Compensatory Strategies in Children with Upper Limbs Deformities due to Amioplasia

Amyoplasia is the most severe form of arthrogryposis and is characterized by congenital multiple joint contractures, hypoplasia or aplasia of skeletal muscles, and limited or complete lack of self-service. The use of compensatory movements allows patients to be partially or completely independent in daily life. The goal. Based on their own observations and literature, describe compensatory and compensatory movements in children with amyoplasia with upper limb lesions, which patients use in performing basic self-care skills. Material and methods. From 2008 to 2019 we examined, 236 patients with amyoplasia (10 months to 16 years old) with a typical lesion of the upper extremities and limitation of self-care. Depending on the nature of the existing anatomical and functional disorders and the level of segmental muscle damage, all patients with amyoplasia were divided into 4 groups. Compensatory movements were studied in each group of patients. Results. The study showed that children's compensatory movements are numerous and depend on the degree of muscle function disorders of the upper and lower extremities, the rate of psychomotor development of the child. Elbow is a key joint to determine the functional independence in daily life. In cases of extensor contracture in the elbow patients have severe functional disorders and need personal assistance. Conclusions. Compensatory movements in children with amyoplasia are useful and help to adapt in daily life and compensate for the loss (or insufficiency) of movements in the joints. Compensatory movements in children are different. They are determined by the range of passive and active movements in the joints of the upper and low extremities.

Pattern Recognition using Morphologies of Anthropophilic and Zoophilic Dermatophytosis Lesions: Comparison between Final-Year Medical Students and Dermatology Residents

Objective: To compared pattern recognition abilities of final-year medical students and dermatology residents to distinguish and classify superficial fungal infections and resembling lesions.Methods: The study was conducted at the Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, in 2019. The participants had to make diagnosis from 78 images including typical and atypical lesions within 50 second. No history or any description was given. The answer sheets were reviewed.Results: Medical students (n = 18) and dermatology residents (n = 19) showed no significant differences in the means of overall accuracy scores. Residents demonstrated a statistically higher mean score than the medical students in diagnoses of anthropophilic infection with mostly presented with typical lesion. However, there were no significant differences in the mean scores for their diagnoses of zoophilic dermatophytosis as atypical lesions and other skin lesions.Conclusion: Pattern recognition was helpful for the diagnosis of cutaneous dermatophytosis, especially in cases of typical lesions. Nonetheless, pattern recognition alone is insufficient for the diagnosis of atypical dermatophytosis lesions: analytical diagnostic skills should also be enhanced to an increase in the accuracies of atypical-lesion diagnoses.

Intracellular klebsiella infections (donovanosis and rhinoscleroma)

Two rare intracellular species of Klebsiella, a Gram-negative bacillus, cause granulomatous disease in humans that is found in small endemic foci in warm climates, linked to poverty and poor hygiene. Donovanosis is caused by Klebsiella granulomatis (previously named Calymmatobacterium granulomatis) and is presumed to be sexually transmitted. Presenting with genital ulcers or growths, often accompanied by an inguinal ‘pseudobubo’ (granuloma inguinale), it is diagnosed by demonstrating Donovan bodies (vacuoles containing capsulated coccoid bacteria) lying within histiocytes in material taken from a typical lesion. Treatment is with azithromycin; surgery may be needed for complications. Rhinoscleroma, caused by Klebsiella rhinoscleromatis, is believed to transfer from person to person; following a period of rhinitis it most typically manifests with bulky growths in the upper respiratory tract. It is diagnosed by demonstrating intracellular organisms in typical lesions, combined with culture. Treatment is with ciprofloxacin; surgical debulking of lesions and/or reconstruction may be required.

Adenocarcinoma of the bladder

Adenocarcinoma of the bladder accounts for 0.5–2 of bladder tumours. Risk factors include bladder exstrophy, bladder augmentation, schistosomiasis, and endometriosis. Bladder adenocarcinoma is classified as primary, arising from the bladder or urachal remnant, and secondary (metastatic). Most patients present with haematuria and irritative voiding symptoms. On imaging, a typical lesion is commonly located at the bladder dome. Compared to urothelial carcinoma (UC), most adenocarcinomas are diagnosed at high grade and advanced stage. Surgical treatment of localized disease entails partial cystectomy for urachal tumours and radical cystectomy for non-urachal or large urachal adenocarcinoma. The optimal treatment for metastatic disease has yet to be defined. Overall survival rates are 20–70% at 5 years, similar to those for UC, when adjusted for stage and grade. Secondary adenocarcinomas commonly arise from a genitourinary or gastrointestinal origin. Differentiation from primary tumours may be complex. Treatment depends on the prognosis of the primary cancer.

Virulence factors of Escherichia coli in relation to the importance of vaccination in pigs

ABSTRACT: Enterotoxigenic Escherichia coli (ETEC) is the major cause of diarrhea in newborn and weaned pigs. Bacteria adhesion to the host cell is considered a specific phenomenon among fimbrial and non-fimbrial adhesins with their respective receptors on enterocytes. Enteric disorders are related with the fimbriae F4 (K88), F5 (K99), F6 (987P), F41, and F18. In addition to ETEC, another category of E. coli , porcine pathogenic E. coli (PEPEC),can cause diarrhea in pigs; it produces the porcine attaching and effacing-associated (Paa) adhesin in, which is capable to cause a typical lesion known as an attaching and effacing (A/E) lesion. Immunization of sows with adhesin is important to stimulate the production of antibodies and their subsequent transfer to piglets through colostrum. The aim of this paper is to illustrate the main impacts of enteric diseases caused by E. coli in swine production and to highlight the importance of continuing research on this bacterium to improve disease prevention through vaccination.

Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma

Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combiningin situliver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC.Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan.Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient.Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small.

Abstract W MP17: Basilar Plaque on High Resolution Mri Predicts Early Neurologic Deterioration After Pontine Infarction

Background: The association between early neurologic deterioration (END) in pontine infarction and basilar stenosis remains unclear. Recently, it has been reported that evaluation of the basilar artery using high-resolution MRI (HRMRI) could provide more accurate information about intracranial artery stenosis than MR angiography (MRA). We aimed this study to identify the relationship between basilar plaque assessed by HRMRI and END after pontine infarction. Methods: Ninety consecutive patients with unilateral pontine infarction within 24 hours of stroke onset were included. All patients underwent diffusion weighted MRI, MRA and HRMRI within 24 hours after admission. Basilar stenosis was assessed with MRA and HRMRI. Basilar plaque on HRMRI was classified as 1) "no plaque" when the wall of the basilar artery was clear; 2) "minimal plaque" when the basilar wall was irregular without clear crescentic thickening; and 3) "apparent plaque" when a typical lesion with a crescentic thickening of the wall could be seen. END was defined as increased NIHSS score by ≥2 during admission. Factors potentially associated with END were validated by multivariate analyses. Results: Sixty-six patients (73%) had paramedian pontine infarction (PPI) and 24 patients (27%) had deep pontine infarction (DPI). END was observed in 29 (32%) patients and they all had PPI. Patients with END had more frequent apparent plaque in basilar artery than without it (79% versus 33%, p=0.001). However, basilar stenosis (>30%) assessed by MRA did not show any differences regardless of the presence of END (24% versus 17%, p=0.380). In univariate analysis with the patients with PPI, END was associated with hypertension (p=0.029) and apparent plaque (p=0.002). After adjusting covariates, END was independently associated with hypertension (OR, 6.672; 95% CI, 1.376-32.367) and apparent plaque (OR, 7.260; 95% CI 1.285-41.030). Conclusion: Our result suggest that basilar stenosis assessed by HRMRI was associated with END in patients with acute pontine infarction. However, the result was not significant when assessed by MRA. We suggest that since basilar stenosis are underestimated with MRA, HRMRI may be more useful in evaluating basilar artery stenosis and predicting END in pontine infarction.

Isolation and Detection of Antibiotic Sensitivity Pattern of Escherichia coli from Ducks in Bangladesh and Nepal

A total of 120 rectal swab samples from ducks (sixty samples from Nepalgunj area of Nepal and 60 from Boyera area under Mymensingh district of Bangladesh) were collected for the isolation of Escherichia coli and their antibiogram study. After cultural and biochemical examination, a total of 40 samples from Nepalgunj and 45 samples from Boyera were found positive for E. coli. Pathogenicity study of 10 positive isolates from Nepalgunj and 12 positive isolates from Boyera were done to detect the presence of enterotoxin. All inoculated mice died showing typical lesion of extensive hemorrhage and massive edema. The isolates from two different origins showed major difference in their antibiogram study. The isolates of Nepal were highly sensitive to ciprofloxacin, co-trimoxazole, chloramphenicol and amoxicillin; moderately sensitive to nalidixic acid and; less sensitive to kanamycin and resistant to cephalexin. However, the isolates of Bangladesh were highly sensitive to ciprofloxacin, chloramphenicol and amoxicillin; moderately sensitive to nalidixic acid, cephalexin, and co-trimoxazole; less sensitive to kanamycin. This variation of antibiotic sensitivity and resistance patterns among the E. coli isolates of Nepal and Bangladesh might be due to strain variations and indiscriminate use of antibiotics in these two different countries.DOI: http://dx.doi.org/10.3329/mh.v1i1.13704 Microbes and Health Vol.1(1) June 2012 pp.6-8

Perosomus elumbis in a Holstein calf infected with bovine viral diarrhea virus

SummaryThe detection of bovine viral diarrhea virus (BVDV) in a female Holstein calf presented with perosomus elumbis, a congenital anomaly, is reported here. A cow with dystocia was evaluated and an abnormal dead calf was detected during vaginal examination. The calf was retrieved via caesarean section and exhibited abnormalities characteristic of PE, such as vertebral and pelvic malformations. These abnormalities were further confirmed using radiographic and necropsy examinations. At necropsy cerebellar hypoplasia was an additional finding, which is a typical lesion associated with bovine virus diarrhea (BVD). Several tissue samples from the calf were tested for the presence of antigens of BVDV and bovine herpesvirus-1 (BHV-1) by ELISA. In addition, sera samples from the dam and calf were tested for the presence of antibodies against BVDV, BHV-1, and bluetongue disease virus (BTV) using a virus neutralization assay. Results indicated that the calf was congenitally infected with BVDV, whereas there was no evidence for the presence of BHV-1 and BTV. In the dam’s serum no antibodies against BVDV, BHV-1, and BTV were detected. Even though the etiology of perosomus elumbis is unknown, BVDV, which causes fetal anomalies at early gestation in cows, may have been a contributing factor in this case.