Lemierre syndrome : more than just a sore throat

A previously healthy, 35-year-old, immunocompetent man presented with a 2-day history of sore throat and unilateral swelling of the right neck. The patient was found to be tachycardic and pyrexic on clinical examination.peer-reviewe

Teaching neuroImages : chordoma

In this study Dr. Azzopardi was responsible for conducting the literature review and drafting the manuscript and accepts responsibility for conduct of research, final approval, and acquisition of data. Dr. Grech accepts responsibility for conduct of research, final approval, acquisition of data, and study supervision and made the radiologic diagnosis.peer-reviewe

Adult colorectal intussusception

A 30-year-old woman presented with severe lower, colicky abdominal pain and difficulty in passing flatus. Clinical examination revealed suprapubic tenderness. An abdominal CT was performed which revealed a soft-tissue mass in the pelvis demonstrating ‘a target sign’ appearance confirming the diagnosis of intussusception. The effect of the intussusceptum within the intussuscipiens creates a layered appearance. There is loss of gas within the rectum, instead, this is replaced by a soft-tissue mass of fat density (Hounsfield units −10). A diagnosis of rectosigmoid intussusception was carried out based on the CT findings with a presumptive diagnosis of an intramural lipoma as the primary lead point. Surgical reduction was performed with resection of the distal sigmoid colon. Histology confirmed an intramural lipoma of the sigmoid colon.peer-reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Specialization of amygdala subregions in emotion processing

The amygdala is important for human fear processing. However, recent research has failed to reveal specificity, with evidence that the amygdala also responds to other emotions. A more nuanced understanding of the amygdala's role in emotion processing, particularly relating to fear, is needed given the importance of effective emotional functioning for everyday function and mental health. We studied 86 healthy participants (44 females), aged 18–49 (mean 26.12 ± 6.6) years, who underwent multiband functional magnetic resonance imaging. We specifically examined the reactivity of four amygdala subregions (using regions of interest analysis) and related brain connectivity networks (using generalized psycho-physiological interaction) to fear, angry, and happy facial stimuli using an emotional face-matching task. All amygdala subregions responded to all stimuli (p-FDR <.05), with this reactivity strongly driven by the superficial and centromedial amygdala (p-FDR <.001). Yet amygdala subregions selectively showed strong functional connectivity with other occipitotemporal and inferior frontal brain regions with particular sensitivity to fear recognition and strongly driven by the basolateral amygdala (p-FDR <.05). These findings suggest that amygdala specialization to fear may not be reflected in its local activity but in its connectivity with other brain regions within a specific face-processing network

An analysis of materials and techniques used to produced the wallpapers at Captain Mills cottage

Wallpaper has been widely used for centuries as a decorative feature to introduce colour and pattern into an interior. Despite its extended usage, or perhaps because of it, wallpaper is largely ephemeral in nature and notoriously difficult conserve and effectively store. As such relatively few examples survive. This research project investigates the materials and techniques used in the manufacture of a collection of layered wallpaper samples taken from Captain Mills Cottage in Port Fairy through the use of microscopy, UV radiation and XRF analysis

Are Pathogenic Leptospira Species Ubiquitous in Urban Recreational Parks in Sydney, Australia?

Leptospirosis is a zoonotic disease caused by the spirochete bacteria Leptospira spp. From December 2017 to December 2023, a total of 34 canine leptospirosis cases were reported in urban Sydney, Australia. During the same spatio-temporal frame, one locally acquired human case was also reported. As it was hypothesised that human residents and companion dogs might both be exposed to pathogenic Leptospira in community green spaces in Sydney, an environmental survey was conducted from December 2023 to January 2024 to detect the presence of pathogenic Leptospira DNA in multipurpose, recreational public parks in the council areas of the Inner West and City of Sydney, Australia. A total of 75 environmental samples were collected from 20 public parks that were easily accessible by human and canine visitors. Quantitative PCR (qPCR) testing targeting pathogenic and intermediate Leptospira spp. was performed, and differences in detection of Leptospira spp. between dog-allowed and dog-prohibited areas were statistically examined. The global Moran&rsquo;s Index was calculated to identify any spatial autocorrelation in the qPCR results. Pathogenic leptospires were detected in all 20 parks, either in water or soil samples (35/75 samples). Cycle threshold (Ct) values were slightly lower for water samples (Ct 28.52&ndash;39.10) compared to soil samples (Ct 33.78&ndash;39.77). The chi-squared test and Fisher&rsquo;s exact test results were statistically non-significant (p &gt; 0.05 for both water and soil samples), and there was no spatial autocorrelation detected in the qPCR results (p &gt; 0.05 for both sample types). Although further research is now required, our preliminary results indicate the presence of pathogenic Leptospira DNA and its potential ubiquity in recreational parks in Sydney