No abstract available.
Humans

STUDY DESIGN: Retrospective cohort study. PURPOSE: To examine the clinical profile and surgical complications in patients with spinal hemangioblastomas and to evaluate the long-term outcome in them. OVERVIEW OF LITERATURE: Although considered to be histologically benign, hemangioblastomas may cause significant neurological deficits. The proportion of spinal hemangioblastomas associated with von Hippel–Lindau (VHL) disease has been estimated be 13%–59%. Preoperative neurological function correlates with postoperative neurological status. Studies have shown no difference in outcomes between sporadic and VHL-associated spinal hemangioblastomas. METHODS: This retrospective study included 14 consecutive patients treated for spinal hemangioblastomas at our institute between January 2000 and June 2013. The mean follow-up period was 5 years. Magnetic resonance imaging of the complete neuraxis was performed in all cases, and preoperative embolization was performed in two cases. RESULTS: In total, 14 patients underwent 18 surgeries, of which 15 were for spinal hemangioblastomas. Of all the patients, 86% had motor weakness and 79% presented with sensory disturbances. Preoperative McCormick functional grades were grade I in 7 (50%), grade II in 3 (21%), and grade III in 4 (29%) patients; 50% patients were diagnosed with VHL disease. All patients underwent complete resection of the tumor. Eight patients experienced deterioration in their neurological status in the immediate postoperative period; among them, five had gradual improvement. At 5-year follow-up, 11 (78.57%) patients showed good functional outcomes. CONCLUSIONS: Microsurgical excision of spinal hemangioblastomas can cause postoperative morbidity, mainly in the form of neurological deterioration. Almost half of our patients had deterioration in the McCormick grade in the immediate postoperative period. However, a complete microsurgical excision can result in good long-term functional outcomes, as most of the immediate postoperative neurological deterioration in our patients was reversible. There was no difference in the long-term functional outcomes between sporadic and VHL-associated spinal hemangioblastomas.
Cohort Studies ; Follow-Up Studies ; Hemangioblastoma* ; Humans ; Magnetic Resonance Imaging ; Microsurgery ; Postoperative Period ; Retrospective Studies ; Spinal Cord ; Spinal Cord Neoplasms ; von Hippel-Lindau Disease*

A 14-year-old girl presented with progressive paraparesis and paresthesia of one-year duration. Magnetic resonance imaging revealed a T6 vertebral hemangioma with epidural compression on the spinal cord. Following angiography and embolization, she underwent dorsal laminectomy and excision of the soft tissue component compressing the cord. In the postoperative period she had rapid worsening of lower limb power and imaging demonstrated an epidural haematoma at the operative site. The patient was taken up for urgent re-exploration and evacuation of haematoma. Postoperatively the patient complained of visual failure, headache and had multiple episodes of seizures. An magnetic resonance imaging brain showed characteristic features of posterior reversible encephalopathy syndrome (PRES) and the patient improved gradually after control of hypertension. This is the first documented case of PRES following spinal cord compression in a patient without any known risk factors. We postulate the possible mechanism involved in its pathogenesis.
Adolescent ; Angiography ; Brain ; Headache ; Hemangioma ; Hematoma ; Humans ; Hypertension ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Paraparesis ; Paresthesia ; Postoperative Period ; Risk Factors ; Seizures ; Spinal Cord ; Spinal Cord Compression

Patients with Pierre Robin sequence exhibit varying degrees of airway obstruction and feeding difficulty. In some patients, airway obstruction may be profound, warranting surgical intervention to maintain a patent airway. The purpose of this article is to highlight the advantages of the tongue-lip adhesion procedure for the management of airway obstruction in such patients compared to the currently available options.
Airway Obstruction ; Humans ; Pierre Robin Syndrome*

Shiga toxin genes (stx) harbouring Escherichia coli (STEC) strains were isolated and identified from diarrhoeal patients visiting the Dhaka Hospital of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh. Of the 189 E. coli strains isolated from 775 diarrhoeal stool specimens, 19 harboured stx1, and one isolate was revealed to have amplicons for both stx1 and stx2 by a PCR assay. Sequence analysis of the 349-bp stx1 from representative isolates revealed 100% homology with the sequence of stx1 available in the GenBank. Among the stx1 positive isolates, two harboured the eae but none were positive for hlyA, katP, etpD or saa genes. Fifteen of the 20 stx positive strains could be categorized into 13 non-O157 serogroups while 4 were untypable and one was a rough strain. Most of the STEC strains were resistant to ampicillin, cephalothin, co-trimoxazole, tetracycline, and nalidixic acid. In the Vero cell assay, all the strains were negative for expression of Shiga toxin (Stx). Randomly amplified polymorphic DNA (RAPD) PCR analysis demonstrated genetic diversity. This is one of the first reports to show the presence of STEC in diarrhoeal patients in Bangladesh.

Aims: This study investigates the community structure and diversity of terrestrial soil bacterial communities thriving in four contrasting Köppen climatic zones of India using high-throughput sequencing. Methodology and results: Soil samples were collected for metagenomic DNA isolation and PCR amplification using primers targeting the 16S rRNA gene region. Amplicons were subjected to Oxford nanopore sequencing and data analysis. Bacterial species diversity, evenness and richness were highest in a humid sub-tropical climatic zone (HSCZ). Firmicutes were the most abundant phylum in the tropical wet climatic zone (TWCZ), arid climatic zone (ACZ) and humid sub-tropical climatic zone (HSCZ), while Proteobacteria in the mountain climatic zone (MCZ). The predominance of class Alphaproteobacteria, Actinobacteria with genera Bradyrhizobium, Chthoniobacter and Mycobacterium, was observed in MCZ in contrast to class Bacilli with genera Bacillus and Paenibacillus in the rest of the zones. OTU abundance was positively correlated with moisture, TOC (total organic carbon), K, MAP (mean annual precipitation) and negatively correlated with pH, Ca, N, B, Fe, P, Mg and MAT (mean annual temperature). A significant correlation was only observed with Fe against Shannon diversity (H’) in multiple regression analysis. Conclusion, significance and impact of study The multidirectional relationship between soil, its microbiota and climate is crucial in modulating bacterial community diversity and its survival in terrestrial ecosystems that significantly contribute to ecosystem function. This work mapped the occurrence and distribution of terrestrial soil bacterial communities in contrasting climatic zones for the first time, enabling us to assess the effect of climate in the mentioned Köppen climatic zones.

The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Evidence-Based Medicine ; Female ; Guidelines as Topic ; Humans ; Infertility ; diagnosis ; therapy ; Male ; Practice Guidelines as Topic ; Primary Health Care ; methods ; standards ; Public Health ; standards ; Singapore