Type B congenital pyloric atresia: a case report

This is a case of congenital pyloric atresia type B not associated with any other anomaly rare condition, seen as an isolated anomaly with excellent prognosis) of  two days female child presenting with vomiting since birth. X-ray abdomen showed only stomach air bubble, sonography showed distended stomach with echoes and on barium meal no passage of contrast was seen beyond pyloric antrum even after 24 hours. Patient underwent Heineke-Mikulicz pyloroplasty and postoperative recovery was uneventful

Case series: imaging features of intraductal papillomas in patients presenting as nipple discharge

Background:The purpose of this study was to evaluate imaging spectrum of intraductal papillomas on breast ultrasonography (US), mammography and contrast enhanced magnetic resonance imaging (CE- MRI) in patients presenting as nipple discharge.Methods: Our study was a prospective study of female patients presenting with the history of pathological nipple discharge. After taking detailed patient history, thorough clinical examination was conducted followed by multimodality imaging approach. The initial imaging work up began with ultrasonography and mammography, then followed by CE-MRI. Provisional diagnosis was given and compared with the final diagnosis achieved by surgery/ fine needle aspiration/ biopsy or clinical and imaging follow up.Results: 7/25 patients had intraductal papilloma as proven by surgery/ FNA. Mass lesion was identified in all 7 cases on sonography and MRI while it was detected in only 3 cases on mammography. Dilated ducts were demonstated in all 7 cases on sonography, in 6 cases on CE- MRI and 5 cases on mammography respectively.Conclusions: Mammography has limited diagnostic accuracy in patients with unexplained nipple discharge and MRI should be considered the diagnostic technique of choice in this clinical setting, with relevant corresponding area focussed on sonography.

Correlation of lateral placental location with development of preeclampsia

Background: Preeclampsia is a complex clinical syndrome which involves multiple organ systems and remains the principle cause of maternal and perinatal morbidity and mortality. Preeclampsia is a disease of trophoblastic tissue. Placental abnormality is one of the initial events in patients who are destined to develop pregnancy induced hypertension subsequently. Objective of this study was to evaluate the association of laterally located placenta on ultrasound with development of preeclampsia.Methods: This prospective observational study was conducted on 200 antenatal women with singleton pregnancy at 18-24 weeks of gestation who attended antenatal clinic of obstetrics and gynaecology, PGIMS Rohtak from October 2017 to October 2018. Detailed antenatal transabdominal ultrasound along with placental location was done between 18-24 weeks of gestation in women who fitted into inclusion criteria. All the antenatal women belonged to 18-24 weeks of gestation were included in the study except those women with chronic hypertension, diabetes mellitus, renal disease, severe anaemia, thyrotoxicosis, low lying placenta, previous history of preeclampsia or eclampsia.Results: Out of 200 antenatal women, 84 had lateral placenta while 116 had central placenta. Out of these 84 women who had lateral placenta, 55 women (65.5%) developed preeclampsia and out of 116 (58%) women who had central placenta, 28 women (24.1%) developed preeclampsia.Conclusions: From the above study, we concluded that women with laterally located placenta by ultrasound at 18-24 weeks of gestation have greater risk of developing preeclampsia

Comparative study of transperineal and transvaginal sonography for localization of placenta in antepartum haermorrhage

Background: Haemorrhage is one of the leading causes of maternal mortality and morbidity in world in pregnant patients.Patients with antepartum haemorrhage confirmation of location of placenta by sonography is must for management. Transvaginal sonography(TVS) has main disadvantage of need of penetration of vagina and  provoking vaginal haemorrhage It can also result in uterine contraction & requirement of special transducer. Transperineal sonography(TPS) is more convenient and safer means of imaging the cervix and lower uterine segment overcoming the short coming of transabdominal sonography and eliminating the risk associated with Transvaginal sonography.  Thus present study was undertaken with a view to evulate patients of antepartum haemorrhage by Transvaginal as well as by transperineal sonography to compare accuracy of transperineal with Transvaginal sonography.Methods: Transvaginal probe was gently introduced for about 3-4 cm beyond the introitus. Distance between internal os and lower edge of placenta was measured. The diagnosis of placenta previa was made if placental edge was located within 5cm of internal os. Transperineal sonography was performed with convex transducer. Bladder was kept empty The transducer was positioned directly on perineum in sagittal orientation over the labia minora with center of transducer typically posterior to urethra and anterior to vaginal orifice and measurement taken.Results: TPS diagnosed placenta previa in 31 cases, 30 of which had placenta previa. TPS  negated placenta previa in 19 cases, none of which had placenta previa. So false positive rate of TPS was found to 4.7%, false negative 0% sensitivity 100% specificity 95.2%. Positive predictive value of TPS was found to be 96.7% and negative predictive value of TVS was found to be 100%.Conclusions: So, to conclude transperineal sonography is easy to perform, well tolerated accurate diagnostic tool with high sensitivity specificity, positive and negative predictive values for localisation of placenta cases of APH. TVS can be replaced by TPS in cases of APH for localisation of placenta

Metastatic Bilateral Malignant Ovarian Tumors Associated with Pregnancy

SummaryObjectiveKrukenberg tumors in pregnancy are extremely rare. Only three cases have been reported, two of which were diagnosed postpartum.Case ReportA 20-year-old, primigravida with bilateral malignant ovarian tumors, who received no prior antenatal care, was presented with intestinal obstruction at 5 months' gestation. Pregnancy was preserved, and bilateral oophorectomy, omentectomy with resection of sigmoid colon growth, and colostomy were performed. The patient aborted spontaneously and postoperatively, and was treated with adjuvant chemotherapy.ConclusionBecause platinum-based chemotherapy can be safely given during pregnancy, hysterectomy can be avoided in cases of bilateral malignant ovarian tumors if the uterus is not grossly involved, so allowing preservation of an existing pregnancy

Characterization of a distinct population of circulating human non-adherent endothelial forming cells and their recruitment via intercellular adhesion molecule-3

Circulating vascular progenitor cells contribute to the pathological vasculogenesis of cancer whilst on the other hand offer much promise in therapeutic revascularization in post-occlusion intervention in cardiovascular disease. However, their characterization has been hampered by the many variables to produce them as well as their described phenotypic and functional heterogeneity. Herein we have isolated, enriched for and then characterized a human umbilical cord blood derived CD133+ population of non-adherent endothelial forming cells (naEFCs) which expressed the hematopoietic progenitor cell markers (CD133, CD34, CD117, CD90 and CD38) together with mature endothelial cell markers (VEGFR2, CD144 and CD31). These cells also expressed low levels of CD45 but did not express the lymphoid markers (CD3, CD4, CD8)or myeloid markers (CD11b and CD14) which distinguishes them from ‘early’ endothelial progenitor cells (EPCs). Functional studies demonstrated that these naEFCs (i) bound Ulex europaeus lectin, (ii)demonstrated acetylated-low density lipoprotein uptake, (iii) increased vascular cell adhesion molecule (VCAM-1) surface expression in response to tumor necrosis factor and (iv) in co-culture with mature endothelial cells increased the number of tubes, tubule branching and loops in a 3- dimensional in vitro matrix. More importantly, naEFCs placed in vivo generated new lumen containing vasculature lined by CD144 expressing human endothelial cells (ECs). Extensive genomic and proteomic analyses of the naEFCs showed that intercellular adhesion molecule (ICAM)-3 is expressed on their cell surface but not on mature endothelial cells. Furthermore, functional analysis demonstrated that ICAM-3 mediated the rolling and adhesive events of the naEFCs under shear stress. We suggest that the distinct population of naEFCs identified and characterized here represents a new valuable therapeutic target to control aberrant vasculogenesis.Sarah L. Appleby, Michaelia P. Cockshell, Jyotsna B. Pippal, Emma J. Thompson, Jeffrey M. Barrett, Katie Tooley, Shaundeep Sen, Wai Yan Sun, Randall Grose, Ian Nicholson, Vitalina Levina, Ira Cooke, Gert Talbo, Angel F. Lopez and Claudine S. Bonde

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Colour Doppler Sonography of Flaccid Penis in Evaluation of Erectile Dysfunction

Erectile dysfunction is a common and potentially treatable problem. Other than psychological, anatomical and metabolic factors, vasculogenic causes also play an important role in erectile dysfunction. Among the various diagnostic tools available for the diagnosis of vasculogenic causes, colour Doppler sonography is noninvasive, simple and promising. Methods: This preliminary prospective study was conducted on 40 patients with erectile dysfunction, coming from a rural background to a hospital situated in a semi-urban setting. Results: It was found that a cut-off value of 10 cm/second for peak systolic velocity in flaccid penis had the best accuracy among three chosen cut-off values, i.e. 5, 10, 15 cm/second, for detecting arterial insufficiency with sensitivity of 94.1%, specificity of 93.6%, negative predictive value of 98% and positive predictive value of 80%. Conclusion: Doppler sonography may be used as a good predictor of clinical response to intracavernosal injection of a vasodilating pharmacological agent

Role of Colour Doppler Imaging in Detecting Prostate Cancer

This prospective study was undertaken to evaluate the role of colour Doppler sonography in the assessment of prostate carcinoma. METHODS: Forty consecutive patients who were suspected of having prostate carcinoma with either raised prostate specific antigen or abnormal digital rectal examination were included in the study. Transrectal greyscale and colour Doppler sonography of the prostate was performed using a 5–9 MHz intracavitary probe. Needle biopsies were taken from areas that showed increased flow on colour Doppler. The results were correlated with the final diagnosis established on histopathological examination. RESULTS: Comparison of greyscale and colour Doppler sonography showed that the latter is more sensitive and specific in predicting the malignancy. The statistical parameters of colour Doppler versus greyscale sonography were: sensitivity 88.23 vs. 73.52, specificity 66.66 vs. 33.33, positive predictive value 93.75 vs. 85.18, and negative predictive value 50 vs. 22.22, respectively. CONCLUSION: Colour Doppler and greyscale sonography should be routinely performed to improve detection of prostate carcinoma and to target the lesion