Amoebic liver abscess (ALA) with jaundice and encephalopathy is a rare occurrence and has been recognised and studied more frequently in recent years. We present a case of massive ALA presenting with jaundice, hepatic encephalopathy, and septicaemia that was treated successfully with percutaneous drainage of the abscess, right-sided chest tube insertion, and anti-amoebic therapy.

Metastatic renal cell carcinoma (RCC) in the nose and paranasal sinuses is very rare. We report an unusual case of metastatic RCC that presented as recurrent epistaxis ten years after curative nephrectomy. The purpose of this report is to draw the attention of clinicians to the possibility of metastatic RCC in patients with recurrent epistaxis and nasal mass. We also discuss treatment options and review the relevant literature.
Adult ; Carcinoma, Renal Cell ; diagnosis ; secondary ; therapy ; Chemoradiotherapy ; Diagnosis, Differential ; Epistaxis ; diagnosis ; therapy ; Humans ; Indoles ; therapeutic use ; Kidney Diseases ; diagnosis ; therapy ; Male ; Neoplasm Metastasis ; Nose ; pathology ; Nose Neoplasms ; diagnosis ; secondary ; therapy ; Positron-Emission Tomography ; Pyrroles ; therapeutic use ; Recurrence ; Tomography, X-Ray Computed

Open fractures with bone loss are a common occurrence following high energy trauma. But usually the bone fragments are lost on the roadside and are not usable. We report a patient who was involved in a head-on collision between two wheelers and presented with a bone fragment embedded in his thigh. Radiological survey revealed no bony injury in that patient. Another patient, who presented at the same time, sustained a segmental fracture of shaft femur and was found to have lost a bone fragment that was similar to the one found in previous patient. CT scan with 3D reconstruction revealed this missing fragment to be the same as that found in previous patient. Both patients had a history of head-on collision while travelling on a two-wheeler. Present case report throws some highlights on the probable mechanism of injury.

To investigate two cyanobacteria isolated from different origins i.e. Lyngbya aestuarii(L. aestuarii) from brackish water and Aphanothece bullosa (A. bullosa) from fresh water paddy fields for antifungal and antileishmanila activity taking Candida albicans and Leishmaniadonovain as targets. Methods: Biomass of L. aestuarii and A. bullosa were harvested after 40 and 60 d respectively and lyophilized twice in methanol (100%) and redissolved in methanol (5%) for bioassay. Antifungal bioassay was done by agar well diffusion method while antileishmanial, by counting cell numbers and flageller motility observation of promastigotes and amastigotes fromL. donovani . Fluconazole and 5% methanol were used as control. Results: Both the cyanobacteria were found to be potent source of antifungal activity keeping fluconazole as positive control, however, methanolic crude extract (15 mg/mL) of A. bullosa was found more potent (larger inhibition zone) over that of methanolic crude extract of L. aestuarii. Similarly antileishmanial activity of crude extract (24.0 mg/mL) of A. bullosa was superior over that of methanolic crude extract of L. aestuarii (25.6 mg/mL). Conclusions: Antifungal and antileishmanial drugs are still limited in the market. Screening of microbes possessing antifungal and antileishmanial activity drug is of prime importance. Cyanobacteria are little explored in this context because most of the drugs in human therapy are derived from microorganisms, mainly bacterial, fungal and actinomycetes. Thus in the present study two cyanobacterial strains from different origins showed potent source of antifungal and antileishmanial biomolecules.

Sarcopenia (loss of muscle mass and/or strength) frequently complicates liver cirrhosis and adversely affects the quality of life; cirrhosis related liver decompensation and significantly decreases wait-list and post-liver transplantation survival. The main therapeutic strategies to improve or reverse sarcopenia include dietary interventions (supplemental calorie and protein intake), increased physical activity (supervised resistance and endurance exercises), hormonal therapy (testosterone), and ammonia lowering agents (L-ornithine L-aspartate, branch chain amino acids) as well as mechanistic approaches that target underlying molecular and metabolic abnormalities. Besides other factors, hyperammonemia has recently gained attention and increase sarcopenia by various mechanisms including increased expression of myostatin, increased phosphorylation of eukaryotic initiation factor 2a, cataplerosis of α ketoglutarate, mitochondrial dysfunction, increased reactive oxygen species that decrease protein synthesis and increased autophagy-mediated proteolysis. Sarcopenia contributes to frailty and increases the risk of minimal and overt hepatic encephalopathy.
Ammonia ; Aspartic Acid ; Fibrosis ; Hepatic Encephalopathy ; Hyperammonemia ; Liver ; Liver Cirrhosis ; Metabolism ; Motor Activity ; Myostatin ; Peptide Initiation Factors ; Phosphorylation ; Proteolysis ; Quality of Life ; Reactive Oxygen Species ; Sarcopenia ; Testosterone

OBJECTIVETo demonstrate changes in different frequencies of cerebral electrical activity or electroencephalogram (EEG) following exposure to high environmental heat in three different age groups of freely moving' rats.

METHODSRats were divided into three groups (i) acute heat stress--subjected to a single exposure for four hours at 38 degrees C; (ii) chronic heat stress--exposed for 21 days daily for one hour at 38 degrees C, and (iii) handling control groups. The digital polygraphic sleep-EEG recordings were performed just after the heat exposure from acute stressed rats and on 22nd day from chronic stressed rats by simultaneous recording of cortical EEG, EOG (electrooculogram), and EMG (electromyogram). Further, power spectrum analyses were performed to analyze the effects of heat stress.

RESULTSThe frequency analysis of EEG signals following exposure to high environmental heat revealed that in all three age groups of rats, changes in higher frequency components (beta 2) were significant in all sleep-wake states following both acute and chronic heat stress conditions. After exposure to acute heat, significant changes in EEG frequencies with respect to their control groups were observed, which were reversed partly or fully in four hours of EEG recording. On the other hand, due to repetitive chronic exposure to hot environment, adaptive and long-term changes in EEG frequency patterns were observed.

CONCLUSIONThe present study has exhibited that the cortical EEG is sensitive to environmental heat and alterations in EEG frequencies in different sleep-wake states due to heat stress can be differentiated efficiently by EEG power spectrum analysis.

Parkinsonism due to an isolated lesion of the substantia nigra following a febrile illness is a rare entity. Anecdotal reports in the literature implicate substantia nigra as peculiarly susceptible to flaviviruses. Here we report a case of isolated substantia nigra involvement in a probable Japanese encephalitis patient who presented with post-encephalitic parkinsonism

Background & Objective:Epilepsy may have an impact on bone health of the patients even before drug therapy is initiated, particularly in the developing countries. This is in view of long delay in diagnosis and lifestyle changes. Therefore, in this study, bone health markers like bone mineral density (BMD) and urinary hydroxyproline were assessed in newly diagnosed epilepsy patients. Methods: The BMD was assessed by DEXA scan, and 24 hour urine hydroxyproline was estimated colorimetrically in 25 newly diagnosed epilepsy patients. Other bone markers like calcium, phosphorus, vitamin D and alkaline phosphatase were also estimated. Results were compared with 25 age and sex matched healthy controls, and were analyzed statistically. Results: The BMD and vitamin D were found to be significantly decreased (p<0.05) while serum alkaline phosphatase and urine calcium and phosphorus were observed to be significantly increased p<0.05) in epilepsy patients as compared to healthy controls. The difference in urinary hydroxyproline and serum calcium/ phosphorus in the two groups was not found to be statistically significant (p>0.05). Conclusions: Bone health is found to be already compromised in epilepsy patients in this study from North India. BMD and urinary hydroxyproline may act as simple, non-invasive, convenient and inexpensive markers to assess bone health in these patients
Bone Density ; Epilepsy

Purpose:Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1％ of all fractures.Open fracture takes 5％-10％ of the all distal femoral fractures,which is at an increased risk of complications.There were limited studies which documented the outcomes of such cases.The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India.Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.They were followed for minimum of six months.Patients were followed up monthly for first four months,at six months and one year after surgery.Clinical and radiological signs of healing,any complications,time to union,and functional outcome were assessed.Results:The mean age of patients was 44.33 years (range 20-82 years) with male predominance of 66.7％.According to Gustilo-Anderson classification,there were 5,15 and 10 patients with open grade Ⅰ,Ⅱ and ⅢA distal femoral fractures respectively.According to orthopaedic trauma association (OTA) classification,majority of patients in our study were of C3 type.The mean time to bony union was 5.6 months (range 4-9 months).Average postoperative knee range of motion (ROM) at the latest follow-up was 98° (range 70°-120°).Lysholm knee scoring scale showed excellent score in 11 patients,good in 9 patients,fair and poor in 5 patients each;however,there was no significant correlation with fracture pattern types (p ＜ 0.05).Knee stiffness was the major complications encountered in the study.The knee ROM was ＜90° in 5 patients and 90°-120° in rest of the patients,while 1 patient had extensor lag of 10°.One patient had implant failure and lost to follow-up;3 patients had deep infection.Conclusion:An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.

Open fractures with bone loss are a common occurrence following high energy trauma. But usually the bone fragments are lost on the roadside and are not usable. We report a patient who was involved in a head-on collision between two wheelers and presented with a bone fragment embedded in his thigh. Radiological survey revealed no bony injury in that patient. Another patient, who presented at the same time, sustained a segmental fracture of shaft femur and was found to have lost a bone fragment that was similar to the one found in previous patient. CT scan with 3D reconstruction revealed this missing fragment to be the same as that found in previous patient. Both patients had a history of head-on collision while travelling on a two-wheeler. Present case report throws some highlights on the probable mechanism of injury.
Accidents, Traffic ; Bone and Bones ; injuries ; Foreign Bodies ; Thigh ; injuries