Cases of advanced abdominal pregnancies one of which was with viable fetus

Cases of advanced abdominal pregnancies, which were admitted to Gondar College of Medical sciences teaching hospital, North-western Ethiopia, in the years 2000 and 2001, are described, and the challenges in the diagnosis and management discussed One of these pregnancies resulted in the delivery of a viable fetus.     

Perception of COVID-19 Pandemic Among IBD Clinicians and IBD Surgeons in Black Sea Region: A Cross-Sectional Questionnaire Study

Background:Since December 2019, the COVID-19 pandemic has created an increasing challenge in managing inflammatory bowel disease patients both medically and surgically. Although several international and national medical/surgical associations published guidelines in this area, there is still a huge difference between daily practices and these guidelines, especially depending on regional practices and governmental policies. Therefore, we aimed to investigate and define gastroenterologists’ and surgeons’ fear of COVID-19 and how they have managed inflammatory bowel disease patients during this pandemic in the Black Sea region.Methods:A 20-question survey was administered to 70 gastroenterology specialists and 80 general surgeons who are mainly focused on the management of inflammatory bowel disease in 5 countries in the Black Sea region.Results:The majority of respondents (81.3%) mentioned that they have concerns that their inflammatory bowel disease patients were at risk of contracting COVID-19. In addition, the majority of respondents (80.3%) believed that inflammatory bowel disease itself, independent of medications, might increase the risk of contracting COVID-19. The majority of gastroenterologists told that they did not stop inflammatory bowel disease medications due to the COVID-19 pandemic unless patients had COVID-19 disease. Surgeons overwhelmingly reached a consensus on how to test patients for COVID-19 perioperatively and came to a conclusion on which of the patients cannot wait to be operated. Both gastroenterologists and general surgeons, usually have similar perceptions.Conclusion:Despite the increasing number of definitive studies, it seems that there are still regional differences in the perception of COVID-19 and inflammatory bowel disease patient care during the pandemic.     

High methionine,low folate and low vitamin B6/B12 (HM-LF-LV) diet causes neurodegeneration and subsequent short-term memory loss

Methionine is an essential amino acid found in rich quantities in average American diet such as meats, fish and eggs. Excessive consumption of such food often exceeds the normal requirement of the methionine in our body; which found to be related to the development of neurodegenerative disorders. However, the mechanistic pathways of methionine’s influence on the brain are unclear. The present study is focus on the effects of high methionine, low folate and low vitamin B6/B12 (HM-LF-LV) diet on the dysfunction of neuronal and vascular specific markers in the brain. C57BL6/J male mice (8–10 week old) were fed with HM-LF-LV diet for a 6 week period. Cognitive function of mice was determine by measuring short-term memory using a Novel Object Recognition test (NORT). Neuronal dysfunction were evaluate by measuring the levels of Neuronal nuclear antigen (NeuN), Neuron-specific-enolase (NSE) and Fluoro-jade C(FJC) fluorescence; while cerebrovascular disruption were evaluate by assessing levels of endothelial junction proteins Vascular Endothelial-Cadherin (VE-Cadherin) and Claudin-5 in harvested brain tissue. Cerebrovascular permeability was assess by evaluating microvascular leakage of fluorescently labeled albumin in vivo. Endothelial and Neuronal Nitric Oxide Synthase (eNOS, nNOS) regulation and vascular inflammation (ICAM: intercellular adhesion molecules) were also evaluate in brain tissue. All assessments were conduct at weekly intervals throughout the study duration. NORT showed a significant temporal decrease in short-term memory of mice fed on HM-LF-LV diet for 6 weeks compared to the wild-type control group. Our experimental data showed that neuronal dysfunction (decreased NeuN levels and increased FJC positive neurons in brain) was more prominent in HM-LF-LV diet fed mice compared to normal diet fed control mice. In experimental mice, cerebrovascular disruption was found to be elevated as evident from increased pial venular permeability (microvascular leakage) and decreased in VE-Cadherin expression compared to control. Slight decrease in nNOS and increase in eNOS in experimental mice suggest a trend towards the decrease in potential for neuronal development due to the long-term HM-LF-LV diet fed. Collectively, our results suggest that a diet containing high methionine, low folate and low vitamin B6/B12 results in increased neuronal degeneration and vascular dysfunction, leading to short-term memory loss. Interestingly, significant neuronal damage precedes vascular dysfunction.     

Efficient Renal Recruitment of Macrophages and T Cells in Mice Lacking the Duffy Antigen/Receptor for Chemokines

The Duffy antigen/receptor for chemokines (DARC) is a chemokine-binding protein that is expressed on erythrocytes and renal endothelial cells. DARC-mediated endothelial transcytosis of chemokines may facilitate the renal recruitment of macrophages and T cells, as has been suggested for neutrophils. We studied the role of Darc in two mouse models of prolonged renal inflammation, one that primarily involves the tubulointerstitium (unilateral ureteral obstruction), and one that requires an adaptive immune response that leads to glomerulonephritis (accelerated nephrotoxic nephritis). Renal expression of Darc and its ligands was increased in both models. Leukocytes effectively infiltrated obstructed kidneys in Darc-deficient mice with pronounced T-cell infiltration at early time points. Development of interstitial fibrosis was comparable in both genotypes. Nephrotoxic nephritis was inducible in Darc-deficient mice, with both an increased humoral immune response and functional impairment during the early phase of disease. Leukocytes efficiently infiltrated kidneys of Darc-deficient mice, with increased cell numbers at early but not late time points. Taken together, renal inflammation developed more rapidly in DARC-deficient mice, without affecting the extent of renal injury at later time points. Thus, genetic elimination of Darc in mice does not prevent the development of renal infiltrates and may even enhance such development during the early phases of interstitial and glomerular diseases in mouse models of prolonged renal inflammation.Chemokines orchestrate the recruitment of inflammatory cells to specific microenvironments in both lymphoid tissue and the sites of inflammation, like the injured kidney.^1,2,3 The Duffy antigen/receptor for chemokines (DARC) is a seven-transmembrane-spanning protein, which binds various inflammatory chemokines of different chemokine subgroups.^1,4,5 It was initially identified as a blood group, the Duffy antigen, involved in rare transfusion reactions. In addition DARC serves as the cellular receptor for invasion of erythrocytes by the malaria parasite Plasmodium vivax.^4,6 DARC is also expressed on endothelium of high endothelial venules in lymphoid tissue and peritubular capillaries in the kidney, where recirculation and extravasation of inflammatory cells takes place.^7,8 The expression of DARC on endothelial cells can be regulated as we demonstrated an increased number of DARC-positive peritubular vessels in biopsies from various forms of human allograft rejection and from glomerulonephritis.^9,10,11 Furthermore, the number of CCR5 positive cells (a receptor for the chemokine CCL5/RANTES) correlated positively with the number of DARC positive vessels, suggesting a potential role of DARC in inflammatory cell recruitment.¹¹However, a functional role for DARC in renal inflammation remains hypothetical, and might depend on the time point and exact inflammatory microenvironment. DARC could function as a chemokine sink on erythrocytes. Darc deficiency might result in an increased inflammatory response, as it has been demonstrated in Darc-deficient mice.^6,12 On the other hand, on endothelial cells DARC is involved in chemokine transcytosis and apical retention, and therefore it might have pro-inflammatory functions.^5,13,14,15 Zarbock et al¹⁶ used two neutrophil-dependent models, ie, ischemia-reperfusion and lipopolysaccharide (LPS)-induced acute renal injury to examine the role of Darc. Darc-deficient mice were protected from renal injury in both models with no renal dysfunction during ischemia-reperfusion injury and only mild renal dysfunction in LPS-induced injury.¹⁶ Neutrophil recruitment to the postischemic kidney was significantly reduced.¹⁶Currently, there is no published evidence for DARC being involved in macrophage or T cell recruitment into diseased kidneys. These cell types are involved in progressive renal diseases. We therefore used two models of renal injury characterized by prominent renal macrophage and T cell accumulation to investigate a potential role of Darc for mediating their renal recruitment. In obstructive nephropathy induced by unilateral ureteral obstruction (UUO) infiltrating macrophages have been identified as mediators of interstitial injury and fibrosis.^17,18 In the nephrotoxic nephritis (NTN) model a T-cell-dependent adaptive immune response leads to immune complex-mediated glomerular and secondary tubulointerstitial injury. This is driven by both macrophages and T cells accumulating in nephritic kidneys.^19,20,21 Here, we show that in both models macrophages and T cells efficiently infiltrate the injured renal tissue in a Darc-independent manner, arguing against a major role for Darc in T cell and monocyte extravasation in these models. Moreover, we demonstrate that renal inflammation developed more rapidly in Darc-deficient mice, without affecting the extent of renal injury at later time points.     

Living donor liver transplantation with replacement of vena cava for Echinococcus alveolaris: A case report

INTRODUCTION

There is no medical treatment for alveolar echinococceal disease (AED) of liver till now. Curative surgical resection is optimal treatment but in most advanced cases curative resection can’t be done. Liver transplantation is accepted treatment option for advanced AED. AED in some case invade surrounding tissue especially inferior vena cava (IVC). Advanced AED with invasion to IVC can be treated with deceased liver transplantation. Although living donor liver transplantation is very difficult to perform in patients with advanced AED with resected IVC, it come into consideration, since there is very few cadaveric liver.

PRESENTATION OF CASE

Here we present a case with advanced stage of AED of liver which cause portal hypertension and cholestasis. AED invaded surrounding tissue, right diaphragm, both lobes of liver and retrohepatic part of IVC. Invasion of IVC forced us to make resection of IVC and reconstruction with cryopreserved venous graft to reestablish blood flow. After that a living donor liver transplantation was done.

DISCUSSION

Curative surgery is the first-choice option in all operable patients with AED of liver. Advanced stage of AED like chronic jaundice, liver abscess, sepsis, repeated attacks of cholangitis, portal hypertension, and Budd-Chiari syndrome may be an indication for liver transplantation. In some advanced stage AED during transplantation replacement of retrohepatic part of IVC could be done with artificial vascular graft, cadaveric aortic and caval vein graft.

CONCLUSION

Although living donor liver transplantation with replacement of IVC is a very difficult operation, it should be considered in the management of advanced AED of liver with IVC invasion because of the rarity of deceased liver.     

Montanide ISA™ 201 adjuvanted FMD vaccine induces improved immune responses and protection in cattle

Despite significant advancements in modern vaccinology, inactivated whole virus vaccines for foot-and-mouth disease (FMD) remain the mainstay for prophylactic and emergency uses. Many efforts are currently devoted to improve the immune responses and protective efficacy of these vaccines. Adjuvants, which are often used to potentiate immune responses, provide an excellent mean to improve the efficacy of FMD vaccines. This study aimed to evaluate three oil adjuvants namely: Montanide ISA-201, ISA-206 (SEPPIC, France) and GAHOL (an in-house developed oil-adjuvant) for adjuvant potential in inactivated FMD vaccine. Groups of cattle (n = 6) were immunized once intramuscularly with monovalent FMDV ‘O’ vaccine formulated in these adjuvants, and humoral (serum neutralizing antibody, IgG₁ and IgG₂) and cellular (lymphoproliferation) responses were measured. Montanide ISA-201 adjuvanted vaccine induced earlier and higher neutralizing antibody responses as compared to the two other adjuvants. All the adjuvants induced mainly serum IgG₁ isotype antibody responses against FMDV. However, Montanide ISA-201 induced relatively higher IgG₂ responses than the other two adjuvants. Lymphoproliferative responses to recall FMDV antigen were relatively higher with Montanide ISA-201, although not always statistically significant. On homologous FMDV challenge at 30 days post-vaccination, 100% (6/6) of the cattle immunized with Montanide-201 adjuvanted vaccine were protected, which was superior to those immunized with ISA-206 (66.6%, 4/6) or GAHOL adjuvanted vaccine (50%, 3/6). Virus replication following challenge infection, as determined by presence of the viral genome in oropharynx and non-structural protein serology, was lowest with Montanide ISA-201 adjuvant. Collectively, these results indicate that the Montanide ISA-201 adjuvanted FMD vaccine induces enhanced immune responses and protective efficacy in cattle.     

A methodological note on modeling the effects of race: the case of psychological distress

Psychological distress is an important indicator of the mental well‐being of the population. Findings regarding racial differences in distress are inconclusive but may represent an important pathway through which disparities exist across a number of physical health outcomes. We used data from the 1994 Minority Health Survey, a nationally representative multiracial/ethnic sample of adults in US households, to examine racial/ethnic differences in psychological distress (n = 3623). Our primary study aim was to examine differences between additive and multiplicative models in assessing the influence of income and gender on the race/distress relationship. We hypothesized that additive models do not sufficiently account for potential interactions of race with income and gender, and may therefore mask important differences in distress between racial groups. The results suggest that our hypotheses were supported. After adjusting for income, there were no statistically significant differences in distress levels between racial groups. However, significant differences emerge when multiplicative models are used demonstrating the complexities of the intersection of race, income and gender in predicting psychological distress. Black men and women of higher income status represent a particularly vulnerable group, whereas Hispanic men are especially hardy. We discuss the implications of our findings for future work on racial health disparities. Copyright © 2008 John Wiley & Sons, Ltd.     

Investigation of the DNMT3B –579 G>T Promoter Polymorphism in Patients with Colorectal Cancer in an Azerbaijani Population

Objective:The main aim of the present study was to determine the clinical significance of the DNA methyltransferase 3B (DNMT3B) gene –579 G>T polymorphism in colorectal cancer (CRC) patients. Methods:A total of 140 patients with CRC and 164 healthy individuals were included in the study. According to the manufacturer’s instructions, DNA was isolated from blood, and genotypes were determined on agarose gel by the PCR-RFLP method. Genotype confirmation was performed using Sanger sequencing in randomly selected samples. Results:When comparing the case and control groups, heterozygous GT (OR=0.53; 95% CI=0.32–0.88), under the dominant model (OR=0.53; 95% CI=0.33–0.87), and the mutant T allele (OR=0.71; 95% CI=0.51–0.98) were statistically associated with a reduced risk of CRC. However, when the age, pathological tumor grade and stage, smoking habit, and alcohol consumption were compared, no significant relationship was determined (P>0.05). Furthermore, among males, heterozygous GT was associated with a reduced risk of CRC (OR=0.40; 95% CI=0.19–0.84). Conclusion:Our study highlighted that the –579 G>T polymorphism of the DNMT3B gene plays a protective role against CRC development.Key Words: DNMT3B, polymorphism, DNA methylation, colorectal cancer     

Preparation and medical outcomes of Nepalese staff and porters compared with foreign nationals on the Annapurna trekking circuit

This cross-sectional study investigates preparedness and medical problems in Nepalese staff and porters compared with foreign nationals trekking at altitude in the Nepal Himalaya. 331 Nepalese and 338 foreign nationals in 61 trekking groups were surveyed over 4 weeks on the Annapurna trekking circuit. Foreign nationals reported that 92% of trekking groups received altitude illness information and carried a medical kit. However, fewer than 30% knew the evacuation insurance status of the Nepalese staff and porters on their trek, 39% would not pay for an ill Nepalese national's helicopter evacuation, and 41% reported insufficient resources to carry an individual. Medical problems occurred in 44% of groups. A significantly higher proportion of Nepalese staff and porters were evacuated compared with foreign nationals. No significant differences in Nepalese and foreign national preparation were found between groups with and without medical problems. Medical problems were commonly encountered, yet many groups lacked resources to evacuate someone dangerously ill. Foreign and Nepalese nationals have a duty of care towards each other; recognizing that preparedness relies not only on a first aid kit, but also on knowledge of acclimatization and individuals' insurance is an important part of health and safety for individuals trekking at altitude.