ABSTRACT
The molecule of 2-Biphenyl Carboxylic Acid (2BCA), which contains peculiar features, was explored making use of density functional theory (DFT) and experimental approaches in the area of quantum computational research. The optimised structure, atomic charges, vibrational frequencies, electrical properties, electrostatic potential surface (ESP), natural bond orbital analysis and potential energy surface (PES) were obtained applying the B3LYP approach with the 6-311++ G (d,p) basis set.. The 2BCA molecule was examined for possible conformers using a PES scan. The methods applied for spectral analyses included FT-IR, FT-RAMAN, NMR, and UV-Vis results. Vibrational frequencies for all typical modes of vibration were found using the Potential Energy Distribution (PED) data. The UV-Vis spectrum was simulated using the TD-DFT technique, which is also seen empirically. The Gauge-Invariant Atomic Orbital (GIAO) approach was employed to model and study the 13C and 1H NMR spectra of the 2BCA molecule in a CDCL3 solution. The spectra were then exploited experimentally to establish their chemical shifts. To predict the donor and acceptor interaction, the NBO analysis was used. The electrostatic potential surface was employed to anticipate the locations of nucleophilic and electrophilic sites. Hirshfeld surfaces and their related fingerprint plots are exploited for the investigation of intermolecular interactions. Reduced Density Gradient (RDG) helps to measure and illustrate electron correlation effects, offering precise insights into chemical bonding, reactivity, and the electronic structure of 2BCA. According to Lipinski and Veber's drug similarity criteria, 2BCA exhibits the typical physicochemical and pharmacokinetic properties that make it a potential oral pharmaceutical candidate. According to the findings of a molecular docking study, the 2BCA molecule has promise as a treatment agent for the Nipah virus (PDB ID: 6 EB9), which causes severe respiratory and neurological symptoms in humans.
Subject(s)
Nipah Virus , Spectrum Analysis, Raman , Static Electricity , Spectroscopy, Fourier Transform Infrared/methods , Nipah Virus/chemistry , Nipah Virus/drug effects , Nipah Virus/metabolism , Spectrum Analysis, Raman/methods , Viral Proteins/chemistry , Viral Proteins/metabolism , Protein Binding , Molecular Docking Simulation , Density Functional Theory , Spectrophotometry, Ultraviolet , Magnetic Resonance Spectroscopy , Models, Molecular , Vibration , Molecular Conformation , Carboxylic Acids/chemistryABSTRACT
Triethylaminium picrate (TEAP) crystals were grown using the slow evaporation solution growth method at ambient (35 °C) temperature. Salt was synthesized from Picric acid, and Triethylamine and methanol was used as solvents. The solution was mixed at a 1:1 ratio and evaporated slowly, produced yellow colour single crystal of TEAP with an average dimension of 19 × 8 × 5 mm3. The structure of the compound was determined by single-crystal X-ray diffraction (SCXRD) study, which confirms that the crystal is belongs to Orthorhombic crystal system, and its crystallinity was confirmed by the Bragg peak in the powder X-ray diffraction pattern. The superamolecular characteristic of the TEAP was confirmed by the Hirshfield analysis. CHN elemental analysis confirmed the stoichiometry and chemical composition of the synthesized complex salts. FT-IR and Polarized Raman spectral analyses confirmed the presence of different functional groups in the complex. UV-vis-NIR study identified the optical transmission window and the lower (TEAP) cut-off wavelength. Vickers' microhardness analysis determined the mechanical stability of the grown crystal. Studies of dielectric and AC conductivity were analyzed as a function of frequency. The thermogravimetry (TG) and differential thermal analysis (DTA) techniques were used to investigate the thermal behaviour of the material. The Kurtz-Perry powder technique was used to analyze the crystal's nonlinear optical properties (NLO) and found that its SHG efficiency was 1.5 times higher than that of potassium dihydrogen phosphate (KDP). The results from the obtained characterizations conclude that the TEAP crystal could be useful for NLO applications.
ABSTRACT
BACKGROUND: Uncomplicated hyperglycaemia is a common presentation in the emergency department (ED). Rapid glucose control is associated with the risk of iatrogenic hypoglycaemia. We sought to determine the safety of a rapid glucose control protocol delivered in a 24-h emergency department observation unit (OU). METHODS: This is a retrospective chart review of patients admitted to the OU for hyperglycaemia where the assessing clinician deemed there was no other reason for medical admission apart from hyperglycaemia; and that the patient could be safely discharged provided their hyperglycaemia was adequately treated. The rapid glucose control protocol consists of 4-6 hourly glucose monitoring and insulin injections according to a sliding scale. We report the demographics, reduction in glucose values and the incidence of hypoglycaemia in the OU. We also determine the rate of discharge from OU and the rate of hospital admission at 30 days. RESULTS: We included 101 patients. The mean age was 53.5 years (95% CI 50.4-56.6) and 64% of patients were male. The mean HbA1c value was 12.8% (95% CI 12.3-13.3). The mean admission and discharge glucose values were 27.2 (95% CI 26.3-28.1) and 13.9 (95% CI 13.2-14.6) mmols/l respectively. There was no incidence of hypoglycaemia in the OU. We successfully discharged 90.1% of the patients from the OU, of which 3 (3.3%) patients were admitted to the hospital within 30 days of discharge. CONCLUSION: ED OU is a safe location to deliver effective management for patients presented with uncomplicated severe hyperglycaemia.
Subject(s)
Blood Glucose , Clinical Observation Units , Hyperglycemia , Blood Glucose Self-Monitoring , Humans , Hyperglycemia/drug therapy , Male , Middle Aged , Retrospective StudiesABSTRACT
In recent decades, disposal of hazardous material has become a challenging task especially in case of landfills where leaching out of waste is possible. In such cases, an efficient and economical liner system using locally available material is very essential. In this paper, an attempt has been made to study the suitability of red soil stabilized using lime and Prosopis juliflora fibers as liner material for landfills. Prosopis is a woody weed available abundantly in tropical and subtropical regions of the world. The fibers were used at 0.0%, 0.25%, 0.50%, 0.75%, and 1.0% by weight of the soil and the amount of lime used was kept constant as 4%. Tests results revealed decrease in plasticity index, increase in UCC strength, ductile behavior, decrease in consolidation settlement, reduction in permeability and shrinkage, and increase in CBR resistance in soils treated with both lime and Prosopis fibers. SEM images of stabilized soil revealed adherence of hydrated products of lime on the fiber surface, which facilitate efficient stress transfer between the soil and fibers. A single composite liner system was modeled using Visual MODFLOW by replacing the compacted clay layer with the stabilized red soil below the HDPE liner and the model was simulated. The simulation result showed that the performance of liner system with stabilized red soil is good and could prevent the aquifer from contamination. From the study, it can be concluded that stabilized red soil possesses the geotechnical properties required for an efficient liner system.
Subject(s)
Hazardous Substances , Prosopis , Refuse Disposal/methods , Soil , Waste Disposal Facilities , Water Pollution/prevention & control , Aluminum Silicates , Calcium Compounds , Clay , Environmental Monitoring , Groundwater , Oxides , Permeability , WoodABSTRACT
OBJECTIVE: To describe the concomitant imaging and genetic findings in children diagnosed with non-syndromic unilateral sensorineural hearing loss. METHODS: A retrospective cohort study was conducted of 60 children diagnosed between January 2005 and December 2015 in a tertiary-level paediatric institution. RESULTS: Average age at diagnosis was 4.3 years. All children were considered non-syndromic. Hearing loss was categorised as mild (17 children), moderate (17 children), severe (7 children) or profound (19 children). Imaging was performed in 43 children (71.66 per cent). Nineteen patients (44.2 per cent) had positive computed tomography or magnetic resonance imaging findings. Genetic testing was performed in 51 children (85 per cent). Sixteen children (31 per cent) tested positive to connexin 26 (GJB2); 1 patient (2 per cent) had a homozygous mutation of GJB2 and 15 were heterozygous carriers. Amongst children who tested positive as heterozygous carriers of a GJB2 mutation, there was a high rate of positive imaging findings (47 per cent compared to 37.2 per cent in the total cohort). A genetic abnormality was confirmed in 50 per cent of children with positive imaging findings who underwent genetic testing. CONCLUSION: Rates of concomitant imaging and genetic findings suggest that both investigations are of value in the study of these patients.
Subject(s)
Connexins/blood , Hearing Loss, Unilateral/diagnostic imaging , Hearing Loss, Unilateral/genetics , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Child , Child, Preschool , Connexin 26 , Female , Hearing Loss, Unilateral/blood , Humans , Male , Mutation , Retrospective StudiesABSTRACT
BACKGROUND: Pachyonychia congenita is a rare keratinising disorder, which typically presents during the first three years of life and usually affects the nails and palmoplantar surfaces. It can involve the larynx and potentially result in life-threatening airway obstruction. METHODS: A case report is presented and the findings of a literature review are reported. The review involved a PubMed search using the keywords 'pachyonychia congenita' together with 'larynx', 'laryngeal involvement', 'laryngeal obstruction', 'airway obstruction', 'hoarseness' and/or 'stridor'. RESULTS: A five-year-old boy, with confirmed pachyonychia congenita, presented with complications of laryngeal involvement over a four-year period. He required three intubations and a tracheostomy for acute airway obstruction. Treatment with potassium titanyl phosphate laser laryngoscopy stabilised the progression of laryngeal disease. CONCLUSION: Patients with pachyonychia congenita and laryngeal involvement can have a varied presentation, ranging from hoarseness to acute airway obstruction. Management can be a challenge, requiring early evaluation, regular surveillance and aggressive treatment. This paper reports our experience in managing and treating the laryngeal complications of a child with pachyonychia congenita.
Subject(s)
Airway Obstruction/etiology , Laryngeal Diseases/etiology , Pachyonychia Congenita/complications , Airway Obstruction/diagnostic imaging , Airway Obstruction/surgery , Child, Preschool , Congenital Abnormalities/etiology , Dyspnea/etiology , Humans , Laryngeal Diseases/diagnostic imaging , Laryngeal Diseases/surgery , Laryngoscopy , Larynx/abnormalities , Male , Pachyonychia Congenita/diagnostic imaging , Pachyonychia Congenita/surgery , Respiratory Sounds/etiologyABSTRACT
OBJECTIVES: Analyze the results and complications of various surgical interventions in a large cohort of children with non-tuberculous mycobacterial (NTM) head and neck infections and suggest a heuristic treatment protocol for managing this condition while aiming to maximize cure and minimize complications. METHODS: Retrospective chart review of 104 consecutive patients diagnosed with head and neck NTM at a tertiary paediatric hospital between January 1994 and December 2013 inclusive. RESULTS: 104 patients ranged in age between 8 months to 15 years (mean age 27 months) were reviewed and 97 patients were included in the final analysis. 6 patients excluded due to lack of follow-up and one excluded due to systemic immunocompromised condition. Sub-sites of NTM infections were submandibular (n=48, 46%), cervical (n=40, 38%), parotid (n=18, 17%) and submental (n=4, 4%). Some patients had more than one lesion so counted twice. Higher cure rates were demonstrated for primary excision (81%, p<0.01) versus incisional interventions (44%, p<0.01). Marginal mandibular nerve palsy following surgery was seen in 7 patients (7.2%). This was permanent in 4 patients (4%) and temporary in 3 patients (3%). All children who were complicated with marginal mandibular palsies had lesions in the submandibular region. The rate of palsy for submandibular disease alone was 15%, while 8% presented permanent palsy and 6% temporary. Marginal mandibular nerve palsy was more likely following excisional compared to incisional procedures (6 versus 1 patient, p<0.01). Hypertrophic scarring occurred in 7 patients: 3 patients following excision and 4 patients after an incisional procedure. One patient suffered long term spinal accessory nerve damage presented as winged scapula. CONCLUSIONS: Excision of NTM provides better cure rates compared to incision although at the expense of long term post-surgical morbidity. Excision should probably be the first line of treatment when the risk for neural damage is low. Incision and drainage with or without antimycobacterial treatment may be the preferred option for at-risk sub-sites (submandibular or parotid) in order to reduce long term morbidity.
Subject(s)
Lymphadenitis/therapy , Mycobacterium Infections, Nontuberculous/therapy , Salivary Gland Diseases/therapy , Soft Tissue Infections/therapy , Adolescent , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Cranial Nerve Diseases/etiology , Curettage , Drainage , Female , Humans , Infant , Lymphadenitis/microbiology , Male , Mandibular Nerve , Mycobacterium Infections, Nontuberculous/complications , Postoperative Complications , Retrospective Studies , Salivary Gland Diseases/microbiology , Soft Tissue Infections/microbiologyABSTRACT
Single crystals of l-arginine 4-nitrophenolate 4-nitrophenol dihydrate (LAPP) have been grown successfully from the solution of l-arginine and 4-nitrophenol. Slow evaporation of solvent technique was adopted to grow the bulk single crystals. Single crystal X-ray diffraction analysis confirms the grown crystal has monoclinic crystal system with space group of P21. Powder X-ray diffraction analysis shows the good crystalline nature. The crystalline perfection of the grown single crystals was analyzed by HRXRD by employing a multicrystal X-ray diffractometer. The functional groups were identified from proton NMR spectroscopic analysis. Linear and nonlinear optical properties were determined by UV-Vis spectrophotometer and Kurtz powder technique respectively. It is found that the grown crystal has no absorption in the green wavelength region and the SHG efficiency was found to be 2.66 times that of the standard KDP. The Thermal stability of the crystal was found by obtaining TG/DTA curve. The mechanical behavior of the grown crystal has been studied by Vicker's microhardness method.
Subject(s)
Arginine/chemistry , Hydroxybenzoates/chemistry , Nitrophenols/chemistry , Crystallization , Crystallography, X-Ray , Differential Thermal Analysis , Hardness , Magnetic Resonance Spectroscopy , Models, Molecular , ThermogravimetryABSTRACT
L-lysine 4-nitrophenolate monohydrate (LLPNP) has been synthesized and grown by solution growth method at room temperature using deionised water as a solvent. The crystal structure of the materials was solved by single crystal X-ray diffraction analysis and it was found that the material has orthorhombic system. The crystallinity of the grown crystals was studied by the powder X-ray diffraction analysis. Molecular structure of the grown crystal was investigated by 1H NMR spectroscopy. The various functional groups of the sample were identified by Fourier transform infrared and Fourier transform-Raman spectroscopic analyses. Thermal stability of the grown crystal has been studied by Thermogravimetric and Differential thermal (TG&DTA) analysis. The optical absorption of the grown crystals has been ascertained by UV-Vis-NIR absorption studies. Second harmonic generation (SHG) efficiency of the material has been determined by Kurtz and Perry technique and the efficiency was found to be 4.45 and 1.4 times greater than that of standard KDP and urea samples, respectively.
Subject(s)
Lysine/chemistry , Crystallization , Crystallography, X-Ray , Fourier Analysis , Lysine/chemical synthesis , Magnetic Resonance Spectroscopy , Materials Testing , Molecular Conformation , Nitrophenols/chemical synthesis , Nitrophenols/chemistry , Optics and Photonics , Organic Chemicals/chemistry , Powders , Spectroscopy, Fourier Transform Infrared , Spectrum Analysis, Raman , Thermogravimetry , Urea/chemistry , X-Ray DiffractionABSTRACT
BACKGROUND: Although there is increasing evidence of barriers to nutritional health among elderly assisted-living residents, there has not been the same emphasis when examining the ways in which these individuals experience their mealtimes, as well as the factors that they perceive as contributing to their overall sense of health and well-being. Mealtimes may be disregarded as being particularly unimportant or hurried and overlooked, especially for those residents who may be lonely and have feelings of isolation, ultimately leading to a reduced food intake and poor nutrition. METHODS: A convenience sample of 38 men and women, aged ≥65 years, were selected from four assisted-living facilities in and around Montclair, NJ, USA, to participate in focus group discussions. Data were analysed using content analysis procedures. RESULTS: Participants described their experiences of mealtimes, and the factors contributing to an overall sense of well-being during these occasions. The ability to make healthy food choices, socialise, interact with staff, friends and family members, and enjoy a tasty meal in a warm and inviting dining environment, may provide a dignity that is unmatched by other services. CONCLUSIONS: The findings of the present study highlight the importance of maintaining the health of elderly assisted-living residents through strategies that enhance their mealtime experiences. Listening to the food voice of elderly through research such as that carried out in the present study will help policy makers develop a plan that will effectively deal with systemic barriers prevalent in these facilities, and incorporate strategies to motivate and encourage their residents to increase their food intake and improve their health and well-being.
Subject(s)
Assisted Living Facilities , Food Services , Meals , Aged , Aged, 80 and over , Eating , Female , Focus Groups , Humans , Interpersonal Relations , Male , Meals/psychology , New Jersey , PersonhoodABSTRACT
OBJECTIVE: The burden of disease due to otitis media (OM) in Asia Pacific countries was reviewed to increase awareness and raise understanding within the region. METHODS: Published literature and unpublished studies were reviewed. RESULTS: In school-age children, OM prevalence varied between 3.25% (Thailand) and 12.23% (Philippines) being highest (42%) in Aboriginal Australian children. OME prevalence at school age varied between 1.14% (Thailand) and 13.8% (Malaysia). Higher prevalence was reported in children with hearing impairment, HIV, pneumonia and rhinitis. CSOM prevalence was 5.4% in Indonesia (all ages), 15% in Aboriginal Australian children and 2-4% in Thailand, Philippines, Malaysia and Vietnam (WHO estimate). OM prevalence/incidence and service utilisation were highest in children 2-5 years of age. The disease burden was substantially higher in Pacific Island children living in New Zealand (25.4% with OME), and was highest in indigenous Australians (>90% with any OM). Streptococcus pneumoniae and Haemophilus influenzae dominated as primary causes of AOM in all studies. Few studies examined pneumococcal serotype distribution. Health-related cost estimates for OM, when available, were substantial. In developing countries, significant investment is needed to provide facilities for detection and treatment of ear disease in children, if long term hearing deficits and other sequelae are to be prevented. CONCLUSION: The available evidence suggests an important burden of disease and economic cost associated with OM in most Asia Pacific countries and a potential benefit of prevention through vaccination. Large, prospective community-based studies are needed to better define the prevalence of ear disease in children, and to predict and track pneumococcal conjugate vaccine impacts. AOM prevention through vaccination may also provide a means of reducing antibiotic use and controlling antibiotic-resistant disease in children. This review highlights the need for additional research, and provides a basis on which to build and develop regional guidelines for OM management.
Subject(s)
Cost of Illness , Otitis Media/epidemiology , Asia/epidemiology , Child , Child, Preschool , Hospitalization/statistics & numerical data , Humans , Otitis Media/economics , Otitis Media/microbiology , Pacific Islands/epidemiology , PrevalenceABSTRACT
INTRODUCTION: This study serves to identify the reasons for unscheduled return visits to the emergency department (ED), paying particular attention to system, physician and patient factors. Its purpose is to highlight inadequacies and plan strategies to reduce re-attendance. METHODS: All patients returning to the ED within 72 hours of initial visit were identified between January 2005 and June 2005. 842 cases were reviewed to identify reasons for unscheduled returns. RESULTS: Unscheduled return visits accounted for two percent of patient encounters with the younger mobile group of patients contributing the largest number. Patients presenting with abdominal pain constituted a quarter of unscheduled returns, where more than half were admitted. Possible causes were lack of rehydration and lack of proper discharge advice to these patients. The assessment and disposition of abdominal pain patients with uncertain aetiology was a major category and 68.7 percent of missed diagnosis came from this group. There was a significant difference in the unscheduled return rates between the senior and junior doctors. There was minimal morbidity and no mortality among patients who returned to the ED for the second time. CONCLUSION: A proposed strategy to reduce the number of unscheduled returns would be to target patients with abdominal pain with more liberal hydration strategies. Discharge advice with information about expected prognosis and specific signs and symptoms to look out for should be included. Educational sessions and better supervision of junior staff emphasising acute abdominal conditions should be actively incorporated to avoid associated morbidities with a missed diagnosis.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Patient Admission , Patient Readmission , Adult , Age Factors , Aged , Appointments and Schedules , Diagnostic Errors , Female , Hospitals , Humans , Male , Medical Records Systems, Computerized , Middle Aged , Treatment OutcomeABSTRACT
Neurofibrillary degeneration is often observed in the brain of patients with type 1 myotonic dystrophy (DM1). It consists principally of the aggregation of Tau isoforms that lack exon 2/3 encoded sequences, and is the consequence of the modified splicing of Tau pre-mRNA. In experimental models of DM1, the splicing of several transcripts is modified due to the loss of Muscleblind-like 1 (MBNL1) function. In the present study, we demonstrate that the MBNL1 protein is also present in the human brain, and consists of several isoforms, as shown by RT-PCR and sequencing. In comparison with controls, we show that the adult DM1 brain exhibits modifications in the splicing of MBNL1, with the preferential expression of long MBNL1 isoforms--a splicing pattern similar to that seen in the fetal human brain. In cultured HeLa cells, the presence of long CUG repeats, such as those found in the DM1 mutation, leads to similar changes in the splicing pattern of MBNL1, and the localization of MBNL1 in nuclear RNA foci. Long CUG repeats also reproduce the repression of Tau exon 2/3 inclusion, as in the human disease, suggesting that their effect on MBNL1 expression may lead to changes in Tau splicing. However, while an overall reduction in the expression of MBNL1 mimics the effect of the DM1 mutation, none of the MBNL1 isoforms tested so far modulates the endogenous splicing of Tau. The modified splicing of Tau thus results from a possibly CUG-mediated loss of function of MBNL1, but not from changes in the MBNL1 expression pattern.
Subject(s)
Alternative Splicing , Brain/metabolism , Myotonic Dystrophy , RNA-Binding Proteins/metabolism , Trinucleotide Repeats , tau Proteins/metabolism , Adult , Animals , COS Cells , Chlorocebus aethiops , Cloning, Molecular/methods , Fetus , Gene Expression Regulation , Green Fluorescent Proteins/genetics , Green Fluorescent Proteins/metabolism , HeLa Cells , Humans , Middle Aged , Myotonic Dystrophy/genetics , Myotonic Dystrophy/metabolism , Myotonic Dystrophy/pathology , Protein Isoforms/genetics , Protein Isoforms/metabolism , Transfection/methodsABSTRACT
OBJECTIVE: Peri-orbital infections can be classified as pre-septal or post-septal depending upon the location of the focus of infection. The ability to differentiate between these two is frequently difficult at the initial presentation, with marked orbital edema and pain limiting the ophthalmic examination. Hence, it is important to identify all the features at presentation that will lead to an accurate and rapid diagnosis and treatment. Our retrospective review of peri-orbital infections identifies contrasting features between these two groups that will aid the clinician in the subsequent management of these infections. DESIGN AND SETTING: A retrospective review over an 11-year period of children admitted to a tertiary children's hospital for the treatment of peri-orbital cellulitis was undertaken. The two subgroups were identified, those suffering from a pre-septal infection and those with a post-septal infection. The groups were compared with respect to their presentation, clinical findings, findings on CT and surgical intervention. RESULTS: Two hundred and sixty-two children were identified with peri-orbital infections, 227 pre-septal, and 35 post-septal. There were statistically significant differences between the pre- and post-septal groups with regards to the following: age (3.9 vs. 7.5 years, p<0.001), medical co-morbidities (19% vs. 0%, p<0.01), a history of trauma (40% vs. 11% of cases, p<0.003), clinical diagnosis of acute sinusitis (9% vs. 91% of cases, p<0.001), and fever (47% vs. 94%, p<0.001). Ophthalmologic examination identified diplopia (p<0.001), opthalmoplegia (p<0.001) and proptosis (p<0.001) as significant features of a post-septal infection. Intravenous antibiotics were successful in treating the majority of cases, with 5% of pre-septal, and 25% of post-septal infections requiring surgery. CONCLUSION: When considering the management of a child with a peri-orbital infection, features from the history and examination such as trauma, medical co-morbidities and ophthalmic signs will guide management and delineate the indications for early CT imaging. In the absence of acute visual compromise or other signs of disease progression, initial management with intravenous antibiotics for 48 h to cover Staphylococcal aureus and Streptococcal pyogenes with nasal decongestant should be considered before surgical intervention is contemplated. A multi team approach is essential in obtaining the best outcome for the child.
Subject(s)
Bacterial Infections/complications , Nasal Septum/microbiology , Orbital Diseases/classification , Orbital Diseases/microbiology , Algorithms , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Child , Child, Preschool , Female , Humans , Injections, Intravenous , Male , Orbital Diseases/drug therapy , Retrospective StudiesABSTRACT
INTRODUCTION: Acute sinusitis is a relatively common condition, which usually responds to medical therapy. In most cases, there are no sequelae or complications subsequent to this infection. However, like many acute illnesses, there are well documented complications of acute sinusitis, and in particular these include peri-orbital and intracranial spread. OBJECTIVE: The purpose of this paper is to highlight the importance of vigilance in peri-orbital involvement and the limitations of imaging techniques, such as computed tomography scanning. An illustrative case is presented to demonstrate this. CONCLUSION: Magnetic resonance imaging scanning is a valuable modality in assessing complex presentations of peri-orbital complications of acute sinusitis.
Subject(s)
Abscess/diagnosis , Magnetic Resonance Imaging/methods , Orbital Diseases/diagnosis , Tomography, X-Ray Computed/methods , Abscess/etiology , Abscess/surgery , Acute Disease , Adolescent , Contrast Media , Drainage , Female , Humans , Orbital Diseases/etiology , Orbital Diseases/surgery , Sinusitis/complicationsABSTRACT
INTRODUCTION: Acute sinusitis is a relatively common condition, which usually responds to medical therapy. In most cases, there are no sequelae or complications subsequent to this infection. However, like many acute illnesses, there are well documented complications of acute sinusitis, and in particular these include peri-orbital and intracranial spread. OBJECTIVE: The purpose of this paper is to highlight the importance of vigilance regarding both peri-orbital involvement of sinusitis and the limitations of imaging techniques such as computed tomography. An illustrative case is presented to demonstrate this. CONCLUSION: Magnetic resonance imaging is a valuable modality in assessing complex presentations of peri-orbital complications of acute sinusitis.
Subject(s)
Epidural Abscess/diagnosis , Orbital Diseases/diagnosis , Sinusitis/diagnosis , Acute Disease , Adolescent , Drainage/methods , Epidural Abscess/complications , Epidural Abscess/surgery , Female , Humans , Magnetic Resonance Imaging , Orbital Diseases/complications , Orbital Diseases/surgery , Severity of Illness Index , Sinusitis/complications , Sinusitis/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
INTRODUCTION: Acute bacterial sinusitis is common in the pediatric population. Intracranial spread of infection is a rare but life-threatening complication of acute sinusitis. Due to the infrequent presentation of this complication, there are no well-defined management protocols for the acute sinusitis. CASE SERIES: We present three pediatric cases where children presented with intracranial sepsis, and the underlying source of infection was from the paranasal sinuses. In all cases, endoscopic sinus surgery was performed in the acute setting, with the use of frontal sinus mini-trephines playing a significant role. DISCUSSION: We describe our experience and review the available literature.
Subject(s)
Central Nervous System Infections/epidemiology , Frontal Sinusitis , Minimally Invasive Surgical Procedures/instrumentation , Trephining/methods , Acute Disease , Central Nervous System Infections/diagnostic imaging , Central Nervous System Infections/surgery , Child , Child, Preschool , Female , Frontal Sinusitis/diagnostic imaging , Frontal Sinusitis/epidemiology , Frontal Sinusitis/surgery , Humans , Male , Tomography, X-Ray ComputedABSTRACT
The utility of angiography and embolisation of selected branches of the external carotid artery is occasionally helpful in the management of recurrent epistaxis, pre-operative devascularisation of tumours such as angiofibromas, and other head and neck conditions. The use of embolisation for recalcitrant post-tonsillectomy bleeding due to the formation of an aneurysm or pseudoaneurysm of branches of the external carotid artery has been described [P. Simoni, J. Bello, B. Kent, Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization, Int. J. Pediatr. Otorhinolaryngol. 59 (2) (2001) 125-128]. There are also reports of pseudoaneurysm formation on the internal carotid following tonsillectomy [F. Tovi, A. Leiberman, Y. Hertzanu, L. Golcman, Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy, Int. J. Pediatr. Otolaryngol. 13 (1987) 69-75]. The repeated presentation of a 5-year-old girl with post-operative tonsillectomy bleeding on three separate occasions, each approximately 1 week apart, prompted the consideration of the diagnosis of aneurysm formation, and hence, angiography was performed. The anomalous finding from this study precluded embolisation due to the risk of blindness. This experience has prompted this review which highlights the important issues of angiographic assessment prior to embolisation. The relevance of this to external carotid artery ligation is also reflected upon.