Cerebellar abscess caused by Listeria monocytogenes in a liver transplant patient.

Brain abscesses are a rare but serious complication and have been documented in transplant recipients. Aspergillus is by far the most frequent etiology of post-transplant brain abscesses. Bacteria, apart from Nocardia, have a low association with brain abscesses in transplant recipients. We report herein the case of a 52-year-old man who had undergone orthotopic liver transplantation (OLT) for end-stage liver disease and hepatocellular carcinoma secondary to chronic hepatitis, and who developed a cerebellar abscess (CA) from Listeria monocytogenes. Three months after transplantation, he presented with a 1-week history of headache and vomiting. Computed tomography scan of the brain revealed a space-occupying lesion in the right cerebellum, which was further confirmed by magnetic resonance imaging. Emergency surgery was planned because of pressure effect on the surrounding structures. The patient recovered smoothly from the surgery. To our knowledge, no reports of Listeria CA following OLT have been published in the English literature. This case shows that, although extremely rare, L. monocytogenes may cause CA in liver transplant recipients, and clinicians should be aware of this, so that prompt diagnosis and treatment can be instituted before serious brain damage can occur.

High-flow oxygen therapy v. standard care in infants with viral bronchiolitis.

Background: High-flow humidified oxygen (HFHO) therapy has demonstrated benefit in infants with bronchiolitis. Objectives: To investigate the efficacy of HFHO in infants with moderate to severe viral bronchiolitis, when used outside the paediatric intensive care unit (PICU), in a hospital with limited PICU resources. Methods: A randomised controlled trial, which enrolled 28 infants between 1 month and 2 years of age, with a clinical diagnosis of acute viral bronchiolitis and moderate to severe respiratory distress. Participants were randomised to receive HFHO 2L/kg/min or oxygen by nasal cannula/ face mask. Respiratory rate, heart rate, oxygen saturations, and modified TAL (M-TAL) score were measured at baseline, 60 - 90 minutes after starting therapy and at 6- and 12-hourly intervals. The primary outcome evaluated was the improvement in respiratory distress (M-TAL score). The secondary outcome assessed was the need for intubation and ventilation. Results: There was a significant improvement in respiratory distress (M-TAL score), in infants who received HFHO therapy. Additionally, there was also a reduction in heart rate in the HFHO group as well as a trend to lower intubation rates. Conclusion: HFHO is a beneficial therapy for infants with moderate-severe viral bronchiolitis. It can be safely used outside the PICU and could potentially reduce the need for intubation and admission to PICU in resource-limited settings. Contributions of the study: High-flow humidified oxygen (HFHO) is effective in infants with moderate to severe bronchiolitis, and not only in those with milder forms of the disease. It can be safely used outside the paediatric intensive care unit, where adequate respiratory monitoring is available. This is important in low-resource areas where there may be insufficient critical care resources to manage these patients.

Genome-Wide Identification and Expression Profiling of the PDI Gene Family Reveals Their Probable Involvement in Abiotic Stress Tolerance in Tomato (Solanum Lycopersicum L.).

Protein disulfide isomerases (PDI) and PDI-like proteins catalyze the formation and isomerization of protein disulfide bonds in the endoplasmic reticulum and prevent the buildup of misfolded proteins under abiotic stress conditions. In the present study, we conducted the first comprehensive genome-wide exploration of the PDI gene family in tomato (Solanum lycopersicum L.). We identified 19 tomato PDI genes that were unevenly distributed on 8 of the 12 tomato chromosomes, with segmental duplications detected for 3 paralogous gene pairs. Expression profiling of the PDI genes revealed that most of them were differentially expressed across different organs and developmental stages of the fruit. Furthermore, most of the PDI genes were highly induced by heat, salt, and abscisic acid (ABA) treatments, while relatively few of the genes were induced by cold and nutrient and water deficit (NWD) stresses. The predominant expression of SlPDI1-1, SlPDI1-3, SlPDI1-4, SlPDI2-1, SlPDI4-1, and SlPDI5-1 in response to abiotic stress and ABA treatment suggested they play regulatory roles in abiotic stress tolerance in tomato in an ABA-dependent manner. Our results provide new insight into the structure and function of PDI genes and will be helpful for the selection of candidate genes involved in fruit development and abiotic stress tolerance in tomato.

Idle emissions from medium heavy-duty diesel and gasoline trucks.

Idle emissions data from 19 medium heavy-duty diesel and gasoline trucks are presented in this paper. Emissions from these trucks were characterized using full-flow exhaust dilution as part of the Coordinating Research Council (CRC) Project E-55/59. Idle emissions data were not available from dedicated measurements, but were extracted from the continuous emissions data on the low-speed transient mode of the medium heavy-duty truck (MHDTLO) cycle. The four gasoline trucks produced very low oxides of nitrogen (NOx) and negligible particulate matter (PM) during idle. However, carbon monoxide (CO) and hydrocarbons (HCs) from these four trucks were approximately 285 and 153 g/hr on average, respectively. The gasoline trucks consumed substantially more fuel at an hourly rate (0.84 gal/hr) than their diesel counterparts (0.44 gal/hr) during idling. The diesel trucks, on the other hand, emitted higher NOx (79 g/hr) and comparatively higher PM (4.1 g/hr), on average, than the gasoline trucks (3.8 g/hr of NOx and 0.9 g/hr of PM, on average). Idle NOx emissions from diesel trucks were high for post-1992 model year engines, but no trends were observed for fuel consumption. Idle emissions and fuel consumption from the medium heavy-duty diesel trucks (MHDDTs) were marginally lower than those from the heavy heavy-duty diesel trucks (HHDDTs), previously reported in the literature.

Tracheal tube cuff pressure monitoring: Assessing current practice in critically ill patients at Chris Hani Baragwanath Academic Hospital.

Background: Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications. Objectives: To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring. Methods: Frequency of CP measurement was assessed using a prospective chart review, followed by an interventional component. In the final stage nurses completed a self-administered questionnaire. Results: A total of 304 charts from 61 patients were reviewed. Patients' ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of respondents were trained in critical care. Knowledge of current critical care CP monitoring guidelines was reported by 62% of the respondents (n=23/37). Only 53% (20/38) reported routinely measuring CP. Almost all respondents (94%) knew of at least one complication of abnormal CP. Conclusion: Having a basic knowledge of CP measurement, having awareness of the complications of abnormal CP and the availability of national best practice guidelines did not translate into appropriate ICU practice. Research into effective implementation strategies to achieve best practice is needed. Contributions of the study: Basic knowledge of cuff pressure measurement may not always result in best practice.Improvement in current practice requires research into effective implementation strategies.

Idle emissions from heavy-duty diesel vehicles: review and recent data.

Heavy-duty diesel vehicle idling consumes fuel and reduces atmospheric quality, but its restriction cannot simply be proscribed, because cab heat or air-conditioning provides essential driver comfort. A comprehensive tailpipe emissions database to describe idling impacts is not yet available. This paper presents a substantial data set that incorporates results from the West Virginia University transient engine test cell, the E-55/59 Study and the Gasoline/Diesel PM Split Study. It covered 75 heavy-duty diesel engines and trucks, which were divided into two groups: vehicles with mechanical fuel injection (MFI) and vehicles with electronic fuel injection (EFI). Idle emissions of CO, hydrocarbon (HC), oxides of nitrogen (NOx), particulate matter (PM), and carbon dioxide (CO2) have been reported. Idle CO2 emissions allowed the projection of fuel consumption during idling. Test-to-test variations were observed for repeat idle tests on the same vehicle because of measurement variation, accessory loads, and ambient conditions. Vehicles fitted with EFI, on average, emitted approximately 20 g/hr of CO, 6 g/hr of HC, 86 g/hr of NOx, 1 g/hr of PM, and 4636 g/hr of CO2 during idle. MFI equipped vehicles emitted approximately 35 g/hr of CO, 23 g/hr of HC, 48 g/hr of NOx, 4 g/hr of PM, and 4484 g/hr of CO2, on average, during idle. Vehicles with EFI emitted less idle CO, HC, and PM, which could be attributed to the efficient combustion and superior fuel atomization in EFI systems. Idle NOx, however, increased with EFI, which corresponds with the advancing of timing to improve idle combustion. Fuel injection management did not have any effect on CO2 and, hence, fuel consumption. Use of air conditioning without increasing engine speed increased idle CO2, NOx, PM, HC, and fuel consumption by 25% on average. When the engine speed was elevated from 600 to 1100 revolutions per minute, CO2 and NOx emissions and fuel consumption increased by >150%, whereas PM and HC emissions increased by approximately 100% and 70%, respectively. Six Detroit Diesel Corp. (DDC) Series 60 engines in engine test cell were found to emit less CO, NOx, and PM emissions and consumed fuel at only 75% of the level found in the chassis dynamometer data. This is because fan and compressor loads were absent in the engine test cell.

Renal thoracic ectopia. A case report.

We report a case that presented with an opacity on chest X-ray that was found to be an abnormal ectopic kidney. Renal ectopia is rare and usually does not require treatment.

Management of renal stab wounds by arteriographic embolisation.

A 26 year old man was admitted with multiple stab wounds to his chest, abdomen and right loin. He was noted to have a large haemothorax, a tender abdomen and frank haematuria. At laparotomy, there was a small non expanding retroperitoneal haematoma that was not explored, and no visceral damage. Post operatively he continued to have haematuria. IVP and ultrasound showed perirenal haematoma and clot in the upper pole calyces but was otherwise normal. Renal arteriography demonstrated a pseudo-aneurysm in the right mid region, feeding an arteriovenous fistula (Figure 1). Selective renal artery embolisation with spring occlusion coils was performed which occluded the branch supplying the false aneurysm and fistula (Figure 2). He had no further haematuria. At six month follow up he remained well, normotensive and with no haematuria. Isotope renogram showed 30% loss of function at the upper pole.

Emblica officinalis Gaertn and serum cholesterol level in experimental rabbits.

Twelve albino rabbits of either sex weighing 1.0-1.25 kg were fed a standard laboratory diet of green grass and sattu (roasted Bengal gram). After a 2-week run-in period their serum cholesterol levels were estimated. All animals were now fed 0.5 g cholesterol and 1.0 g clarified butter daily and were not divided into 3 groups of 4 animals each. While all received the standard cholesterol-rich diet, Group A animals received no additional substances, animals in Group B were each fed 10 mg vitamin C daily, while those in Group C were each given 1.0 g fresh Amla (Emblica officinalis Gaertn). Mean serum cholesterol levels in all three groups rose to significantly higher levels by the end of the second week. There was a further rise by the end of the third and fourth weeks in Groups A and B. However, animals in Group C (i.e. those given Amla) showed significantly lower mean serum cholesterol levels at the end of the second week than their counterparts in Groups A and B. At the end of the third and fourth weeks the differences were even more pronounced.

Comparison of patients' assessment of urinary flow strength with uroflowmetry.

OBJECTIVE: The objective of the study was to compare patients' self-assessment of urinary flow strength with uroflowmetry. METHODS: The study was set in the routine uroflow clinic of the urology department. All patients had symptoms of bladder outlet obstruction. They answered 2 questions and a multiple-choice pictorial representation of flow trajectory. Patients were encouraged to provide 3 flows with at least one volume over 150 ml. The maximum flow rate Qmax was compared with the subjective evaluations. RESULTS: Qmax was normally distributed. Answers to the questions did separate patients significantly (p < 0.001). However, overlap between groups was large; the group who answered that their flow was poor included many false positives. Pictorial assessment showed low correlation with Qmax, again with a high false-positive rate. CONCLUSION: Patients' self-assessment of strength of stream is unreliable as a measure of Qmax and therefore of obstruction. Resection of prostate on history alone is not recommended.

Hypertension associated with increased renin concentrations in nephroblastoma.

An infant with severe hypertension who had a nephroblastoma which was secreting active renin is described. Nephroblastoma must be included in the differential diagnosis of hypertension associated with increased renin concentrations, even in the absence of an abdominal mass.

Evaluation of a combination of a unani pharmacopeal preparation (itrifal ustukhudoos) with cloves (qaranfal) in allergic rhinitis - a preliminary clinical study.

Allergic Rhinitis is typically characterized by sneezing, rhinorrhoea, nasal obstruction, nasal, conjunctival & pharyngeal itching and lacrimation all occurring in a temporal relation to allergen exposure. The peak incidence of this disease occurs in childhood and adolescence, with most of the cases belonging to the atopic category.There is a high incidence of patients of allergic rhinitis attending the outdoor sections of Ajmal Khan Tibbiya College Hospital. Many of them are dissatisfied with conventional anti-histaminic drugs. An open study was carried out on 20 such patients aged between 15 to 50 years to evaluate the clinical efficacy of a unani pharmacopeal preparation [Itrifal ustukhudoos] added with cloves [qaranfal]. Preliminary clinical study showed promising results. The study is into the next phase in which a comparative double-blind trial is being conducted with this combination and Allegra (Fexofenadine hydrochloride).

Amphotericin versus sodium stibogluconate in first-line treatment of Indian kala-azar.

Patients do not always respond to treatment of visceral leishmaniasis with pentavalent antimony, and the drug has toxic effects. Amphotericin B might be useful as an alternative first-line treatment for the disease. We compared the efficacy of amphotericin and sodium stibogluconate in a prospective randomised trial in 80 uncomplicated and parasitologically confirmed cases of Indian kala-azar. None of the patients had received an antileishmanial agent before. Sodium stibogluconate was given at 20 mg/kg in two divided doses daily for 40 days, and amphotericin in fourteen doses of 0.5 mg/kg infused in 5% dextrose on alternate days. All 40 patients randomised to amphotericin were cured; of the 40 patients assigned to sodium stibogluconate, 28 (70%) showed initial cure and 25 (62.5%) showed definitive cure (p < 0.001). With amphotericin, there was quicker abatement of fever and more complete spleen regression with no serious adverse effects. Amphotericin is effective in the first-line treatment of Indian kala-azar and superior to antimony therapy.

Bladder transection revisited.

OBJECTIVE: To ascertain the safety and effectiveness of bladder transection for the treatment of enuresis and urinary frequency. PATIENTS AND METHODS: Twelve patients who had an open bladder transection performed at the Victoria Infirmary, Glasgow, were followed up for a mean of 37 months. RESULTS: Of the 12 patients, three were 'cured', seven were better, two were no better and none were worse than before the operation. All six patients with preoperative enuresis were cured of this by the procedure. CONCLUSIONS: Bladder transection remains a useful procedure in selected patients and avoids the problems associated with enterocystoplasty.

Amphotericin versus pentamidine in antimony-unresponsive kala-azar.

We compared the efficacy of amphotericin B and pentamidine isethionate in a prospective randomised trial in 120 uncomplicated and parasitologically confirmed cases of antimony-unresponsive kala-azar. Doses were twenty intramuscular injections of pentamidine 4 mg/kg on alternate days or fourteen definitive doses of amphotericin 0.5 mg/kg infused in 5% dextrose on alternate days. 48 (80%) patients given pentamidine showed initial cure and 46 (77%) showed definitive cure compared with 60 (100%) and 59 (98%) cases, respectively, on amphotericin (p < 0.001). Amphotericin also brought about quicker abatement of fever and more complete spleen regression.

Autoimmune disorders complicating adolescent Hodgkin's disease.

Four adolescents with Hodgkin's disease also developed autoimmune diseases. There were two idiopathic thrombocytopenic purpura (ITP), one polymyositis, and one scleroderma. The first two patients developed ITP in the absence of a spleen, and with their Hodgkin's disease in remission. The first patient with Hodgkin's disease has been continuously free of cancer for over five years. The second patient was a 17-year-old male whoe Hodgkin's disease recurred, but whose disease was in remission at the time the ITP occurred. The polymyositis occurred in an 18-year-old youth when he was in his initial remission for his Hodgkin's disease, but his disease subsequently recurred two years later. This youth presented with Coombs positive autoimmune hemolytic anemia. The polymyositis did not respond to therapy, and he is left with severe muscle wasting and weakness; however, the polymyositis is now quiescent. The scleroderma occurred in an 18-year-old female who had been continuously free of Hodgkin's disease for eight years. The scleroderma did not respond to drug therapy and she now has moderate skin changes, but remains in continuous remission of her Hodgkin's disease. Although there are a few reports of Hodgkin's disease and concurrent autoimmune disorders, physicians dealing with cancer in adolescents should be aware of this association.

Cisplatin therapy in recurrent childhood brain tumors.

Twenty-two patients with brain tumors were initially treated with surgery, radiation therapy, and/or adjuvant chemotherapy. Histologic diagnosis included 11 gliomas, seven ependymomas, one dysgerminoma, one teratocarcinoma, one pinealoma, and one small cell tumor. At recurrence, documented on computerized tomographic scan, cisplatin (60 mg/m2/day iv X 2) was given every 3-4 weeks. Seventeen patients received two or more courses and were considered to be evaluable for response. Response parameters included change in the size of tumor on computerized tomographic scan and/or in clinical findings. Four patients had complete response, five had partial response, four had stable disease, and four had disease progression. Toxic effects were manageable. The number of patients with grade 3-4 toxic reactions, by category, were: thrombocytic, ten; leukocytic, four; renal, five; metabolic, four; gastrointestinal, none; and neurologic, seven. Two of the 14 patients tested had grade 3-4 ototoxicity. Acute fluid retention with decreased serum electrolytes and serious but reversible changes in the mental status, which were experienced in earlier patients, decreased in severity with increasing experience of the investigator. In summary, cisplatin appears to be active in a spectrum of brain tumors and should be studied further for therapeutic efficacy.