Laparoscopic cholecystectomy for left-sided gallbladder (sinistroposition).

Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are situated under the left lobe of the liver between Segment III and IV or on Segment III to the left of the falciform ligament. Because routine preoperative studies may not detect the anomaly, it may provide the surgeons with an unusual surprise during laparoscopy. Awareness of the unpredictable confluence of the cystic duct into the common bile duct and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual problem.     

Somatic translocation and differential expression of Ig mu transgene copies implicate a role for the Igh locus in memory B cell development

Memory B cells of mice with Ig mu transgenes often carry transgene copies that have moved into the Igh locus via somatic translocation. This phenomenon has been attributed to a selection pressure for somatic hypermutations, which generally are observed at much higher frequencies in translocated copies than in ectopic copies. We tested this idea by immunizing Ig-mu transgenic mice in a manner designed to select B cells that required only one V(H) mutation for a switch in antigenic specificity and recruitment into the memory pool. Despite the minimal mutation requirement, hybridomas carrying somatic translocations to the Igh locus were obtained. Importantly, this occurred despite the fact that translocated and untranslocated mu-transgenes were mutated comparably. Evidently, a strong selection advantage was conferred upon B cells by the somatic translocations. Among the hybridomas, translocated mu-transgenes were active, while ectopic mu-transgenes were uniformly silent. The translocated copy that had conferred an affinity-based selection advantage was expressed at the highest level. Moreover, translocated copies were differentially expressed among hybridoma members, which belonged to a common post-mutational lineage. This suggests that adjustments in transgene expression levels had occurred during memory cell development. These results indicate that, apart from their potential influences on somatic hypermutagenesis and class switch recombination, elements in the Igh locus promote the selection of memory B cells in another way, possibly by regulating the level of Ig expression at various stages of antigen-driven differentiation.     

Factors Influencing the Varus Deformity of Humeral Head in Proximal Humerus Fractures and Its Relation to Functional Outcome

BackgroundFractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. Proper reduction, stable internal fixation and early initiation of physiotherapy help to achieve a good functional outcome. Aim of this study was to evaluate varus fixation/malunion of proximal humerus fractures and its relation to functional outcome.Materials and MethodsWe retrospectively evaluated 32 patients with proximal humerus fractures who were surgically treated between 2015 and 2017 at tertiary care hospital. We divided the patients into three groups on the basis of the neck-shaft angle as valgus group, normal group and varus group to observe the influence of neck-shaft angle on efficacy. Patients were evaluated for functional outcome using the Constant–Murley score.ResultsTwo-part fractures had better functional outcome (Constant score = 75.15) compared to three parts with the moderate functional outcome (Constant score = 68.81) and the four-part fracture had poor functional outcome (Constant score = 52.66). After 6 months of follow-up, 13 patients had a neck-shaft angle of less than 126°. The functional outcome is significantly better among patients with normal neck-shaft angle and had a mean Constant score of 76.63 as compared to patients with varus deformity had a mean Constant score 60 (p = 0.001). 10 patients did not have medial support, in which 08 patients had neck-shaft angle less than 126° and 2 had a normal neck-shaft angle.ConclusionHigh fracture comminution, improper restoration of medial continuity causes varus deformity of the humeral head and it leads to poor functional outcome. The small sample size is the limitation of our study.     

Influence of Fluctuating Water Temperature and Dietary Oxytetracycline on the Safety of Monosex Nile Tilapia Oreochromis niloticus Fries

The influence of fluctuating water temperature and dietary oxytetracycline (OTC) at 0 (0X), 80 (1X), 240 (3X), 400 (5X) and 800 mg (10X)/kg biomass/day for 30 consecutive days on the safety of monosex (all male) Nile tilapia Oreochromis niloticus fries in terms of feeding, growth, survival and histopathology of vital organs were assessed. A dose-dependent decline in feed intake and biomass was recorded. The OTC-dosed groups recorded higher mortalities than the control. The therapeutic OTC-dosing (1X) in conjunction with low temperature caused 75.56 ± 8.01% mortality and 25.75% reduced feed intake in 30 days. The mortalities increased with increasing OTC-doses from 85.19 ± 3.39% (1X) to 95.56 ± 2.22% (10X) and fluctuating temperature (12.00–21.50°C) even after the withdrawal of OTC. Relatively mild to moderate histopathological lesions were observed in the kidney, liver and intestine of OTC-dosed fries. These results suggested that dietary OTC and low water temperature may cause adverse effects on monosex O. niloticus fries.

     

GENDER AND AGE DIFFERENCES IN ANEMIA PREVALENCE DURING THE LIFECYCLE IN KUWAIT

Anemia remains a significant worldwide public health problem. Most studies of anemia and iron deficiency, the major cause of anemia, have targeted small children and reproductive age women. Much less is known about anemia in other lifecycle groups, especially preschool age children, prepubertal boys and girls, or in older adults. Yet recent studies indicate that anemia may increase the risk for chronic diseases and accelerate declining function in older adults. We examined anemia throughout the lifecycle in Kuwait by analyzing data from the 2002 Kuwait Nutrition Surveillance Program. Over 13,000 individuals of both sexes representing all ages were studied. The prevalence of anemia was higher in females than males between 6 months and 3 years. From age 4 to 14 years, there was a reversal with males having a higher rate of anemia. Older females had a lower prevalence of anemia than younger females. These results imply certain policy options.     

An overview on in situ micronization technique – An emerging novel concept in advanced drug delivery

The use of drug powders containing micronized drug particles has been increasing in several pharmaceutical dosage forms to overcome the dissolution and bioavailability problems. Most of the newly developed drugs are poorly water soluble which limits dissolution rate and bioavailability. The dissolution rate can be enhanced by micronization of the drug particles. The properties of the micronized drug substance such as particle size, size distribution, shape, surface properties, and agglomeration behaviour and powder flow are affected by the type of micronization technique used. Mechanical communition, spray drying and supercritical fluid (SCF) technology are the most commonly employed techniques for production of micronized drug particles but the characteristics of the resulting drug product cannot be controlled using these techniques. Hence, a newer technique called in situ micronization is developed in order to overcome the limitations associated with the other techniques. This review summarizes the existing knowledge on in situ micronization techniques. The properties of the resulting drug substance obtained by in situ micronization were also compared.