Closed Degloving Injury of the Foot Caused by a High Impact Force: A Case Report.

An 18-year-old male subject was referred to our MRI scanning center, by an orthopedic surgeon, for a swelling over the plantar region of the foot. He had been in a motor vehicle accident a few weeks back, with no evidence of fracture at the time of injury. In subsequent weeks, he developed a swelling over his foot. MRI showed the presence of a fluid intensity lesion in the subdermal and dermal layers of his foot. Unguarded motor vehicle accidents often tend to cause severe injuries. Sometimes, they even need operative management since a motor vehicle collision is a high-impact accident. One of the pathologies caused by a high impact force is the Morel-Lavallée lesion or a closed type of degloving injury. A Morel-Lavallee lesion also needs operative intervention if major vascular channels are involved in the degloving. However, if the major vessels supplying the region of degloving are intact, open surgery may not be needed. In such cases, incision and drainage along with serial wound dressing may be attempted. The primary risk in closed degloving is recurrent or subsequent tissue necrosis. Close and watchful monitoring is needed to anticipate and prevent these. Closed degloving injuries or Morel-Lavallée lesions have been commonly described in the thigh and pelvis region. Here, we describe a case that developed in the dermal and fascial layers of the foot and was managed conservatively. The epidermal layer showed regeneration, and the patient did not need subsequent amputation.

Rectus Sheath Hematoma in a Recovering Dengue Patient: A Case Report.

A 63-year-old male patient recovering from dengue came to our department for contrast-enhanced computed tomography (CECT) for the evaluation of abdominal pain. An ultrasound performed in the periphery diagnosed him with a rectus abscess. The CECT evaluation done in our department clarified that the collection in his rectus sheath was hemorrhagic and not infective, as previously thought. The patient was managed conservatively and recovered without complications. Like most infectious diseases, dengue is a disease of tropical countries. System-wise data collection processes are inadequate in many developing countries, which means complications and adverse effects of common diseases are not adequately captured. Furthermore, resource limitations restrict the availability of more expensive diagnostic tests to central locations. Peripherally located regions with lower purchasing capacity have greater access to relatively inexpensive tests. This causes deficits in the management of some common disease entities, like dengue. Considering these issues, it is important to optimize healthcare testing for low-resource settings. This can only be achieved with adequate sensitization of healthcare providers in diagnosis and management.

Scattered Musculoskeletal Venous Malformations in Children: A Rare Report on Clinical Evaluation and Sclerotherapy with Adjunctive Stasis of Efflux.

Introduction: Venous malformations are rare lesions of unknown etiology, with a reported incidence of 0.8-1%. Patients with inexorable growth and expansion of vascular malformations, or" have an unpredictable clinical course and a wide range of presenting symptoms. Often, they are erroneously diagnosed and inadequately treated due to their rarity and lack of expertise among clinicians. To author's information this is the first report of diffuse venous malformations with multiple phleboliths involving various compartments of the upper extremity in children. Case Report: The uthors discuss the clinical presentation, evaluation, and treatment over 8 months of slow-flow venous malformations with phleboliths in an11-year-old girl presenting with multiple painful swellings throughout her right upper extremity. The right upper extremity had multiple swellings over the right hand, forearm, arm, and shoulder region involving multiple compartments. The digital swellings had bluish discoloration, indicating a vascular nature. Blood tests revealed a raised D-dimer level (2.42 mg/L). Radiographs, Ultrasound, Magnetic resonance imaging, and CT angiography suggested a slow-flow venous malformation. The excisional biopsy confirmed the diagnosis. Ultrasound-guided Sclerotherapy with the Sclerotherapy with Adjunctive Stasis of Efflux Technique was performed for other lesions. Sodium Tetradecyl Sulfate (60 mg/2 mL; 0.5mL) was used in each lesion. Post-intervention, at 6 months follow-up, cosmetic appearance improved drastically, with the hands benefitted most. Parents were satisfied with overall outcome. Sclerotherapy was stopped after 4 cycles. Conclusion: Ultrasound-guided sclerotherapy is effective in treating venous malformations. The ideal result is seen after 4-5 sittings. Sclerotherapy must be performed in the operating theatre under sedation or appropriate anesthesia with resuscitation equipment at the ready disposal. Excision is reserved for bigger superficial lesions.

Synthetic propeptide inhibits mosquito midgut chitinase and blocks sporogonic development of malaria parasite.

Incessant transmission of the parasite by mosquitoes makes most attempts to control malaria fail. Blocking of parasite transmission by mosquitoes therefore is a rational strategy to combat the disease. Upon ingestion of blood meal mosquitoes secrete chitinase into the midgut. This mosquito chitinase is a zymogen which is activated by the removal of a propeptide from the N-terminal. Since the midgut peritrophic matrix acts as a physical barrier, the activated chitinase is likely to contribute to the further development of the malaria parasite in the mosquito. Earlier it has been shown that inhibiting chitinase activity in the mosquito midgut blocked sporogonic development of the malaria parasite. Since synthetic propeptides of several zymogens have been found to be potent inhibitors of their respective enzymes, we tested propeptide of mosquito midgut chitinase as an inhibitor and found that the propeptide almost completely inhibited the recombinant or purified native Anopheles gambiae chitinase. We also examined the effect of the inhibitory peptide on malaria parasite development. The result showed that the synthetic propeptide blocked the development of human malaria parasite Plasmodium falciparum in the African malaria vector An. gambiae and avian malaria parasite Plasmodium gallinaceum in Aedes aegypti mosquitoes. This study implies that the expression of inhibitory mosquito midgut chitinase propeptide in response to blood meal may alter the mosquito's vectorial capacity. This may lead to developing novel strategies for controlling the spread of malaria.