Nasal glioma and encephalocele: two separate entities. Report of two cases

The term "nasal glioma" is a confusing misnomer as it implies a neoplastic condition with malignant potential, which it is not. Nasal glioma is a rare development abnormality and should be differentiated from glioma, which is a malignant tumor of the brain, and from a primary encephalocele, which is herniation of the cranial contents through a bone defect in the skull, through which it retains an intact connection with the central nervous system. Two cases of nasal glioma, one with and one without intracranial connections, are described and the literature is reviewed.     

Emergence of a population of small, diploid hepatocytes during hepatocarcinogenesis

The sequential treatment of young Wistar rats with two differentcarcinogens (diethylnitrosamine - plus partial hepatectomy -as an initiator, and 2-acetylaminofluorene as a cytotometricselection pressure) induces the appearance of foci and nodulesof liver cells which are phenotypically altered. By means ofan algorithm which takes into account binuclearity as well ascell-to-cell aggregation it is possible to compute cellularploidy distributions from flow-cytometric analysis of eitherhepatocyte suspensions or suspensions of hepatocytic nuclei.Cell suspensions isolated from carcinogen-treated rats can beshown to contain, already after 8 weeks, 70% small, diploidhepatocytes, whereas suspensions from normal or partially hepatectomizedcontrol livers contain only 10% diploid cells (the remainder-beingmostly tetraploid). Isolated nodules, i.e., expanding clonesof proliferating cells, believed to be neoplastic precursorlesions, contained almost only diploid cells. These observationssuggest that the selective outgrowth of a population of small,diploid hepatocytes may be a significant early step in the developmentof liver cancer.     

ECT in mixed affective states: a case series

There is limited information regarding the effectiveness of electroconvulsive therapy (ECT) as a treatment for patients in a mixed affective state. The authors report their experience using this treatment in medication-resistant patients meeting Research Diagnostic Criteria (RDC) for both mania and major depression. Clinical and response characteristics of these patients are described. Forty-one consecutively admitted patients meeting the RDC for mania received pharmacotherapy. Eight patients failing to respond to pharmacotherapy were referred for ECT, and seven consented. All met RDC for both mania and major depressive disorder. All patients receiving ECT remitted. The patient who did not accept ECT did not improve and ultimately needed transfer to a state hospital for longer term care. Mixed manic-depressive states are responsive to ECT, even in medication-refractory patients.     

Evaluation of inhibitory potential of some selective methanolic plants extracts on biological characteristics of Acanthamoeba castellanii using human corneal epithelial cells in vitro

Acanthamoeba is an opportunistic protozoan pathogen and known to be one of the most ubiquitous organisms, play a vital role in ecosystem, and recognized to cause blinding keratitis and rare but fatal granulomatous encephalitis involving the central nervous system with a very poor prognosis. This is due to limited availability of effective anti-Acanthamoeba drugs. The objective of the present study was to determine the efficacy of methanolic plants crude extracts on the viability and biological properties of Acanthamoeba castellanii (T4 genotype) and its cytotoxic effects on human corneal epithelial cells (HCEC). Using HCEC, it was observed that Acanthamoeba exhibited binding (>90 %) and cytotoxicity (>80 %) to host cells. However, plant crude extracts remarkably inhibited more than 70 and 60 % of Acanthamoeba binding and cytotoxicity to HCEC, respectively. It was further established that crude extracts (ranging from 0.1 to 1.5 mg/ml) exhibited amoebicidal effects, i.e., >50 % of trophozoites were killed/reduced at maximum dose (1.5 mg/ml) within 1 h incubation. However, the residual subpopulation remained static over longer incubations. Furthermore, growth assay demonstrated crude extracts inhibited >50 % Acanthamoeba numbers up to 7 days. Our results confirmed that plant crude extracts has inhibitory effects on Acanthamoeba growth and viability. Overall, these findings revealed that tested plant extracts is inhibitory to Acanthamoeba properties associated with pathogenesis. To the best of our knowledge, our findings demonstrated for the first time that selected methanol plant crude extracts exhibits inhibitory effects on biological properties of Acanthamoeba without any toxic effects on HCEC cells in vitro.     

Phenotypic and genotypic characterization of enteroaggregative Escherichia coli isolates from pediatric population in Pakistan

Enteroaggregative Escherichia coli (EAEC) are a leading cause of diarrhea among children. The objective of this study was to define the frequency of EAEC among diarrheal children from flood‐affected areas as well as sporadic cases, determine multidrug resistance, and evaluation of virulence using an in vivo model of pathogenesis. Stool samples were collected from 225 diarrheal children from 2010 to 2011 from flood‐affected areas as well as from sporadic cases in Pakistan. Identified EAEC isolates were characterized by phylogrouping, antibiotic resistance patterns including the extended‐spectrum beta lactamase spectrum, single nucleotide polymorphism detection in gyrA and parC, and virulence potential using wax worm, G. mellonella. A total of 35 (12.5%) confirmed EAEC isolates were identified among 225 E. coli isolates. EAEC isolates displayed high resistance to tetracycline, ampicillin, and cefaclor. A total of 34.28% were ESBL positive. Single nucleotide polymorphism detection revealed 37.14% and 68.57% isolates were positive for SNPs in gyrA (A₆₆₀‐T₆₆₀) and parC (C₃₃₀‐T₃₃₀), respectively. Phylogrouping revealed that B2 phylogroup was more prevalent among all EAEC isolates tested followed by D, A, B1, and non‐typeable (NT). Infection of G. mellonella with EAEC showed that killing infective dose was 100% higher than E. coli DH5 alpha control. EAEC are prevalent among Pakistani children with diarrhea, they are highly resistant to antibiotics, and predominantly fall into B2 phylogroup. Epidemiologic surveillance of EAEC and other E. coli pathotypes is critical to assess not only the role of these pathogens in diarrheal disease but also to determine the extent of multidrug resistance among the population.     

Prevalence,pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir

The aim of this study was to determine specific pattern of port site microbial colonisation, sensitivity and resistance to different antibiotics of bacteria isolated from port site infection (PSI) in low risk patients after elective laparoscopic cholecystectomy in surgical wards at tertiary care hospital of Kashmir. This is a prospective study. The study included 675 consecutive patients of postoperative PSI after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months. Culture swabs were taken from port sites with signs of PSI and transported to the microbiology laboratory. The positive swab cultures were subjected to antibiotic susceptibility test. The data obtained was analysed by using appropriate statistical analytical tests. The incidence of PSI after elective laparoscopic cholecystectomy is 6·7%. The commonest organism responsible for PSI is pseudomonas, 19 (42·2%) cases. Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital,pseudomonas was found 100% resistant to the combination of ampicillin + sulbactum and ceftriaxone and it was sensitive to imipenem, amikacin and vancomycin in 89·47,57 and 52·63% of cases respectively. Our study will be helpful in choosing effective empirical prophylactic antibiotic therapy in cases of elective laparoscopiccholecystectomy and will have a great impact on morbidity and mortality in them because of PSI.     

Two Automated Techniques for Carotid Lumen Diameter Measurement: Regional versus Boundary Approaches

The degree of stenosis in the carotid artery can be predicted using automated carotid lumen diameter (LD) measured from B-mode ultrasound images. Systolic velocity-based methods for measurement of LD are subjective. With the advancement of high resolution imaging, image-based methods have started to emerge. However, they require robust image analysis for accurate LD measurement. This paper presents two different algorithms for automated segmentation of the lumen borders in carotid ultrasound images. Both algorithms are modeled as a two stage process. Stage one consists of a global-based model using scale-space framework for the extraction of the region of interest. This stage is common to both algorithms. Stage two is modeled using a local-based strategy that extracts the lumen interfaces. At this stage, the algorithm-1 is modeled as a region-based strategy using a classification framework, whereas the algorithm-2 is modeled as a boundary-based approach that uses the level set framework. Two sets of databases (DB), Japan DB (JDB) (202 patients, 404 images) and Hong Kong DB (HKDB) (50 patients, 300 images) were used in this study. Two trained neuroradiologists performed manual LD tracings. The mean automated LD measured was 6.35 ± 0.95 mm for JDB and 6.20 ± 1.35 mm for HKDB. The precision-of-merit was: 97.4 % and 98.0 % w.r.t to two manual tracings for JDB and 99.7 % and 97.9 % w.r.t to two manual tracings for HKDB. Statistical tests such as ANOVA, Chi-Squared, T-test, and Mann-Whitney test were conducted to show the stability and reliability of the automated techniques.     

Differences in mean and variability of heart rate and ambulatory rate-pressure product when valsartan or carvedilol is added to lisinopril

Guidelines recommend combining β-blockers and angiotensin-converting enzyme (ACE) inhibitors in high-risk heart disease but not in the initial treatment of hypertension. The mechanism of this benefit has not been determined. After 3 weeks of lisinopril (L, 40 mg/day) run-in, 30 subjects entered a single-blinded, forced-titration, crossover study in which carvedilol (C, 20 then 40 mg/day) or a control renin-angiotensin blocker, valsartan (V, 160 then 320 mg/day) were added to L. Ambulatory blood pressure (ABP) and heart rate monitoring was performed at the end of each period. Rate-pressure product (RPP, systolic BP × heart rate, an indicator of cardiac oxygen consumption) was measured over 24 hours, daytime (6 am to midnight), and nighttime (midnight to 6 am) periods. Variability (standard deviation and range) of RPP, BP, and heart rate was also investigated. After 4 weeks, mean 24-hour systolic BP was about 8 mm Hg lower when either V or C was added to L (P < .01 each). Heart rate was consistently lower with C (8 beats/min over 24 hours, P < .000) but was slightly increased with V (about 2 beats/min, P = NS). Consequently, C lowered RPP to a greater degree than V over 24 hours (about 8% vs. 2%, P < .000) and during daytime and nighttime periods (P < .000 each). In addition, RPP variability (SD but not range) was consistently lower on C than V. When added to L, C reduces the mean and variability (SD) of 24-hour heart rate and cardiac workload to a greater degree than valsartan. These effects may contribute to the outcome benefits observed with β-blocker–ACE inhibitor combinations.