Histological analysis of motoneuron survival and microglia inhibition after nerve root avulsion treated with nerve graft implantation and minocycline: an experimental study

Motor vehicle accidents are the most common cause of injuries involving avulsion of the brachial plexus in humans, resulting in debilitating motor dysfunction. Lack of an established animal model to test drug treatments hinders the introduction of new pharmacological agents. Avulsion injury of cervical ventral roots can be replicated in rats, resulting in a progressive loss of the motoneurons and increase in neurotoxic expression of microglia. This is a report on the effect of prompt nerve implantation and minocycline treatment on the suppression of microglia activation and survival of motoneurons. 20 adult female Sprague-Dawley rats were used for this study, which was approved by the Animal Ethical Committee, USM (approval number /2011/(73)(346)). The animals underwent surgical avulsion of the C6 nerve root, followed by reimplantation with peripheral nerve graft and treatment with intraperitoneal minocycline. At 6 weeks postoperatively, immunohistochemistry using primary antibody Iba1 (microglia) and nicotinamide adenine dinucleotide phosphate diaphorase (NADPh) with neutral-red staining (motoneuron) under flourescence microscopy was performed at the C6 spinal cord segment and then quantified. This study showed signifi cant reduction of microglia expression in the study group; mean ranks of control and study group were 15.2 and 11.6, respectively; U=9.5, Z=3.02, p0.05. This may be due to the effect of the surgery; the surgery has the potential to cause additional trauma to the cord parenchyma, leading to further motoneuron loss and an increase in scarring around the avulsed region, thus impeding regeneration of the motoneuron

Cholera admissions in adults 1989-1994: a hospital based study

In order to gain insight into the distribution of cholera over the years and proportion of monthly admissions under our adult medical services, we scrutinized our records of hospital discharges between 1989 and 1994. Only culture positive cases were included. Each year most of the cases of cholera are admitted between May and November with almost disease free interval from December to April. In 1992 admission rate was 4.24/1000 medical admissions which increased to 12.65 in 1993 and 13.73 in 1994. Though the Vibrio cholerae 01 Ogawa was the major isolate upto May, 1993, Vibrio cholerae non-01 serogroup 0139 dominated between June and August, 1993. Ogawa strain re-established itself in October, 1993. In August, 1994, non-01 strain reappeared and became the major isolate in September. Cholera has caused multiple epidemics throughout the Indian subcontinent. Since 1800, there have been seven pandemics of cholera. The seventh pandemic originated in Indonesia and continues today

Dietary practices and beliefs of patients with chronic liver disease

Objective: To study of the dietary practices and beliefs of patients suffering from chronic liver disease. Setting: Two private tertcary care hospitals. Method: Fifty patients presenting to the Gastroenterology Clinics at the Aga Khan University Hospital and Baqai Hospital, with compensated liver disease and no other co-morbid condition which required dietary modifications, were enrolled in the study. Patients were interviewed regarding their current dietary practices using an open-ended questionnaire. Results: The mean age of the patients was 48 years and the majority were in relatively poor nutritional status. Four had BMI\u27s \u3c 18; 58% had Hb \u3c 12 g/dl and 36% had albumin levels \u3c 3 gm/dl. The percentage of patients avoiding various foods is as follows: meats 72%, fats and oils 64%, salt 42%, spices 34%, milk and milk products 28%, rice 20%. Conclusion: The most commonly cited reason for avoiding a given food was the advice of the family doctor, followed by advice by gastroenterologists, family and friends. Concepts from alternative medicine and continuation of dietary restrictions imposed during a decompensated phase also influenced intake. Compromised nutritional status is a poor predictor of clinical outcome in liver disease therefore it is important that gastroenterologists be proactive regarding nutritional counseling and both patients and their primary care physicians understand the importance of not imposing unnecessary restrictions on dietary intake

Standardising neonatal and paediatric antibiotic clinical trial design and conduct: the PENTA-ID network view.

Antimicrobial development for children remains challenging due to multiple barriers to conducting randomised clinical trials (CTs). There is currently considerable heterogeneity in the design and conduct of paediatric antibiotic studies, hampering comparison and meta-analytic approaches. The board of the European networks for paediatric research at the European Medicines Agency (EMA), in collaboration with the Paediatric European Network for Treatments of AIDS-Infectious Diseases network (www.penta-id.org), recently developed a Working Group on paediatric antibiotic CT design, involving academic, regulatory and industry representatives. The evidence base for any specific criteria for the design and conduct of efficacy and safety antibiotic trials for children is very limited and will evolve over time as further studies are conducted. The suggestions being put forward here are based on the adult EMA guidance, adapted for neonates and children. In particular, this document provides suggested guidance on the general principles of harmonisation between regulatory and strategic trials, including (1) standardised key inclusion/exclusion criteria and widely applicable outcome measures for specific clinical infectious syndromes (CIS) to be used in CTs on efficacy of antibiotic in children; (2) key components of safety that should be reported in paediatric antibiotic CTs; (3) standardised sample sizes for safety studies. Summarising views from a range of key stakeholders, specific criteria for the design and conduct of efficacy and safety antibiotic trials in specific CIS for children have been suggested. The recommended criteria are intended to be applicable to both regulatory and clinical investigator-led strategic trials and could be the basis for harmonisation in the design and conduct of CTs on antibiotics in children. The next step is further discussion internationally with investigators, paediatric CTs networks and regulators

Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis?

Background: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction in pregnant women and this can be clinically confused with acute fatty liver of pregnancy. Methods: We studied the clinical and laboratory data as well as the maternal and fetal outcomes of 12 pregnant women presenting with fulminant hepatic failure in order to determine the etiology of the disease. The clinical diagnoses were subsequently correlated with serologic assays for acute HEV infection. All patients were severely ill with deep jaundice, grade 3-4 encephalopathy and abnormal prothrombin times. Results: A clinical diagnosis of acute viral hepatitis was made in nine patients and of acute fatty liver in the other three cases. IgM and IgG antibodies confirmed acute viral hepatitis E in six of the nine patients while one had acute hepatitis A infection. HEV IgM and IgG antibodies were, however, also positive in two of the three patients thought to have acute fatty liver. Maternal and fetal mortality were 16.6% and 50%, respectively.CONCLUSIONS: We conclude that hepatitis E is the usual cause of acute liver failure in our pregnant women and that clinical and laboratory features do not permit accurate distinction between acute HEV infection and acute fatty liver of pregnancy. The prognosis in patients with acute HEV infection is much better than in other groups with severe liver failure (mortality 16% vs 68%)

Peculiar histopathological features of giardiasis in distal duodenal biopsies

Histological changes in 20 Giardia positive duodenal biopsies (Group A) were compared with 50, Giardia negative duodenal biopsies (Group B), taken during the same period. Stool examinations in Group B were negative for Giardia. Surface epithelium, villous and crypt architecture and cellular infiltrates were examined and compared between the groups. Atrophic changes in the villi were more common in Group A as compared to B(P \u3c 0.0001). Intraepithelial neutrophil infiltration (P \u3c 0.001), infiltration of the lamina propria with plasma cells (P \u3c 0.5), and presence of eosinophils in the lamina propria (P \u3c 0.001) were significant findings in group A. Some of the changes were related to the density of Giardia colonization e.g., the goblet cell depletion (P \u3c 0.05) and the density of plasma cell infiltration in lamina propria (P \u3c 0.01). Erosions and ulcerations were less commonly seen in group A. Thus we conclude that giardiasis manifests its peculiar features in the distal duodenal mucosa and a biopsy of this region is an important diagnostic tool for detection of this disease

PM10 Retrieval From Spectroradiometer Measurements.

This study attempts to determine the aerosol optical thickness (AOT) from spectroradiometer data. The spectroradiometer is used to measure the atmospheric transmittances in a wide spectrum over Penang Island, Malaysia