Two-staged reverse sural flap: a versatile flap with consistent results in the soft tissue reconstruction of distal leg and heel defects—an institutional experience

European Journal of Orthopaedic Surgery & Traumatology - Reverse sural flap (RSF) is commonly used for soft tissue reconstruction of distal leg and heel defects. The classic method of flap...     

The emergence of subclades A1 and A3 avipoxviruses in India

During the years 2010–2018, avipoxvirus (APV) outbreaks were observed in the domestic chickens and pigeons present in the eastern Indian state of Odisha. Based on typical pox lesions, followed by molecular techniques, the overall morbidity was found to be 18%–19.23% and 16.92%–23% in chickens and pigeons, respectively. The cutaneous forms of the disease were observed with varied rates of mortality, being 47.36%–52.77% in chickens and 39.13%–92% in pigeons. PCR amplification targeting the viral P4b core protein‐coding gene and the DNA polymerase gene confirmed the presence of APV strains in 10 birds. Subsequent phylogenetic analysis of these two genes confirmed that the circulating strains were members of APV clade A. The subclade analysis revealed the introduction of A1 and A3 subclades in Indian chickens and pigeons, respectively. This study is the first molecular record of APVs circulating in eastern Indian birds (Odisha) and involves the first use of the polymerase gene to reveal the circulating clades of Indian APVs.     

Early anticoagulation after mechanical valve implantation, and related complications

BACKGROUND AND AIM OF THE STUDY: Anticoagulation is started soon after mechanical valve replacement as the risk of thromboembolic complications is especially high during the first six months after surgery. At present there is no consensus on the optimal protocol to prevent early thrombogenic complications, without increasing the risk of postoperative hemorrhagic events. Herein is presented a comparative analysis of the various anticoagulation protocols utilized at the authors' institution. METHODS: Between July 2001 and October 2006, a total of 503 patients underwent mechanical valve implantation at the authors' institution. The patients were allocated to three comparable groups, depending on the anticoagulation regime administered. Group A patients (n = 221) received only oral anticoagulation from the first postoperative day; group B patients (n = 159) received oral anticoagulation plus low-molecular weight heparin; and group C patients (n = 123) received unfractionated heparin within 12 h of surgery in addition to oral anticoagulation. RESULTS: At 48 h after surgery the mean postoperative drainage was 514.1 +/- 202 ml, 783.4 +/- 369.7 ml, and 718.4 +/- 305.5 ml in groups A, B and C, respectively. Two patients in group A, 12 in group B and nine in group C required the reinsertion of additional intercostal/pericardial drains for collections (p = 0.002). Twelve patients had tamponade (seven in group B, five in group C; p = 0.002), and nine (five in group B, four in group C) required re-exploration for excessive drainage at >48 h after surgery (p = 0.01). There were three incidents of valve thrombosis within the first postoperative six months (one in each group). Two of these patients had a suboptimal International Normalized Ratio (INR), while the third patient had an INR >5 with congestive heart failure with hepatic failure. All three were successfully thrombolyzed and recovered after initial ventilatory and inotropic support. The incidence of thromboembolic stroke was low in all groups. CONCLUSION: Early oral anticoagulation alone provides optimum anticoagulation and is associated with minimum complications. Early supplementation with heparin increases the risk of hemorrhagic complications but without reducing the thromboembolic risk.     

First report of a nonsense mutation at codon 15(TGG-->TAG) in exon 1 of the beta globin gene in a beta thalassemia trait in State of Orissa, India

Prevention of beta thalassemia requires knowledge of the molecular spectrum occurring in the population at risk. This knowledge is particularly necessary when prevention control is applied to a multiethnic population. For this purpose, we are analyzing different populations of Orissa (India). During the study we encountered a beta thalassemia major patient (a child) who was doubly heterozygous for IVS I-5(G-->C) and codon 15(G-->A) alleles where codon 15(G-->A) was for the first time found in the father of the patient. Also, the patient showed severe clinical abnormalities because of the severe nature of these beta thalassemia alleles. This will provide further insights into beta globin gene regulation and the genotype-phenotype relationship.     

Utility of glomerular morphometry in diagnosing pediatric renal disease

BackgroundMorphometry has now become a useful adjunct to the diagnostic armamentarium of light, immunofluorescence, and electron microscopy, as it provides a deep insight into quantitative parameters of nephropathies. There has been a limited study on its utility especially in diagnosing pediatric renal diseases. This study is probably the first in India to assess the contribution of this diagnostic modality in pediatric renal disease to the best of authors’ knowledge.MethodsIt''s a retrospective cross-sectional study covering a period of 05 years at a tertiary care hospital. The study includes 28 cases of pediatric (age till 14 years) nephropathies. The diseases were divided into two groups—nephrotic presentation and nephritic presentation. Glomerular morphometry was performed and mean was calculated for Bowman''s capsule area, glomerular capillary tuft area, and Bowman''s space area; for the three groups, respectively. Renal parameters serum creatinine, blood urea, 24 h urine protein were studied along with hemoglobin and serum cholesterol for the cases. Data were analyzed using SPSS software, version 25, for one-way ANOVA comparing mean in the three groups.ResultsWe found a positive and significant correlation between Bowman''s capsule area with proteinuria, blood urea, and serum creatinine. There was positive and significant correlation between glomerular capillary tuft area and serum creatinine and Bowman''s space area and proteinuria in both the groups.ConclusionGlomerular morphometry may contribute to the diagnosis of some glomerulopathies and the association between glomerular morphometric parameters and laboratory data may promote better understanding of the prognosis of these patients.     

Contribution of ionic silver to genotoxic potential of nanosilver in human liver HepG2 and colon Caco2 cells evaluated by the cytokinesis‐block micronucleus assay

Extensive human exposure to food‐ and cosmetics‐related consumer products containing nanosilver is of public concern because of the lack of information about their safety. Genotoxicity is an important endpoint for the safety and health hazard assessment of regulated products including nanomaterials. The in vitro cytokinesis‐block micronucleus (CBMN) assay is a very useful test for predictive genotoxicity testing. Recently, we have reported the genotoxicity of 20 nm nanosilver in human liver HepG2 and colon Caco2 cells evaluated using the CBMN assay. The objective of our present study was three‐fold: (i) to evaluate if HepG2 and Caco2 cells are valuable in vitro models for rapid genotoxicity screening of nanosilver; (ii) to test the hypothesis that the nanoparticle size and cell types are critical determinants of its genotoxicity; and (iii) to determine if ionic silver contributes to the nanosilver genotoxicity. With these objectives in mind, we evaluated the genotoxic potential of 50 nm nanosilver of the same shape, composition, surface charge, obtained from the same commercial source, under the same experimental conditions and the same genotoxic CBMN endpoint used for the previously tested 20 nm silver. The ionic silver (silver acetate) was also evaluated under the same conditions. Results of our study show that up to the concentrations tested in these cell types, the smaller (20 nm) nanosilver induces micronucleus formation in both the cell types but the larger (50 nm) nanosilver and the ionic silver provide a much weaker response compared with controls under the same conditions. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.     

Single-nucleotide and copy-number variance related to severity of hypospadias

Background

The genetic association of hypospadias-risk studies has been conducted in Caucasians, Chinese-Han populations and few in Indian populations. However, no comprehensive approach has been followed to assess genetic involvement in the severity of the disorder.

Methods

The study evaluated to establish the correlation between genotyped single nucleotide and copy number variants (SNPs/CNVs) and severity of hypospadias by an association in a total 30 SNPs in genes related to sex hormone-biosynthesis and metabolism; embryonic-development and phospholipase-d-signalling pathways on 138 surgery-confirmed hypospadias-cases from North India (84 penile and 28 cases of penoscrotal-hypospadias as compared with 31 cases of glanular?+?coronal), and analyzed and identified CNVs in four familial cases (18 members) and three paired-sporadic cases (6 members) using array-based comparative-genomic-hybridization and validated in 32 hypospadias samples by TaqMan assay.

Results

Based on odds ratio at 95% CI, Z Statistic and Significance Levels, STS gene-rs17268974 was associated with Penile-Hypospadias and 9-SNPs [seven-SNPs (rs5934740; rs5934842; rs5934913; rs6639811; rs3923341; rs17268974; rs5934937)] of STS gene; rs7562326-SRD5A2 and rs1877031-STARD3 were associated with penoscrotal-hypospadias. On aggregate analysis with p?<?0.001, we identified homozygous-loss of Ch7:q34 (PRSS3P2, PRSS2). On validation in previously CNV-characterized and new (32 hypospadias cases), we identified PRSS3P2-loss in most of the grade 3 and 4 hypospadias. Hence, Grade 1 and 2 (coronal and granular) show no-PRSS3P2-loss and no-association with SNPs in STS; SRD5A2; STARD3-gene but Grade 3 and 4 (Penile and Penoscrotal) show PRSS3P2-loss accompanied with the association of SNPs in STS; SRD5A2; STARD3.

Conclusions

Hence, homozygous-loss of PRSS3P2 accompanied with the association of STS; SRD5A2; STARD3 may link to the severity of the disease.

     

Knowledge,Attitude and Practice (KAP) Study of Pediatricians on Infantile Spasms

Objective

To investigate the knowledge, attitude, and practice of Infantile Spasms among pediatricians.

Methods

A survey was carried out among pediatricians serving in Punjab, Haryana, Chandigarh, Himachal Pradesh and Delhi. The survey was done by Survey Monkey Software through emails by using a structured questionnaire between July 2016 and December 2017.

Results

A total of 236 pediatricians responded to the survey. Most of the respondents (95.5%) correctly considered Infantile Spasms as a seizure type. The most preferred investigation was Electroencephalogram by 91.8% pediatricians; however, only 57.7% considered it to decide the treatment. Perinatal asphyxia was the most recognized etiology (60.7% pediatricians). For treatment of Infantile Spasms, 66.8% follow Nelson textbook of Pediatrics. Adrenocorticotropic hormone was the most preferred first choice drug by 40% pediatricians. Alternate anti-epileptic drug was considered by 60.9% pediatricians when there is no clinical response. Only 24% pediatricians considered treatment response as a complete cessation of spasms. Majority (90%) of pediatricians felt that there is a necessity for increased awareness and 62% pediatricians felt that available information was insufficient.

Conclusions

A substantial number of pediatricians lack precise knowledge on evidence-based practice of Infantile Spasms. In developing countries, where pediatricians provide the initial management of Infantile Spasms, there is need to empower them and develop simplified national guidelines/consensus statement for management of Infantile Spasms.