Anatomical variations and developmental insights of tendons in the first extensor compartment of the hand: Cadaveric study with surgical implications.

Background: Anatomical variations in first extensor compartment play a role in the development of de Quervain's disease. This study delves into the detailed examination of these anatomical variations. Methods: 50 upper limbs (28 male and 22 female) from 25 for-malin-embalmed adult human cadavers were dissected to investigate variations in tendons of first extensor compartment. Results: Accessory tendons to main tendon of abductor pollicis longus (APL) were reported in 49 (98%) cases, with 34% having two accessory tendons, 52% having three, and 12% having four. Terminal ends of these accessory tendons were generally consistent, except in one case where it split into two tendinous bands at insertion site, which was most commonly at base of first metacarpal. Extensor pollicis brevis (EPB) was found as a single tendon in 48 cases, with one case each of duplication and absence. In 19 cases (38%), muscle belly of EPB was fused with that of APL to some extent and it typically inserted at base of the proximal phalanx of the thumb. Average length of muscle belly, tendon, and muscle tendon ratio (MTR) of APL was 15.99±0.62 cm, 5.91±0.76 cm and 2.71 and of EPB was 6.39±0.29 cm, 9.15±0.74 cm and 0.70 respectively. Conclusion: APL variations range from accessory tendons, splitting of tendons to various insertion points. Additionally, length and insertions points of these accessory tendons are key factors in deciding their usability as graft sources for tendon reconstruction and in surgical treatments of conditions like de Quervain's tenosynovitis.

Initiatives for Early Medical Student Engagement with the Field of Otolaryngology - Head and Neck Surgery.

OBJECTIVE: Early exposure and mentorship in surgical specialties like otolaryngology - head and neck surgery are critical for medical students. This paper presents initiatives implemented at our institution to engage early-career medical students with the field. METHODS: A hands-on laryngoscope workshop was organised, and a centralised online platform was created for research and mentorship opportunities using a collaborative project management tool. Both measures were advertised via e-mail to student interest groups and campus diversity groups. At the end of the workshop, participating students completed an online distributed survey. RESULTS: Students' perception of their knowledge of airway anatomy and related clinical scenarios significantly improved after the laryngoscopy workshop (p = 0.001 and p = 0.002, respectively). All attendees indicated that the workshop increased their comfort level with procedures and that they would recommend the workshop to colleagues. Nearly half of participants reported becoming 'very interested' in exploring otolaryngology - head and neck surgery through future elective courses. CONCLUSION: Implementation of such initiatives at other institutions can generate medical student interest and may improve diversity in otolaryngology - head and neck surgery.

Multiple primary malignant neoplasms: a case of colonic adenocarcinoma and non-Hodgkin's lymphoma on a background of ulcerative colitis.

The presence of an adenocarcinoma and non-Hodgkin's lymphoma in an individual is an uncommon finding. In this case report, we discuss the case of an elderly man presenting with a synchronous moderately differentiated colonic adenocarcinoma alongside a distal ileal extranodal marginal zone lymphoma, on a background of ulcerative colitis. He underwent an elective open panproctocolectomy with an end ileostomy for the management of his malignancy.

Multiple primary malignant neoplasms: a case of colonic adenocarcinoma and non-Hodgkin's lymphoma on a background of ulcerative colitis.

The presence of an adenocarcinoma and non-Hodgkin's lymphoma in an individual is an uncommon finding. In this case report, we discuss the case of an elderly man presenting with a synchronous moderately differentiated colonic adenocarcinoma alongside a distal ileal extranodal marginal zone lymphoma, on a background of ulcerative colitis. He underwent an elective open panproctocolectomy with an end ileostomy for the management of his malignancy.

PrEP Eligibility and Interest Among Clinic- and Community-Recruited Young Black Women in Atlanta, Georgia, USA.

BACKGROUND: Atlanta has been identified as an HIV "hot spot" for Black women and ranks 5th in the US with new infections. Yet little is known about PrEP eligibility or interest among young Black women in Atlanta. METHODS: A convenience sample of 1,261 Black women (ages 14-24 years) were recruited from two settings: community venues and sexual health clinics. They provided self-reported sexual behavior data and specimens for laboratory testing for chlamydia (CT) and gonorrhea (GC) infections. For each woman, the number of key self-reported behavioral HIV risk factors was calculated (0-6 factors for the clinic sample, 0-3 factors for the community sample). A single item assessed PrEP interest in the community sample only. RESULTS: Bacterial STI positivity, an indicator for PrEP eligibility, was 20.5% (17.1% CT, 6.3% GC) and 20.9% (18.8% CT, 5.2% GC) for the clinic and community samples, respectively. Of the 144 STI positive women from the clinic sample, 20.1% reported no behavioral risk indicators and 47.2% reported > 2 behavioral indicators. Of the 117 STI positive women from the community sample, 21.4% reported no behavioral risk indicators. 60.7% of the community sample reported they would be likely or very likely to use PrEP if available. CONCLUSION: Young Black women in Atlanta, whether sampled from community or sexual health settings, are at substantial risk for HIV infection and meet several PrEP eligibility criteria. Scaling up PrEP among women in Atlanta could have significant implications for HIV in this high burden region.

Can geodata be used to determine the distribution of fast food outlets in relation to the prevalence and severity of asthma? A novel methodology.

RESEARCH QUESTION: Can the distribution of fast food outlets be obtained and effectively used to identify if there is a relationship between the placement of these and the prevalence and severity of asthma, rhinoconjunctivitis and eczema (ARE) in children and adolescents? METHOD: Fast food restaurant location data was obtained for seven countries. Data from the International Study of Asthma and Allergies in Childhood (ISAAC) was used from 53 centres in the same seven countries. Each ISAAC centre provided a detailed map of the study area. The location of restaurants and ISAAC centres were overlaid using the ArcMap software, and the number of restaurants within each ISAAC centre counted. Bivariate regression analysis was used to compare outlet density with ARE prevalence and severity. RESULTS: The results from the analyses showed a positive (non-significant) trend on a regression plot between outlet density and ARE severity. This project has shown that it is practical to systematically obtain and map fast food outlets and compare their distribution worldwide with the prevalence and severity of diseases, in this case ARE. The devised methodology has proven to be an efficient way to obtain restaurant distribution data in a form that is manageable and suitable to compare with area based disease prevalences. This project has shown that a larger scale investigation is both feasible and warranted.

Inhibition of human mitochondrial peptide deformylase causes apoptosis in c-myc-overexpressing hematopoietic cancers.

Inhibition of human mitochondrial peptide deformylase (HsPDF) depolarizes the mitochondrial membrane, reduces mitochondrial protein translation and causes apoptosis in Burkitt's lymphoma. We showed that HsPDF mRNA and protein levels were overexpressed in cancer cells and primary acute myeloid leukemia samples. Myc regulates mitochondria and metabolism; we also demonstrated c-myc regulated the expression of HsPDF, likely indirectly. Inhibition of HsPDF by actinonin blocked mitochondrial protein translation and caused apoptotic death of myc-positive Burkitt's lymphoma, but not myc-negative B cells. Inhibition of mitochondrial translation by chloramphenicol or tetracycline, structurally different inhibitors of the mitochondrial ribosome, which is upstream of deformylase activity, followed by treatment with actinonin, resulted in reversal of the biochemical events and abrogation of the apoptosis induced by actinonin. This reversal was specific to inhibitors of HsPDF. Inhibition of HsPDF resulted in a mitochondrial unfolded protein response (increased transcription factors CHOP and CEB/P and the mitochondrial protease Lon), which may be a mechanism mediating cell death. Therefore, HsPDF may be a therapeutic target for these hematopoietic cancers, acting via a new mechanism.

Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results.

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November-December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states - Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1-348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7-33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.

Complete esophageal obliteration secondary to cytomegalovirus in AIDS patient.

HIV-related benign esophageal strictures have been reported secondary to idiopathic esophageal ulceration, cytomegalovirus (CMV) esophagitis, herpetic esophagitis, and increased sensitivity to radiation therapy. Despite extensive and deep nature of CMV ulceration, stricture formation is uncommon. There have been anecdotal reports of esophageal strictures secondary to CMV infection in HIV patients. Esophageal stricture has been reported during active CMV ulceration as well as subsequent to successful treatment. Esophageal strictures secondary to CMV have also been reported without prior ulceration. We report a patient with CMV esophagitis presenting with ulceration and stricture who developed total obliteration of esophageal lumen following treatment with gancyclovir.

Sildenafil therapy in secondary pulmonary hypertension: Is there benefit in prolonged use?

BACKGROUND: Sildenafil is of benefit to selected patients with pulmonary hypertension due to parenchymal lung or cardiac disease. We present data from patients with secondary pulmonary hypertension, comparing their right heart catheter results and six minute walking distance to time on treatment. METHODS: 25 patients with symptomatic secondary pulmonary hypertension received sildenafil 50 mg tds in a 5-year period. Underlying causes were chronic inoperable thromboembolic disease (11), COPD (6), interstitial lung disease (5) and valvular heart disease (3). Their cardio-pulmonary haemodynamics were measured with right heart catheterization prior to treatment, post-treatment at 2, 6 and 12 months and subsequently depending upon clinical need. Six-minute walk distance was also measured. RESULTS: Patient age range was 40 to 83 (median 70.5) years. Time of treatment to latest right heart catheter was 2 to 60 (median 17) months and 8 to 61 (median 34) months to clinic follow-up or death. There was a significant reduction in six-minute walk distance from baseline to long term (>12 months) follow-up (p=0.002). Pulmonary vascular resistance was significantly reduced from baseline to 12 months (p=0.049). The mean pulmonary arterial (PA) pressure was significantly reduced at long-term follow-up (p=0.009). 20 patients had an improved PA pressure with treatment. In those with a worsening PA pressure, two had an improvement in cardiac output and six minute walk distance, two had stable cardiac output at 20 and 21 months, and one had measurements taken during a significant illness. Three patients, who had a reduction in PA pressure, subsequently died of progression of underlying illness at 8 months, from myocardial infarction at 34 months, and from aspergillus pneumonia at 59 months. CONCLUSION: Long-term use of sildenafil in patients with secondary forms of pulmonary hypertension is associated with a sustained improvement in cardio-pulmonary haemodynamics. Lack of improvement may be attributed to other factors apart from treatment failure, such as underlying disease progression or unrelated concurrent illness at time of assessment.

Baseline evaluation of routine HIV testing among tuberculosis patients in Botswana.

In January 2004, the government of Botswana introduced a policy of routine, non-compulsory human immunodeficiency virus (HIV) testing to increase testing and access to antiretroviral treatment (ART) for individuals presenting for medical treatment. Before a systematic implementation of the policy, we conducted a cross-sectional survey of tuberculosis (TB) record data from 46 clinics in 10 districts to assess baseline HIV testing rates among TB patients. Recorded HIV results from the facility TB register and TB treatment card were reviewed. Of the 1242 TB patients entered in the register, 47% had a recorded HIV result and 84% of these were co-infected with HIV. TB treatment cards were available for 862 (69%) registered patients. Among the 411 (47%) with test results recorded on the treatment card, 341 (83%) were HIV-infected; of these, 12% were reported to be receiving ART.

A novel approach to the management of acute tracheal tear.

OBJECTIVE: We describe the emergency use of a covered, expandable, removable tracheal stent in a patient who developed a large posterior tracheal tear complicating endobronchial therapy for large airway obstruction. METHOD: Case report and review of the literature concerning management of acute tracheal tear. RESULTS AND CONCLUSION: Our patient demonstrates that endotracheal stenting is an option for managing acute large airway tear. Moreover, the use of a removable stent allows not only for rapid closure of the defect but also removal once the defect has healed, thus avoiding long-term complications of stent deployment.

Radiotherapy: a novel treatment for pneumothorax.

Pneumothorax is a relatively common condition that is usually managed either conservatively, by chest tube drainage or, if a refractory air leak persists, then with cardiothoracic intervention. However, there is a small group of patients with a persistent air leak in whom surgical intervention is felt to be inappropriate. This study looks at a novel management strategy in a patient presenting with this scenario. A male with underlying bullous lung disease presented with a right pneumothorax. Complete re-expansion was not achieved, despite chest tube drainage and suction. Cardiothoracic intervention was felt to be inappropriate and the air leak persisted despite prolonged conservative management. Ventilation scintigraphy was therefore used to localise the air leak prior to targeted radiotherapy in an attempt to seal the leak via radiation-induced fibrosis. Three weeks after the first fraction of radiotherapy, the air leak ceased. In complex cases of pneumothorax with persistent air leak where cardiothoracic intervention is deemed inappropriate, identification of the air leak site and localised radiotherapy could be considered.

Bolus thrombolytic infusion during prolonged refractory cardiac arrest of undiagnosed cause.

Acute myocardial infarction (AMI) and pulmonary embolism (PE) account for about 70% of cardiac arrest. Although thrombolytic therapy is an effective therapy for both AMI and PE, it is not routinely recommended during cardiopulmonary resuscitation (CPR) for fear of life threatening bleeding complications. Numerous case reports and retrospective studies have suggested a beneficial effect of thrombolytics in cardiac arrest secondary to AMI and PE; however, we present a case of successful use of bolus thrombolytics during CPR in a patient with undifferentiated cardiac arrest (undiagnosed cause) after prolonged conventional resuscitation without success.

Airway management of patients with tracheobronchial stents.

The use of tracheobronchial stents for compromised large airways is increasing. We provide a case series highlighting some of the complications of airway management in patients with tracheobronchial stents in situ and propose an approach for dealing with this potentially complicated situation.

Novel approach to management of a posterior tracheal tear complicating percutaneous tracheostomy.

We treated a patient who developed a posterior tracheal wall perforation and severe respiratory compromise following percutaneous tracheostomy, using a covered expandable metallic stent. The stent was deployed under direct vision using rigid and fibreoptic bronchoscopy. The defect was sealed and the right lung, which had been collapsed, was re-expanded. The patient was subsequently weaned from mechanical ventilation. Late complications included halitosis, which was treated with nebulized colistin sulphate, and the development of intratracheal granulation tissue, which was cleared using low power (10 W) Nd:YAG laser.

Congenital cystic lesions in head and neck.

Congenital lesions by definition are present at birth; but certain congenital lesions of the head and neck, like branchial cysts and dermoid cysts, clinically present in childhood, early adulthood or late in life. A good history and a high degree of suspicion are the key to the adequate management of such lesions. Here we present a series of six case reports of congenital cystic lesions of the head and neck.