To present a case of skeletal metastasis from a gallbladder malignancy, a rare occurrence.A 75 year old Nigerian woman presented in the surgical outpatient clinic of the University of Port Harcourt Teaching Hospital with a two month history of right hypochondrial pain and three weeks swelling on the forehead. Physical examination revealed an ill looking, emaciated elderly woman in mild painful distress. She was pale, afebrile and anicteric. Skull x-ray revealed a well circumscribed soft tissue mass over a lytic bone defect in the frontal region. Abdominal ultrasound scan showed an enlarged gallbladder with a thickened wall and intraluminal echogenic mass, surrounding lymphadenopathy and intrahepatic metastasis. Radiological diagnosis of advanced gallbladder carcinoma with both local and distant metastases was made.Carcinoma of the gallbladder with skeletal metastasis is a rare finding. However, in any patient with gallbladder malignancy distant metastasis with skeletal involvement should be sought.

OBJECTIVE:

This study aimed to assess the performance of a laboratory-developed recombinant CFP-10/ESAT-6 fusion protein (rCFP-10/ESAT-6)-based enzyme-linked immunospot (ELISPOT) assay for the diagnosis of spinal tuberculosis (TB) in China, and to evaluate the value of the ELISPOT assay for monitoring the efficacy of surgical treatment.

METHODS:

In the first part of the study, a total of 78 participants were consecutively recruited for ELISPOT using rCFP-10/ESAT-6 as a stimulus. The cutoff value for ELISPOT positivity was based on the results of receiver operating characteristic curve analysis. In the second part, this approach was evaluated in a prospective study including 102 patients with suspected spinal TB. Data on clinical characteristics of the patients and conventional laboratory results were collected, and blood samples were obtained for ELISPOT using rCFP-10/ESAT-6 as a stimulus.

RESULTS:

Among the 102 patients with suspected spinal TB, 11 were excluded from the study. Twenty-three patients (25.2%) had culture-confirmed TB and 29 (31.9%) patients had probable TB. Among the spinal TB patients, the ELISPOT had a sensitivity of 82.7%, compared to a sensitivity of 61.5% for the purified protein derivative (PPD) skin test. The specificity was 87.2% for ELISPOT and 46.2% for the PPD skin test among 39 subjects with non-TB disease. The number of spot-forming cells and/or the positive rate of the ELISPOT assay were associated with aging, emaciation, and paravertebral abscess. The number of subjects with responses to rCFP-10/ESAT-6 slightly decreased after surgical treatment in spinal TB patients.

CONCLUSIONS:

A laboratory-developed rCFP-10/ESAT-6 ELISPOT assay is a useful adjunct to current tests for the diagnosis of spinal TB.

Many Arctic animals carry high body burdens of organochlorine contaminants (OCs) due to long-range transport of persistent pollutants. It has been shown that seasonal mobilization of body fat in these species results in increased blood concentration of OCs. We investigated OC assimilation, tissue distribution and biotransformation in farmed Arctic fox (Vulpes lagopus) continuously fed a diet containing contaminated minke whale blubber or lard (control) from eight weeks of age in August 2003 until sampling when they were at their fattest (in November 2004) and leanest (in June 2005). Markedly higher tissue (liver, adrenals, brain and blood) OC levels were found in June than in November, despite low exposure to OCs during emaciation, suggesting that OCs had been redistributed from adipose tissues to vital organs. There were no differences in the activities of hepatic biotransforming enzymes between exposed fat and control fat foxes, except for 16α-hydroxylation that was higher in exposed fat foxes. In emaciated foxes, ethoxyresorufin activity was higher in exposed than in control foxes, indicating an enhanced potential for toxicity of OCs with emaciation. Lower activities of 6β- and 2β- hydroxylation were found in lean than in fat foxes, irrespective of OC treatment. The results show that emaciation increase the toxic potential of accumulated OCs and emphasize that body adiposity need to be considered when time-trend analyses, risk assessments and effect studies are designed. Environ. Toxicol. Chem. © 2013 SETAC.

To analyze the status of malnutrition and its influencing factors in children under 5 years old in Guangnan District of Yunnan Province in 2009 - 2010.By the random cluster sampling and stratified sampling methods, 1002 children within 5 years old in rural areas were selected from poverty-stricken counties in Yunnan Province. The questionnaire survey including questionnaire, anthropometric measurement and dietary survey such as height and weight were used respectively for the survey. Z score was used for evaluating the nutritional status. The prevalence of malnutrition was calculated by statistics software. Multiple factors analysis was finished by non condition Logistic regression in software.During 2009 - 2010, of all children under the age of 5 years old, the underweight rate is 18.8%, stunted growth rate is 34.3% and emaciation rate is 3.1% in impoverished rural area of Yunnan Province. Removing other variables, the result indicated: (1) Comparing with these children under 2 years old who are provided with breastfeeding, the children under 2 years old who are not given breastfeeding are more possible to get malnutrition. (2) The children under 2 years old who were added more vegetable and fruit supplement are less possible to get malnutrition than those children who were added less vegetable and fruit supplement during the past 7 days. (3) The children under 2 years old with good conditions are less possible to get malnutrition than the children with normal conditions or bad conditions.Malnutrition in children under 5 years old in pour rural areas of Yunnan province should not be ignored. The main influencing factors of children malnutrition include feeding ways, increasing supplementary food, and the conditions compared with other children under 2 years old.

Background:

It has been reported that children nursed in orphanages loose one month of lineal growth for every three months they spend in the orphanage.

Objective:

The purpose of this study was to evaluate the daily variation of weight- for- length and length-for-age among infants under 24 months of age, living in a temporary public orphanage in Mexico.

Methods:

Ninety children from 0 to 24 months of age, who were institutionalized at an orphanage, were assessed during a three month period. Upon arrival their height and weight were measured daily, Monday through Friday. Daily growth velocity for weight and length was calculated. Length-for age (LAZ) and weight-for-length (WHZ) age z- scores were calculated based on WHO criteria. Risk of overweight (ROW) and overweight (OW) were classified using the WHO criteria.

Results:

The increments of daily weight were lower than the normal range (9 g daily), but the ROW and OW increased from 10% and 3% at the beginning of the study to 14% and 11% at the end. At the end of the follow-up, WHZ was inversely associated to length (cm/day) velocity (r = -302, p < 0.01). Although a significant increase in ROW and OW was observed, at the end of the study, 31% of the children showed signs of stunting (-2 SD in length-age) and 5% remained emaciated (-2 SD in weight-length).

Conclusions:

Children living in an orphanage showed reduced increments of weight and length-for-age, as well as a reduced length velocity and an increased ROW and OW.

Tephrosia cinerea has been associated with ascites and liver fibrosis in sheep in Brazil. The dried plant was fed ad libitum to three sheep for 55-80days. Three additional sheep were used as controls. All the treated sheep presented with hypoalbuminemia and increased γ-glutamyltransferase and aspartate aminotransferase activities. Anorexia, apathy, rough coat, ascites, and emaciation were observed after 45-60days of feeding with T. cinerea. At necropsy 55-80days after feeding of the plant commenced, the treated sheep had ascites, hydrothorax and hydropericardium, and their livers were firm and whitish, with a nodular surface. Histologically, the main hepatic lesions were periacinar fibrosis associated with hemorrhages and necrosis. On electron microscopy, a severe swelling of sinusoidal endothelial cells, frequently obstructing the lumen of the sinusoid was observed. The space of Disse was compressed by the swollen endothelial cells and microvilli usually present on the surface of hepatocytes adjacent to the space of Disse were not apparent. Dense bundles of collagen fibers were present in the spaces of Disse and within the sinusoids between profiles of swollen endothelial cells. It is concluded that T. cinerea causes periacinar fibrosis, similar to poisoning by Galenia africana in sheep and goats and veno-occlusive disease in different species.

BACKGROUND:

In areas where visceral leishmaniasis (VL) and malaria are co-endemic, co-infections are common. Clinical implications range from potential diagnostic delay to increased disease-related morbidity as compared to VL patients. Nevertheless, public awareness of the disease remains limited. In VL-endemic areas with unstable and seasonal malaria, vulnerability to the disease persists through all age-groups, suggesting that in these populations, malaria may easily co-occur with VL, with potentially severe clinical effects.

METHODS:

A retrospective case--control study was performed using medical records of VL patients admitted to Tabarakallah and Gedarif Teaching Hospitals (Gedarif State) and Al`Azaza kala-azar Clinic (Sennar State), Sudan (2005--2010). Patients positively diagnosed with VL and malaria were identified as cases and VL patients without microscopy-detectable malaria as controls. Associations between patient characteristics and the occurrence of the co-infection were investigated using logistic regression analysis. Confirmation of epidemiological outcomes was obtained with an independently collected dataset, composed by Medecins Sans Frontieres (MSF) at Um-el-Kher and Kassab Hospitals, Gedarif State (1998).

RESULTS:

The prevalence of malaria co-infection among VL surveyed patients ranged from 3.8 to 60.8%, with a median of 26.2%. Co-infected patients presented at hospital with deteriorated clinical pictures. Emaciation (Odds Ratio (OR): 2.46; 95% Confidence Interval (95%CI): 1.72-3.50), jaundice (OR: 2.52; 95%CI: 1.04-6.09) and moderate anemia (OR: 1.58; 95%CI: 1.10-2.28) were found to be positively associated with the co-infection, while severity of splenomegaly (OR: 0.53; 95%CI: 0.35-0.81) and, to a less extent, hepatomegaly (OR: 0.52; 95%CI: 0.27-1.01) appeared to be reduced by concomitant VL and malaria. The in-hospital case-fatality rates did not significantly differ between co- and mono-infected patients (OR: 1.13; 95% CI: 0.59-2.17). Conversely, a significantly increased mortality rate (OR: 4.38; 95% CI: 1.83-10.48) was observed by MSF amongst co-infected patients enrolled at Um-el-Kher and Kassab Hospitals, who also suffered an enhanced risk of severe anemia (OR: 3.44; 95% CI: 1.68-7.02) compared to VL mono-infections.

CONCLUSIONS:

In endemic VL areas with unstable seasonal malaria, like eastern Sudan, VL patients are highly exposed to the risk of developing concomitant malaria. Prompt diagnosis and effective treatment of malaria are essential to ensure that its co-infection does not result into poor prognoses.

According to a high anti-osteoporotic efficacy of Sigma Anti-bonding Molecule Calcium Carbonate (SAC), repeated-dose toxicities of SAC were investigated to assess its feasibility as drug or functional food ingredient. Male ICR mice were given drinking water containing 0.006, 0.02 or 0.06% SAC for 4 weeks. SAC feeding decreased the body weights and feed and water consumptions of mice in a dose-dependent manner, especially, leading to severe emaciation and 70% death in 3 weeks in the high-dose (0.06%) group. Not only kidney and heart weights, but also the levels of blood urea nitrogen, creatinine, aspartate transaminase, and creatine phospokinase significantly increased after SAC administration, indicative of nephrotoxicity and cardiotoxicity. Such renal and cardiac toxicities were also confirmed by microscopic findings, exhibiting renal crystals and cardiac fibrosis, which may be due to the insoluble crystal formation and calcium overload, respectively. In conclusion, it is suggested that no observed adverse effect level of SAC is lower than 0.006% in mice, and that a long-term intake may cause serious adverse effects on renal and cardiac functions.

The Great Shearwater (Puffinus gravis) is an abundant pelagic seabird that undertakes transequatorial migrations between the North and South Atlantic Ocean. This species is a useful indicator of large-scale alterations in marine dynamics due to its wide geographic range, long-distance migrations, and relative abundance. From 1993 to 2011, 12 separate mortality events, with 4,961 Great Shearwaters recovered, were documented along the eastern coast of the United States. Of these, seven events (n=4,885) occurred in the Southeast (SE) and five (n=76) in the Northeast (NE) United States. The cause of death was determined either by necropsy (n=60) or external examination (n=4,901). All Great Shearwaters stranded along the SE United States were emaciated while 58% were emaciated in the NE United States. No plastic was observed in Great Shearwaters in the SE US (n=27), but the gastrointestinal tract of 82% (n=27) of all stranded birds along the NE United States had at least one plastic bead. There was no evidence of infectious disease or heavy metals in stranded Great Shearwaters examined (n=14, from the 2005 SE event). Stable isotope analysis of feathers (n=9, from a 2007 SE event) suggests dietary differences between emaciated stranded birds and live-caught healthy birds. The temporal distribution of stranding detections suggests a general increase in the number of observed Great Shearwater strandings over the past two decades. From 1993 to 2000 there were a total of three mortality events with 296 individual Great Shearwaters. However, there was a threefold increase in the number of mortality events from 2001 to 2011 (nine events involving 4,665 individuals). The causes of this apparent increase in strandings are unknown but may be due to an increase in reporting effort over the past two decades combined with changing oceanographic conditions in the South Atlantic Ocean, leading to large-scale mortality of emaciated Great Shearwaters along the east coast of the United States.

This paper explores early issues of separation-individuation, unconscious conflict, and trauma, revived and reworked in Picasso's turbulent protracted adolescence. During this critical period Picasso traveled between Barcelona and Paris four times, from age 19 to 23. His melancholic mood, related both to separation conflict and the current realities of his uprooted life and emerging career, was expressed in his painting of emaciated, despondent figures, the predominance of monochromatic blue, and his choice of social outcasts as subjects. Of particular significance are his paintings of blind persons. Separation and loss, his depressive disposition, and his choice of blind subjects were psychologically interrelated. Picasso's developmental transformation from adolescence to adulthood, marked by his finally settling in Paris, encompassed change in his personal and artistic identity.