Management of post-tuberculous complex aspergilloma of the lung: role of surgical resection.

Of 14 patients with complex aspergilloma complicating healed tuberculosis, 12 underwent lobectomy or pneumonectomy for recurrent haemoptysis. No deaths occurred, though one patient needed re-exploration for bleeding. There was no postoperative worsening of dyspnoea despite a mean forced vital capacity (FVC) of 60% predicted for the patients undergoing surgery and of 20% predicted for two patients with severe restrictive defects, perhaps owing to the fact that there was little or no function in the resected part of the lung, as shown by preoperative isotope ventilation-perfusion scanning, and that patients were under the age of 50 and generally fit. There has been no recurrence of haemoptysis during follow up, which has been from 12 to 33 months. Surgical resection, provided that cases are carefully selected, offers the best chance of cure with low mortality and morbidity.     

Sexual dimorphism of the extraorbital lacrimal glands in SF-1 knockout mice

Sexual dimorphism (SD) represents all the differences between males and females of the same species. SD of the murine lacrimal gland and the major effect of testosterone on its formation are well documented. Steroidogenic factor-1 (SF-1, NR5a1) is a nuclear receptor essential for the fetal development of steroid hormones producing organs and SF-1 knockout mice (Sf-1 KO) are therefore born without gonads and adrenal glands. The aim of this study was to investigate whether SD in lacrimal glands is present in the absence of exposure to sex hormones during development. Lacrimal glands from adult Sf-1 KO male and female mice without hormonal exposure, and from males that were treated with testosterone propionate (TP) prior to sacrifice, were examined. After sacrifice, glandular tissue was processed using standard histological procedures. Paraffin sections were analysed by stereology and immunostained against the androgen receptor (AR). Our results showed that there were no statistically significant differences in the mean volumes of acini, connective tissue or ductal system between males, females, and males on TP. The same pertains to the mean length of the ducts in all three groups. In the absence of sex hormones, sex chromosomes proved to be insufficient in inducing sexual dimorphism in LG. However, nuclei of the acinar cells in males on TP were positive for AR, whereas in males without TP no expression of AR was detected. Administration of TP induced the expression of AR in the nuclei of acinar cells of males but did not affect the morphology of LG. We conclude that SD in the lacrimal gland is not present in Sf-1 KO mice and this suggests that sex hormones have a major role in the development of SD in the lacrimal gland.     

Effects of two anaesthetic regimes, MS-222 and eugenol, on plasma biochemical profile in Barbus sharpeyi

For choosing an anaesthetic agent for a particular purpose, the different properties has been notified such as the convenience for use, safety for the fish, humans and the environment, effectiveness, physiological disturbances and its cost. Invariably, in any study with clove oil, it has been regarded as an effective and acceptable alternative to other anaesthetics. The aim of the present study was to investigate effects of two anaesthetic regimes, MS-222 and eugenol, on plasma biochemical parameters in Barbus sharpeyi. B. sharpeyi fingerlings (mean weight, 5?g?±?1; mean length, 6?cm?±?1) were exposed to MS-222 (100?ppm) and eugenol (40?ppm) for induction of anaesthesia. Blood samples were taken to verify the effects of these anaesthetics on plasma biochemical parameters may use as an indicator of stress at time 0 (designated for each tank at the time of exposure to anaesthetic agent), 0.5, 1, 2 and 24?h after exposure by caudal severance. Plasma biochemical parameters concentrations were not significantly affected in B. sharpeyi (p?<?0.05). These results were expected because the trials were conducted in short-term exposures. Ion balance appears to be altered only in long-term stressing condition. Based on the results of this study, eugenol appears to be a safe anesthetic for use in B. sharpeyi.     

Gelfoam haemostatic agent with or without autologous bone marrow-derived stem cells for the regeneration of critical-size mandibular defects in the rabbit

This study evaluated the effect of Gelfoam sponge with and without autologous bone marrow-derived stem cells (BMSCs) on bone regeneration in critical-size mandibular defects. The study involved 56 New Zealand rabbits assigned to four groups (14 in each). The osseous defects in group I were irrigated with normal saline, those in group II were grafted with autogenous tibial bone, and those in group III were filled with Gelfoam sponge. Group IV defects were treated as for group III, but the interface between the Gelfoam sponge and bone surface was injected with BMSCs. At the end of 4 weeks, seven rabbits in each group were euthanized; the remaining animals were euthanized at the end of the experiment, at 8 weeks postoperative. The percentage area of newly formed bone was significantly higher in group IV at week 4 (0.030 ± 0.01%) and week 8 (0.060 ± 0.03%) than in group I (0.01 ± 0.00% and 0.02 ± 0.00%, respectively) and group III (0.08 ± 0.01% and 0.015 ± 0.02%, respectively), but was lower than that in group II (0.038 ± 0.02% and 0.082 ± 0.01%, respectively). Thus, the combination of Gelfoam and autologous BMSCs promoted the regeneration of mandibular critical-size defects better than the use of Gelfoam alone. However, the amount of newly generated bone was lower than in defects grafted with autogenous bone.     

Comparison of ß-lactam plus aminoglycoside versus ß-lactam plus fluoroquinolone empirical therapy in serious nosocomial infections due to Gram-negative bacilli

We sought to compare clinical cure on day 7 and a 28-day all-cause mortality in patients who received an anti-pseudomonal ß-lactam with a fluoroquinolone or an aminoglycoside for treatment of nosocomial bacteremia or pneumonia due to Gram-negative bacilli while in the ICU. This retrospective cohort study was conducted in critically ill patients at an academic medical centre from January 2005 to August 2011. A total of 129 patients (83 receiving aminoglycoside and 46 receiving fluoroquinolone combinations) were included. Seven-day clinical cure rates were 74% and 72% for fluoroquinolone and aminoglycoside groups, respectively (p = 0.84). There was no significant difference in the odds of clinical cure with a fluoroquinolone as compared to an aminoglycoside combination (adjusted odds ratio 2.4, 95% confidence interval [CI] 0.7–9.0). There was no significant difference in 28-day mortality in patients who received a fluoroquinolone or an aminoglycoside combination (22% vs. 18%, adjusted hazard ratio 0.82, 95% CI 0.29–2.28).     

Incidence of Pseudomonas aeruginosa bacteremia: a population-based study

Background

The incidence of Pseudomonas aeruginosa bacteremia has not been defined in a population-based investigation.

Methods

We performed a retrospective, population-based incidence study using resources of the Rochester Epidemiology Project of Olmsted County, Minnesota. We identified all Olmsted County residents with P. aeruginosa bacteremia between January 1, 1997, and December 31, 2006, by microbiology records in the only 2 laboratories in the county. Medical records were reviewed to confirm diagnosis, residency status, and clinical characteristics.

Results

Age-adjusted incidence per 100,000 person-years was 10.8 (95% confidence interval [CI], 7.5-14.0) in men and 3.7 (95% CI, 2.2-5.2) in women for total P. aeruginosa bacteremia, and 8.4 (95% CI, 5.5-11.2) in men and 2.5 (95% CI, 1.3-3.8) in women for monomicrobial P. aeruginosa bacteremia. There was no significant change in incidence of total P. aeruginosa bacteremia during the past decade (P = .418). Incidence increased exponentially with age, with a greater magnitude of increase in men compared with women for total and monomicrobial P. aeruginosa bacteremia (P = .007 and P = .015, respectively). In patients with monomicrobial P. aeruginosa bacteremia, the median age was 69 years, and 78.4% of cases were either nosocomial or health care associated. Most patients had multiple comorbid conditions. The urinary tract was the most common primary source of infection. The 28-day all-cause mortality of monomicrobial P. aeruginosa bacteremia was 25.5%. In vitro susceptibility to ciprofloxacin was 95.3%.

Conclusion

To our knowledge, this is the first population-based incidence study of P. aeruginosa bacteremia. The incidence of P. aeruginosa bacteremia has remained stable during the past decade. Fluoroquinolone susceptibility is high among local P. aeruginosa bacteremia isolates.     

Clinical Presentation and Management of Severe Acute Renal Failure in McArdle Disease

McArdle disease, also known as glycogen storage disease type V, is an autosomal recessive disease due to the absence of myophosphorylase activity, leading to the complete disruption of glycogen breakdown in muscles. We present a rare case of a Caucasian male, aged 26 years, who developed rhabdomyolysis-induced acute renal failure and uremic encephalopathy. Neurological examination and histopathological studies supported the diagnosis of McArdle disease. The severity of his symptoms necessitated urgent hemodialysis, upon which the patient reported improvement in status. Acute renal failure in McArdle disease usually resolves with supportive treatment and maintenance of regular physical activity. Nevertheless, in more severe cases, intensive care with urgent hemodialysis may be needed. A multidisciplinary approach is necessary for the adequate management of similar cases.     

Determinants of and changes in catastrophic health expenditure in the occupied Palestinian territory: an analysis of ten rounds of the Palestinian Households Expenditure and Consumptions Survey (1996–2011)

Background

Catastrophic health expenditure (CHE) is measured to assess the financial protection from the risk of health-related conditions, which is considered a principle performance goal of any health system. The incidence and intensity of CHE in the occupied Palestinian territory between 1998 and 2007 was assessed in previous research; however, no research has assessed the occurrence of CHE in different population groups in the occupied Palestinian territory. The objective of this study was to examine the changes in the occurrence of CHE in different groups of Palestinians from 1996 to 2011, which was a period of increasing political turmoil, transformation of the national health system, and economic hardship faced by the population.