Role of intra-abdominal pressure in the outcomes of perforation peritonitis: A prospective observational study

OBJECTIVES

Intra-abdominal pressure (IAP) has been investigated for its role in causing morbidity and mortality, with various studies showing different degrees of correlation. There remains paucity of literature on this subject, applied to patients of perforation peritonitis, especially in the Indian subcontinent.

MATERIAL AND METHODS

It is a prospective observational study involving 40 patients of perforation peritonitis undergoing exploratory laparotomy. IAP was measured as per WSACS (World Society of Abdominal Compartment Syndrome) guidelines. APACHE II (Acute Physiology And Chronic Health Evaluation- II) and SOFA (Sequential Organ Failure Assessment) were calculated. Data was collected regarding occurrence of prolonged ileus, burst abdomen, duration of hospital stay, 30 day mortality, and was statistically analyzed to correlate with IAP.

RESULTS

At admission, mean IAP was 13.37 mmHg, and the incidence of IAH was 65%. IAH was seen in 17.9% and 7.6% at 24 h and 48 h post-operatively. Incidence of prolonged ileus and burst abdomen were 7.7% and 22.5% respectively. Mortality rate was 17.5%. Mean duration of hospital stay was 13.45 days. Post-operative IAP correlated with mortality (p: 0.014) and post-operative SOFA score (p <0.05). Statistically significant correlation was also seen with the occurrence of prolonged ileus (p: 0.006). IAP did not significantly correlate with APACHE II score, occurrence of burst abdomen, and duration of hospital stay.

CONCLUSION

Rise in IAP correlates with deterioration of SOFA score, and also with the occurrence of prolonged ileus. IAP is also a predictor of mortality. IAP measured post-operatively (24 and 48 hours) had a better correlation with these outcomes than the value measured at admission. No statistically significant correlation of IAP with the occurrence of burst abdomen and duration of hospital stay could be found, which warrants further studies with a larger population.

Angiopoietins as biomarkers of disease severity and bacterial burden in pulmonary tuberculosis

BACKGROUND

Circulating angiogenic factors of the vascular endothelial growth factor family are important biomarkers of disease severity in pulmonary tuberculosis (PTB). However, the role of angiopoietins, which are also involved in angiogenesis, in PTB is not known.

OBJECTIVE AND DESIGN

To examine the association of circulating angiopoietins with TB disease or latent tuberculous infection (LTBI), we examined the systemic levels of angiopoietin (Ang) 1, Ang 2 and Tie-2 receptor in individuals with PTB (n = 44), LTBI (n = 44) or no tuberculous infection (NTBI) (n = 44).

RESULTS

Circulating levels of Ang-1, Ang-2 and Tie-2 were significantly higher in PTB than in individuals with LTBI or NTBI. Moreover, Ang-1, Ang-2 and Tie-2 levels were significantly higher in PTB with bilateral disease. The levels of these factors also exhibited a significant positive relationship with bacterial burdens in PTB. Receiver operating characteristics curve analysis revealed Ang-2 as a marker distinguishing PTB from LTBI or NTBI. Finally, the circulating levels of Ang-1, Ang-2 and Tie-2 were significantly reduced following anti-tuberculosis chemotherapy.

CONCLUSIONS

Our data demonstrate that PTB is associated with elevated levels of circulating angiopoietins, possibly reflecting endothelial dysfunction. In addition, Ang-2 could prove useful as a biomarker to monitor disease severity, bacterial burden and therapeutic responses.

Predatory potential of Platynectes sp. (Coleoptera: Dytiscidae) on Aedes albopictus, the vector of dengue/chikungunya in Kerala, India

Unused and discarded latex collection containers (LCCs) are the major breeding habitats of Aedes albopictus in the rubber plantations of Kerala, India. Platynectes sp. (Family: Dytiscidae) was observed to invade these habitats during the monsoon season and voraciously devour the larval instars of this major vector species of arbo-viral diseases. Field observations showed a reduction of 70.91% (p = 0.0017) and 100% in Aedes larval density, on the first and four days post release of eight beetles per LCC respectively. In laboratory, a beetle was found to devour 17.75 + 5.0 late larval instars of Ae. albopictus per day. Our findings indicate Platynectes sp. could be a potential bio-control agent against Ae. albopictus, the vector of chikungunya/dengue fevers, in rubber plantations.

Fatal haemorrhagic pulmonary oedema and associated angioedema after the ingestion of rofecoxib

Angioedema is a recognised side effect of rofecoxib, a cyclo-oxygenase-2 (COX-2) inhibitor. But death resulting from a haemorrhagic pulmonary oedema after its ingestion has not been recorded. The case of a 60 year old man who died from haemorrhagic pulmonary oedema in the presence of angioedema after the ingestion of two doses of 12.5 mg of rofecoxib is reported.

Responses to the prolonged head-up tilt followed by sublingual nitrate provocation in asymptomatic older adults

BACKGROUND

prolonged head-up tilt testing and sublingual nitrate provocation are increasingly used in the diagnosis of neurocardiogenic syncope. However there are few data regarding the results of these tests in asymptomatic older subjects.

OBJECTIVE

to assess the responses to the prolonged head-up tilt test followed by sublingual glyceryl trinitrate provocation in asymptomatic subjects over the age of 60 years.

DESIGN

observational study.

METHODS

we recruited 64 asymptomatic subjects over the age of 60 (39 men, 25 women) from two general practice lists in Nottingham and Leicester. Exclusion criteria were: history of syncope, ischaemic heart disease, cerebrovascular disease, marked aortic stenosis, carotid artery disease and being unable to stand for the duration of the test. All subjects underwent a full clinical examination, a 12-lead electrocardiogram and a 30-40-min head-up tilt test, during which we monitored the heart rate and blood pressure continuously. We ended the test prematurely if the subjects developed syncope or symptoms of presyncope associated with hypotension with or without bradycardia. If they remained asymptomatic at the end of this period, they received 400 microg of sublingual glyceryl trinitrate and monitoring continued for another 15 min.

SETTINGS

two teaching hospitals in Nottingham and Leicester.

RESULTS

six (9%) of the subjects had a positive response (syncope or presyncope) to the prolonged head-up tilt test prior to glyceryl trinitrate provocation. After provocation, 30 (52%) of the remaining 58 subjects had a positive response.

CONCLUSION

the role of sublingual glyceryl trinitrate provocation following prolonged head-up tilt testing in the diagnosis of neurocardiogenic (vasovagal) syncope in older people is questionable, as many asymptomatic older subjects demonstrate syncopal or presyncopal symptoms.

A non-radioactive method for mapping restriction fragment length polymorphic genetic markers in Anopheles gambiae

A non-radioactive method for in situ hybridisation of Restriction Fragment Length Polymorphic (RFLP) markers to the polytene chromosome of Anopheles gambiae, the important malaria vector, which yielded good readable quality of chromosomal bands is reported. The methodology adopted was a Biotin-Streptavidin-Alkaline Phosphatase system which yielded fluorescent signals when stained with dyes such as Nitro Blue Tetrazolium and Bromo Chloro Indolyl Phosphate.

Susceptibility status of Mansonia annulifera to Brugia malayi parasites in Cherthala, Alappuzha district, Kerala

Laboratory studies conducted on Ma. annulifera collected from Cherthala region, Kerala, endemic for Brugian filariasis indicated that this species is highly susceptible to B. malayi parasites. The experimental infection index of this species was relatively higher (2.74). No significant loss of larvae during development was recorded. The extrinsic incubation period was estimated to be 8 days.

Efficacy of diethylcarbamazine-medicated salt for microfilaraemia of Brugia malayi

BACKGROUND

Pilot studies in India and abroad have demonstrated the benefit of cooking salt fortified with diethylcarbamazine citrate (DEC) for the control of lymphatic filariasis. In India, DEC-medicated salt has been introduced on a commercial basis in the Cherthala region of Kerala, which is endemic for Brugia malayi (B. malayi). We studied the efficacy of DEC-medicated salt in the clearance of microfilaraemia of B. malayi.

METHODS

Eighteen cases of microfilaraemia (11 men; 7 women) were selected; 14 in the experimental group (i.e. treated with 0.2% w/w DEC-medicated salt) and the rest as the control group who were given a placebo. The consumption of salt and the status of parasitaemia were monitored till all the microfilaria carriers became negative.

RESULTS

There was a significant reduction in the density of microfilariae (intensity) among the treated individuals over a period of time. The duration required for the clearance of microfilariae ranged from 9 to 30 [mean (SD) 19.4 (1.7)] weeks. All microfilaraemics except one reported side-effects which were mild-to-moderate and persisted for a maximum period of one month.

CONCLUSION

DEC-medicated salt effectively clears microfilariae within 30 weeks in parasitaemic individuals. No 'endemic normals' reported any side-effects, though these were common among the microfilaria carriers.

Virus isolation from wild-caught mosquitoes during a Japanese encephalitis outbreak in Kerala in 1996

Out of 5357 wild-caught mosquitoes in 163 pools tested for virus using antigen capture ELISA and an insect-bioassay (inoculation into Toxorhynchites splendens larvae and identification by IFA using JE virus-specific monoclonal antibody), 16 flavivirus isolations were made of which 12 (75%) were identified as JE virus. Of the 12 JE virus isolations, 7 were from Culex tritaeniorhynchus, 3 from Mansonia uniformis and 1 each from Ma. indiana and Anopheles subpictus. Four isolations from Mansonia species for the first time reported here are noteworthy.

Phytoremediation: a novel strategy for the removal of toxic metals from the environment using plants

Toxic metal pollution of waters and soils is a major environmental problem, and most conventional remediation approaches do not provide acceptable solutions. The use of specially selected and engineered metal-accumulating plants for environmental clean-up is an emerging technology called phytoremediation. Three subsets of this technology are applicable to toxic metal remediation: (1) Phytoextraction--the use of metal-accumulating plants to remove toxic metals from soil; (2) Rhizofiltration--the use of plant roots to remove toxic metals from polluted waters; and (3) Phytostabilization--the use of plants to eliminate the bioavailability of toxic metals in soils. Biological mechanisms of toxic metal uptake, translocation and resistance as well as strategies for improving phytoremediation are also discussed.

The resting and house frequenting behavior of Mansonia annulifera, Ma. uniformis and Ma. indiana, the vectors of Malayan filariasis in Kerala State, India

Mansonia annulifera, was recorded to be an endophilic species, preferring to rest indoors, while Ma. uniformis was exophilic, having a predilection for outdoor resting habitats, eg bushes and shrubs. Ma. indiana did not show a clear preference to either of these biotopes. In indoor resting collections, the unfed proportion of Ma. uniformis was significantly higher during post-dusk compared to day hours (p < 0.05), indicating that this exophilic species enters houses during dusk hours for feeding. The full fed proportion was higher during day hours compared to dusk/night hours. The semigravid proportion showed a significant reduction during post-dusk hours (p < 0.05). These findings suggest that after having a blood-meal this species rest indoors and leave the houses for outdoor resting sites during the dusk hours on the subsequent night.

Seasonal abundance & biting behaviour of Mansonia annulifera, M. uniformis & M. indiana & their relative role in the transmission of malayan filariasis in Shertallai (Kerala state)

Three species of Mansonia (Mansonioides) mosquitoes, viz., Mansonia annulifera, M. uniformis and M. indiana were recorded in the Shertallai region of Kerala state. M. annulifera and M. uniformis were recorded throughout the year while M. indiana was seasonal and in small numbers. Their indoor resting density was 3.29, 0.25 and 0.10 per man per h and the man biting density was 24.67, 12.74 and 0.47 per man per night respectively. Vector density fluctuated through seasons and reached a peak during the monsoon/post-monsoon period when there was an increase in the breeding surface area and a relatively higher survival of the adults. The biting tendency of M. annulifera and M. indiana was relatively more indoors (endophagic) whereas it was outdoors (exophagic) for M. uniformis. All these mosquitoes showed a predilection towards cattle, with varying degrees of zoophily. The relative abundance, man biting behaviour and a higher transmission potential indicate that M. annulifera is a more potent vector of Brugia malayi, than M. uniformis in this region.

Biting rhythm of the vectors of Malayan filariasis, Mansonia annulifera, M. uniformis & M. indiana in Shertallai (Kerala state), India

Biting activity of Mansonioides mosquitoes through all night collections for a period of two years in Shertallai region, in south India was studied. M. annulifera bites uniformly throughout the night, with two peaks of activity, one after midnight (24.00-01.00 h) and another before dawn (04.00-05.00 h). M. uniformis was found to be predominantly dusk biting, with its peak of activity between 1800 to 1900 h. M. indiana showed two peaks of biting activity one after dusk (2000-2100 h) and another before dawn (0300-0400 h). All biting, with its peak of activity between 1800 to 1900 h. M. indiana showed two peaks of biting activity one after dusk (2000-2100 h) and another before dawn (0300-0400 h). All these species following a particular pattern of activity cycles discerned the biting rhythm of Mansonioides mosquitoes to be species-specific.

Primary carcinoma of vagina with uterine prolapse

Eleven cases of primary carcinoma of vagina were admitted in Kasturba Medical College Hospital during the last 10 years, of which 6 cases aged 44-72 years, were associated with 3rd degree uterine prolapse. All the patients attended the hospital in late stage in spite of having 3rd degree uterine prolapse. Blood stained discharge and ulceration on the prolapsed part, irreducible prolapse with urinary retention and marked oedema of local and surrounding tissues were the presenting symptoms. Lesion on the vagina varied in size from 5 cm to 15 cm. IVP in both the cases of irreducible prolapse and retention of urine revealed hydroureter and hydronephrosis bilaterally. X-ray chest revealed secondaries in one patient only. Histopathology of vaginal biopsy revealed well differentiated squamous cell carcinoma in 5 cases and undifferentiated squamous cell carcinoma in one. Since the patients were in late stage of malignancy and were inoperable, treatment with external telecobalt therapy was undertaken. One patient developed vesicovaginal fistula during the treatment period and another patient developed it at the end of telecobalt therapy.

Salivary paracetamol elimination in patients with congestive cardiac failure

1. Salivary paracetamol elimination was studied in nine patients with congestive cardiac failure (CCF). Six healthy volunteers served as the control group. 2. Paracetamol elimination t1/2 and apparent volume of distribution were significantly higher in patients with CCF compared with controls. There was no significant change in the clearance rate. 3. Drug therapy of failure for a period of 15 days returned the t1/2 and V values to normality.

Population movement and malaria persistence in Rameswaram Island

The role of population movement on the persistent transmission of malaria in Rameswaram Island was studied. Majority of the inhabitants of the island are fishermen, who engage in perennial fishing. They move from one coastal place to the other for fishing and stay in temporary camps depending on season and fish availability. Such seasonal fishing camps attract fishermen from the mainland coastal villages also. The parasitological and entomological studies carried out in these places reveal that some of the camps are highly vulnerable to the movement of individuals with malaria infection and highly receptive. Rameswaram being a holy place, receives pilgrims from all over India and Nepal. Plasmodium falciparum cases recorded from the pilgrims of North India indicate the danger of the possible introduction of chloroquine-resistant parasite in the island. Also, a large number of passengers in transit from various countries, many of which are at risk of malaria transmission, stay in the island before or after visiting Sri Lanka. Such population movements being a continuous and regular feature are significant and result in failures in the operational programmes.