Management of Acute Kidney Injury in Critically Ill Children

Acute kidney injury (AKI) is common in critically ill patients, afecting almost one in four critically ill children and one in three neonates. Higher stages of AKI portend worse outcomes. Identifying AKI timely and instituting appropriate measures to prevent and manage severe AKI is important, since it is independently associated with mortality. Methods to predict severe AKI should be applied to all critically ill patients. Assessment of volume status to prevent the development of fuid overload is useful to prevent adverse outcomes. Patients with metabolic or clinical complications of AKI need prompt kidney replacement therapy (KRT). Various modes of KRT are available, and the choice of modality depends most on the technical competence of the center, patient size, and hemodynamic stability. Given the signifcant risk of chronic kidney disease, patients with AKI require long-term follow-up. It is important to focus on improving awareness about AKI, incorporate AKI prevention as a quality initiative, and improve detection, prevention, and management of AKI with the aim of reducing acute and long-term morbidity and mortality

Mid-term follow-up of superior pubic ramus osteotomy in locked symphysis pubis with urethral injury: A case report / 中华创伤杂志(英文版)

A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate. The patient underwent delayed urethral repair 10 weeks after the index surgery. At 3-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.

In silico and in vitro analysis of quorum quenching active phytochemicals from the ethanolic extract of medicinal plants against quorum sensing mediated virulence factors of Acinetobacter baumannii

Inhibition of quorum sensing called quorum quenching (QQ) is now extensively utilized in the prevention of bacterial infections. In the present study, in silico and in vitro analysis of quorum quenching (QQ) or anti-Quorum sensing (QS) activity of ethanolic extract of medicinal plants against QS mediated virulence factors of human pathogenic bacteria Acinetobacter baumannii has been investigated. The effect of plant extracts on QS by acyl homoserine lactone (AHL) has been carried out by quantification of secreted AHL by high-pressure liquid chromatography (HPLC). Measurement of QQ activity was determined by maximum inhibition of virulence factors and AHL production which was recorded in E. globules and A. indica extracts. In silico analysis was studied with possible bioactive compounds in the ethanolic extract of respective plant material that were characterized by gas chromatography equipped with mass spectroscopy (GCMS) against the enzyme responsible for the production of signaling molecule which mediates QS AHL synthase. Distinct reduction of all the QS-mediated virulence factors was recorded in the E. globules and A. indica. Among the different bioactive compounds, the ethanolic leaf extract of E. globules of GCMS analyzed compound, Hexadeconoic acid, 1-(hydroxymethyl), 1, 2-ethannediyl ester interacted with 1KZF protein (AHL synthase) and showed binding energy of −11.2 kcal/mol to MET 42 and TYR 54. Phytochemicals mediated inhibition of AHL synthase activity which was responsible for AHL production would suggest the possible utilization of plant extracts as an antibacterial agent to fight against disease-causing pathogenic bacteria.

A Comparison of Hand Traced Conventional Lateral Cephalogram with Digital Lateral Cephalogram Using Different Calibration Techniques of Dolphin Imaging (Version 11.5).

Objective:The purpose of the study was to evaluate and compare hand tracings on conventional lateral cephalograms with different calibration techniques available in dolphin imaging on digital lateral cephalogram. Materials and Methods:50 Conventional lateral cephalogram and 50 digital lateral cephalogram were taken in (NHP) at same period of timeon the same patient. Two angular measurements Facial Axis Angle and ANB angle two linear measurements Sella to Nasion and Sella to articulare have been taken. The digital images were traced by calibration 3 techniques Ruler, DPI and Land mark available in Dolphin Imaging Software Version 11.5.The conventional were traced on lead acetate paper and data has been collected.Results: In measurement of Facial Axis Angle conventional when compared with different calibration techniques Ruler Land Mark technique show <0.001significantvalue. In measurement of ANB angle shows no significant values. In measurement of S-N length Ruler compared with DPI has shown significant p value <0.001. DPI compared with conventional shows 0.001. S-AR length has shown significant value p value 0.006, DPI compared with Landmark shows 0.007,Landmark compared with conventional shows 0.003. Conclusion: According to our study conventional when compared with calibration techniques ruler has show only one significant value DPI and land mark has shown two significant values so our study conclude that using ruler is the better option for calibration of digital radiograph. As ruler is more accurate to conventional we compare DPI and Landmark techniques to ruler, landmark shows less variation with ruler so according to our study the second option for calibration of digital radiograph is landmark and last option comes DPI.

Transarterial chemoembolization in unresectable hepatocellular carcinoma with portal vein thrombosis: a perspective on survival

Portal vein thrombosis is considered a relative contraindication for transarterial chemoembolization [TACE] in hepatocellular carcinoma. The purpose of our study was to evaluate the efficacy of TACE treatment in patients with hepatocellular carcinoma with portal vein [PV] thrombosis. From April 2011 to June 2013, 17 patients with unresectable hepatocellular carcinoma with PV thrombosis were studied. Patients were assessed for tumor response by imaging at regular intervals and the data compared with the baseline laboratory and imaging characteristics obtained before treatment. Univariate analysis was used to assess the treatments impact on patient survival. Survival analysis was performed using Kaplan-Meier estimations. Overall survival rates at three, six and 12 months were 82%, 71%, and 47%, respectively, with a median of 10 months. Patients in Child-Pugh class A had a median survival of 15 months compared to five months for those patients in Child-Pugh class B. The median survival period of patients responsive to treatment was 13 months while that of non-responders was five months. Patients with ascites at the time of presentation had median survival period of six months while those who did not had a median survival period of 13 months. In univariate analysis, response to chemoembolization [p < 0.001], ascites [p < 0.050] and Child-Pugh class at diagnosis [p < 0.050] were found to be significant prognostic factors. TACE is a promising procedure in unresectable hepatocellular carcinoma with PV thrombosis. Response to chemoembolization, ascites and Child-Pugh class were the most important determining factors of survival

Gallbladder tubrculosis mimicking malignancy: A rare case report.

Summary: Gallbladder tuberculosis is an extremely rare disorder even in endemic region. It often mimics gallbladder malignancy as both of them share some common presentations. This entity is very rarely diagnosed pre-operatively as neither clinical features nor radiology are pathognomonic of gallbladder tuberculosis. The case reported here presented as chronic calculous cholecystitis with mass at gallbladder neck. Patient underwent laparotomy with suspicion of gallbladder carcinoma, which was eventually diagnosed as a case of gallbladder TB following histopathological examination of the resected specimen. He also had pulmonary TB in association and was completely cured with short course antitubercular chemotherapy.

Misdiagnosed Case of Bronchial Carcinoid Presenting with Refractory Dyspnoea and Wheeze: A Rare Case Report and Review of Literature

A 59-year-old male smoker presented with persistent wheezing and occasional coughing that had been ongoing for two years and had been unsuccessfully treated with an inhalational β2 agonist, an anticholinergic and an inhalational steroid in the last year. On clinical examination, a left-sided wheeze was detected. The initial chest X-ray was normal. A computed tomography (CT) scan of thorax demonstrated a mass lesion in the left main bronchus. On subsequent bronchoscopy, an endobronchial polypoid mass was detected in the left main bronchus, completely occluding the bronchial lumen. A biopsy taken from the mass revealed features of bronchial carcinoid. Bronchial carcinoid can present uncommonly with wheezes, resulting in misdiagnosis as bronchial asthma or chronic obstructive pulmonary disease (COPD). If an asthma or COPD patient does not respond to conventional therapy, a CT scan and subsequent bronchoscopy is warranted.

Osteoblast response to commercially available demineralized bone matrices - An in-vitro study.

Objective: Reconstruction of lost attachment apparatus is a major goal of periodontal therapy. Although various osteoinductive bone replacement grafts (BRGs) have been used with apparent clinical success, unequivocal evidence of osteoinductivity may be obtained only through the demonstration of increased osteoblastic/osteoclastic differentiation following exposure to these materials. Materials and Methods: Bone marrow stem cells (BMSCs) obtained from rat femur were cultured in Dulbecco's Modified Eagles Medium (DMEM) and 10% fetal bovine serum (FBS). They were then exposed to two demineralized bone matrices (DBM's) - Grafton and Osseograft, and divided into three groups, comprising of a negative control (BMSC + DMEM + 10% FBS), Grafton, Osseograft. An osteogenic medium (OM) (10 hm dexamethasone, 10 hm b-glycerophosphate, and 50 μg/ml ascorbic acid) was added to create three subgroups comprising of a positive control (OM), Grafton with OM, Osseograft with OM. Results: After an initial phase (up to day 5), both Grafton and Osseograft induced an increased proliferative activity in the BMSCs, which reached a plateau after day 10. These grafts also induced increased alkaline phosphatase activity when compared to the control groups and to BMSCs with an OM. Conclusion: Both Osseograft and Grafton are capable of inducing osteoblastic proliferation and differentiation.

Osteoblast response (initial adhesion and alkaline phosphatase activity) following exposure to a barrier membrane/enamel matrix derivative combination.

BACKGROUND AND OBJECTIVE: The enamel matrix derivative (EMD) has been used in combination with barrier membranes to optimize regeneration in vertical osseous defects. However, the osteoblast response when exposed to the EMD/barrier membrane combination has not yet been evaluated. The osteoblast behavior when exposed to a combination of regenerative materials must be evaluated to fully understand their effect on bone regeneration. Therefore, the present study was undertaken to estimate the initial adhesion and alkaline phosphatase (ALP) activity of an osteoblast cell line (SaOS-2) when exposed to four commercially available resorbable membranes and determine if the addition of EMD had any modulatory effect on osteoblast behavior. MATERIALS AND METHODS: 5 x 104 SaOS-2 cells between passages 7-10 were cultured in two 24-well culture plates. Plate A was used for the adhesion assay and Plate B was used for the ALP assay. A MTT (3-[4, 5-dimethylthiazolyl-2]-2, 5-diphenyltetrazolium bromide) assay was done after 24 hours to determine the adhesion of the osteoblastic cells to four barrier membranes: 1) a non cross-linked porcine Type I and III collagen membrane (BG), 2) a weakly cross-linked Type I collagen membrane (HG), 3) a glutaraldehyde cross-linked bovine Type I collagen (BM), and 4) a resorbable polymer membrane (CP). Osteoblast differentiation was studied using an ALP assay with p-nitro phenyl phosphate as the substrate at 24 hours, 72 hours, and 1 week. A total of 50 microg/ml of EMD dissolved in 10 mM acetic acid was added into each well and the entire experimental protocol outlined above was repeated. RESULTS: The osteoblast adhesion to collagen barriers showed a statistically insignificant reduction following the addition of EMD. Adhesion to the polymer barrier, although significantly lower when compared with collagen barriers, was unaffected by the addition of EMD. ALP activity after 1 week among the various groups was as follows: EMD alone (75.59+/-2.5)>EMD/BG(64.78+/-3.04)>EMD/HG(55.40+/-3.89) approximately EMD/BM(54.75+/-4.17)>BG (51.32+/-2.76)>HG(49.92+/-2.4)>BM(48.14+/-1.4)>Control(46.29+/-1.39)>EMD/CP (37.46+/-3.54)>CP(32.12+/-1.49) CONCLUSION: There was no additive effect on osteoblast adhesion/ALP activity following exposure to an EMD/polymer combination. EMD/collagen positively influences osteoblast differentiation in a time dependent manner.

Genital fistula--our experience.

Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery.

Sciatic nerve schwannoma

Isolated peripheral nerve schwannoma, which is not a part of neurofibromatosis Type-1 or unrelated to radiation is uncommon. They usually arise from a major nerve trunk and present commonly with progressive neurological deficits. Sciatic nerve schwannoma is one such uncommon occurrence that presented with a rather common neurological presentation, sciatica, which could be excised microscopically without any sequel

Carcinoma oesophagus in a 14 year old child: report of a case and review of literature.

A 14 year old boy with well differentiated squamous cell carcinoma of the upper oesophagus is being presented because of its rarity. The patient presented with dysphagia for 8 months. Barium swallow and endoscopy revealed a narrowing in the upper oesophagus with a proximal dilatation diverticulum. No definite aetiologic factor could be demonstrated. The case was treated with definitive irradiation with excellent immediate response.