Abdominal apoplexy: rupture of short gastric artery after retching

Abdominal apoplexy, or idiopathic spontaneous intraperitoneal hemorrhage (ISIH), is a rare but often fatal condition resulting from a variety of disease processes affecting abdominal vasculature. A 30-year-old woman presented with acute abdominal pain and breathlessness and was in class II hypovolemic shock. She had a history of multiple episodes of retching with non-bilious vomiting prior to that. Computed tomography (CT) reported a non-rotation of the gut, gross intraperitoneal free fluid with debris, and possible perforated appendicitis. Laparoscopy revealed a gross hemoperitoneum of 2.5 L, with bowel findings consistent with non-rotation of the gut, but technical difficulty in identifying the source of bleeding led to conversion to laparotomy. A ruptured short gastric artery was ascertained to be the source of bleeding and was successfully ligated. A retrospective review of the preoperative CT showed intraperitoneal free fluid with Hounsfield unit measurements of 48 and 52, suggestive of acute hemoperitoneum. ISIH is often a delayed diagnosis or missed diagnosis due to its low incidence. The presence of vomiting and abdominal pain with hypovolemic shock, especially in a young individual, should raise the suspicion of ISIH, which can be confirmed via early CT imaging to facilitate achieving hemostasis during surgery

Identifiability of the Simplex Volume Minimization Criterion for Blind Hyperspectral Unmixing: The No Pure-Pixel Case

In blind hyperspectral unmixing (HU), the pure-pixel assumption is well-known to be powerful in enabling simple and effective blind HU solutions. However, the pure-pixel assumption is not always satisfied in an exact sense, especially for scenarios where pixels are heavily mixed. In the no pure-pixel case, a good blind HU approach to consider is the minimum volume enclosing simplex (MVES). Empirical experience has suggested that MVES algorithms can perform well without pure pixels, although it was not totally clear why this is true from a theoretical viewpoint. This paper aims to address the latter issue. We develop an analysis framework wherein the perfect endmember identifiability of MVES is studied under the noiseless case. We prove that MVES is indeed robust against lack of pure pixels, as long as the pixels do not get too heavily mixed and too asymmetrically spread. The theoretical results are verified by numerical simulations

Effects of El Niño Southern Oscillation on Food Prices, Dietary and Nutrient Intake among children: Case Study in Iquitos, Peru

El Niño Southern Oscillation (ENSO) is a naturally occurring atmospheric phenomenon that leads to inter-annual shifts in precipitation, temperature, and river discharge in Peru. More recently, there is evidence to suggest that ENSO is evolving in response to Global Climate Change. Very little research has been conducted on how ENSO affects food prices, dietary intake, and overall nutritional security. The major objectives of this thesis are to explore the relationship of ENSO and: (1) river discharge, (2) food prices, (3) frequency of meal patterns, (4) amount of food consumed, (5) Dietary Diversity (DD), (6) macronutrient and micronutrient intake, and (7) nutrient adequacy among children 9-36 months of age in the Peruvian Amazon. Data on monthly ENSO indices were extracted from National Oceanic and Atmospheric Administration (1969 to 2015). Daily river data was retrieved from the Sedaloreto water treatment plant (1969 to 2015) in Iquitos, Peru. Data on weekly food prices were obtained from Peruvian Ministry of Agriculture and Irrigation (2008 to 2015). Data on monthly dietary intake were obtained from The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development birth cohort study in Iquitos, Peru (2010 to 2014). Using regression models, Multivariate ENSO index (MEI) was identified as the best fit for associations with river discharge levels, in comparison to other ENSO indices. In addition, severe categories of MEI were also strongly associated with river flows. Using time series regression, ENSO severity, river level and seasonality were associated with local food prices, particularly yucca, eggs and sugar. Results from longitudinal poisson, negative binomial, and regression models show that under moderate El Niño & La Niña, and strong La Niña, there were reduction in the number of meals with fish, grains, plantain, dairy, sugar and rice. In strong La Niña, reduction of rice and grains were 18-20%, and interestingly, there is a higher intake of plantains by 99% suggesting possible substitutions. The practice of consuming gifted foods is higher during moderate El Niño and weak La Niña and is higher among girls compared to boys. Despite seasonal availability, DD remained consistent, however under La Niña conditions, girl’s DD score is reduced significantly compared to boys. Energy intake was significantly lower under moderate El Niño and significantly higher during weak La Niña. Girls consumed 89-112 less calories than boys even after adjusting for weight and other covariates, particularly under moderate La Niña. Further, gender differences were found in animal source protein intake, iron, zinc, calcium intake under various ENSO conditions. Overall, there was high prevalence of inadequacy for vitamin A (among the non-breastfed group), calcium, iron, folate, and zinc. Nutrient Adequacy Ratios of calcium, iron, and zinc were negatively associated with weak, and strong La Niña. This is the first study to show ENSO associations with local ecological factors, regional food prices and dietary intake in the same setting and time frame. These findings illustrate that ENSO, a large scale atmospheric phenomenon, is linked with individual-level dietary intake. The findings also highlight the gender differences in dietary intake observed under various ENSO conditions. Further studies are needed to explore how dietary patterns in other ENSO-affected regions (South East Asia, Southern China, Zimbabwe, Ethiopia) are altered. Peruvian national nutritional programs should strongly consider using ENSO indices as a factor in determining the distribution of additional food and cash subsidies to the most vulnerable households, and especially, to such households with girls

2,7-dichlorofluorescein hydrazide as a new fluorescent probe for mercury quantification: Application to industrial effluents and polluted water samples

A new fluorescent probe 2,7-dichlorofluorescein hydrazide for mercury quantification in aqueous medium has been described. It is based on the spirolactam ring opening of colorless and nonfluorescent 2,7-dichlorofluorescein hydrazide induced by Hg2+ ions through the hydrolytic cleavage of amide bond to produce green-colored highly fluorescent dichlorofluorescein in alkaline medium. The significant color change of this reagent in the presence of mercury ions can be used as a sensitive naked-eye detector. The working range, limit of detection, and relative standard deviations were found to be 0.2-20 ngmL-1, 0.042 ngmL-1, and 0.69 respectively. The proposed method is free from most of the common interfering ions present in the environmental samples. The developed method has been successfully applied to determine trace level mercury from water, soil, and industrial effluents. © 2013 Sureshkumar Kempahanumakkagari et al

BIOAVAILABLE FORMS OF HEAVY METALS FROM RICE SAMPLES AND ITS POTENTIAL HEALTH RISK ASSESSMENT

Food crops grown in contaminated soils have a greater accumulation of heavy metals and the consumption of food crops grown in the contaminated soils are the source of metals that enters into the human body. Rice being a major food crop, the presence of heavy metals should be monitored regularly for reducing health risk. The analysis of total heavy metal always overestimates the content which leads to misinterpretation of results; however, bioaccessible heavy metal analysis projects the actual health risk. Hence, the present study aims to assess the bioavailable form of heavy metals in rice. The rice samples were collected from 20 different places and used for the inherent and bioavailable metal estimation. In vitro simulated digestion method was applied for bioaccessible metal analysis. Metal concentration in polished rice ranged from 0.10 to 0.82, 0.10 to 1.07, 0.11 to 0.56 and 0.23 to 1.09 mg  kg-1 for Lead (Pb), Nickel (Ni), Cadmium (Cd) and Chromium (Cr), respectively. Twenty five percent of the samples recorded less than 0.028, 0.01, 0.01, and 0.03 mg kg-1 of bioaccessible Pb, Ni, Cd, and Cr, respectively. A significant negative correlation was observed between total metal concentration and bioaccessibility percentage. Targeted Hazard Quotient (THQ) of all the metals were less than one for adults indicating that there were no health risks, which undoubtedly reveals the importance of bioaccessible metal analysis. Hence, regular monitoring of heavy metals is essential to reduce the intensive accumulation in the human food chain.  Also, the present study has opened up a wide scope on human health risk assessment using an in vitro digestion model

A challenging case of spontaneous idiopathic omental infarction in a trisomy 21 patient

Omental infarction (OI) is a rare cause of acute abdominal pain that is often missed out. Due to its non-specific presentation can mimic other commoner conditions such as acute appendicitis, acute diverticulitis, and tuberculosis abdomen. We present a 42-year-old gentleman with trisomy 21 presenting right iliac fossa pain. Examination revealed tenderness in the right lower quadrant and blood parameters showed leucocytosis. With an initial impression of acute appendicitis, the patient was subjected to surgery. Intraoperatively, there were abnormalities to the omentum suggestive of OI, resulting in partial omentectomy. Symptom resolution occurred immediately and the patient was discharged early. OI is a rare cause of acute abdomen that can mimic other abdominal pathologies. In trisomy 21 patients who present with acute abdomen, thorough assessments including preoperative imaging are advisable. Diagnostic laparoscopy is recommended as OI can be managed via minimally invasive surgery, hence ensuring good surgical outcomes

Risk factors for early childhood growth faltering in rural Cambodia: a cross-sectional study.

OBJECTIVE: This study aimed to determine risk factors of growth faltering by assessing childhood nutrition and household water, sanitation, and hygiene (WASH) variables and their association with nutritional status of children under 24 months in rural Cambodia. DESIGN: We conducted surveys in 491 villages (clusters) randomised across 55 rural communes in Cambodia in September 2016 to measure associations between child, household and community-level risk factors for stunting and length-for-age z-score (LAZ). We measured 4036 children under 24 months of age from 3877 households (491 clusters). We analysed associations between nutrition/WASH practices and child growth (LAZ, stunting) using generalised estimating equations (GEEs) to fit linear regression models with robust SEs in a pooled analysis and in age-stratified analyses; child-level and household-level variables were modelled separately from community-level variables. RESULTS: After adjustment for potential confounding, we found household-level and community-level water, sanitation and hygiene factors to be associated with child growth among children under 24 months: presence of water and soap at a household's handwashing station was positively associated with child growth (adjusted mean difference in LAZ +0.10, 95% CI 0.03 to 0.16); household-level use of an improved drinking water source and adequate child stool disposal practices were protective against stunting (adjusted prevalence ratio (aPR) 0.80, 95% CI 0.67 to 0.97; aPR 0.82, 95% CI 0.64 to 1.03). In our age-stratified analysis, we found associations between child growth and community-level factors among children 1-6 months of age: shared sanitation was negatively associated with growth (-0.47 LAZ, 95% CI -0.90 to -0.05 compared with children in communities with no shared facilities); improved sanitation facilities were protective against stunting (aPR 0.43, 95% CI 0.21 to 0.88 compared with children in communities with no improved sanitation facilities); and open defecation was associated with more stunting (aPR 2.13, 95% CI 1.10 to 4.11 compared with children in communities with no open defecation). These sanitation risk factors were only measured in the youngest age strata (1-6 months). Presence of water and soap at the household level were associated with taller children in the 1-6 month and 6-12 month age strata (+0.10 LAZ, 95% CI -0.02 to 0.22 among children 1-6 months of age; +0.11 LAZ, 95% CI -0.02 to 0.25 among children 6-12 months of age compared with children in households with no water and soap). Household use of improved drinking water source was positively associated with growth among older children (+0.13 LAZ, 95% CI -0.01 to 0.28 among children 12-24 months of age). CONCLUSION: In rural Cambodia, water, sanitation and hygiene behaviours were associated with growth faltering among children under 24 months of age. Community-level sanitation factors were positively associated with growth, particularly for infants under 6 months of age. We should continue to make effort to: investigate the relationships between water, sanitation, hygiene and human health and expand WASH access for young children

Merendino procedure as an alternative to total gastrectomy in the treatment of gastrointestinal stromal tumors of the gastroesophageal junction: A case series

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the alimentary canal and are postulated to have originated from the interstitial cells of Cajal. We present three patients with an age range from 43 to 63 years old diagnosed with GIST of the gastroesophageal junction (GEJ). All patients were noted to have submucosal lesions through gastroscopy, in which the largest was 5 cm × 7 cm in size. All of them underwent emergent surgery due to various reasons, and the Merendino procedure was performed as the surgery of choice. All of them recovered well and were discharged on days 10–12. The histopathological examination demonstrated a GIST. Merendino procedure can improve patients’ digestive functions and nutritional status, leading to a better quality of life after surgery with a reduction in postoperative complications. This case series demonstrated proximal gastrectomy with Merendino procedure reconstruction as a safe, efficient, and feasible approach in treating gastric GISTs at the GEJ