1/5th LC(50)=～8.48 mgL(-1)), SL-II (1/8th LC(50)=～5.30 mgL(-1)) and SL-III (1/10th LC(50)=～4.24 mgL(-1)) were calculated using LC(50) value and the fish specimens were exposed to these concentrations. Erythrocyte and gill cells were sampled on day 0, 1, 3, 5, 7, 14, 21, 28 and 35 of exposure for assessment of micronuclei induction in blood erythrocytes and DNA damage using SCGE assay in both blood erythrocytes and gill cells. Significant effects (p<0.01) for both concentration and time of exposure were observed in treated fish. Micronuclei induction in erythrocytes was highest (8.4 mgL(-1)) on day 7 of exposure. The highest level of DNA damage in the SCGE was observed in both tissues on day 5 at all concentrations followed by gradual non-linear decline. This study further confirmed that the micronucleus and SCGE assays are useful in determining potential genotoxicity of water pollutants and might be appropriate as part of monitoring program.     

Efficacy of laparoscopic cholecystectomy in acalculous gallbladder disease: long-term follow-up.

OBJECTIVE: Our aim was to determine the efficacy of laparoscopic cholecystectomy in symptomatic patients with ultrasound negative and abnormal gallbladder ejection fractions; Patients with gallbladder ejection fractions less than 35% on hepatobiliary scan were offered laparoscopic cholecystectomy. METHODS: Between January 1995 and January 2001, 1564 patients underwent laparoscopic cholecystectomy at our institution: 256 were confirmed to have acalculous gallbladder disease by pathology report and reconfirmation of abnormal hepatobiliary scan data. A 30-day postoperative follow-up was obtained by retrospective medical record review. For this study, we contacted all 256 patients by mail questionnaire and followed up on nonresponders with telephone interviews; we also reviewed hospital records to verify preoperative symptom patterns. The survey was completed by 154 patients (60%): 48 (31%) by mail and 106 (69%) by telephone interviews. The study included 115 (75%) female and 39 (25%) male patients, and the average age was 42 years (range, 13 to 95). All hepatobiliary laboratory parameters were normal pre- and postoperatively. The survey was completed in December 2001, 1 to 5 years postoperatively (mean 3 years). RESULTS: Preoperatively, 142 patients (92%) had right upper quadrant pain, 114 (74%) had nausea, 88 (57%) had vomiting, 120 (73%) had heartburn, and 118 (77%) had food intolerance. In a 30-day postoperative period, these numbers had reduced to 48 (37%), 14 (90%), 8 (5%), 22 (14%), and 34 (22%), respectively. had laparoscopic cholecystectomy, and 95% stated that they would recommend laparoscopic cholecystectomy to other patients. CONCLUSION: This study shows that patients with acalculous gallbladder disease benefit from laparoscopic cholecystectomy.     

Isolation and characterization of 26 polymorphic microsatellite loci in golden mahseer, Tor putitora (Teleostei, Cyprinidae) and their cross-species amplification in four related species

Twenty six polymorphic single-locus microsatellite loci were developed in golden mahseer, Tor putitora. The number of observed alleles per locus ranged from 5 to 16. The observed and expected heterozygosities ranged from 0.2721 to 0.9830 and from 0.4631 to 0.9216, respectively. No significant linkage disequilibrium was detected among the loci. Eight loci showed significant deviation from Hardy–Weinberg equilibrium, but none of them had evidence for null alleles. Twenty-four primer pairs cross-amplified each in Tor khudree and Naziritor chelynoides and 25 each in T. tor and T. mosal mahanadicus. These microsatellite loci should be useful for genetic diversity studies and conservation of golden mahseer and its closely related species.     

Toxicity of the herbicide atrazine: effects on lipid peroxidation and activities of antioxidant enzymes in the freshwater fish Channa punctatus (Bloch)

The present study was undertaken to evaluate the toxicity and effects of a commercial formulation of the herbicide atrazine (Rasayanzine) on lipid peroxidation and antioxidant enzyme system in the freshwater air breathing fish Channa punctatus. The 12, 24, 48, 72 and 96 h LC(50) of atrazine, calculated by probit analysis, were determined to be 77.091, 64.053, 49.100, 44.412 and 42.381 mg·L(-1), respectively, in a semi static system with significant difference (p < 0.05) in LC(10-90) values obtained for different times of exposure. In addition to concentration and time dependent decrease in mortality rate, stress signs in the form of behavioral changes were also observed in response to the test chemical. In fish exposed for 15 days to different sublethal concentrations of the herbicide (1/4 LC(50) = ～10.600 mg·L(-1), 1/8 LC(50) = ～5.300 mg·L(-1) and 1/10 LC(50) = ～4.238 mg·L(-1)) induction of oxidative stress in the liver was evidence by increased lipid peroxidation levels. The antioxidants superoxide dismutase (SOD), catalase (CAT) and glutathione reductase (GR) responded positively in a concentration dependent pattern, thus, suggesting the use of these antioxidants as potential biomarkers of toxicity associated with contaminations exposure in freshwater fishes.     

Comparison of needle aspiration cytologic diagnosis with excisional biopsy tissue diagnosis of palpable tumors of the breast in a community hospital.

Fine needle aspiration cytologic examination has not extensively been used in our hospital in the work-up evaluation of solid tumors of the breast and its reliability as a basis on which to perform definitive treatment of carcinoma of the breast was in question. One hundred and five aspiration cytologic specimens were obtained from palpable solid tumors of the breast just prior to excisional biopsy. Specimens were numbered and submitted to three different staff pathologists for diagnosis in a single blind manner. Results were then compared with tissue diagnosis of the same tumors. Of 105 specimens taken at biopsy of the breast, 28 malignant lesions were diagnosed on the final tissue report. Of those, ten were diagnosed as malignant (Class V), two were highly suspicious (Class IV) and six were insufficient specimens (Class O). Of those diagnosed as class IV and V by the results of cytologic examination, all were malignant on permanent section for a specificity of 100 per cent and a sensitivity of 36 per cent. The cytologic diagnoses of Classes I, II and III did not correlate with any histologic report, benign or malignant. Malignant growths were misdiagnosed by cytologic examination in 36 per cent and missed because of inadequate specimens in 28 per cent. We believe that a Class V cytologic finding is sufficient basis on which to perform definitive treatment of carcinoma of the breast provided rigid criteria are used. There is a learning curve associated with this diagnostic modality.     

Is the faculty of family planning and reproductive health care guidance on emergency contraception being followed in general practice? An audit in the West Midlands, UK

BACKGROUND AND METHODOLOGY: In 2003, the Faculty of Family Planning and Reproductive Health Care (FFPRHC) of the Royal College of Obstetricians and Gynaecologists published guidance on emergency contraception (EC). A literature search revealed no published work describing doctors' actions when prescribing EC. In order to assess the extent to which the FFPRHC Guidance is being followed in general practice, an audit of the medical notes of women requesting EC between January 2003 and December 2004 in six general practice surgeries located in the West Midlands, UK was conducted. From the medical notes, discussions between health care professionals and patients requesting EC regarding ongoing contraceptive needs, the risk of sexually transmitted infections (STIs) and the availability of the emergency intrauterine device (IUD) were recorded. RESULTS: A total of 718 emergency contraceptive pill consultations were analysed. The median age for presentation was 24 years. The 20-24 years age group accounted for the most consultations (30.9%). In 40% of consultations there was no evidence of future contraceptive needs having been discussed. Only 20 (2.8%) consultation notes contained evidence that STIs had been discussed. Chlamydia tests were undertaken in only 15/718 (1.7%) consultations. In only 10 (1.4%) of the consultations was the IUD discussed with the patient as an alternative form of EC. DISCUSSION AND CONCLUSIONS: This audit suggests that the FFPRHC Guidance on EC is not being followed in general practice, and therefore patients requesting EC may not be receiving the highest standard of care.     

Blood culture fluorescence rates predict severity and mortality of invasive pneumococcal pneumonia

Invasive pneumococcal pneumonia is associated with high rates of mortality. Clinical assessment tools have poor sensitivity for predicting clinical outcomes. Molecular measurements of bacterial load correlate closely with clinical outcome but require specialist facilities and expertise. This study describes how routine blood culture testing can estimate bacterial load and predict clinical outcome for invasive pneumococcal pneumonia. Between December 2009 to March 2014, clinical and laboratory data were collected for 50 patients with Streptococcus pneumoniae bacteraemia secondary to community-acquired pneumonia. Fluorescence rates (FR) were calculated from growth curves generated by BACTEC blood culture analysers by dividing change in fluorescence units (FU), measured at the first point of detectable fluorescence and at the point of automated BACTEC positivity, by time in hours. The mean age of the patients was 70.6 years (49.6–86.3). Forty patients survived invasive pneumococcal disease and ten patients died. These two groups did not significantly differ by demographic or clinical characteristics. The mean FR for the non-survival group (3.62?×?10^?3 FU/h) was significantly higher (p?<?0.001) than that of the survival group (1.73?×?10^?3 FU/h). FR did not vary by serotype. We determined that an FR of 2.59?×?10^?3 FU/h might represent a useful threshold for predicting high mortality risk with a sensitivity of 91 % and a specificity of 97 %. Our FR calculation uses cheap and accessible routine blood culture techniques to predict mortality in a small retrospective cohort study. In patients admitted to hospital with pneumococcal bacteraemia and, potentially, other organisms, this single tool could guide early escalation of clinical care.     

CASE REPORT: Gastric Phytobezoar

In summary bezoars are rarely symptomatic. CT scan of the abdomen is rapidly becoming the first tool of diagnosis, while endoscopy still remains the best diagnostic test. Medical treatment is usually successful, as in this case and rarely do patients require surgery.