First observation of Afromorgus chinensis (boheman, 1858) (Coleoptera: Trogidae) on a rabbit (Oryctolagus cuniculus L., 1758) carcass and its implications in forensic entomology

Beetles (Coleoptera) are known to constitute forensic evidence in medico-legal investigations as their presence can be used to date human remains in almost all decomposition stages. Many forensic studies focus on the successional colonization pattern of flies (Diptera); however, beetles have not so far been studied extensively for this aspect. A beetle of the genus Afromorgus Scholtz, 1986, A. chinensis (Boheman, 1858) (Scarabaeoidea: Trogidae), was found beneath a late decaying rabbit carcass at Paya Indah Wetland, Dengkil, Malaysia, for the first time. Both genus and species are already known to occur in Malaysia from literature.

New developmental data of Chrysomya megacephala (Diptera: Calliphoridae) in tropical temperatures and its implications in forensic entomology

The estimation of the postmortem interval (PMI) is an essential information in death investigations. It is necessary to know the developmental data of the most important necrophagous insect species in every geographical area. Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae) is one of the most common species associated with human body decomposition, especially in the tropics, so a precise knowledge of its life cycle is crucial. However, despite its ubiquity, developmental data in a range of tropical temperatures is scarce. For this reason, the aim of this study is to provide the developmental data of the blowfly, C. megacephala, in a range of tropical temperatures and to apply these data in forensic entomology. Four temperatures were examined (i.e., 27.0°C 29.5°C, 32.0°C and 34.5°C) and the time of developments from egg to adult were recorded. To build the growth curves, five larvae per day were measured with a digital caliper. Accumulated degree-days were calculated and the isomorphen diagram for this species was plotted. As we predicted, the results showed that the life cycle of this species was affected by the increasing temperature. The implications of these new data for determining the minimum PMI in forensic entomology were discussed.

Guidelines on retention of pathology records and materials (Version 2/2022)

No abstract available.

Medico-legal autopsies of homicidal deaths: A five-year retrospective study in Hospital Sungai Buloh

INTRODUCTION

Homicide is the act of killing one human being by another, encompassing death as a result of criminal act including justifiable homicide such as judicial killing and self-defence. This study aimed to ascertain the epidemiology and patterns of injury of homicide victims.

MATERIALS AND METHODS

We reviewed records of medico-legal autopsy cases performed at the Department of Forensic Medicine, Hospital Sungai Buloh, for a period of five years, from January 2012 until December 2016. Subjects' demographic data such as age, gender, nationality, ethnicity and cause of death were recorded.

RESULTS

A total of 122 homicide cases were documented. 90% of the victims were 18 to 65 years old. Males contributed 80% of the subjects. An alarming 42% of the subjects comprised of non-Malaysians. Indonesian subjects contributed one-third of the non-citizen category, followed by Bangladeshis at 20.4%. Other nationalities were Burmese, Nepalese, Pakistani, Vietnamese and unspecified. Among Malaysians, 50% of the subjects were Indians, followed by Malay (31.5%) and Chinese (17.8%). Sharp and blunt force traumas were the most common injuries found, contributing 33% and 32% respectively. Asphyxiation and firearm injuries recorded an almost similar frequency, contributing 25% in combination. Other patterns included combined sharp and blunt objects (4.9%) and burns (3%).

CONCLUSIONS

A large number of immigrants in the country have significantly increased the forensic casework. Sharp and blunt objects continue to be the weapon of choice due to its easy accessibility. As domestic violence including fatal spousal and child abuse continue to rise, in-depth study in the area is warranted.

Methanol outbreak: a Malaysian tertiary hospital experience

Introduction

Methanol poisoning usually occurs in a cluster and initial diagnosis can be challenging. Mortality is high without immediate interventions. This paper describes a methanol poisoning outbreak and difficulties in managing a large number of patients with limited resources.

Methodology

A retrospective analysis of a methanol poisoning outbreak in September 2018 was performed, describing patients who presented to a major tertiary referral centre.

Result

A total of 31 patients were received over the period of 9 days. Thirty of them were males with a mean age of 32 years old. They were mostly foreigners. From the 31 patients, 19.3% were dead on arrival, 3.2% died in the emergency department and 38.7% survived and discharged. The overall mortality rate was 61.3%. Out of the 12 patients who survived, two patients had toxic optic neuropathy, and one patient had uveitis. The rest of the survivors did not have any long-term complications.

Osmolar gap and lactate had strong correlations with patient’s mortality. Serum pH, bicarbonate, lactate, potassium, anion gap, osmolar gap and measured serum osmolarity between the alive and dead patients were significant. Post-mortem findings of the brain were unremarkable.

Conclusion

The mortality rate was higher, and the morbidity includes permanent visual impairment and severe neurological sequelae. Language barrier, severity of illness, late presentation, unavailability of intravenous ethanol and fomipezole and delayed dialysis may have been the contributing factors. Patient was managed based on clinical presentation. Laboratory parameters showed difference in median between group that survived and succumbed for pH, serum bicarbonate, lactate, potassium and osmolar and anion gap. Management of methanol toxicity outbreak in resource-limited area will benefit from a well-designed guideline that is adaptable to the locality.

An Ultrasonically Powered Implantable Microprobe for Electrolytic Ablation

Electrolytic ablation (EA) is a promising nonthermal tumor ablation technique that destroys malignant cells through induction of a locoregional pH change. EA is typically performed by inserting needle electrodes inside the tumor followed by application of direct current (DC), thus inducing electrolysis and creating localized pH changes around the electrodes. In this paper, we report an ultrasonically powered implantable EA microprobe that may increase the clinical relevance of EA by allowing wireless control over device operation (capability to remotely turn the device on and off) and providing flexibility in treatment options (easier to administer fractionated doses over a longer period). The wireless EA microprobe consists of a millimeter-sized piezoelectric ultrasonic receiver, a rectifier circuit, and a pair of platinum electrodes (overall size is 9 × 3 × 2 mm³). Once implanted through a minimally invasive procedure, the microprobe can stay within a solid tumor and be repeatedly used as needed. Ultrasonic power allows for efficient power delivery to mm-scale devices implanted deep within soft tissues of the body. The microprobe is capable of producing a direct current of 90 µA at a voltage of 5 V across the electrodes under low-intensity ultrasound (~200 mW/cm²). The DC power creates acidic (pH < 2) and alkaline (pH > 12.9) regions around the anode and the cathode, respectively. The pH change, measured using tissue-mimicking agarose gel, extends to 0.8 cm³ in volume within an hour at an expansion rate of 0.5 mm³/min. The microprobe-mediated EA ablative capability is demonstrated in vitro in cancer cells and ex vivo in mouse liver.

Association of coronary artery calcium score with calcification and degree of stenosis: An autopsy study

INTRODUCTION

Coronary artery disease (CAD) is a known cause of major cardiovascular events and calcium score (CS) has been developed as a marker of coronary atherosclerosis. Yet, the relationship between post mortem computed tomography (PMCT) CS with histologically observed calcification and the severity of coronary artery stenosis has not been widely explored and is still unclear. This study aims to determine the association between coronary artery PMCT CS with histologically observed calcification and degree of stenosis of coronary arteries in post-mortem cases.

MATERIALS & METHODS

This was a cross-sectional study involving 101 subjects recruited from the National Institute of Forensic Medicine (IPFN) Hospital Kuala Lumpur (HKL) over a period of 15 months, from December 2012 until April 2014. PMCT CS of the coronary arteries was calculated using Agatston-Janowitz score. Histological presence of calcification was observed and the degree of stenosis was calculated using an image analysis technique.

RESULTS

PMCT CS increased with increasing severity of stenosis (p<0.001). PMCT CS showed a positive correlation with the presence of calcification (r=-0.82, p<0.001).

CONCLUSION

Calcium score is strongly associated with coronary artery calcification and the degree of luminal stenosis in post mortem subjects. Thus, PMCT may be useful as a non-invasive tool in diagnosing CAD in the event that an autopsy is not possible.

Detection of human Sarcocystosis using dried blood on filter papers: An Immunofluorescent Antibody Test

Sarcocystosis, a parasitic infection caused by a protozoa belonging to the genus Sarcocystis, is found worldwide in both and animals. Sarcocystis spp., require two animal hosts to complete their life cycle. The infection has gathered more global attention after recent outbreaks, especially amongst wester travellers to Malaysia. Other than sporadic cases and the current outbreaks, little information is available regarding human Sarcocystis infection in Malaysia. The present study aims to determine the prevalence of sarcocystosis among humans using an immunofluorescent antibody (IFA) test applied to dried blood on filter papers. A total of 200 blood samples were collected on filter papers from autopsy cases at two Malaysian hospitals: Sungai Buloh Hospital (peninsular Malaysia) and Queen Elizabeth Hospital (Malaysian Borneo). Antigens were prepared from bradyzoites harvested from positive goats' muscle samples. Of the 200 samples, 32 (16%) had Sarcocystis antibodies that showed positive fluorescence reactions on filter papers. There was no significant difference (t-test, p value > 0.05) in prevalence rates between samples collected from autopsies at peninsular Malaysia and Malaysian Borneo. The results demonstrated that the filter paper technique can be used as one of the alternative serological tests in the diagnostic of human sarcocystosis.

Palladium-Catalyzed Regioselective Heck–Suzuki–Miyaura Cascade Cyclization for the Synthesis of Trisubstituted Arylideneisoquinolinones

An Ugi four-component reaction was used to construct propargylamide starting materials for a subsequent domino Heck–Suzuki–Miyaura cross-coupling reaction to give derivatives of 4-benzylidene-1-oxo-3,4-dihydro-1H-isoquinoline.

Maternal voluntary exercise ameliorates learning deficit in rat pups exposed, in utero, to valproic acid; role of BDNF and VEGF and their receptors

In utero exposure to therapeutic doses of valproic acid (VPA) during pregnancy can produce physical malformation and CNS abnormalities in the offspring. There is evidence indicating that even lower doses of VPA during pregnancy could cause cognitive impairment in offspring. It has been demonstrated that maternal exercise has positive effects on offspring's cognitive function. In this study we evaluated the preventive potential of maternal voluntary exercise on cognitive deficits induced by in utero exposure to VPA, in rat pups. Furthermore, the alteration of hippocampal brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) and their respective receptors were measured. In treatment groups, pregnant rats received VPA (10 and 20 mg/kg) daily on the gestation days (GD) 7 for twelve days with or without access to a running wheel. In control groups, rats received saline with or without access to a running wheel. On postnatal day (PND) 30, learning and memory of rat pups were assessed using the Morris Water Maze (MWM) task. Also, on PND 30, hippocampal BDNF and VEGF were measured by ELISA and western blot analysis respectively. VEGFR (VEGF receptor) and TrkB (Tyrosine receptor kinase B, the receptor for BDNF) expressions were assessed using immunofluorescence staining. Results revealed that maternal voluntary exercise enhanced learning in offspring but had little effect on memory retention. Exposure to VPA during pregnancy disturbed learning and memory in rat pups. Maternal voluntary exercise could ameliorate some aspects of cognitive deficit induced by VPA. TrkB and VEGFR2 expression were enhanced in pups from running mothers. VPA, at both doses, suppressed exercise induced expression of these two receptors. Voluntary exercise and to a much greater extent VPA administration increased hippocampal BDNF. Voluntary exercise of mothers caused an enhance expression of VEGF in rat pups as did VPA administration, although to a smaller amount.

Post mortem troponin T analysis in sudden death: Is it useful?

INTRODUCTION

Cardiac-related diseases contributed approximately 50-60% of sudden natural death cases. This study aimed to describe the cardiac troponin T (cTnT) findings in post mortem subjects irrespective of the cause and manner of death, and the possible use of post mortem serum cTnT as a modality in investigating sudden natural death.

METHODS

The study samples comprised 140 subjects aged 18 to 50 years old, natural and unnatural causes of sudden death brought to the Department of Forensic Medicine, Hospital Sungai Buloh (HSgB) and Hospital Sultanah Aminah Johor Bahru (HSAJB) for a period of 12 months. The subjects were categorised into 5 groups: cardiovascular disease (CVD), sudden unexplained death (SUD), thoracic trauma (TT), non-thoracic trauma (NTT) and other diseases (OD).

RESULTS

Median troponin concentration in cases of CVD, SUD, TT, NTT, and OD were 0.51 μg/L, 0.17 μg/L, 0.62 μg/L, 0.90 μg/L and 0.51 μg/L respectively. We found no significant difference of troponin T level in different causes of death (p ≥ 0.05). NTT has the highest median troponin concentration with 0.90 μg/L, SUD possessed the lowest median concentration with 0.17 μg/L.

CONCLUSION

Troponin T is neither specific nor useful as cardiac biomarker for post mortem sample. Therefore, it may not be a useful diagnostic tool at autopsy.

Leptospirosis in pregnancy: A lesson in subtlety

INTRODUCTION

Leptospirosis is a zoonotic disease caused by spirochaete of the genus Leptospira. Human infection occurs after exposure to water or soil contaminated by urine from an infected animal. Most patients manifest as self-limited systemic illness. However 10% of patients manifest as severe disease associated with high fatality. The disease affects mostly men, cases involving pregnant women are uncommon. We presented a case of leptospirosis in a pregnant woman leading to mortality of both mother and foetus.

CASE REPORT

A 28-year-old woman at 18 weeks of gestation, had shortness of breath and collapsed. She was brought unconscious to the emergency department and died shortly after arrival. A week prior to this, she had presented to the same hospital with pain on both thighs. Examination of the patient and ultrasound of the foetus revealed normal findings. Post mortem examination revealed hepatosplenomegaly and congested lungs; no jaundice, meningeal inflammation or cardiac abnormalities was evident. Histopathology examination of the lungs revealed pulmonary haemorrhages and oedema. Multiple infarcts were seen in the spleen and the kidneys showed foci of acute tubular necrosis. Laboratory investigations revealed Leptospira IgM antibody and PCR for leptospira were positive. This case illustrates the subtleness of clinical presentation of leptospirosis. The diagnosis was obscure even at post-mortem and was only suspected following histopathological examination, leading to further investigations.

CONCLUSION

Leptospirosis may have a subtle presentation and a high index of suspicion for this infection is required for early identification of the disease.

A sudden paediatric death due to hand, foot and mouth disease: the importance of vigilance

BACKGROUND

Hand, foot and mouth disease (HFMD) is caused by enteroviruses such as Coxsackie virus A16 (CVA16) and Enterovirus 71 (EV71). The diagnostic hallmarks are oral ulcers and maculo-papular or vesicular rash on the hands and feet. Severe form of this disease can lead to death due to neurological and cardiopulmonary complications. This case report aims to describe a fatal case of HFMD with minimal oral and skin manifestations.

CASE REPORT

A four-year-old girl was brought to a hospital after suddenly becoming unresponsive at home. She had a history of fever and lethargy for three days prior to her demise. The patient, and f ive other children in her neighbourhood had been diagnosed to have HFMD at a local health clinic; the other children had recovered without complications.

RESULTS

Autopsy revealed a few punctate, sub-epidermal vesicles measuring 1 to 2 mm on the palm of her right hand and sole of the right foot, visible only with a magnifying glass. Internal examination revealed prominent nodularity at the oro- and hypopharynxes. The lungs were markedly congested and oedematous. Histopathology of the lung showed marked oedema and haemorrhage with mild pneumonic changes. Oedema with increase in macroglia and astrocytic proliferation were seen in the cerebral tissue, but no lymphocytic infiltration was evident. Enterovirus EV71 was detected by polymerase chain reaction in samples from the lung, cerebrospinal fluid and serum. The cause of death was given as HFMD complicated by pneumonia.

CONCLUSION

Fatal HFMD may have minimal signs. A complete history, careful physical examination and relevant investigations lead to a diagnosis at post mortem examination. Awareness of the subtle signs and rapid deterioration associated with a fatal case of HFMD is a challenge to clinicians who encounter these cases.

Acute pulmonary thromboembolism in a case of fatal child abuse

Child abuse is a worldwide problem. The four major types of abuse include physical abuse, child neglect, psychological maltreatment and sexual violence. We describe a fatal case of child abuse which presented with numerous old and recent soft tissue injuries all over the body. The injuries on the legs have immobilized the victim for quite some time, giving rise to deep vein thrombosis, leading to death as a result of acute pulmonary thromboembolism. This case demonstrates presence of both elements of abuse and neglect in one victim. As this category of crime involves a helpless child, we would also like to reiterate that the community has an obligation to prevent such tragedies and educating the public to recognize the signs and symptoms of abuse would be of utmost important. Ultimately, the community must also be responsible for reporting such offences and the act of silence is akin to condoning a crime witnessed.

Review of local herbal compounds found in the Iranian traditional medicine known to optimise male fertility

The male reproductive function can be influenced by many different factors, including genetic, environmental and socioeconomic parameters leading to a progressive decline. However, the cause of infertility cannot be found in a significant proportion of couples, and even with the presence of the sign of testicular dysfunction or obstructive azoospermia, the main aetiology is not identified. In the absence of knowledge about predisposing factor, targeted therapeutic modalities for male infertility may not be possible, and a wide variety of empiric drug approaches, even with low scientific evidence, have been utilised in current conventional medicine. According to the recently updated reports of the European Association of Urology guidelines on male infertility, the implication of previous recommendations and complementary alternative medicine based on the old literature has been suggested to improve a multifaceted integrative therapeutic approach for this disease. We have reviewed the potential herbal active compounds optimising male fertility, according to the principles of Iranian traditional medicine.

Meta-Analysis Finds Use of Inhaled Corticosteroids During Pregnancy Safe: A Systematic Meta-Analysis Review

Inhaled corticosteroids (ICs) are the drug of choice for asthmatic women during pregnancy, but the results on the effects of these medications on obstetrical and perinatal outcomes are not conclusive. Meta-analysis is the statistical analysis of a collection of analysis results from individual studies for the purpose of integrating the findings. Meta-analysis techniques are necessary because only summary statistics are available in the literature. In order to determine the risk of exposure to ICs, we pooled data from all clinical studies that evaluated the pregnancy and perinatal outcomes in women exposed to this group of drugs during pregnancy by the meta-analytic technique.

PUBMED, OVID, EMBASE and SCOPUS databases were searched for studies that investigated birth outcome following exposure to ICs during pregnancy. Data were collected from 1997 to 2005 (up to 31 December). Types of outcome investigated were major malformations, pre-term delivery, low birth weight and pregnancy-induced hypertension. The criteria for inclusion of studies in this meta-analysis were exposure of women to any therapeutic dosage of any ICs (fluticasone, beclomethasone, budesonide, triamcinolone and flunisolide) during pregnancy.

The results showed that ICs do not increase the risk of major malformations, preterm delivery, low birth weight and pregnancy-induced hypertension. In conclusion, ICs do not increase the rates of any obstetrical outcomes investigated in the present study and interestingly improve the symptoms and are helpful in the management of asthma and thus can be used comfortably during pregnancy.

Effect of protein source and protease addition on performance, blood metabolites and nutrient digestibility of turkeys fed on low-protein diets from 28 to 55 d post hatch

The objective of this study was to investigate the effect of a monocomponent protease and dietary inclusion of canola meal (CM) and poultry by-product meal (PBM) on growth performance, carcass characteristics and blood metabolites of turkeys fed on low crude protein (CP) diets from 28 to 55 d post hatch. Experimental treatments included control, maize-soybean meal diet including 258.3 g/kg CP; negative control 1 (NC1), maize-soybean meal diet with reduced CP (232.4 g/kg); NC2, control diet (CP, 258.3 g/kg) including CM (80 g/kg) and PBM (80 g/kg); NC3, maize-soybean meal diet with reduced CP (232.4 g/kg) including CM (80 g/kg) and PBM (80 g/kg). Also, the NC1 + P and NC3 + P diets were created by addition of protease enzyme (30 000 units/kg of diet) to the NC1 and NC3 diets, respectively. The NC3 group had lower body weight gain (BWG) compared to those fed on the control diet, and no improvement with enzyme addition (NC3 + P) was achieved. The protease addition to the NC1 diet (NC1 + P) improved BWG to the level of the control diet. The NC1 group had higher feed conversion ratio (FCR) compared to the control and NC3 + P, but protease addition to the NC1 diet improved FCR. Protease addition to the low CP diets resulted in higher nitrogen (N) retention than in the control and NC2 groups. Also, the NC1 + P and NC3 + P diets increased apparent ileal digestibility (AID) of CP compared to the control group. It was concluded that addition of CM (up to 80 g/kg) and PBM (up to 80 g/kg) to turkey diets had no negative effect on growth performance from 28 to 55 d of age. The NC1 + P group achieved the BWG of the control group which was partially due to increases in N retention and AID of CP, but the NC3 + P group failed to recover the growth losses. This difference implies that the efficacy of the protease may depend upon the protein source in the ration.

An efficient visible light photocatalyst based on tin porphyrin intercalated between TiO2–graphene nanosheets for inactivation of E. coli and investigation of charge transfer mechanism

Tin porphyrin intercalated between the TiO₂–grphene nanocomposite. The inactivation of E. coli over the prepared compound was significantly increased via the interaction of tin porphyrin between the TiO₂–graphene nanocomposite.

Utility of endoscopic ultrasonography in the evaluation of dilated common bile duct of undetermined etiology

INTRODUCTION

Occasionally, common bile duct (CBD) dilatation is discovered while working up patients for various causes. Not infrequently, the usual imaging modalities fail to identify the cause and endoscopic ultrasonography (EUS) becomes necessary. The aim of this study is to assess the value of EUS in identifying the cause of CBD dilatation undiagnosed by transabdominal ultrasonography.

PATIENTS AND METHODS

During 1 year, 152 consecutive patients who were referred for evaluation of dilated CBD (diameter ≥7 mm) discovered incidentally during transabdominal ultrasonography were included. Final diagnoses were confirmed by endoscopic retrograde cholangiopancreatography, EUS-guided fine-needle aspiration, surgical exploration, or clinical follow-up of at least 10 months.

RESULTS

One hundred and fifty two patients (54% female) with dilated CBD were included. Mean age of patients was 60 ± 17 years. The final diagnoses was choledocholithiasis in 32 (21.1%), passed CBD stone in 35 (23%), opium-induced CBD dilation in 14 (9.2%), post-cholecystectomy states in 20 (13.1%), ampullary neoplasia in 15 (15.8%), cholangiocarcinoma in 14 (9.2%) and pancreatic head cancer in 9 (5.9%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS for patients with abnormal EUS was 89.5%, 100.0%, 100.0%, 91.2%, and 90.9%, respectively.

CONCLUSION

After diagnosis of CBD dilation by transabdominal ultrasonography, EUS may be a reasonable next choice for determining the etiology of dilated CBD.

Evaluation of opium effect on pancreatobiliary system in opium addicted patients by endoscopic ultrasonography

INTRODUCTION

Pancreatobiliary abnormalities in patients with opium addiction have not been widely evaluated by endoscopic ultrasonography before.

MATERIALS AND METHODS

Patients without any pancreatobiliary disease or symptom during 10 months were enrolled in this study. Common bile duct (CBD), pancreatic duct (PD) and portal vein (PV) diameters, gallbladder wall thickness and surface area of the papilla and abnormalities were evaluated in both groups by endosonography.

RESULTS

In total, 199 patients were evaluated. 36 (18.1%) cases were addicted to opium. Mean age of the patients was 56.0 ± 14.2 years. Opium users had a statistically significant higher (all P < 0.001) mean diameters of distal CBD (4.6 ± 1.9 vs. 3.1 ± 1.0 mm), middle part of CBD (7.5 ± 3.1 vs. 4.6 ± 1.6 mm), PD in head (3.3 ± 1.3 vs. 2.3 ± 0.7 mm) and PV (10.3 ± 2.3 vs. 8.9 ± 2.1 mm). However, the difference in the diameters of PD in the body of pancreas and gallbladder wall thickness did not reach statistical significance. The size of the papilla as measured by the surface area of the papilla of Vater was also significantly larger in opium users (40.6 ± 17.1 vs. 29.9 ± 13.5, P < 0.001).

CONCLUSION

Opium addicted persons have larger diameters of CBD, PV and a larger surface area of the papilla of Vater. Dilated PD only in the head of the pancreas might be an important clue to differentiate opium-induced CBD dilation from periampullary tumors and chronic pancreatitis. The clinical significance of these findings warrants further investigation.

The polymorphism of human leucocyte antigen-G gene in a healthy population of Iran

Human leucocyte antigen-G (HLA-G) is a non-classical HLA class I molecule that unlike the classical HLA, has low polymorphism. This molecule, initially, found on invasive trophoblast cells and is postulated to have mediatory role in maternal-fetal interface. So far 43 alleles of HLA-G gene have been found. Studies on alleles of HLA-G gene could be useful in understanding the genetic variants of HLA-G alleles in Iranian population. The goal of this research was to determine the polymorphism of HLA-G gene in a healthy population of Iran. Genomic DNA was isolated from the whole blood of 102 randomly selected, healthy, unrelated Iranian individuals using salting-out technique followed by polymerase chain reaction (PCR) amplification of the exons 2 and 3 of HLA-G gene. For the performance of PCR-restriction fragment length polymorphism method, the PCR products were digested with several restriction enzymes and the resulted fragments were analysed using gel electrophoresis. The obtained results indicated nine alleles of HLA-G in Iranian individuals including G*01011 (4%), G*01012 (29.86%), G*01013 (10.8%), G*01015 (1.47%), G*01017 (1.96%), G*01018 (2.45%), G*01041 (29.4%), G*01043 (1.96%) and the null allele G* 0105N (18.1%). According to this study, in the Iranian subjects the most incident alleles were G*01012 and G*01041. The results for the frequency of G*01012 showed some similarity with Caucasians (36.3%).

Air embolism in the agitated traumatic brain injury patient: an unusual complication

Central venous catheters are often utilized in the acute care management of the traumatic brain injury (TBI) patient. While in the agitated phase of recovery, TBI patients often focus on removing indwelling tubes or venous access lines. Air embolism is among the most serious complications reported in the use of central venous catheters. We present a case of air embolism in an agitated patient, and discuss prevention methodologies. A 38-year-old male was involved in a fall, with an initial Glasgow Coma Scale of 12. CAT scan imaging revealed a left frontal intracerebral haematoma. He required central venous catheter placement for management of associated chest and abdominal injuries. Agitated from early in his stay, the patient was able to twist off several hubs from the central venous catheter with his teeth, resulting in an air embolus. The patient experienced sudden clinical deterioration with oxygen saturation decling to 70%. The patient's course improved after several days of ventilatory support. He eventually successfully completed inpatient rehabilitation, achieving independence in activities of daily living and ambulation. This case illustrates a serious potential complication in the agitated patient. Physicians and rehabilitation specialists should advocate for secured taping of central venous catheter hubs and adequate padding of catheter dressings in agitated patients.