Dengue fever mimicking acute appendicitis: A case report

AbstractINTRODUCTIONDengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy.PRESENTATION OF CASEA 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus.DISCUSSIONThis unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery.CONCLUSIONThis case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis

Laparoscopic colectomy for colonic neoplasms in a developing country

AbstractAimTo report the outcome of patients treated for colonic neoplasms using a laparoscopic assisted technique since its introduction at the University Hospital of the West Indies, Jamaica.Subjects and MethodsAll consecutive patients undergoing laparoscopic assisted colectomy were entered into a prospective database and this data analysed. Data collected included patient demographics, pre-operative diagnosis, operative events, post-operative morbidity and outcome.ResultsOver the thirty-six months period July 1, 2005–December 31, 2005 and July 1, 2006–December 31, 2008, thirty patients each underwent laparoscopic assisted colectomy for a colonic neoplasm. Their mean age was 63 years with M: F ratio of 1:2. Seventy-four per cent of the patients had carcinomas which was located on the right and sigmoid colon in 17 and 10 patients respectively. Mean operative time was 98 min for patients with right-sided lesions and blood loss for the entire group was minimal. Two patients were converted to open resections. Median duration of hospitalization was five days. There was no mortality but three patients had complications. After median follow-up of 30 months, there was no local or systemic recurrence.ConclusionsAppropriately selected patients with colonic neoplasms can be safely subjected to a laparoscopic assisted resection and expect to enjoy the advantages of this technique even in a developing country setting.The outcome of thirty consecutive laparoscopic assisted colectomies is reported demonstrating that this technique can be safely applied to selected patients with colonic carcinomas in developing countries

Lesbian and bisexual women's human rights, sexual rights and sexual citizenship: negotiating sexual health in England.

Lesbian and bisexual women's sexual health is neglected in much Government policy and practice in England and Wales. This paper examines lesbian and bisexual women's negotiation of sexual health, drawing on findings from a small research project. Themes explored include invisibility and lack of information, influences on decision-making and sexual activities and experiences of services and barriers to sexual healthcare. Key issues of importance in this respect are homophobic and heterosexist social contexts. Drawing on understandings of lesbian, gay and bisexual human rights, sexual rights and sexual citizenship, it is argued that these are useful lenses through which to examine and address lesbian and bisexual women's sexual health and related inequalities

A beryllium-10 chronology of late-glacial moraines in the upper Rakaia valley, Southern Alps, New Zealand supports Southern- Hemisphere warming during the Younger Dryas

Interhemispheric differences in the timing of pauses or reversals in the temperature rise at the end of the last ice age can help to clarify the mechanisms that influence glacial terminations. Our beryllium-10 (10Be) surface-exposure chronology for the moraines of the upper Rakaia valley of New Zealand's Southern Alps, combined with glaciological modeling, show that late-glacial temperature change in the atmosphere over the Southern Alps exhibited an Antarctic-like pattern. During the Antarctic Cold Reversal, the upper Rakaia glacier built two well-defined, closely-spaced moraines on Reischek knob at 13,900 ± 120 [1σ; ± 310 yrs when including a 2.1% production-rate (PR) uncertainty] and 13,140 ± 250 (±370) yrs ago, in positions consistent with mean annual temperature approximately 2 °C cooler than modern values. The formation of distinct, widely-spaced moraines at 12,140 ± 200 (±320) and 11,620 ± 160 (±290) yrs ago on Meins Knob, 2 km up-valley from the Reischek knob moraines, indicates that the glacier thinned by ∼250 m during Heinrich Stadial 0 (HS 0, coeval with the Younger Dryas 12,900 to 11,600 yrs ago). The glacier-inferred temperature rise in the upper Rakaia valley during HS 0 was about 1 °C. Because a similar pattern is documented by well-dated glacial geomorphologic records from the Andes of South America, the implication is that this late-glacial atmospheric climate signal extended from 79°S north to at least 36°S, and thus was a major feature of Southern Hemisphere paleoclimate during the last glacial termination

Pesticide And Transformation Product Detections And Age-Dating Relations From Till And Sand Deposits

Pesticide and transformation product concentrations and frequencies in ground water from areas of similar crop and pesticide applications may vary substantially with differing lithologies. Pesticide analysis data for atrazine, metolachlor, alachlor, acetochlor, and cyanazine and their pesticide transformation products were collected at 69 monitoring wells in Illinois and northern Indiana to document occurrence of pesticides and their transformation products in two agricultural areas of differing lithologies, till, and sand. The till is primarily tile drained and has preferential fractured flow, whereas the sand primarily has surface water drainage and primary porosity flow. Transformation products represent most of the agricultural pesticides in ground water regardless of aquifer material – till or sand. Transformation products were detected more frequently than parent pesticides in both the till and sand, with metolachlor ethane sulfonic acid being most frequently detected. Estimated ground-water recharge dates for the sand were based on chlorofluorocarbon analyses. These age-dating data indicate that ground water recharged prior to 1990 is more likely to have a detection of a pesticide or pesticide transformation product. Detections were twice as frequent in ground water recharged prior to 1990 (82%) than in ground water recharged on or after 1990 (33%). The highest concentrations of atrazine, alachlor, metolachlor, and their transformation products, also were detected in samples from ground water recharged prior to 1990. These age ⁄ pesticide detection relations are opposite of what would normally be expected, and may be the result of preferential flow and ⁄ or ground-water mixing between aquifers and aquitards as evident by the detection of acetochlor transformation products in samples with estimated ground-water ages predating initial pesticide application

Theory of inelastic lifetimes of low-energy electrons in metals

Electron dynamics in the bulk and at the surface of solid materials are well known to play a key role in a variety of physical and chemical phenomena. In this article we describe the main aspects of the interaction of low-energy electrons with solids, and report extensive calculations of inelastic lifetimes of both low-energy electrons in bulk materials and image-potential states at metal surfaces. New calculations of inelastic lifetimes in a homogeneous electron gas are presented, by using various well-known representations of the electronic response of the medium. Band-structure calculations, which have been recently carried out by the authors and collaborators, are reviewed, and future work is addressed.Comment: 28 pages, 18 figures, to appear in Chem. Phy

Determination of the mechanical properties of amorphous materials through instrumented nanoindentation

A novel methodology based on instrumented indentation is developed to determine the mechanical properties of amorphous materials which present cohesive-frictional behaviour. The approach is based on the concept of a universal hardness equation, which results from the assumption of a characteristic indentation pressure proportional to the hardness. The actual universal hardness equation is obtained from a detailed finite element analysis of the process of sharp indentation for a very wide range of material properties, and the inverse problem (i.e. how to extract the elastic modulus, the compressive yield strength and the friction angle) from instrumented indentation is solved. The applicability and limitations of the novel approach are highlighted. Finally, the model is validated against experimental data in metallic and ceramic glasses as well as polymers, covering a wide range of amorphous materials in terms of elastic modulus, yield strength and friction angle

N-body simulations of gravitational dynamics

We describe the astrophysical and numerical basis of N-body simulations, both of collisional stellar systems (dense star clusters and galactic centres) and collisionless stellar dynamics (galaxies and large-scale structure). We explain and discuss the state-of-the-art algorithms used for these quite different regimes, attempt to give a fair critique, and point out possible directions of future improvement and development. We briefly touch upon the history of N-body simulations and their most important results.Comment: invited review (28 pages), to appear in European Physics Journal Plu