Antimicrobial resistance in bacteria isolated from the poultry production system in Nepal

SETTING

Twenty poultry farms in five provinces of Nepal were selected for studying bacterial pathogens and their antimicrobial resistance (AMR) patterns.

OBJECTIVE

To document the proportion of cloacal swabs collected from 3,230 broiler and 3,230 layer chickens from September to December 2021 that grew isolates of Escherichia coli, Enterococcus spp. and Salmonella spp. along with their AMR patterns.

DESIGN

This was a cross-sectional descriptive study.

RESULTS

In broiler birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 36%, 39% and 63% of swabs. In layer birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 31%, 48% and 60% of swabs. For both bird types, there was variation in bacterial prevalence between the regions. For all three bacterial isolates, the lowest antimicrobial resistance was found with amikacin. For the other nine antibiotics tested, >50% of bacterial isolates showed resistance; between 60% and 90% of isolates showed resistance to ciprofloxacin and trimethoprim-sulfamethoxazole. Multidrug resistance ranged from 45% to 46% for Salmonella spp., 37-44% for E. coli and 13-17% for Enterococcus spp.

CONCLUSION

This study shows that a large proportion of poultry in Nepal are infected with potentially pathogenic bacteria, and these are frequently resistant to commonly used antibiotics. Nepal urgently needs to implement corrective measures.

Delta-like factor 1 negatively regulates angiogenesis as a target gene of miR-126-5p after indirect revascularization surgery in patients with moyamoya disease

Promoting endothelial cell (EC) proliferation and angiogenesis after indirect revascularization surgery is crucial for decreasing the stroke rate in moyamoya patients. However, the role of delta-like factor 1 (DLK1) in regulating EC proliferation in chronically ischaemic brains and the specific mechanisms remain unclear. Therefore, we compared the expression levels of DLK1 in the dura mater (DM) tissues of  patients with moyamoya disease and patients with aneurysms, and dual luciferase reporter and RNA binding protein immunoprecipitation assays were conducted to determine whether DLK1 is a target gene of miR-126-5p. The effect of DLK1 on EC proliferation and the interaction between DLK1 and miR-126-5p were explored in vitro. Then, we established an animal model of two-vessel occlusion together with encephalo-myo-synangiosis (2VO+EMS). The temporalis muscles (TMs) of the animals were transfected with DLK1 lentiviral RNA (Lv-DLK1) and short hairpin RNA (sh-DLK1) to compare the DLK1 expression, angiogenesis (CD31 count), and numbers of vacuoles and impaired tight junctions in the ECs of TM-covered chronically ischaemic brains as well as the cognitive improvement in each group. DLK1 expression was lower in the DM tissues of moyamoya patients than in those of the aneurysm patients, and DLK1 was identified as a target gene of miR-126-5p. In vitro, DLK1 inhibited EC proliferation, migration and angiogenesis and exerted effects opposite those of miR-126-5p. In 2VO+EMS rats, compared to the control transfection, the TM transfection of Lv-DLK1 induced significantly higher DLK1 expression and worse angiogenesis in the TM-covered ischaemic brain as well as less extensive cognitive improvement, while the transfection of sh-DLK1 into the TM had the opposite effects. In summary, DLK1, a target gene of miR-126-5p, negatively regulates angiogenesis in chronically ischaemic brains and is expected to be a new target to improve the efficacy of indirect revascularization surgery and the prognosis of moyamoya patients.

Intracranial Infection Caused by Multidrug-resistant Acinetobacter Baumannii

Objective: To report the successful treatment of a patient who underwent vestibular schwannoma resection and developed intracranial infection caused by multidrug-resistant Acinetobacter baumannii (MRAB), and to review the recent relevant literature. Methods: The patient was diagnosed with MRAB infection based on clinical manifestations and cerebrospinal fluid (CSF) culture. The treatment included external ventricular drainage, posterior fossa decompressive craniectomy, and endoscopic lavage for fourth ventricle, subdural drainage, and intravenous injection /ventricular irrigation of sulperazone. Results: The MRAB-induced intracranial infection was successfully cured. The follow-up lasted for 84 months, and the patient has resumed normal life and work. Conclusion: Active individualized treatment should be administered at the earliest. The drainage of CSF, ventricular lavage, and proper choice of antibiotics are key to treat intracranial infections caused by MRAB.

Non-functional pituitary carcinoma

We present as case to review and present the clinical features, diagnosis and treatment of non-functional pituitary carcinoma (NFPC). We operated on a case of NFPC. After surgery, gamma knife therapy, temozolomide chemotherapy and whole craniospinal irradiation, the patient still had poor tumor control and died 7 months after operation. FPC is very rare. It needs to be diagnosed with a combination of clinical suspicion, imaging and dynamic monitoring. It is necessary to find more effective methods to control the progress of tumor while routine treatment fails.

Successful retrieval of a retained J guidewire from the right atrium and aorta arch using a self-invented snare device

Guidewire retention during an interventional treatment is a very rare complication that can lead to possible serious complications, such as thrombosis, embolization, sepsis, and perforation. Hence, a retained guidewire must be retrieved as soon as possible. Here, we provide the first report of a case of accidental retention of a 0.035” J guidewire in the right atrium and aortic arch during basilar artery aneurysm embolization. We found that due to the heavier weight of the J guidewire and its hydrophilic-coated layer, it could not be removed using previously reported methods for micro-guidewire retention. Therefore, we constructed a self-invented snare device consisting of a 0.014” micro-guidewire and a 4-Fr MP-A1 catheter and successfully retrieved the J guidewire, thus avoiding open surgery and its associated serious complications. According to our experience, this novel technique described here is quite easy to perform, safe and effective and can avoid serious complications and prevent the need for open surgery.

The trend of indirect anastomosis formation in a 2-vessel occlusion plus encephalo-myo-synangiosis rat model

Background

Basic research on the factors influencing indirect anastomosis formation in a 2-vessel occlusion plus encephalo-myo-synangiosis (2VO + EMS) rat model is conducive to improving the efficacy of indirect revascularization surgery in the clinic. However, the time point at which anastomosis between the rat temporal muscle (TM) and brain naturally has the greatest effect after encephalo-myo-synangiosis (EMS) remains unknown. Therefore, we conducted this study to explore the peak time of indirect anastomosis formation in the 2VO + EMS rat model.

Methods

Forty 2VO + EMS rats were randomly divided into five groups (n=8) according to the length of time (by week) after EMS, and 2VO rats were used as the control group (n=8). The expression of vascular endothelial growth factor (VEGF) and CD31 on the EMS side of the brain, perfusion ratio [improvement of cerebral blood perfusion (CBP) on the EMS side] and Morris water maze (MWM) results were compared between groups. Furthermore, the trends of the above variables were explored over weeks.

Results

Overall, the expression of VEGF and CD31, the perfusion ratio and the cognitive improvement in the 2VO + EMS rat model gradually increased over weeks after EMS. The VEGF and CD31 expression (as detected by immunofluorescence), perfusion ratio and number of times crossing the platform area peaked at 4 weeks after EMS. In addition, both the escape latency and the time spent in the target quadrant peaked in the fifth week after EMS.

Conclusions

After establishing the 2VO + EMS rat model, the degree of endothelial cell (EC) proliferation and CBP improvement on the EMS side of the brain peaked at 4 weeks after EMS, whereas the cognitive improvement peaked in the fifth week.

Comparison of the Effectiveness of Ring-Stripping Retrograde Endarterectomy and Carotid Artery Crossover Bypass in the Treatment of Patients with Symptomatic Riles Type 1A Common Carotid Artery Occlusion

OBJECTIVE

The surgical procedure most appropriate for treating symptomatic Riles type 1A common carotid artery occlusion (CCAO) is unclear. This study compares the effects of ring-stripping retrograde endarterectomy (RSRE) and carotid artery crossover bypass (CACB) on cerebral perfusion improvement in patients with symptomatic Riles type 1A CCAO.

METHODS

We conducted a retrospective analysis of symptomatic Riles type 1A CCAO patients treated at our centre. Postoperative improvements in the ipsilateral internal carotid artery (ICA) flow rate, ipsilateral cerebral blood perfusion (CBP) and the stroke recurrence rate were compared between patients who underwent RSRE and those who underwent CACB.

RESULTS

A total of 20 CCAO patients were surgically treated at our centre from 2011 to 2018. Nine of these patients underwent RSRE, and eleven underwent CACB. No significant differences were identified between the groups in the ipsilateral blood flow rate of the ICA immediately after surgery and the ipsilateral-to-contralateral mean transit time ratios 1 day after surgery. However, the flow rate in the ICA was significantly higher in the RSRE group than in the CACB group 1 year after surgery (135.44 ± 19.22 ml/min vs. 116.36 ± 17.70 ml/min, p = 0.033). For CBP, the ipsilateral-to-contralateral mean transit time ratios were significantly lower in RSRE patients than in CACB patients 1 year after surgery (1.005 ± 0.052 vs. 1.064 ± 0.066, p = 0.044). In addition, the postoperative modified Rankin scale (mRS) score at the latest follow-up point (p = 0.884) and the stroke recurrence rate during the follow-up (88.9% vs. 90.9%, p > 0.999) were not significantly different between the two groups.

CONCLUSIONS

Although the postoperative mRS score and the stroke recurrence rate were not significantly different between RSRE and CACB patients, compared to CACB, RSRE was better for improving the ipsilateral ICA flow rate and cerebral perfusion in symptomatic Riles type 1A CCAO patients.

Supraorbital eyebrow keyhole approach for microsurgical management of ruptured anterior communicating artery aneurysm

The mortality and disability rate of patients with ruptured anterior communicating artery (AComA) aneurysm after bleeding is high. Even with the most advanced treatment methods, the incidence of complications remains high. The purpose of the present study was to determine the efficacy of microsurgery via supraorbital eyebrow keyhole approach (SOEK) in clipping ruptured AComA aneurysms. Between September 2010 and October 2018, 543 patients with intracranial aneurysms were admitted to the Department of Neurosurgery of the Third Affiliated Hospital of Sun Yat-Sen University (Guangzhou, China). Among them, 85 patients with ruptured AComA aneurysm and subarachnoid hemorrhage (SAH) underwent microsurgical clipping via the SOEK approach. In those patients, the clipping rate, complications and clinical efficacy of treatment were evaluated. The average age of the patients was 52.69±9.94 years (range, 28-78 years). The proportions of small, medium and large aneurysms were 83.5, 15.3 and 1.2%, respectively. Procedural complications occurred in 9 cases (10.5%). The occlusion rate of the aneurysms was 98.8%. The average follow-up period was 37.9 (±24.5) months. A total of 81.2% of the patients with SAH had a good clinical prognosisat 1 year (modified Rankin scale score, ≤2). In conclusion, for a skilled and experienced surgeon, SOEK was indicated to be a safe procedure for the treatment of ruptured AComA aneurysms; it provided sufficient intra-operative exposure and a high clipping rate.

Factors determining the side of approach for clipping ruptured anterior communicating artery aneurysm via supraorbital eyebrow keyhole approach

PURPOSE

The purpose of this study was to review the microsurgical anatomy and clipping of ruptured anterior communicating artery (AComA) aneurysms and to plan and avoid complications before operation.

METHODS

A total of 523 cases of cerebral aneurysms admitted to the neurosurgery department of the Third Affiliated Hospital of Sun Yat-Sen University from September 2010 to October 2018 were analyzed retrospectively. Among them, 85 patients had ruptured AComA aneurysms. This study was limited to 85 of these cases, whose satisfactory preoperative angiographic diagnostic films can be retrieved from the hospital database system because of the need for detailed review.

RESULTS

We performed supraorbital eyebrow keyhole approach (SOEK) craniotomy in 85 patients to clip 85 AComA aneurysms, in the setting of subarachnoid hemorrhage (SAH). Patients' mean age was (52.69 ± 9.94) years (range, 28-78 years). The proportions of small, medium and large aneurysms were 83.5%, 15.3%, and 1.2%, respectively. The average size of the aneurysms was (5.07 ± 2.36) mm. There were 77.8% of patients with inferior aneurysms and 81.3% of patients with superior aneurysms achieved good results. There was a significant correlation between A1 dominance and operation method (p < 0.001). There was no significant relationship between surgical approach and aneurysm projection or A2 plane (p = 0.157 &p = 0.318).

CONCLUSION

Regardless of whether the A2 plane is open or closed, the A1 dominant side is still a better choice for accessing AComA aneurysms to avoid dangerous premature bleeding.

The surgical approach for clipping anterior communicating artery Aneurysm

Anterior communicating artery (ACoA) aneurysm, accounts for 30%-35% of all the aneurysm making it one of the most common intracranial aneurysms. Although the Pterional approach is considered as the safe and appropriate method in ACoA aneurysm surgery, temporalis atrophy and injury to a frontal branch of the facial nerve are few inexorable complications. With the advancement of minimally invasive surgery several modified approaches, such as the supraorbital eyebrow incision approach, the minipterional approach, the mini-supraorbital approach, and the lateral supraorbital approach has been recently introduced and has been used as an alternative.

Combining Internal Carotid Artery Occlusion with Intermediate-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: Case Report and Review of Literature

We summarize the treatment effectiveness and experience of a patient who underwent internal carotid balloon occlusion combined with Intermediate-flow bypass as a treatment for large-giant cavernous sinus segment internalcarotid artery (CS ICA) aneurysms. A 62-year-old woman presented with a large aneurysm on the right side of the cavernoussinus with dizziness for about two years and Oculomot or nerve palsy. An extra cranial intracranial (EC-IC) Intermediate-flow by pass using a radial artery bypass graft (RABG) and proximal balloon occlusion of the Right ICA were performed. The patient experienced no new neurologic deficit after this treatment. Follow up radiologic evaluations using Computed Tomography Angiography revealed complete aneurysm occlusion. For patients with large-giant CS ICA aneurysms, treatment of ICA occlusion combined with Intermediate-flow superficial temporal artery-Radial artery-middle cerebralartery bypass surgery was an effective and safe surgical strategy.

Cerebral venous thrombosis secondary to hyperthyroidism: A case report

Cerebral Venous Thrombosis (CVT) is a rare form of Stroke characterized by thrombus formation in the cerebral veins. CVT is a result of various reasons among which the hyperthyroidism is not so frequently encountered. This is probably the first case report published from Nepal. The aim of this case report is to give the message that persistent severe headache in patient with hyperthyroidism can be the red flag and needs to be investigated further. We present a case of a 35 years old female who presented with complaints of severe headache and persistent in nature associated with vomiting since 5 days. She was a diagnosed subacute thryroiditis and under medicine from 1 month before presenting to us. Her Magnetic Resonance Venography (MRV) brain showed venous thrombosis within superior saggital sinus, left transverse sinus and sigmoid sinus. Her thyroid function test showed pretreatment T3 of 2.98 ng/ml T4 of 1.02 mg/ ml and TSH of 0.12 μIU/L. She was kept on anticoagulants and other supportive measures. The patient showed improving status with the conservative management.Nepal Journal of Neuroscience 15:29-31, 2018

Microsurgical Management of Tuberculum Sellae Meningiomas by the supraorbital keyhole eyebrow approach: Surgical Outcome

The aim of this study was to evaluate (surgical) visual outcomes in patients treated via supraorbital keyhole eyebrow incision approach. Data from 14 patients with TSMs (Tuberculum Sellae Meningioma) who underwent microsurgical treatment by a supraorbital keyhole eyebrow skin incision between September 2006 and September 2013 were retrospectively collected and analyzed. Patients were analyzed on the basis of clinical, radiological, and surgical factors that appeared to affect the outcome. To quantify the extent of ophthalmological disturbances Visual impairment score was used to analyze visual acuity and visual fields, which range from 0 (best) to 100 (worst). Change in visual function was assessed as the main outcome. The mean age of the 10 women and 4 men enrolled in the study was 56.50years (range, 42~74 years). The presenting symptom was asymmetrical visual loss in 71.4% of the patients.And examination revealed decreased visual acuity (Snellen notation) in 100% and impaired visual fields (Goldmann perimetry) in 58.3 % (7/12 cases, central scotoma and temporal anopia n=1, classical bitemporal hemianopia n=4, incongruent homonymous hemianopia n=2 , 2 cases data N/A) of the patients. Simpson grades I resection via a supraorbital keyhole eyebrow skin incision approach, were achieved in 100% of the patients. Quality of life was assessed according to Karnofsky scale and was 86.67 (range: 70~100). The mean follow-up duration was 51.73 months (range: 27~91 months).No recurrent tumors were observed during this period. According to the findings of this study, this approach provides a pleasing cosmetic outcome and also decreases brain manipulation while minimizing the likelihood of procedure-related morbidity. A favorable visual outcome was observed in most of the patients in the late postoperative period. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page : 26-32

Chiari Malformation-I with Syringomyelia: A Non-specific Presentation and Surgical Consideration

Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base of skull with tonsillar herniation (≥5 mm) below the foramen magnum, which is detected on MRI. It has a diverse range of symptoms with non-specific presentation leading to the chances of misdiagnosis and untimely recognition of the disorder. Syringomyelia is the most common result of Chiari-I. The selection of surgical or non-surgical management depends upon the patient symptoms and the presence of absence of Syringomyelia. The objective of this case report is to give a broad perspective on Chiari Malformation-I from the symptoms and clinical findings obtained in a patient with Syringomyelia associated with Chiari Malformation-I and to discuss about the different surgical options as well as the psychological support required for the management of the condition.Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 105-108