Plain film radiography is an economical method of visualising radio-opaque objects, but computed tomography still remains the gold standard of initial imaging. However, in cases of organic foreign bodies, magnetic resonance imaging may be required, as wooden objects tend to mimic air on standard CT window settings. Although complications associated with intra-orbital trauma include visual loss, orbital inflammation, secondary infection, osteomyelitis, ptosis and even brain abscess, in rare cases, no visual morbidity occurs. In this case, although the foreign body was there for more than a week, the patient did not have any associated orbital cellulitis. This may be due to the inert nature of the foreign body, unlike in cases of intraorbital organic foreign bodies. Interestingly, the kind of injury sustained in this patient, i.e. a foreign body embedded in the inferior orbital rim and causing a fracture, is usually associated with high velocity injuries and thus greater visual disability. Our patient was fortunate as his vision was still 6/6 in both eyes, and he did not develop any long term ocular complications. Patients with suspected intraorbital foreign body are usually started on systemic antibiotics because of the high incidence of secondary orbital infections. Anaerobic coverage should be provided where the foreign body is suspected to be composed of organic material. Our patient was started on amoxicillin clavulanate for broad spectrum Gram-positive and Gram-negative coverage, and metronidazole for anaerobic coverage. Management of the intraorbital foreign body depends on clinical presentation, nature and the location of the foreign body in the orbit. Because foreign bodies can cause irritation of the mucosa that can be result in sinusitis, the removal of all foreign bodies is generally recommended, even when they do not produce symptoms. In rare cases, the foreign body may extrude spontaneously, but in general, the decision of whether to remove an intraorbital foreign body has to be made by the co-managing team. Presentation of the patient with visual compromise, ptosis, diplopia, orbital inflam-mation or infection mandates urgent removal.
Likewise, surgical removal is indicated for all organic foreign bodies because of the high rate of secondary complications. However, surgical exploration in case of inorganic foreign bodies depends on their location and the potential complications if left in place. For instance, 25 liter pot the access to anteriorly located intraorbital foreign bodies is relatively simple, and thus these should be removed. In posteriorly located foreign bodies, however, the risk of surgery may outweigh the benefits, so in the absence of significant orbital complications, these should be left untouched.With an estimated 50 million infections per year across many countries, Dengue is now recognized as one of the major public health problems worldwide. It is a mosquito-borne illness belonging to the genus flavivirus and consisting of 4 distinct serotypes, namely DENV-1, DENV-2, DENV-3 and DENV-4 . In majority of the cases, the illness is self-limiting with mild symptoms such as fever, rash and joint pain . However, this may predispose to a severe form with infection with a different serotype . Today, dengue is endemic in more than 100 countries across Asia, Africa, America, Eastern Mediterranean, and West Pacific. Central to this is the enlarging habitat of its vectors, Aedes aegypti and Aedes albopictus. Aedes aegypti in particular, is highly adaptive in crowded areas; hence epidemics have been seen in cities with un-planned urbanization and overcrowding. Pakistan also had its share of dengue outbreaks in the recent years owing to the factors mentioned above. Epidemics have been reported especially in urban areas of Karachi and Lahore; situation worsening especially after monsoonal rains and floods. In October 2010, a total of 1809 cases were suspected out which 881 cases were confirmed of Dengue infection. In 2011, worst outbreak occurred in the country when more than 14,000 people were affected with dengue with over 300 deaths. Considering the current situation of Dengue virus and unavailability of data in Pakistan urgent attention and oversight is required to ensure effective preventive and curative program development. The objective of this study was to estimate the proportion of Dengue virus specific IgG ELISA among asymptomatic children between the ages of 1 year to 15 years, residing in an urban population of Karachi. When re-infected this population would potentially be at a higher risk of developing severe forms of dengue hemorrhagic fever. A cross sectional survey was conducted from September 2011 to February 2012 to estimate the prevalence of dengue virus. The study cohort consisted of children between one to 15 years of age. The study participants were stratified by geographical zone and age group. There were four zones in the Garden area. The participants were divided into three age groups of 1 – 5 years, 6 – 10 years and 11 – 15 years. Seventy five children were included from each age group in each zone to ensure that the sample was representative not only 1 zone that why each zone was divided equally. Thus a total of 900 children were enrolled in the study and for the selection of respondents systematic random sampling technique was used.
After taking written consent from the parents/guardians, data was collected by research medical officers using a questionnaire, specially prepared for this survey. Information was collected on household socioeconomic status, medical history of febrile episodes including previous dengue infection followed by general clinical examination. Anthropometry height and weight was also performed. Blood samples were collected from the subjects and sent to Research Laboratory, Aga Khan University, Pakistan for determining complete blood counts and serum IgG antibodies for Dengue. Complete blood counts were tested using automated hematology analyzer .Dengue IgG antibodies was determined by Enzyme Linked ImmunoSorbent Assay , using Pan Bio Kits . Our study indicated that 46% of the population had been infected with dengue virus, making them susceptible to severe forms of dengue fever. To date, no study of this sort had been conducted from Karachi, Pakistan. Our study showed that Dengue IgG was found more in elderly children . This finding has also been reported by other researchers in their settings. Our study also showed greater preponderance of dengue IgG antibodies in males compared to females. Where reports suggest no significant differences associated with sex that might be different from Pakistan’s perspective owing to the fact that majority of the females remain indoors while males spend their maximum time outside. As mentioned previously, the dengue vectors are highly adaptable to any environment, hence it is probable for male children of such ages to become exposed to its habitat more often and contracting the virus. In our study, analysis revealed dengue IgG positivity to be more among lowest categories of socioeconomic position, comprising of 19% of the studied population. This was consistent with the study reported from Brazil. In our study, the finding was perhaps expected as Garden is a modern urban area with high rise buildings and inhabited by affluent communities.Employing strategies for water purification was also found to be important in the study, indicating a more likelihood to prior dengue infection in absence of water purification. In our analyses, 39% reported to purify water for consumption, using methods such boiling , filtering and chlorination . It can be conceived that untreated water would be the possible niche for the Aedes mosquitoes to breed and multiply. Unique in this study is the positive association of stunting with IgG positivity . Our analysis also revealed a lesser likelihood of IgG positivity in presence of anemia and thrombocytopenia. These 3 conditions are pretty prevalent in this part of the world, each clinical correlate limiting us to offer any interpretation to its significance with IgG positivity. Some limitations are to note in this study. For instance we opted to collect information from a relatively affluent community of Karachi. Though previous studies on Dengue from around the world have indicated Dengue to be a threat for the urban areas, including squatter settlements would have provided a comparative picture showing proportional associations of positive IgG with overcrowding, sanitation and presence of domestic animals. The important and interesting aspect is to assess the serotype of the most prevalent dengue virus in these settings, as limited literature suggests DENV-2 and DENV-3 to be most prevailing in Pakistan.Lead is a naturally occurring metal that is used in many industrial processes, some of which lead to contamination of urban environments.
Lead deposition in urban areas is often atmospheric, originating from manufacturing, especially battery production, as well as in gasoline, and paint residues. Lead toxicities in people result in developmental, cognitive, motor, behavioral and physical injury, and for this reason, there is no acceptable lead level in the human system. In urban environments, lead may enter soils through atmospheric deposition, from dust near roadways, and from paint chips near buildings. Food grown in lead contaminated soils may be ingested, entering the consumer either directlyas transported particles containing lead or by absorption of lead salts in the crop consumed. Lead is persistent in soil. Since food insecurity is highest in large cities, recent efforts to produce food locally and in community gardens has increased, and lead ingestion must be examined carefully in urban food production systems. Attempts to alleviate food insecurity of impoverished citizens in cities by “guerrilla farming” activists may be putting consumers of such foods at risk, especially when farming on “Brownfield” sites previously contaminated with lead. Thus, those attempting food production in cities may be at risk for lead consumption and poisoning. Radish , a root vegetable, commonly grown worldwide, is consumed raw, raspberry cultivation pot as well as in a variety of preparations. Because radish grows rapidly from seed, it is preferred in school gardens where children can observe its rapid growth and development. All parts of radish are consumed, including foliage, the fleshy tap root, seed oils, and the immature seed pods. Ten species of radish are described in literature. The ability of globe radish to absorb lead is known, and some varieties are “hyper-accumulators”. The variability of lead uptake in radish cultivars is not known. Lead salts occur in soil as oxides of metallic Pb or as salts that result from chemical reactions that may occur in soil. The solubility of lead salts in water is quite variable, from highly soluble lead nitrate to practically insoluble lead sulfate . Lead is a divalent cation and is easily adsorbed onto clay colloids, or other cation exchange sites including organic matter, when it is in a soluble ionic state. Since lead reacts with oxygen and many other elements, there are likely many possible lead compounds and intermediates which may be present in contaminated soils.
In this study we present lead uptake data by five cultivars of radish growing in soils of two different textures, using two different lead salts as the lead sources.Soil was collected from 211 West Foothill Blvd, Claremont, CA , USA, which was a site known to be contaminated with lead. Multiple samples were collected along three linear transects of the site equidistant within a plot measuring 45 × 45 m. combined and homogenized. Samples were collected from the upper 20 cm of soil in spring of 2013. The site soil was dried, ground and sieved at the University of California Agriculture and Natural Resources lab and analyzed for lead content using a nitric acid digest/extraction and detection by inductively coupled atomic plasma emission spectrometry following procedures of Sah and Miller & Meyer and Keliher. Soil was passed through a 2 mm screen to remove rock and other large particles and blended with washed sand in a 3:1 ratio to improve bulk density for container culture of radish seedlings. Urea was added at a rate of 1.25 g per 5” container containing 1.54 kg of blended sand and site soil to provide nitrogen for seedling growth. Five varieties of radish and one of mustard were obtained from High Mowing Organic Seeds and seeded 1gm of each variety in each experimental unit . The study included radish cultivars “Cherry Belle”, “White Beauty”, “Purple Plum”, “French Breakfast” and “Rudolf” as well as the known lead hyper-accumulator Red Giant Mustard Brassica juncea L. As a control, one of the radish cultivars and RGM were grown in soil-less media composed of peat moss and sand and fertilized with urea as above.