Gas Under Right Hemidiaphragm: A Rare Presentation of Unruptured Liver Abscess

A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered

Diabetes control, dyslipidemia, hsCRP and mild cognitive impairment in non-elderly people with type 2 diabetes mellitus

Background: Mild Cognitive Impairment (MCI) a transitional stage between normal aging and dementia has been observed more in people with diabetes when compared with general population. The risk factors for MCI in type 2 diabetes mellitus (T2DM) have been defined in elderly patients and aging may itself contribute to declining in cognitive functions. As the large number people with T2DM are under 60years, the prevalence of MCI and factors contributing to it are not much studied. So, this study aimed to find out the factors contributing to MCI in non-elderly T2DM patients.Methods: In this cross-sectional study, 257 patients with T2DM underwent cognitive assessment by Montreal cognitive assessment test and the cognitive levels were correlated with their glycosylated hemoglobin, lipid profile, and highly sensitive C-reactive protein (hsCRP).Results: The prevalence of mild cognitive impairment (MCI) was 64.2%.  MCI significantly correlated with duration of diabetes, socioeconomic status, HbA1c, serum triglycerides, low-density lipoprotein, very low-density lipoprotein and hsCRP levels. The factors that were statistically insignificant were body mass index and high-density lipoprotein levels.Conclusions: Cognitive impairment is seen even in non-elderly T2DM patients. It should be considered along with the other complications of diabetes and individuals with T2DM should be screened for cognitive impairment to prevent progression to dementia

Case report- a rare survival of 2,4-D (ethyl ester) ingestions

2,4-Dichlorophenoxyacetic acid (usually called 2,4-D) is a widely used systemic herbicide. Ingestion of 2,4 D (Ethyl Ester) is rarely reported. Ingestion of this substance leads to neurotoxicity, cardiotoxicity, hematotoxicity and nephrotoxicity. Previously reported cases describe toxicities of this agent with very high fatality, only 2 survived case reports are available. In our case the substance was identified readily and treatment started within hours of ingestion with prompt gastric lavage and forced alkaline diuresis. At the time of admission patient had already lost consciousness (i.e. neurotoxicity), patient had developed muscle fibrillations and fasciculations (i.e. myotoxicity) and during the hospital stay he got acute kidney injury (i.e. nephrotoxicity) but all toxicities recovered with treatment. Previously reported fatal cases had late identification of substance and only symptomatic supportive treatment was given whereas we used aggressive approach with forced diuresis and haemodialysis. We are reporting third survived case of 2,4-D (Ethyl Ester) poisoning and emphasizing key points in the management, early identification of substance, early institution of forced alkaline diuresis and use of renal function tests as prognostic marker with timely hemodialysis.

Atypical presentation of intra-articular osteochondroma of knee in adolescent- case report

Osteochondroma is most common benign bone tumor around knee joint. They occur during the period of growth, grows away from joint line and rarely responsible for mechanical symptoms. This paper reports a rare presentation of intra-articular osteochondroma in knee with mechanical instability symptoms, mild to moderate pain and swelling of knee joint. Patient was 20 years old male and misdiagnosed as chronic nonspecific synovitis, tubercular arthritis and anterior cruciate ligament tear of knee. We assessed him clinically and radiologically and diagnosis was established based on MRI and arthroscopy. He was treated by open excision of tumor, and patients recover uneventfully. Instability of knee joint in this case can be attributed due to rough surface of osteochondroma just beneath lower attachment of patellar tendon

Suppression of uPAR Retards Radiation-Induced Invasion and Migration Mediated by Integrin β1/FAK Signaling in Medulloblastoma

Despite effective radiotherapy for the initial stages of cancer, several studies have reported the recurrence of various cancers, including medulloblastoma. Here, we attempt to capitalize on the radiation-induced aggressive behavior of medulloblastoma cells by comparing the extracellular protease activity and the expression pattern of molecules, known to be involved in cell adhesion, migration and invasion, between non-irradiated and irradiated cells.We identified an increase in invasion and migration of irradiated compared to non-irradiated medulloblastoma cells. RT-PCR analysis confirmed increased expression of uPA, uPAR, focal adhesion kinase (FAK), N-Cadherin and integrin subunits (e.g., α3, α5 and β1) in irradiated cells. Furthermore, we noticed a ∼2-fold increase in tyrosine phosphorylation of FAK in irradiated cells. Immunoprecipitation studies confirmed increased interaction of integrin β1 and FAK in irradiated cells. In addition, our results show that overexpression of uPAR in cancer cells can mimic radiation-induced activation of FAK signaling. Moreover, by inhibiting FAK phosphorylation, we were able to reduce the radiation-induced invasiveness of the cancer cells. In this vein, we studied the effect of siRNA-mediated knockdown of uPAR on cell migration and adhesion in irradiated and non-irradiated medulloblastoma cells. Downregulation of uPAR reduced the radiation-induced adhesion, migration and invasion of the irradiated cells, primarily by inhibiting phosphorylation of FAK, Paxillin and Rac-1/Cdc42. As observed from the immunoprecipitation studies, uPAR knockdown reduced interaction among the focal adhesion molecules, such as FAK, Paxillin and p130Cas, which are known to play key roles in cancer metastasis. Pretreatment with uPAR shRNA expressing construct reduced uPAR and phospho FAK expression levels in pre-established medulloblastoma in nude mice.

Assessment of Malnutrition in Pre-School children visiting immunization clinic, Maharana Bhoopal Hospital, Udaipur (Rajasthan)

Background: The pre-school age groups (2-5years) were evaluated for growth and nutritional status at immunization clinic at Maharana Bhoopal hospital, Udaipur. Objectives: To study the malnutrition in pre-school children. Material & Methods: The cross sectional study had been carried out between august 2013 to November 2013 with 1080children at immunization clinic Maharana Bhoopal Hospital Udaipur. Body weight, height were recorded including with age, gender and also education and occupation and socio-economic status of mother by interviewing the mother at the time they attended the immunization clinic and by the help of MAMTA CARD. Result: The age and sex distribution of 1080 examined children revealed that 52.8% were males while 47.2% were females. The malnutrition in the subjects was determined as per World Health Organization child growth standards [1]. Data reveals that 4.2% of male children, 4.1% of female children were severely stunted and 10.7% of male children, 11.2% of female children were stunted. Whereas 3.1% of male children, 4.7% of female children were found to be severely wasted and 11.4% of male children, 12.3% of female children were wasted. Also found that 7.5% of male children, 7.6% of female children were overweight and 1.9% of male children, 1.0% of female children were obese. Conclusion: There is need of more education about nutrition and dietary habits to population including proper antenatal and postnatal care of mother to decrease the prevalence of malnutrition in children

Integrated p-n Junctions for Efficient Solar Water Splitting upon TiO2/CdS/BiSbS3 Ternary Hybrids for Improved Hydrogen Evolution and Mechanistic Insights

The development of efficient and novel p-n heterojunctions for photoelectrochemical (PEC) water splitting is still a challenging problem. We have demonstrated the complementary nature of (p-type) BiSbS3 as a sensitizer when coupled with (n-type) TiO2/CdS to improve the photocatalytic activity and solar to hydrogen conversion efficiency. The as-prepared p-n heterojunction TiO2/CdS/BiSbS3 exhibits good visible light harvesting capacity and high charge separation over the binary heterojunction, which are confirmed by photoluminescence (PL) and electrical impedance spectroscopy (EIS). The ternary heterojunction produces higher H-2 than the binary systems TiO2/CdS and TiO2/BiSbS3. This ternary heterojunction system displayed the highest photocurrent density of 5 mA center dot cm(-2) at 1.23 V vs. reversible hydrogen electrode (RHE) in neutral conditions, and STH of 3.8% at 0.52 V vs. RHE is observed. The improved photocatalytic response was due to the favorable energy band positions of CdS and BiSbS3. This study highlights the p-n junction made up of TiO2/CdS/BiSbS3, which promises efficient charge formation, separation, and suppression of charge recombination for improved PEC water splitting efficiency. Further, no appreciable loss of activity was observed for the photoanode over 2500 s. Band alignment and interfaces mechanisms have been studied as well

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum