Detection of Mutations in SARS-CoV-2 Genomic Clades using COVIDSeq-NGS among International Travelers

Introduction/Objective

Numerous SARS-CoV-2 variants/lineages have been identified based on genome sequencing. As of June 15, 2022 almost 11,399,573 whole genome sequences have been deposited in the GISAID-database. Severity and spread of COVID19 is based on their efficiency of infection and to multiply in host. That largely depend upon the structural mutation in spike, ORF and N proteins etc. That happens due to translation of genomic mutations during polypeptide synthesis. Also, the mutations are region/country specific. Specific mutation and combination of mutation causes the emergence of new strains. However, the strains can migrate from one region to other through travelers. The main objective of the current study is profiling of mutations in the genome of SARSCoV2 using Next- Generation-Sequencing (NGS) in international travelers and phylogenetic analysis of the sequences to find out different clades of SARSCoV2.

Methods/Case Report

A total of 557 SARSCoV2 genomes were sequenced on S4-sequencing flow-cell on NovaSeq 6000. For NGS of SARS-CoV-2 genome, Illumina, COVIDSeq kits and the protocols will be used strictly as recommended by the manufacturer. After NGS the analysis was done followed by FASTA sequences retrieval, mutations recording and phylogeny.

Results (if a Case Study enter NA)

This study reports 11 clades (19A, B, 20A, B, C, D, 20E; EU1, 20G, 20H; Beta V2, 20I: Alpha V1, 21D; and Eta) for the first time in international travelers. To best of our knowledge, this is the first report of the COVIDSeq approach for detection of mutation in SARSCoV2 genomic clades. The study revealed some dominants mutations was (Orf1a: P2018Q, K1053R, E176V, Orf1b: A520V, T2165A, S: D1127G, D614G, L18F etc. in other genes).

Conclusion

Profiling of common mutations among travelers could fill some gaps about the existence of SARS-CoV-2 variants information. However, further studies are needed to consolidate these findings before to be utilized for development of a potential therapeutic strategy.

Variegation in the Number of Islets of Langerhans in the Pancreas of Rats Fed on Sodium Cyclamate

Objective: To observe the effects of an artificial sweetener (sodium cyclamate) on a rat's pancreas and glucose levels. Study Design: Laboratory-based experimental study. Place and Duration of Study: Army Medical College Rawalpindi, in association with the National Institute of Health, Islamabad, Pakistan from Jun 2014 to Jan 2015. Methodology: Forty Sprague Dawley rats (male and female housed separately to avoid mating and pregnancy) were involved in the experiment. Twenty rats in each control and experimental group. C served as control and E for the experimental group. A normal laboratory diet was fed to control Group-C for two months, whereas through an oral gavage needle, artificial sweetener 60mg/kg/day (sodium cyclamate) was fed to experimental animals for two months. During the two months after twelve-hour fasting, rats' blood glucose level was recorded weekly. At the commencement and completion of these two months, the weight of the animals was noted. Results: Fasting blood sugars of experimental group was found to be statistically significant from week 3 to 9 with p-values of 0.034, <0.001, <0.001, 0.002, 0.001, <0.001, <0.001 respectively. Number of islets of Langerhans was significantly higher 13.70 ± 1.87μm in experimental group compared with control group with the p-value of <0.001. Conclusion: Sodium cyclamate not only affected the glucose metabolism but also disturbed the normal histology of the endocrine pancreas.

Effects of Microwave Oven Exposed Diet on Animal Weight and Testicular Tissue and Relative Role of Mentha Piperita

Background: Usage of electronic gadgets like microwave oven is increasing day by day that heats the food by exposing it to electromagnetic radiations which has many hazardous effects on human health including fertility. Aim: To find the effects of microwave oven exposed diet on weight and testis of mice along with protective effects of Mentha Piperita and Melatonin Study Design: Randomized control trial. Methodology: Adult male mice (n=32) were divided into four groups. Control group (G1) received standard pellets prepared for mice. Second group (G2) was given mice pellets exposed to microwave oven. Third group (G3) received Mentha Piperita leaf extract along with mice pellets exposed to microwave oven and the fourth group (G4) received oral melatonin along with pellets exposed to microwave oven. After experimental period, wt of each mice was again recorded and then mice were sacrificed. Data analyzed by SPSS 21.0v. Results: There was no statistically significant difference of weight gain of animals but there was significant reduction in weight of testis in group G2 but in G3 and G4 wt of the testis was close to control. Conclusion: It was concluded that microwave oven exposed diet had no significant effect on overall weight gain of the animal but it significantly reduced weight of the testis in group G2. However, Mentha Piperita and Melatonin both had ameliorative effects on the wt of the testicular tissue. Keywords: Mice, Testis, Weight, Mentha piperita and Melatonin

Consequences of Microwave oven Exposed Diet on The Basal Lamina of Seminiferous Tubules of Mice

Usage of electronic gadgets like microwave oven is increasing day by day that heats the food by exposing it to electromagnetic radiations which has many hazardous effects on human health including fertility. Aim: To find the effects of microwave oven exposed diet on basal lamina of seminiferous tubules of mice alongwith protective effects of Mentha piperita and melatonin on the same tissue. Study Design: Randomized control trial. Methodology: Adult male mice (n=32) were divided into four groups. Control group (G1) received standard pellets prepared for mice. Second group (G2) was given mice pellets exposed to microwave oven. Third group (G3) received Mentha Piperita leaf extract along with mice pellets exposed to microwave oven and the fourth group (G4) received oral melatonin along with pellets exposed to microwave oven. Later their testicular tissue was removed for histological examination while basal lamina disruption was assessed by scoring. Data analyzed by SPSS 22.0v. Results: In group G2, there was slight disruption in the basal lamina in 75% of the cases while in experimental group G3, there was slight disruption of basal lamina only in 12.5% of the cases. However, in group G4, only 25% specimen had slight disruption of basal lamina Conclusion: It was concluded that microwave oven exposed diet produced severe disruption of basal lamina in group G2 that decreased in Mentha piperita and melatonin treated groups. However, Mentha piperita treated group produced better results than melatonin treated group. Keywords: Mice, Testis, Basal Lamina, Mentha piperita and Melatonin

AMELIORATIVE EFFECTS OF PUNICA GRANATUMON RENAL TUBULAR NECROSIS INDUCED BY NANDROLONE DECANOATE IN MICE MODEL

Objective: To observe the effects of nandrolone decanoateon renal tubules and its protection by punicagranatum (pomegranate) in mice. Study Design: Lab based experimental study. Place and Duration of Study: One year in Anatomy department, Army Medical College, Rawalpindi, in association with National Institution of Health, Islamabad. Methodology: Forty healthy BALB/c mice of both sexes with weight range of 2 5-30gms were equally disseminated into four groups, A as control while B, C and D as trial groups. Three trial groups were inoculated Nandrolone Decanoate 1mg per 100gm of body weight, through intramuscular injections in the hind limb, once weekly for eight weeks. Pomegranate nector was administered in animals of trial group C (3ml per kg of body weight) en route oral gavage tube daily, whereas animals in trial group D was administered pomegranate peel extract (200mg per kg body weight) via oral gavage tube daily for eight weeks. Evaluation of the outcomes of trial groups B, C & D was done amongst them and with control group A. Results: In nandrolone decanoate injected experimental group B, tubular necrosis were appreciated in comparison with control group A (p˂ 0.001), and showed statistical improvement when evaluation was done with pomegranate nectar and pomegranate peel extract treated trial groups C (0.001) and D (p=0.001), correspondingly. Conclusion: Punicagranatum in two forms, as nectar and peel extract, has almost identical curative effects on steroid administered renal tubular mutilation.

An overview of the taxonomic instability of endangered Golden and Zhobi mahseer in Pakistan

In South and South East Asia three genera of fish species i.e. Tor, Neolissochilus and Naziritor are commonly known as Mahseer with at least 47 species. Among these 23 belongs to genus Tor, 22 to Neolissochilus and one to Naziritor i.e. Naziritor zhobensis. Recently another species added to genus Naziritor is Naziritor chelynoides in India. Among Tor species Tor putitora (Hamilton) is the most widely distributed Mahseer in Pakistan and other countries of the Indian subcontinent. However, based alone on morphological characters some authors identify the Pakistani counterparts as Tor macrolepis (Heckel), (a species presumed to be found exclusively in the Indus River system) distinct from Tor putitora (a species found in Ganga Brahmaputra River system). In order to resolve this taxonomic ambiguity, present study carried out meristic and morphometric measurements of Mahseer collected from a total of 11 water bodies of Pakistan. Ratios between the morphometric characters were calculated and statistically analyzed using t-test and correlation coefficient. Two species identified as Tor putitora and Naziritor zhobensis were the sole Mahseer inhabitants of Indus system in Pakistan. Tor putitora occurred at all surveyed sites while Nazirtor zhobensis had a distribution range from river Zhob to tributaries of river Gomal the right bank tributaries of River Indus. The study corroborates that there are no unequivocal morphological synapomorphies in any existing populations of both species. The study further demonstrates that head length, a character frequently used in Mahseer taxonomy, is not a good measure for species identification. Finally the present study establishes that Naziritor zhobensis still exists in the water bodies of Pakistan and that golden Mahseer occurring in Indus riverine system of Pakistan is Tor putitora.

Association between Atopic Dermatitis and Hypertension: A Systematic Review and Meta-Analysis

BACKGROUND

Previous studies found conflicting results about the association of atopic dermatitis (AD) with hypertension.

OBJECTIVES

Determine whether AD and AD severity are associated with hypertension.

METHODS

A systematic review was performed of published studies in MEDLINE, EMBASE, Scopus, Web of Science, and GREAT databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale.

RESULTS

Fifty-one studies met inclusion criteria; 19 had sufficient data for meta-analysis. AD was associated with higher odds of hypertension compared to healthy controls (increased in 9 of 16 studies; pooled prevalence: 16.4% vs 13.8%; random-effects regression, pooled unadjusted odds ratio [OR][95% confidence interval <CI95>]: 1.16 [1.04-1.30]), but lower odds of hypertension compared to psoriasis (decreased in 5 of 8 studies; 15.4% vs 24.8%; 0.53 [0.37-0.76]). In particular, moderate-severe AD were associated with hypertension compared to healthy controls (increased in 4 of 6 studies; 24.9% vs 14.7%; 2.33 [1.10-4.94]). Hypertension was commonly reported as an adverse-event secondary to AD treatments, particularly systemic cyclosporine A. Limitations include lack of longitudinal studies or individual-level data and potential confounding.

CONCLUSIONS

AD, particularly moderate-to-severe disease, was associated with increased hypertension compared to healthy controls, but lower odds than psoriasis.

Underlying mechanisms of cytotoxicity in HepG2 hepatocarcinoma cells exposed to arsenic, cadmium and mercury individually and in combination

BACKGROUND

Toxicity data regarding combinational exposure of humans to arsenic, cadmium and mercury is scarce. Although hepatotoxicity has been reported, limited information is available on their mechanistic underpinnings. The cytotoxic mechanisms of these metals were determined in HepG2 hepatocarcinoma cell lines after individual and combinational exposure.

METHODS

HepG2 cells were exposed to heavy metals (sodium arsenite, cadmium chloride, and mercury chloride) individually or in combination for 24 h, after which cell density, mitochondrial membrane potential (ΔΨm), reactive oxygen species (ROS), reduced glutathione (GSH), adenosine triphosphate (ATP) and caspase-3/7 activity was assessed.

RESULTS AND DISCUSSION

Cadmium (IC₅₀ = 0.43 mg/L) and the combination (0.45 mg/L, arsenic reference) were most cytotoxic, followed by arsenic (6.71 mg/L) and mercury (28.23 mg/L). Depolarisation of the ΔΨm and reductions in ROS, GSH and ATP levels occurred. Arsenic, cadmium and the combination increased caspase-3/7 activity, while mercury reduced it.

CONCLUSION

The combination produced a greater, albeit mechanistically similar, cytotoxicity compared to individual metals. Cytotoxicity was dependent on altered mitochondrial integrity, redox-status, and bioenergetics. Although the combination's cytotoxicity was associated with caspase-3/7 activity, this was not true for mercury. Heavy metal interactions should be assessed to elucidate molecular underpinnings of cytotoxicity.

What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study

BACKGROUND

Multiple strategies have been used to evaluate the minimal important change (MIC) of the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD). The meaningfulness of these MICs is not well established across all severities of atopic dermatitis (AD).

OBJECTIVES

To determine the MIC of percentage and absolute improvement of EASI and SCORAD scores in adults and children with AD.

METHODS

We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 826). An anchor-based approach was used to determine thresholds for the percentage and absolute MICs of EASI, SCORAD and objective SCORAD (O-SCORAD) at follow-up from baseline.

RESULTS

One-grade improvements of Physician's Global Assessment (PGA) and validated Investigator Global Assessment scale for AD (vIGA-AD) were associated with 50%, 35% and 35% decreases of EASI, SCORAD and O-SCORAD, respectively. The thresholds for percentage MIC of EASI (Kruskal-Wallis test, P = 0·61), SCORAD (P = 0·07) and O-SCORAD (P = 0·09) were similar across baseline AD severities. One-grade improvements of PGA and vIGA-AD were associated with 14·0- and 14·9-point decreases of EASI, 19·9- and 14·9-point decreases of SCORAD, and 15·5- and 17·4-point decreases of O-SCORAD. The thresholds for the absolute MIC of EASI (P < 0·001), SCORAD (P < 0·001) and O-SCORAD (P < 0·001) significantly differed by baseline AD severity. Percentage and absolute MICs for EASI and SCORAD were associated with improvements of AD symptoms and quality of life.

CONCLUSIONS

EASI 50, SCORAD 35 and O-SCORAD 35 were meaningful percentage MICs regardless of baseline AD severity. The absolute MICs for EASI, SCORAD and O-SCORAD varied by baseline AD severity.

Measurement properties of the product of investigator's global assessment and body surface area in children and adults with atopic dermatitis

BACKGROUND

Multiple clinician-reported outcome measures exist for atopic dermatitis (AD) severity. However, there is no gold standard for use in clinical practice.

OBJECTIVES

To determine the measurement properties of the product of validated Investigator's Global Assessment for AD (vIGA) and body surface area (BSA) overall or divided into six categories (cBSA: 0%/0.1, <10%/10, <30%/30, <50%/50, <70%/70 and <90%/90-100%) and compare with other clinician-reported and patient-reported outcomes in adults and children with AD.

METHODS

We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 653).

RESULTS

vIGA*BSA and vIGA*cBSA had good convergent validity with BSA (Spearman's ρ = 0.97 and 0.93), eczema area and severity index (ρ = 0.94 and 0.92), and objective SCORAD (ρ = 0.88 and 0.89); and weak-to-good convergent validity with Numeric Rating Scale average itch (ρ = 0.22 and 0.22) and worst itch (ρ = 0.27 and 0.28), Patient-Oriented Eczema Measure (ρ = 0.44 and 0.43), Dermatology Life Quality Index (ρ = 0.48 and 0.49), ItchyQOL (ρ = 0.45 and 0.46), PROMIS Sleep Disturbance (ρ = 0.46 and 0.37) and sleep-related impairment (ρ = 0.31 and 0.31) in adults and/or children; very good discriminant validity for physician-reported global AD severity; good responsiveness to change of severity of AD and itch; and good reliability (intraclass correlation coefficient [95% confidence interval]: 0.72 [0.60-0.81] and 0.74 [0.62-0.82]) with no floor or ceiling effects. Thresholds for interpretability bands and clinically important difference were established.

CONCLUSIONS

vIGA*BSA and vIGA*cBSA scores showed good convergent and discriminant validity, reliability, responsiveness and interpretability in adults and children with AD, and were feasible for use in clinical practice. vIGA*BSA and vIGA*cBSA had slightly lower convergent validity than EASI or objective SCORAD, but might be more efficient to collect and score.

Measurement properties of the Rajka-Langeland severity score in children and adults with atopic dermatitis

BACKGROUND

Multiple atopic dermatitis (AD) severity scales exist, with no gold standard for use in clinical practice.

OBJECTIVES

To determine the measurement properties of the Rajka-Langeland score and compare it with other clinician-reported outcomes in adults and children with AD.

METHODS

We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 427).

RESULTS

Rajka-Langeland had good concurrent validity with the Eczema Area and Severity Index (Spearman rho = 0·63), SCORing AD (SCORAD) (rho = 0·61), objective-SCORAD (rho = 0·52) and body surface area (rho = 0·51); good convergent validity with the numeric rating scale average-itch (rho = 0·60) and worst-itch (rho = 0·59), Patient-Oriented Eczema Measure (rho = 0·57), Dermatology Life Quality Index (rho = 0·53), Patient-Reported Outcomes Measurement Information System Itch Questionnaire (rho = 0·35-0·55) in adults and/or children; fair discriminant validity for patient- and physician-reported global AD severity; good responsiveness to change of severity of AD and itch; good reliability; internal consistency; with no floor or ceiling effects. Interpretability bands (3, clear/almost clear; 4-5, mild; 6-7, moderate; 8-9, severe) and minimal clinically important difference (1 point) were established.

CONCLUSIONS

The Rajka-Langeland score showed good construct validity, reliability, internal consistency and responsiveness in adults and children with AD.

Plasticiser-Free 3D Printed Hydrophilic Matrices: Quantitative 3D Surface Texture, Mechanical, Swelling, Erosion, Drug Release and Pharmacokinetic Studies

Hydroxypropyl methyl cellulose, HPMC, a hydrophilic polymer, is widely used for the development of extended release hydrophilic matrices and it is also considered as a good contender for the fabrication of 3D printing of matrix tablets. It is often combined with plasticisers to enable extrusion. The aim of the current project was to develop plasticizer-free 3D printed hydrophilic matrices using drug loaded filaments prepared via HME to achieve an in vitro (swelling, erosion and drug release) and in vivo (drug absorption) performance which is analogous to hydrophilic matrix tablets developed through conventional approaches. Additionally, the morphology of the printed tablets was studied using quantitative 3D surface texture studies and the porosity calculated. Filaments were produced successfully and used to produce matrix tablets with acceptable drug loading (95-105%), mechanical and surface texture properties regardless of the employed HPMC grade. The viscosity of HPMC had a discernible impact on the swelling, erosion, HPMC dissolution, drug release and pharmacokinetic findings. The highest viscosity grade (K100M) results in higher degree of swelling, decreased HPMC dissolution, low matrix erosion, decreased drug release and extended drug absorption profile. Overall, this study demonstrated that the drug loaded (glipizide) filaments and matrix tablets of medium to high viscosity grades of HPMC, without the aid of plasticisers, can be successfully prepared. Furthermore, the in vitro and in vivo studies have revealed the successful fabrication of extended release matrices.

Histomorphological Effects Of Hunger Stress On Ovaries

BACKGROUND

Incidence of stress is on the rise in our daily life involving various neurobiological, endocrinological and behavioral changes. Hunger stress has a potent influence on mental, physical, and reproductive health by affecting the hypothalamic-pituitary gonadal axis.

METHODS

It was a laboratory based randomized control trial. Adult female mice (BALB-c strain) weighing 25-27 grams on first day of estrous cycle were taken in two groups (ten each). Group A was kept in normal environment of animal house for one month. Group B was given hunger stress by restricting the diet to about 50% per day for one month. Right ovaries of the animals were dissected out and observed for shape, color, and weight. Histological slides were prepared for the count of primary, secondary, and tertiary follicles.

RESULTS

Statistically significant decrease in animal and ovary weight with significant fall in ovarian follicles was observed.

CONCLUSIONS

Hunger stress affects the ovaries by reducing its weight and number of follicles.

Effect of graded levels of dietary corn steep liquor on growth performance, nutrient digestibility, haematology and histopathology of broilers

This experiment was conducted to assess nutritional potential of corn steep liquor (CSL) as an alternative protein source in broiler's diet. A total of 280-day-old unsexed broiler chicks were randomly distributed into four experimental groups in a simple randomised experimental design (each group had seven replicates; 10 birds per each). Four iso-nitrogenous and iso-caloric broiler starter and finisher diets (C, LCSL, MCSL and HCSL) were formulated containing 0%, 5%, 10% and 15% CSL respectively. Results revealed that chicks fed MCSL diet had significantly (p ≤ .05) the heaviest Body weight, highest Body weight gain and the lowest feed conversion ratio followed by those fed HCSL diet. In the starter period, LCSL and MCSL diets resulted in better (p ≤ .05) dry matter (DM) (89.57%) and crude protein (67.67%) digestibilities respectively. In the finisher period, DM, crude fibre and fat digestibilities were not affected by CSL inclusion levels; while crude protein digestibility was significantly (p ≤ .05) high in the groups fed LCSL and HCSL diets. The CSL inclusion had no effect on blood haematology except serum uric acid, which tended to increase with increasing CSL levels. No microscopic changes were exhibited on liver, heart, kidneys and intestine of birds across all dietary treatments. However, crops in birds fed HCSL diet showed moderate to severe hypertrophy and hyperplasia of the mucosal lining. The study showed that CSL could be added up to 15% in broiler's diet without any adverse effect on bird's performance.

Characterization of maize genotypes for genetic diversity on the basis of inter simple sequence repeats

Genetic diversity in crops is essential to make improvements related to superior germplasms. Implementation of molecular markers to identify suitable genotypes speeds up the breeding progress by enhancing selection efficiency. This study was carried out to probe genetic diversity among 21 maize genotypes using 20 inter simple sequence repeat (ISSR) markers. We identified a total of 190 polymorphic bands with an average of 9.5 alleles per primer. The highest number of polymorphic bands (17) was found using ISSR marker UBC-10, whereas the lowest number of polymorphic bands (4) was found using UBC-809. The coefficient of genetic similarity ranged from 0.888 to 0.118%. The highest similarity was found between accessions 12 (015224) and 9 (015114), whereas the lowest similarity was found between genotypes 20 (EV-5098) and 14 (015030). The polymorphism information content ranged from 0.17 to 0.47. A dendrogram was generated based on Jaccard's distance matrix. The genotypes were found to group into two major clusters that could be further partitioned into two sub-clusters. Genotypes located within the same cluster are genetically more closely related to each other. The present study efficiently identified diverse genotypes that may be used for creating new varieties with distinct characteristics. The identified genotypes could be used as parents for future development of diverse populations.

Knowledge of Ebola virus disease among a university population: A cross-sectional study

This cross-sectional study aimed to evaluate the knowledge of a Pakistani university population (students and employees) regarding Ebola virus disease. A total of 2,200 individuals were approached and 1,647 were enrolled in the study. We observed that the vast majority of study participants (91.8%) had inadequate knowledge of Ebola virus disease (knowledge score ≤ 12). Our findings highlight the need to increase the knowledge of Ebola virus disease by using multidimensional approach involving awareness campaigns, print, electronic, and social media.

BODIPY-phenylacetylene macrocycle motifs for enhanced light-harvesting and energy transfer applications

BODIPY-phenylacetylene macrocyclic hybrids are reported, where energy transfer is observed from the phenylacetylene unit to the BODIPY core.

Generation and annihilation of localized persistent-activity states in a two-population neural-field model

We investigate the generation and annihilation of persistent localized activity states, so-called bumps, in response to transient spatiotemporal external input in a two-population neural-field model of the Wilson-Cowan type. Such persistent cortical states have been implicated as a biological substrate for short-term working memory, that is, the ability to store stimulus-related information for a few seconds and discard it once it is no longer relevant. In previous studies of the same model it has been established that the stability of bump states hinges on the relative inhibitory constant τ, i.e., the ratio of the time constants governing the dynamics of the inhibitory and excitatory populations: persistent bump states are typically only stable for values of τ smaller than a critical value τcr. We find here that τ is also a key parameter determining whether a transient input can generate a persistent bump state (in the regime where τ<τcr) or not. For small values of τ generation of the persistent states is found to depend only on the overall strength of the transient input, i.e., as long as the magnitude and duration of the excitatory transient input are larger and/or long enough, the persistent state will be activated. For higher values of τ we find that only specific combinations of amplitude and duration leads to persistent activation. For the corresponding annihilation process, no such delicate selectivity on the transient input is observed.

A case of a gastrointestinal stromal tumour presenting as acute abdomen

BACKGROUND

Gastrointestinal stromal tumour (GIST) has many modes of presentation. This is the first reported GIST presenting as an acute abdomen.

METHODS

A man presented with signs and symptoms suggestive of acute appendicitis. Examination under anaesthesia revealed a mass. At laparotomy a strangulated mass was found originating from the greater curve of the stomach. Subsequent histopathology confirmed this to be a gastrointestinal stromal tumour, probably of a benign nature. Post-operative investigations did not show any metastatic spread.

CONCLUSIONS

GISTs arise from the gastrointestinal tract, omentum, and mesentery. Presentation is generally non-specific and it is rare for them to present acutely. Management should include staging to exclude any metastatic spread.

Use of vacuum-assisted closure for healing of a persistent perineal sinus following panproctocolectomy: report of a case

Perineal sinus is a troublesome complication after proctectomy for inflammatory bowel disease or rectal cancer. The results from treatment with simple dressings with or without surgical debridement are suboptimal. Definitive management may require complex operations with muscular or musculocutaneous flaps. Vacuum-assisted dressings have been used successfully for management of chronic wounds and soft tissue defects. This technique was successfully used in the management of a perineal sinus, which occurred after proctectomy for rectal cancer developing on a background of inflammatory bowel disease and preoperative radiotherapy.

Surgical treatment of hepatic hydatid cyst

Hydatid disease of the liver is caused by the tapeworm Echinococcus granulosus, and the highest incidence of human infestation occurs in sheep and cattle-raising areas. Although, still an uncommon occurrence, it is being seen with increasing frequency; hence, it is important that surgeons make themselves aware of the pathology and treatment of the disease. The liver is most commonly involved, although many other organs, including lungs and brain may also be affected. An echinococcal cyst of the liver was reported in a patient who is a resident in Northern Ireland but had originally lived and worked in mainland Britain. Details of the lifecycle, pathology, diagnostic techniques and surgical management of hydatid cysts are reviewed.

Marine natural products as lead anti-HIV agents

Current anti-HIV drugs have extreme side effects and resistance to these drugs develops rapidly. The marine environment holds an unprecedented number of unusual chemical structural classes with activity against HIV. We review the literature on anti-HIV activity of marine natural products and discuss the efficacy of different structural classes.

Management of severe acute pancreatitis

BACKGROUND

Acute pancreatitis is still associated with significant morbidity and mortality. Current management guidelines are sometimes equivocal, particularly in relation to the surgical treatment of severe disease. This review assesses available investigative and treatment strategies to allow the development of a formalized management approach.

METHODS

A literature review of diagnosis, staging and management of acute pancreatitis was performed.

RESULTS AND CONCLUSION

Recent evidence has helped to clarify the roles of computed tomography, endoscopic retrograde cholangiopancreatography, prophylactic antibiotics, enteral feeding and fine-needle aspiration for bacteriology in the management of acute pancreatitis. Despite a relative shortage of prospective randomized trials there has been a significant change in the surgical management of acute pancreatitis over the past 20 years. This change has been away from early aggressive surgical intervention towards more conservative management, except when infected necrosis is confirmed. A formalized approach, with appropriate use of the various non-surgical and surgical options, is feasible in the management of severe acute pancreatitis.

Conservative management of major liver trauma

Images