Shortening peel-away sheaths prior to dialysis line insertion--potential decrease of patient risk.

Placement of tunnelled dialysis lines is effective using ultrasoundand fluoroscopic guidance [1] and has a higher success ratethan ‘blind’ insertion [2]. After the ultrasound guided access into a neck vein, wires andcatheters are guided in to a suitable position in the     

Pseudomonas aeruginosa elastase stimulates ERK signaling pathway and enhances IL- 8 production by alveolar epithelial cells in culture

OBJECTIVE AND DESIGN: Bacterial products as well as the host airway inflammatory responses contribute to the pathogenesis of Pseudomonas infections. We sought to determine if Pseudomonas elastase (PE) induces mitogen-activated protein (MAP) kinase activity in association with interleukin-8 (IL-8) production by alveolar epithelial cells. METHODS: We utilized Western blot analysis to detect phosphorylation of signaling intermediates and ELISA was used to measure IL-8 production. RESULTS: We found that PE induces phosphorylation of the extracellular signal-regulated (ERK1/2) proteins of the MAPK pathway in A549 epithelial cells. Similar results were obtained using primary cultures of rabbit alveolar type II epithelial cells. PE also enhanced IL-8 production, which was abolished in the presence of the ERK activation inhibitor U0126. CONCLUSIONS: We conclude that PE activates the ERK1/2 arm of the MAPK pathway and that activation of this pathway results in enhanced IL-8 production. The results demonstrate that PE may augment pulmonary inflammation via cellular signaling that regulates expression of IL-8.     

Primary carcinoma of gallbladder in Yazd, Iran: A 14-year study (1992–2006)

Aim: To investigate the clinico‐pathological profile and stage of disease at presentation of patients with carcinoma of the gallbladder diagnosed during 1992–2006 in Iran. Methods: During this study period 34 consecutive patients with gallbladder carcinoma were identified using a pathology‐based tumor database. The data extracted for each study patient included their gender, age at diagnosis, signs and symptoms, presence of gallstones and histopathological pattern of the gallbladder carcinoma and the UICC/AJCC TNM staging system was used for labeling the stages of the disease. Results: The median age of the 34 patients studied was 69.50 with most between 61 and 70 years of age. The age range of the men was between 53 and 80 years with a median age of 71.50 years and that of the women was between 33 and 79 years with a median age of 68.50 years. The most common symptom was pain in the right hypochondrium. More women had gallstones (15/34) than men (3/10). Adenocarcinoma was the most common histopathological type (91.18%) with the commonest subtype being papillary (47.06%). Eighteen patients had stage IB and stage IIA (52.94%) carcinomas whereas stages IIB and III were observed in six (17.6%) and seven cases (20.6%), respectively. Only three cases (8.82%) were seen in stage IV. The follow up of gall bladder carcinoma (GBC) patients in this study ranged from 6 to 60 months. However, there was a progressive reduction of patients attending follow‐up oncology clinic, particularly by those who had stages III and IV of the disease. Conclusion: Most patients (52.94%) presented with early disease (stage IB and IIA) which carries a good prognosis. Early detection of GBC and a national consensus for the evidence‐based management of GBC in Iran should be the major components of a strategy aimed at improving therapeutic outcome.     

High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies

Non-A, non-B is a major form of hepatitis in haemodialysis (HD)patients. Hepatitis C virus (HCV) has been recently identifiedas the leading cause of non-A, non-B hepatitis in HD. A variableprevalence of hepatitis in HD has appeared in the literature,ranging between 1% and 29% in the Western world, and between30% and 54% in Saudi Arabia, but all these reports used first-generationELISA. Using second-generation enzyme immunoassay, we conducteda multi-centre study involving 22 HD centres all over SaudiArabia in order to establish the prevalence and risk factorsfor HCV in HD patients in Saudi Arabia. A total of 1147 patientswere studied, with a mean age of 43.4±15.3 years. Fivehundred and eighty were males and 567 were females. The overallprevalence rate of positive anti-HCV was 68%, with a range fromas low as 14.5%, to 94.7%. To our knowledge, this is the highestvalue reported among dialysis patients world-wide. A positivecorrelation was found between anti-HCV positivity and male sex(P=0.005), longer duration on dialysis (P=0.002) and blood transfusion(P=0.003). However, interestingly 62.6% of the patients whohad not had blood transfusion had anti-HCV antibodies. HCV antibodieswere also found more frequently in Egyptians, Pakistanis andYemenis than in Saudis. A comparison between those centres withlow prevalence of positive HCV and those with high prevalenceregarding risk factors was carried out, and it was found thatthe major difference between them was the adherence of the staffto universal infection precautions. In conclusion, HCV is amajor health problem in HD patients in Saudi Arabia. Identifiablerisk factors are longer duration in dialysis, blood transfusion,male sex, nationality and most importantly the lack of adherenceto universal infection precautions.     

Idiopathic neonatal pleural effusion

We present two cases of neonatal pleural effusion, a relatively rare condition, most commonly due to chylothorax. One had bilateral hypoplastic lungs and the other suffered birth asphyxia. Both died before any treatment could be initiated.     

Occular loiasis in a Zambian woman

Asymptomatic infection with Loa loa, an eye worm, is reported in a 32-year old Zambian woman. The patient revealed up to 28% eosinophilia but microfileraemia was not noticed. One gravid female parasite 56 X 0.56 mm, extracted from lower lid of left eye of the patient, is described. Treatment with diethylcarbamazine (DEC) extended over three weeks was successful against another parasite in tissues.