Tapping for pneumoperitoneum in neonates and infants

Purpose The aim of this study was to shed some light on the presence of pneumoperitoneum in neonates and infants and to present and evaluate our method for its treatment.Materials and methods This study included 33 patients diagnosed with pneumoperitoneum during 2004–2011, of whom 19 were girls and 14 were boys, and their ages ranged from 1 week to 5 months; 21 patients were neonates and seven of them were premature; two were aged less than 32 weeks and had mild pneumoperitoneum, which could be treated conservatively and five were aged between 32 and 34 weeks. Tapping was performed for all patients. Tapping can help in selection of patients with necrotizing enterocolitis needing exploration when the aspirate is bilious or feculent. Tapping could be performed as a temporary measure before exploration to decrease respiratory distress and the occurrence of abdominal compartment syndrome and also as a routine procedure in patients with pneumoperitoneum. Tapping is an easy procedure and can be performed with the patient in bed or in the incubator. Pneumoperitoneum is not an absolute indication for surgical exploration and a small subset of patients should be managed by laparotomy. Each patient with pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain, or surgical exploration. Pneumoperitoneum occurs in neonates more frequently than in infants, and most cases are idiopathic.Results A total of 29 patients were treated by tapping alone (in nine patients, tapping was performed once; in 13, it was performed twice, and in the other seven, it was performed three to four times). Rapid improvement in the general condition and respiratory distress occurred in most patients. Six patients (five neonates and one infant) were explored because of: (a) aspiration of a bile-stained or feculent fluid in two patients and (b) failure of conservative treatment in four patients.Conclusion Pneumoperitoneum occurs in neonates more than infants and most cases are idiopathic. Each case of pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain or surgical exploration. Pneumoperitoneum is not an absolute indication for surgical exploration and small subset of patients should be managed by laparotomy. Tapping is an easy job and can be done with the patient in bed or in the incubator. Tapping could be performed as a routine in cases of pneumoperitoneum. Tapping could be done as a temporary measure before exploration to decrease respiratory distress and abdominal compartment syndrome

Diabetic Septic Foot in Omdurman Teaching Hospital

Objective: To audit the management of diabetic septic foot [DSF] lesions in Omdurman Teaching Hospital, usingWagner classification. Patients and methods: This is a retrospective study on 208 patients with DSF admitted to Omdurman Teaching Hospital, Sudan between June 2006 and May 2007. Data were analyzed manually Results: The male to female ratio was 2:1. The mean age± SD was 56 ± 12.35 year. 16.8% patients were grade 1. 33 (15.9%) patients were grade 2. grades 3, 4, 5 patients were 66 (37 %), 38 (18.3%) and 36 (17.3%) respectively. Major lower limb amputation and mortality were 19.2%, and 6.7% respectively.Conclusion: Preventive measures for patients at risk are highly needed as well early presentation isencouraged when ulcer develops in diabetic foot to avoid subsequent complications.Key words: Diabetes Mellitus, Diabetic septic foot, amputatio

Disrupted working memory circuitry and psychotic symptoms in 22q11.2 deletion syndrome.

22q11.2 deletion syndrome (22q11DS) is a recurrent genetic mutation that is highly penetrant for psychosis. Behavioral research suggests that 22q11DS patients exhibit a characteristic neurocognitive phenotype that includes differential impairment in spatial working memory (WM). Notably, spatial WM has also been proposed as an endophenotype for idiopathic psychotic disorder, yet little is known about the neurobiological substrates of WM in 22q11DS. In order to investigate the neural systems engaged during spatial WM in 22q11DS patients, we collected functional magnetic resonance imaging (fMRI) data while 41 participants (16 22q11DS patients, 25 demographically matched controls) performed a spatial capacity WM task that included manipulations of delay length and load level. Relative to controls, 22q11DS patients showed reduced neural activation during task performance in the intraparietal sulcus (IPS) and superior frontal sulcus (SFS). In addition, the typical increases in neural activity within spatial WM-relevant regions with greater memory load were not observed in 22q11DS. We further investigated whether neural dysfunction during WM was associated with behavioral WM performance, assessed via the University of Maryland letter-number sequencing (LNS) task, and positive psychotic symptoms, assessed via the Structured Interview for Prodromal Syndromes (SIPS), in 22q11DS patients. WM load activity within IPS and SFS was positively correlated with LNS task performance; moreover, WM load activity within IPS was inversely correlated with the severity of unusual thought content and delusional ideas, indicating that decreased recruitment of working memory-associated neural circuitry is associated with more severe positive symptoms. These results suggest that 22q11DS patients show reduced neural recruitment of brain regions critical for spatial WM function, which may be related to characteristic behavioral manifestations of the disorder

Morphology of colorectal carcinoma among Nigerians: A 30-year review

Background: The incidence of colorectal carcinoma has been on the increase in the developing countries, including Nigeria, as a result of change in diet and adoption of western lifestyle.Objectives: The aim of this review is to highlight the prevalence, age and sex distribution, anatomical location, and morphological characteristics of colorectal carcinomas in Ilorin, Nigeria.Materials and Methods: This is a retrospective study of all cases of histologically diagnosed colorectal carcinoma in the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over a 30-year period (January 1979–December 2008), using the departmental record and histological slides of the cases.Result: A total of 241 cases of colorectal carcinoma were reported, 144 cases (60%) in males and 96 cases (40%) in females with a male: female ratio of 1.5:1. The peak age of occurrence for males was between 51 and 60 years, while that of the females was between 41 and 50 years. The malignancy was found in the rectum in 60.2% of the cases, while the least affected site is the descending colon (1.2%). The exophytic occluding masses were found in 82.2% of the cases, and the most common histological type is adenocarcinoma (77.2%) with well-, moderately, and poorly differentiated forms constituting 52.3%, 32.8%, and 14.9% respectively. Of the 241 cases that were seen over the last 30 years, 93 cases (38.6%) were seen in the last 5 years.Conclusion: Colorectal carcinoma is no longer a rare disease in Nigeria. The surge in the incidence reported in the last 5 years in this center calls for a pragmatic action in its control, with emphasize on colonoscopic  screening for those with family history, and possibly making digital rectal examination a mandatory aspect of clinical examination, because most colorectal carcinomas are within the reach of examining finger

Prevalence of metabolic syndrome among apparently healthy adults in a rural community, in north-western Nigeria

Background: Metabolic syndrome (MetS) is a cluster of multiple metabolic abnormalities that increases the risk of cardiovascular morbidity and mortality, and a resultant severe economic implication.This study assessed the burden of MetS in a Nigerian rural community setting.Method: This was a cross-sectional, community based study on apparently healthy subjects.A multi stage cluster sampling technique was employed to recruit the study subjects.A standardized pre-tested questionnaire was used to obtain data, and blood samples from subjects were analysed using standard laboratory techniques. MetS was defined using the NCEP-ATP3 criteria. Data were analysed using STATA version 11, and a p value of <0.05 was considered statistically significant.Results: A total of 450 subjects completed the study, with 38% being males, and a mean age of 40.27±16.41 years. MetS was found in 116 (25.78%) of the subjects.Of these, systemic hypertension was found in 91(78.45%), while all (116) had elevated cholesterol and triglycerides.Abdominal adiposity was found in 45 (38.79%) subjects and 44 (37.93%) had Type 2 diabetes mellitus.Conclusion: The prevalence of MetS and its components in our studied population was high; hence the need for further large population based studies to determine its predictors in our environment

Current trends in the management of acute kidney injury in children

Acute Kidney Injury (AKI) previously known as acute renal failure (ARF) is a common problem in the paediatric emergency wards with infections likesepsis and malaria being the commonest causes in Nigeria. It has been known by various nomenclatures with a lack of standardised definition. This has made comparison of data very difficult. In the last decade, attempts have been made to standardize the definition by developing a classification criterion termed “RIFLE”. This is in turn undergoing variousmodifications with the most recent classification system developed by the Kidney Disease: Improving Global Outcomes (KDIGO). Despite these interesting developments, the basis of these classifications which is the use of serum creatinine measurements is fraught with its own limitations.This has led to discovery of various urinary and serum biomarkers like the cystatin C and neutrophil gelatinase associated lipocalin (NGAL) which appear to have very promising advantages over the well known creatinine measurements. Management of AKI continues to be anticipatory with appropriate fluid therapy and adequate treatment of infections. The benefits of furosemide and dopamine in management are still a constant source of debate. Treatment of life threatening complications like hyperkalaemia and hypertension as well as maintaining the kidney through the period of non-function can lead to remarkable recovery of renal homeostatic function.Keywords: acute kidney injury, paediatrics, managemen

Differential expression analysis with global network adjustment

<p>Background: Large-scale chromosomal deletions or other non-specific perturbations of the transcriptome can alter the expression of hundreds or thousands of genes, and it is of biological interest to understand which genes are most profoundly affected. We present a method for predicting a gene’s expression as a function of other genes thereby accounting for the effect of transcriptional regulation that confounds the identification of genes differentially expressed relative to a regulatory network. The challenge in constructing such models is that the number of possible regulator transcripts within a global network is on the order of thousands, and the number of biological samples is typically on the order of 10. Nevertheless, there are large gene expression databases that can be used to construct networks that could be helpful in modeling transcriptional regulation in smaller experiments.</p> <p>Results: We demonstrate a type of penalized regression model that can be estimated from large gene expression databases, and then applied to smaller experiments. The ridge parameter is selected by minimizing the cross-validation error of the predictions in the independent out-sample. This tends to increase the model stability and leads to a much greater degree of parameter shrinkage, but the resulting biased estimation is mitigated by a second round of regression. Nevertheless, the proposed computationally efficient “over-shrinkage” method outperforms previously used LASSO-based techniques. In two independent datasets, we find that the median proportion of explained variability in expression is approximately 25%, and this results in a substantial increase in the signal-to-noise ratio allowing more powerful inferences on differential gene expression leading to biologically intuitive findings. We also show that a large proportion of gene dependencies are conditional on the biological state, which would be impossible with standard differential expression methods.</p> <p>Conclusions: By adjusting for the effects of the global network on individual genes, both the sensitivity and reliability of differential expression measures are greatly improved.</p&gt

Chemical characterization of some substituted hydroxyapatites

Synthetic multi-substituted hydroxyapatite nano powders containing silicon and or carbonate prepared by a wet chemical method. The process parameters are set up to allow the simultaneous substitution of carbonate and silicon ions in the place of phosphorus. The chemical and structural characterizations of the prepared powders are determined with the aid of; XRF, ICP, XRD and FTIR. The results show that, the ion substitution in the crystal lattice of HA caused a change in the unit cell dimensions and affected the degree of crystallization of the produced powders. The apatite formation abilityy of the prepared discs from the synthesized powders is determined by immersing in SBF solution for different periods. The degree of ion release was determined in the obtained solutions. The examined surface of the immersed discs under SEM and analyzed by CDS showed a more dense HA layer than those of un-substituted ones. The HA with the substituted silicon and carbonate ions, showed the highest solubility with greater rate of ion release, compared with carbonate-free powder. All prepared powders took sodium ion from the SBF solution during immersion, which was not recorded before

Superconformal Flavor Simplified

A simple explanation of the flavor hierarchies can arise if matter fields interact with a conformal sector and different generations have different anomalous dimensions under the CFT. However, in the original study by Nelson and Strassler many supersymmetric models of this type were considered to be 'incalculable' because the R-charges were not sufficiently constrained by the superpotential. We point out that nearly all such models are calculable with the use of a-maximization. Utilizing this, we construct the simplest vector-like flavor models and discuss their viability. A significant constraint on these models comes from requiring that the visible gauge couplings remain perturbative throughout the conformal window needed to generate the hierarchies. However, we find that there is a small class of simple flavor models that can evade this bound.Comment: 43 pages, 1 figure; V3: small corrections and clarifications, references adde