We describe a patient with previously undiagnosed diabetes who developed superficial necrotic bullous dermatitis due to Aeromonas sobria infection following a fish pedicure (also known as fish spa, fish therapy or Ichthyotherapy). A major concern regarding fish pedicure involves the transmission of viral and bacterial infections. It has been shown that fish tank water contains a wide variety of bacteria, including non-pathogenic as well as potentially pathogenic species. Commonly in fish spas the tank water is heated to a temperature of 25 to 30°C. Such temperatures favour overall bacterial growth and at the same time increase skin porosity upon immersion, hence indirectly promoting potential skin infections. The authors discuss three potential routes of transmission (from fish or tub surface to man, from water to man, and from man to man via the tub water) and analyse the potential risk of bacterial or viral transmission associated with fish pedicures. On the basis of the current case study and the consensus view of experts, the authors advise against fish pedicure, in particular for patients with diabetes or a compromised immune system.
Aim: To present an uncommon, life-threatening case of intestinal ischemia complicated by cerebral stroke, thoraco-abdominal aorta and splenic artery thrombosis, in a woman with thrombophilia presenting common clinical signs.
Presentation of Case: A 42-year-old woman was admitted to hospital for lower abdominal pain, vomiting and fever. Emergency abdominal surgery evidenced intestinal ischemia requiring 80 cm ileum resection. The day following surgery, the patient lost consciousness and was admitted to the stroke unit. Thereafter, the patient was transferred to the intensive care unit due to respiratory failure. A brain-thoracic-abdominal CT-angiography showed occlusion of left medium cerebral artery, a thrombotic formation in thoracic and abdominal aorta, and partial occlusion of splenic artery. Homocysteine levels were 56.8mmol/l, screening for homozygosis mutation MTHFRC677T positive. Resolution of systemic thrombosis lasted one month. Patient was finally transferred to a rehabilitation center.
Discussion: Vascular disease and ischemic stroke have rarely been reported in subjects with thrombophilia and MTHFR polymorphisms. Our patient, affected by thrombophilia and high homocysteine levels, faced multiple vascular and cerebral complications. High concentration of homocysteine, with consequent vessel deposits, was detrimental for endothelium and vessel walls, due to action on blood coagulation factors and lipoproteins, with increased platelet adhesion and aggregation.
Conclusion: This case report represents an uncommon, sudden, life-threatening complication in thrombophilic patients, in spite of the common clinical signs presented. This clinical report should alert physicians to the importance of carrying out a careful clinical examination in the presence of thrombophilic patients presenting with apparently common clinical signs, such as abdominal pain, vomiting and fever.
Aims: Non-Syndromic congenital absence of primary dentition is rare. A female child with congenital absence of primary incisors (n=6) is presented.
Presentation of Case: A 4 year-old non-syndromic female child reported with missing several teeth. Intraoral examination revealed absence of (n=6) all four Mandibular Primary Incisors and two Maxillary Primary Lateral Incisors. Radiographic examination revealed absence of corresponding permanent tooth buds.
Discussion: The management of this situation is critical for the child and parent point of view due to higher number of missing teeth and early age of reporting. The hypodontia leads to speech problems with lowered self esteem and restricted diet causing malnourishment. Management options include Removable partial denture, Speech therapy, orthodontic jaw expansion, Mini implants.
Conclusion: This report presents a rare case of Oligodontia in female child of 4 years old and various management options.
Purpose: The human vascular endothelial growth factor (VEGF)-A gene transcribes a signaling protein involved in the regulation of angiogenesis, vasculogenesis and endothelial cell growth. Two insertion/deletion (I/D) simple nucleotide polymorphisms (SNPs, rs34357231 & rs35569394) in the promoter region of the gene have been significantly associated with several human diseases. These SNPs were computationally examined with respect to changes in punitive transcriptional factor binding sites (TFBS) and these changes were discussed in relation to the diseases.
Methods: The JASPAR CORE and ConSite databases were instrumental in identifying the TFBS. The Vector NTI Advance 11.5 computer program was employed in locating all the TFBS in the VEGFA gene from 2.7 kb upstream of the transcriptional start site to 1.6 kb past the 3’UTR. The JASPAR CORE database was also involved in computing each nucleotide occurrence (%) within the TFBS.
Results: Regulatory SNPs (rSNPs) in the promoter region of the VEGFA gene alter the DNA landscape for potential transcriptional factors (TFs) to attach resulting in changes in TFBS. The VEGFA-deletion (D) allele of these SNPs has been found to be a risk factor for diabetic retinopathy, diabetic microvascular complications in patients with type 1 diabetes mellitus, breast cancer in north Indian patients, and bladder cancer. The changes in TFs associated with the TFBS are examined with respect to these human diseases.
Conclusion: The VEGFA-insertion (I) allele provides punitive TFBS for the AR, EGR1 & 2, KLF5 and SP1 TFs whose BS do not occur with the VEGFA-D allele. These TFs have been linked to prostate cancer, cancer suppression and oncogenic processes and if not regulating the VEGFA gene may pose a risk for disease.
Laboratory mice with Middle Cerebral Artery Occlusion (MCAO) represent the main animal models for ischemic stroke research. Appropriate anesthetic protocols are essential, as anesthetic agents might affect the central nervous system (CNS) and therefore interfere with the outcome of pre-clinical ischemic stroke studies. In the present study we sought to investigate whether isoflurane, a widely used inhalational anesthetic, has any effect on MCAO mice pretreated with simvastatin, a well-known neuroprotective compound, compared with the administration of injectable ketamine/xylazine combination. Forty adult C57Bl/6J mice randomly allocated into four groups underwent ischemic injury by permanent coagulation of the Middle Cerebral Artery (MCA): Group A (n=11) animals were anesthetized with ketamine/xylazine, Group B (n=9) with isoflurane, Group C (n=9) with ketamine/xylazine after pretreatment with simvastatin 2h before permanent Middle Cerebral Artery Occlusion (pMCAO) and Group D (n=11) with isoflurane after similar pretreatment with simvastatin. The potential neuroprotective effect of the anesthetics was evaluated in terms of brain infarct volumes and neuron death. No significant differences, both quantitatively and qualitatively, were detected in brain lesions measured up to 7 days after pMCAO when comparing isoflurane inhalational anesthesia to ketamine/xylazine injectable anesthesia. Group C mice (simvastatin-treated ketamine/xylazine) had a significantly reduced brain infarct volume compared to Group A mice (non-simvastatin ketamine/xylazine) (P<.0005). Similarly Group D mice (simvastatin-treated isoflurane) had a significantly reduced brain infarct volume compared to Group B mice (non-simvastatin isoflurane) (P<.0005). No difference between morphology and number of apoptotic neurons was detected due to the two different anesthetic regimens. These results demonstrated the safe use of the established anesthetic agent isoflurane in mice where simvastatin is investigated as a neuroprotective compound.
Objective: This cross-sectional study was design to investigate prevalence and risk factors of generalized anxiety disorder in traumatic brain injury (TBI).
Materials and Methods: The Group studied consists of 204 patients of mild and moderate TBI between 14- days to one-year post injury. Demographic characteristics of the participants were assessed on a self-designed semi structured performa. Interviews focused on assessment of severity of TBI, generalized anxiety disorder (GAD) and quality of life (Qol) using GCS, GAD-7 and WHOBREF-QOL respectively.
Results: Total 204 patients were included. 11.76% participants were found to have generalized anxiety disorder. None of the demographic variables were associated with GAD except injury severity. Mild TBI patient (75.00%) had higher occurrence of GAD than the moderate cases (25.00%). GAD patients also had poor Qol than those without GAD in all domains except physical and social health domain. Neuroanatomical localization was also correlated with GAD. Left frontal contusions were the most common (37.50 %) lesions associated with GAD.
Conclusion: GAD is commonly associated, yet under diagnosed clinical entities in head injury and have tremendous impact in overall outcome measures. Every patient of head injury warrants psychiatric evaluation and concomitant treatment if required to ensure the attainment of not only neuroanatomical intact but overall productive and qualitative life vindicating the holistic and multidisciplinary treatment approach.
Background: Pleurodesis is indicated in thoracic pathologies associated with pleural effusions or pneumothoraces resulting from incurable diseases and therefore risked with high chance of recurrence
Objective: To compare the success rates of the oral forms of tetracycline and injectable form of cyclophosphamide as chemical pleurodesants in clinical practice.
Materials and Methods: Prospective study.
Results: There were 33 patients who underwent pleurodesis of 40 pleural spaces (bilateral in 7 patients) M: F=1:2.3 (10 vs 23) Age range: 15-80 years (mean= 49 years). The primary outcome measure was taken at four weeks post pleurodesis. This was the success rate of the pleurodesis which was taken as non-recurrence of pleural effusion or pneumothorax at four weeks. At one month, 16(80%) of the pleural spaces that underwent pleurodesis with tetracycline hydrochloride were free from recurrence which makes for 80% success rate and 20% (recurrence) failure rate for tetracycline. The equivalent figures for cyclophosphamide were 85% and 15% respectively.
Conclusion: The oral form of tetracycline and cyclophosphamide injection can give approximately same outcome as sclerosants for pleurodesis in appropriate patients.
Recently, plant growth hormones have been widely used in green houses and the consumptions of agriculture food products have markedly increased; however their toxicological aspects are still unclear. The aim of the present study is to illustrate the toxicities of plant growth hormones; gibberellic (GA3) and indole acetic acid (IAA) on ocular tissues of pregnant Wistar albino rats and their offsprings. Intra-gastric administration of either GA3 or IAA (100 mg/kg body weight) to mother rats were carried out for one month prior to conception as well as throughout gestation period (n=20). The control received saline-free organochemical compounds (n=10). At parturition, mother rats and their offsprings were sacrificed by light anesthesia, and their ocular regions were separated and investigated for light and transmission electron microscopy, immunochemical staining of Caspase-3, Bcl-2 and p53 and assessments of antioxidant enzymes and DNA fragmentation. Maternal administration of either GA3 or IAA was found to develop cataractous lenses to about 6% (3/20) in GA3-treatment and 4% (2/20) in IAA-treatment. The applied organochemical compounds developed retinopathy in mother rats and their offsprings. These were characterized by apparent damage of ganglion and nuclear cells. In mothers, the photoreceptor’s outer segment showed spotty dissolution of their stacked membranes while in offsprings, there was still lack of differentiation. The retinal tissue showed discrete positive immunostaining foci with P53, Pcl2 and caspase-3, especially in ganglion and nuclear cells compared with control. The antioxidant enzymes' catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR) and peroxidase (GPx) showed apparent depletion and vice versa for malondialdhyde (MDA) and hydrogen peroxide (H2O2), the markers of cell death. DNA fragmentation was markedly detected.
Finally, it was concluded that maternal administration of GA3 and IAA led to the development of retinopathy and development of cataractous lenses parallel to the increase of immunostaining of caspase-3, Pcl2 and P53 and decrease of the endogenous antioxidant system and increase of DNA damage.
Aims: Thyroid dysfunction is commonly encountered in pregnancy and can affect maternal and Fetal outcomes. Limited data are available from north east India on the prevalence of various thyroid disorders in pregnancy. The present study was hence conducted to evaluate the prevalence of thyroid disorders in a large government hospital in Assam.
Study Design: Prospective cohort study.
Place and Duration of Study: Sample: Department of endocrinology and department of obstetrics, Gauhati medical college, Guwahati between may 2011 to April 2013.
Methodology: Pregnant women irrespective of gestational age attending the antenatal clinic of Gauhati medical college were screened for thyroid dysfunction by estimation of serum free t34 (FT4), TSH and thyroid peroxidase antibodies (TPOAB). Subjects with known thyroid disorders, chronic illness or on medications known to affect thyroid status were excluded from the study. Results were interpreted as per the American thyroid association (ATA) 2011 guidelines.
Results: A total of 542 pregnant women were enrolled for this prospective cohort study. The mean age was 23.85±4.04 yrs. Of the 542 women screened, 69.18% were Euthyroid, 21.58% had subclinical hypothyroidism (SCH), 5.35% had overt hypothyroidism (OH), hyperthyroidism was observed in 2.39% and 1.47% had gestational Thyrotoxicosis. TPOAB were positive in 18.08% of women.
Conclusion: A high prevalence of thyroid disorders specially hypothyroidism were seen in this study using the newer ATA diagnostic criteria emphasizing the need for screening of all women during pregnancy.
Aim: To examine the socio-demographic characteristics, main source of information about family planning and contraceptive choices of women attending the family planning clinic of a tertiary hospital in Southwest Nigeria.
Study Design: A retrospective descriptive analysis of the case records of all new clients.
Place and Duration: Family planning clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between 1st January 2006 and 31st December 2011.
Methods: This study was carried out on 733 new clients seeking contraceptive services within the study period. The age, marital status, parity, occupation, religion, ethnicity and educational level completed; source of information about family planning, interval between last confinement and first visit, and the intention of the clients were obtained.
Results: A total of 733 new clients attended the family planning clinic during the period of review. There were 4145 new gynaecological consultations during the period and the contraceptive prevalence represented 17.6% of the total gynaecological consultations. The age of the clients ranged between 17 and 48 years with a mean of 32.5±5.5 years. There was a low patronage of family planning clinic by the teenagers and unmarried women as they accounted for only 0.3% and 2.9% respectively of all clients seen during the period. The source of information about family planning services was mainly from health personnel 516, (70.5%). IUCD and injectables were the most frequently selected methods irrespective of the socio-demographic characteristics of the clients, their intention for family planning uptake; and interval between last confinement and commencement of family planning.
Conclusion: This study showed that unmarried females and teenagers had a poor patronage of conventional family planning centers. Instead of the health personnel, the mass media should play a pivotal and leading role in information dissemination so that awareness on the use and utilization of contraception will be higher than what it is presently.