An unusual presentation of a Gastrointestinal stromal tumour (GIST)

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumours (GIST) are rare tumours, now more frequently identified with the new imaging modalities like computerised tomography (CT) and magnetic resonance imaging (MRI). We report a rare presentation of a GIST with an unusual diagnostic workup in a multidisciplinary setting leading to a definitive diagnosis and treatment.</p> <p>Case presentation</p> <p>A 55-year-old lady was admitted under the general surgeons, with 3-day history of abdominal pain, three-week history of loss of appetite and weight. The patient was sequentially investigated with ultrasonography, computerised tomography and finally selective angiogram in a multidisciplinary setting. The selective angiogram showed a GIST with intratumour bleed, leading to successful surgical excision and being recurrence free at 22 month follow up.</p> <p>Conclusion</p> <p>Clinical presentation of these tumours can be varied and gastrointestinal bleeding is the commonest mode described in the literature. The clinician needs to be aware of much more rare presentations of the GIST including an intra tumour bleed. A structured multidisciplinary approach would lead to successful diagnosis and treatment.</p

Analysis of bacteria-challenged wild silkmoth, Antheraea mylitta (lepidoptera) transcriptome reveals potential immune genes

BACKGROUND: In the recent years a strong resemblance has been observed between the insect immune system and the mammalian innate immune mechanisms suggesting their common origin. Among the insects, only the dipterans (Drosophila and various mosquito species) have been widely investigated for their immune responses towards diverse pathogens. In the present study we constructed and analysed the immune transcriptome of the lepidopteran Antheraea mylitta, an economically important Indian tasar silkmoth with a view to unravel the potential immune-related genes and pathways. RESULTS: An expressed sequence tag (EST) library was constructed from mRNA obtained from fat bodies of A. mylitta larvae that had been challenged by infection with Escherichia coli cells. We identified 719 unique ESTs from a total of 1412 sequences so generated. A third of the transcriptome showed similarity with previously characterized immune-related genes that included both the known and putative immune genes. Of the four putative novel defence proteins (DFPs) annotated by PSI-BLAST three showed similarity to extracellular matrix proteins from vertebrates implicated in innate immunity, while the fourth was similar to, yet distinct from, the anti-microbial protein cecropin. Finally, we analysed the expression profiles of 15 potential immune-related genes, and the majority of them were induced more prominently with E. coli compared to Micrococcus luteus. We also identified several unknown proteins, some of which could have probable immune-related functions based on the results of the ProDom analysis. CONCLUSION: The present study has identified many potential immune-related genes in A. mylitta some of which are vertebrate homologues and others are hitherto unreported putative defence proteins. Several genes were present as members of gene families, as has also been observed in other insect species

Dental caries and the associated factors influencing it in tribal, suburban and urban school children of Tamil Nadu, India: a cross sectional study

Background. The study was planned to assess the prevalence of dental caries among tribal, suburban and urban children of Tiruchengode and Erode of Tamil Nadu state, India. The objective of the study was to assess the association of dental caries with family background, dental service availability, transportation and knowledge on preventive dental measures among these three groups. Design and methods. Cross-sectional study. A total of 1028 school children in the age range of 9-12 years from various government schools located in Palamalai and Kolli Hills (tribal), Tiruchengode (suburban) and Erode (urban), Tamil Nadu, were included in the study. Decayed, filled, and missing teeth (DMFT), decayed and filled teeth (dft) and Significant Caries Index were recorded. A specially prepared questionnaire was used to record all the data regarding oral hygiene practices, socioeconomic background, dental treatment availability, parent’s education level were used for the study. ANOVA t-test and post hoc test were used for comparing quantitative variables between the 3 subgroups. Results. The tribal school children had 89.3% caries prevalence, where as it was 77% in suburban and 55% in urban school children. The mean DMFT score among tribal, suburban and urban school children were statistically significant different (P=0.001) between the three groups. There was a highly significant difference (P=0.001) in the mean DMFT score based on brushing frequency. There was a statistically significant difference (P=0.018) in the mean DMFT scores in the urban group based on the mothers education status. There were no statistically significant differences in the mean DMFT scores based on the presence or absence of television in their house and the parents’ income. Conclusions. Oral hygiene practices, dietary habits and access to dental care services played an important role in prevalence of dental caries. It was observed that the socioeconomic status, parents’ educational status and mass media influenced the oral health of these children but without a significant contribution

SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock.

BACKGROUND: The systemic inflammatory response syndrome (SIRS) is a complex immune response which can be precipitated by non-infectious aetiologies such as trauma, burns or pancreatitis. Addressing the underlying cause is crucial because it can be associated with increased mortality. Although the current literature associates chronic heart failure with SIRS, acute right ventricular dysfunction has not previously been reported to trigger SIRS. This case report describes the presentation of acute right ventricular dysfunction that triggered SIRS and mimicked septic shock. CASE PRESENTATION: A 70-year-old male presented to the Intensive Care Unit (ICU) with elevated inflammatory markers and refractory hypotension after a robotic-assisted laparoscopic radical choledochectomy with pancreaticoduodenectomy. Septic shock was misdiagnosed, and he was later found to have a pulmonary embolus. Thrombectomy and antimicrobials had no significant efect on lowering the elevated inflammatory markers or improving the persistent hypotension. Through Point of Care Ultrasound (POCUS), right ventricular dysfunction was diagnosed. Treatment with intravenous milrinone improved blood pressure, normalised inflammatory markers and led to a prompt discharge from the ICU. CONCLUSION: Acute right ventricular dysfunction can trigger SIRS, which may mimic septic shock and delay appropriate treatment

Influence of Tap Water Quality and Household Water Use Activities on Indoor Air and Internal Dose Levels of Trihalomethanes

Individual exposure to trihalomethanes (THMs) in tap water can occur through ingestion, inhalation, or dermal exposure. Studies indicate that activities associated with inhaled or dermal exposure routes result in a greater increase in blood THM concentration than does ingestion. We measured blood and exhaled air concentrations of THM as biomarkers of exposure to participants conducting 14 common household water use activities, including ingestion of hot and cold tap water beverages, showering, clothes washing, hand washing, bathing, dish washing, and indirect shower exposure. We conducted our study at a single residence in each of two water utility service areas, one with relatively high and the other low total THM in the residence tap water. To maintain a consistent exposure environment for seven participants, we controlled water use activities, exposure time, air exchange, water flow and temperature, and nonstudy THM sources to the indoor air. We collected reference samples for water supply and air (pre–water use activity), as well as tap water and ambient air samples. We collected blood samples before and after each activity and exhaled breath samples at baseline and postactivity. All hot water use activities yielded a 2-fold increase in blood or breath THM concentrations for at least one individual. The greatest observed increase in blood and exhaled breath THM concentration in any participant was due to showering (direct and indirect), bathing, and hand dishwashing. Average increase in blood THM concentration ranged from 57 to 358 pg/mL due to these activities. More research is needed to determine whether acute and frequent exposures to THM at these concentrations have public health implications. Further research is also needed in designing epidemiologic studies that minimize data collection burden yet maximize accuracy in classification of dermal and inhalation THM exposure during hot water use activities

Responsibility loadings for dental services by general dentists

Extent: 6p.BACKGROUND: Responsibility loadings determine relative value units of dental services that translate services into a common scale of work effort. The aims of this paper were to elicit responsibility loadings for a subset of dental services and to relate responsibility loadings to ratings of importance of the components of responsibility. METHODS: Responsibility loadings and ratings of components of responsibility were collected using mailed questionnaires from a random sample of Australian private general practice dentists in 2007 (response rate = 77%). RESULTS: Median responsibility loadings were 1.25 for an initial oral examination and for a 3+-surface amalgam restoration, 1.50 for a simple extraction and for root canal obturation (single canal), and 1.75 for subgingival curettage (per quadrant). Across the five services coefficients from a multivariate logit model showed that ratings of importance of knowledge (0.34), dexterity (0.24), physical effort (0.28) and mental effort (0.48) were associated with responsibility loadings (P < 0.05). CONCLUSIONS: The elicited median responsibility loadings showed agreement with previous estimates indicating convergent validity. Components of responsibility were associated with loadings indicating that components can explain and predict responsibility aspects of dental service provision.David S. Brennan and A. John Spence

Predictors of symptom persistence and respiratory sequelae in respiratory symptomatics presenting to a post-COVID clinic

Background: COVID-19 infection causes the persistence of respiratory symptoms and functional impairment, which require prolonged follow-up care. Identification of individuals at risk for respiratory sequelae helps in optimal follow-up and early identification of complications. Aims and Objectives: The present study aims to find the clinical profile, predictors of respiratory symptom persistence, and functional impairment in post-COVID patients. Materials and Methods: Prospective observational study was done on patients who attended the post-COVID clinic in the pulmonary medicine outpatient department (OPD) in a tertiary care center in central Kerala from June 2021 to August 2021 with persisting respiratory symptoms after becoming COVID-19 negative and evaluated with a proforma regarding clinical history and symptoms. Patients were followed up at one and 3 months. Clinical, functional, and radiological factors were assessed. They were reassessed at 3 months. Spirometry was done in those with persistent symptoms at 3 months. High-resolution computed tomography (CT) was performed in those with significant desaturation on 6-min walk test (6MWT). Results: Of 348 patients, 6 died, 4 lost follow-up, 12 patients had alternative diagnoses during the study period. About 29.4% were symptomatic at 3 months. CT severity score improved over 3 months and the proportion of patients with exercise-induced desaturation in 6MWT decreased over 3 months. All patients showed a restrictive abnormality except two. A significant association was found between the persistence of symptoms at 3 months and type 2 diabetes mellitus, severe illness during the initial phase, persistent elevation of inflammatory markers, and increased radiological involvement. Alternative diagnosis and treatment-related complication was seen in 12 patients, which included infections such as tuberculosis, nocardia and fungal infection, malignancy, CTEPH, and post-intubation tracheal stenosis. Conclusion: A minor group of severe COVID-19 pneumonia survivors have delayed resolution of symptoms with functional impairment. Improvement in spirometry lags behind clinical and radiological improvement

A novel isolator-based system promotes viability of human embryos during laboratory processing

In vitro fertilisation (IVF) and related technologies are arguably the most challenging of all cell culture applications. The starting material is a single cell from which one aims to produce an embryo capable of establishing a pregnancy eventually leading to a live birth. Laboratory processing during IVF treatment requires open manipulations of gametes and embryos, which typically involves exposure to ambient conditions. To reduce the risk of cellular stress, we have developed a totally enclosed system of interlinked isolator-based workstations designed to maintain oocytes and embryos in a physiological environment throughout the IVF process. Comparison of clinical and laboratory data before and after the introduction of the new system revealed that significantly more embryos developed to the blastocyst stage in the enclosed isolator-based system compared with conventional open-fronted laminar flow hoods. Moreover, blastocysts produced in the isolator-based system contained significantly more cells and their development was accelerated. Consistent with this, the introduction of the enclosed system was accompanied by a significant increase in the clinical pregnancy rate and in the proportion of embryos implanting following transfer to the uterus. The data indicate that protection from ambient conditions promotes improved development of human embryos. Importantly, we found that it was entirely feasible to conduct all IVF-related procedures in the isolator-based workstations

The C5a anaphylatoxin receptor CD88 is expressed in presynaptic terminals of hippocampal mossy fibres

Background: In the periphery, C5a acts through the G-protein coupled receptor CD88 to enhance/maintain inflammatory responses. In the brain, CD88 can be expressed on astrocytes, microglia and neurons. Previous studies have shown that the hippocampal CA3 region displays CD88-immunolabelling, and CD88 mRNA is present within dentate gyrus granule cells. As granule cells send dense axonal projections (mossy fibres) to CA3 pyramidal neurons, CD88 expression could be expressed on mossy fibres. However, the cellular location of CD88 within the hippocampal CA3 region is unknown

Regional Multiple Pathology Scores Are Associated with Cognitive Decline in Lewy Body Dementias.

Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are characterized by the presence of α-synuclein-containing Lewy bodies and Lewy neurites. However, both dementias also show variable degrees of Alzheimer's disease (AD) pathology (senile plaques and neurofibrillary tangles), particularly in areas of the cortex associated with higher cognitive functions. This study investigates the contribution of the individual and combined pathologies in determining the rate of cognitive decline. Cortical α-synuclein, phosphorylated tau (phosphotau) and Aβ plaque pathology in 34 PDD and 55 DLB patients was assessed semi-quantitatively in four regions of the neocortex. The decline in cognition, assessed by Mini Mental State Examination, correlated positively with the cortical α-synuclein load. Patients also had varying degrees of senile Aβ plaque and phosphotau pathology. Regression analyses pointed to a combined pathology (Aβ plaque plus phosphotau plus α-synuclein-positive features), particularly in the prefrontal cortex (BA9) and temporal lobe neocortex with the superior and middle temporal gyrus (BA21, 22), being a major determining factor in the development of dementia. Thus, cognitive decline in Lewy body dementias is not a consequence of α-synuclein-induced neurodegeneration alone but senile plaque and phosphorylated tau pathology also contribute to the overall deficits.The main fundingwas provided by the Alzheimer’s SocietyUK and the BUPA Foundation. The research in Newcastle was supported in part by the Dunhill Medical Trust (R173/1110). Tissue for this study was provided by (i) the Newcastle Brain Tissue Resource; (ii) the London Neurodegenerative Brain Bank; and (iii) the Thomas Willis Oxford Brain Collection. All three resources are funded in part by grants from the UK Medical Research Council and by Brains for Dementia Research, a joint venture between Alzheimer’s Society and Alzheimer’s Research UK. In Singapore, funding was provided by a Centre grant (NMRC/CG/NUHS/2010) and a Clinical Scientist Award (NMRC/CSA/032/2011) from the National Medical Research Council.This is the final published version. It first appeared at http://onlinelibrary.wiley.com/doi/10.1111/bpa.12182/abstract