Comparative study of fresh femoral neck fractures managed by multiple cancellous screws with and without fibular graft in young adults

Objectives

Aim of our study was to assess the role of addition of fibular strut graft to multiple cancellous screws in functional outcome, union and complications associated with those managed by only multiple cancellous screws in fresh femoral neck fractures.

Methods

A randomized control trial study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws (group A) and multiple cancellous screws with fibular graft (group B). Patients aged between 20 and 50 years, having Gardens type III or IV fracture with duration of injury less than two weeks were included in the study.

Results

Eighty seven cases were analysed n = 45 were in group A and n = 42 in group B. Functional outcome (Harris hip score) was excellent in 30 patients in group A as compared to 12 in Group B which was statistically significant favouring group A. The time of full weight bearing, union and non union rates showed no statistical significance (p > 0.05). On statistical grounds none of the procedures proved to be better than other.

Conclusions

Fresh femoral neck fracture in young adults managed with multiple cancellous screws fixation with fibular graft has no added advantage over multiple cancellous screws fixation alone.     

NG2-expressing cells in the nervous system: role of the proteoglycan in migration and glial-neuron interaction

The NG2 glycoprotein is a type I membrane protein expressed in the developing and adult central nervous system (CNS) by subpopulations of glia including oligodendroglial precursor cells (OPCs), and in the developing CNS additionally by pericytes. In the mouse CNS, expression of NG2 protein is already observed at embryonic day 13 and peaks between postnatal days 8 and 12. NG2+ cells persist in grey and white matter in adult mouse brain: cells in the developing and adult brain show clear differences in migration, cell-cycle length and lineage restriction. Several groups have provided evidence that subpopulations of NG2+ cells can generate neurons in vivo. Neuronal stimulation in the developing and adult hippocampus leads to Ca2+ signals in apposing NG2+ glia, suggesting that these cells may modulate synaptic activity, and NG2+ cells often ensheath synapses. The structure of the protein with two N-terminal LamininG/Neurexin/Sex-hormone-binding globulin domains suggests a role in adhesion. The C-terminal PSD-95/DiscsLarge/Zona Occludens-1 (PDZ)-binding motif has been found to associate with several PDZ proteins including the Glutamate Receptor Interacting Protein GRIP: NG2 may thus act to position AMPA receptors on glia towards sites of neuronal glutamate release. Furthermore, the NG2 proteoglycan plays a role in cell migration and spreading and associates with actin-containing cytoskeletal structures.     

Polymerase chain reaction detection of Plasmodium vivax and Plasmodium falciparum DNA from stored serum samples: implications for retrospective diagnosis of malaria

Polymerase chain reaction (PCR) detection of Plasmodium DNA is highly sensitive in diagnosing malaria. The specimen of choice for this assay has been whole blood samples from malaria patients. To retrospectively determine malaria infection rates in populations or cohorts for whom stored serum samples are available, we determined the ability of a nested PCR assay to detect Plasmodium DNA in stored serum samples. The PCR result was positive in 20 of 23 serum samples from patients with microscopy-confirmed malaria and negative in 8 of 8 healthy controls, resulting in a sensitivity of 87% and specificity of 100%. In all positive samples, species were correctly identified by PCR except for one case where a mixed infection was detected. The PCR is able to detect Plasmodium DNA in serum samples frozen up to 2.5 years and has the potential for the retrospective identification of malaria parasitemia in patient cohorts to determine potential interactions of malaria and other diseases such as human immunodeficiency virus/acquired immunodeficiency syndrome.     

Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor α antagonists

Objective

To evaluate the risk of serious bacterial infections associated with tumor necrosis factor α (TNFα) antagonists among rheumatoid arthritis (RA) patients.

Methods

A retrospective cohort study of US RA patients enrolled in a large health care organization identified patients who received either TNFα antagonists or methotrexate (MTX). Administrative data were used to identify hospitalizations with possible bacterial infections; corresponding medical records were abstracted and reviewed by infectious disease specialists for evidence of definite infections. Proportional hazards models evaluated time‐dependent infection risks associated with TNFα antagonists.

Results

Hospital medical records with claims‐identified suspected bacterial infections were abstracted (n = 187) among RA patients who received TNFα antagonists (n = 2,393; observation time 3,894 person‐years) or MTX (n = 2,933; 4,846 person‐years). Over a median followup time of 17 months, the rate of hospitalization with a confirmed bacterial infection was 2.7% among the patients treated with TNFα antagonists compared with 2.0% among the patients treated with MTX only. The multivariable‐adjusted hazard ratio (HR) of infection among the patients who received TNFα antagonists was 1.9 (95% confidence interval [95% CI] 1.3–2.8) compared with patients who received MTX only. The incidence of infections was highest within 6 months after initiating TNFα antagonist therapy (2.9 versus 1.4 infections per 100 person‐years; multivariable‐adjusted HR 4.2, 95% CI 2.0–8.8).

Conclusion

The multivariable‐adjusted risk of hospitalization with a physician‐confirmed definite bacterial infection was ∼2‐fold higher overall and 4‐fold higher in the first 6 months among patients receiving TNFα antagonists versus those receiving MTX alone. RA patients were at increased risk of serious infections, irrespective of the method used to define an infectious outcome. Patients and physicians should vigilantly monitor for signs of infection when using TNFα antagonists, particularly shortly after treatment initiation.

     

Association between oxidative stress and coronary lipid risk factors in hypothyroid women is independent of body mass index

Hypothyroidism enhances the progression of atherogenesis. Furthermore, dyslipidemia, hypertension, and obesity are known risk factors for atherosclerosis. Oxidative stress is implicated in the pathogenesis of cardiovascular diseases. However, there are contradicting reports on the existence of oxidative stress in hypothyroidism. Thus, the aim of the study is to evaluate the presence of oxidative stress in hypothyroidism and, if so, its possible association with various coronary lipid risk factors. The present study was carried out in a group of 27 freshly diagnosed normotensive primary hypothyroid female patients in comparison with healthy subjects. Their body mass index (BMI), serum thyroid profile, lipid profile, glucose, protein carbonylation, thiobarbituric acid reactive substances (TBARS), and blood antioxidant enzyme levels were estimated. The TBARS and protein carbonylation were significantly higher in cases compared with those in controls. Reduced glutathione was lower and glutathione peroxidase was higher in the test group compared with those in controls. Various lipid risk factors for coronary artery disease were significantly higher among the hypothyroid women in comparison with those in controls. The level of TBARS correlated significantly with various lipid risk factors among the hypothyroid women even after correcting the effect of BMI. However, no significant associations were observed between BMI and these risk factors when the effect of TBARS was nullified. In hypothyroidism, the coronary lipid risk factors seem to be more associated with lipid peroxidation than BMI. In conclusion, the present study indicates the presence of oxidative stress in hypothyroid patients and its association with atherogenic dyslipidemia, which is independent of BMI.     

A tertiary care hospital-based study of conventional risk factors including lipid profile in proven coronary artery disease

BACKGROUND: The prevalence and mortality rates of coronary artery disease have been known to be higher in the Indian than the Western population. Most data on lipid levels in Indians have been obtained from studies on migrant Asian Indians. There are insufficient data on lipid profile and other conventional risk factors in Indian patients living within India. METHODS AND RESULTS: The study included 2656 consecutive patients who underwent coronary angiography between March 1998 and February 2002. Of these, 2399 subjects had angiographically proven coronary artery disease (group 1) while 257 had normal coronary arteries (group 2). Lipid values were measured in the fasting state on the morning the coronary angiography was done. Patients receiving lipid-lowering agents, those having renal, hepatic or thyroid disorders, patients presenting within 8 weeks after acute myocardial infarction, and patients who were taking noncardiac drugs that affect the lipid profile were excluded from the study. Other conventional risk factors were also recorded. In subjects with coronary artery disease and normal coronary arteries, the levels of mean total cholesterol recorded were 178.5+/-42.1 mg/dl v. 154.1+/-40.2 mg/dl (p<0.001), high-density lipoprotein cholesterol 30.6+/-9 mg/dl v. 27.3+/-6.8 mg/dl (p<0.001), low-density lipoprotein cholesterol 109.8+/-35.4 mg/dl v 93.6+/-33.9 mg/dl (p<0.001), and triglyceride 190.7+/-95.4 mg/dl v. 157.6+/-73.5 mg/dl (p<0.001), respectively. In subgroup analysis by age, the younger coronary artery disease group (< or = 40 years) had significantly higher total and low-density lipoprotein cholesterol levels than the older group (> 40 years), viz. 194.6+/-51.4 mg/dl v. 176.3+/-40.2 mg/dl (p<0.001), and 118.3+/-39.6 mg/dl v. 108.7+/-36.1 mg/dl (p=0.001). Triglyceride levels were not significantly different [211.7+/-105.1 mg/dl v. 187.8+/-93.6 mg/dl (p=ns)], being equally high in both subgroups and, although high-density lipoprotein cholesterol levels were different, this difference was minimal, being equally low in both [32.7+/-9.5 mg/dl v. 30.3+/-9.0 mg/dl (p=ns)]. In the subgroup analysis of those with coronary artery disease, diabetics had significantly lower total cholesterol [174+/-41.1 mg/dl v. 180.4+/-42.4 mg/dl (p<0.001)] and low-density lipoprotein cholesterol levels [105.8+/-34 mg/dl v. 111.5+/-35.8 mg/dl (p<0.001)] than non-diabetics, whereas triglyceride and high-density lipoprotein cholesterol levels were not significantly different, triglycerides being equally high in both [186.2+/-95.5 mg/dl v. 192.5+/-95.2 mg/dl (p=ns)], and high-density lipoprotein equally low in both [30.9+/-9.3 mg/dl v. 30.5+/-9 mg/dl (p=ns)]. The commonest associated conventional risk factor in diabetics was hypertension and, in the younger age group (< or = 40 years), it was smoking and a positive family history of premature coronary artery disease. CONCLUSIONS: We conclude that in north Indians, coronary artery disease occurs at much lower levels of total cholesterol and low-density lipoprotein cholesterol than other populations, and high triglyceride and low high-density lipoprotein levels are more of a universal phenomenon in this population. Younger patients have a more atherogenic lipid profile than the older subgroup with coronary artery disease, and smoking and a family history of premature coronary artery disease are the most common associated risk factors. Total cholesterol levels seem to play a lesser role in the occurrence of coronary artery disease in diabetics, the presence of which is in itself overwhelming for the occurrence of coronary artery disease.     

<Emphasis Type="Italic">Emblica officinalis</Emphasis> Exerts Antihypertensive Effect in a Rat Model of DOCA-Salt-Induced Hypertension: Role of (p) eNOS,NO and Oxidative Stress

Emblica officinalis (EO) has antioxidant properties that could improve redox-sensitive vascular, cardiac and renal changes associated with deoxycorticosterone acetate/1% NaCl high salt (DOCA/HS)-induced hypertension. We determined whether hydroalcoholic lyophilized extract of EO may influence DOCA/HS-induced hypertension by modulating activity of (p) eNOS and endogenous antioxidants. Hypertension was induced in rats by DOCA-salt (20 mg/kg, s.c.) twice weekly for 5 weeks and replacing drinking water with 1% NaCl solution. These rats received cotreatment of different doses of EO (75, 150 and 300 mg/kg/day) for 5 weeks. EO significantly decreased arterial blood pressure and heart rate along with cardiac and renal hypertrophy in a dose-dependent fashion as compared to DOCA control rats. Increased TBARS and decreased endogenous antioxidants including GSH, SOD and GSHPx activity in serum, heart and kidney tissues of hypertensive rats were also normalized. Furthermore, this antihypertensive activity of EO was also linked with increased serum NO, K⁺ levels and decreased Na⁺ levels. Moreover, EO robustly increased activated eNOS expression in heart. Our results demonstrate that EO reduces oxidative stress, prevents development and progression of hypertension as well as cardiac and renal hypertrophy in DOCA/HS-induced hypertension via modulation of activated eNOS, endogenous antioxidants, serum NO and electrolyte levels.