Tarsal navicular stress fractures: radiographic evaluation

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.     

STEP: an intervention to address the issue of stigma related to leprosy in Southern Nepal

This paper focuses primarily on the extent to which a Stigma Elimination Programme (STEP) affected the social participation of people affected by leprosy in southern Nepal. The Participation Scale (popularly known as The P Scale) was applied to compare leprosy affected people who participated in STEP groups with a control group comprising leprosy affected people who lived in villages where STEP had not been implemented. It was found that STEP participants had significantly higher levels of participation compared with controls and that their levels of social participation were higher than would be expected even for the general population. It was also found that leprosy affected people without visible deformity or ulceration (whether in the STEP group or not) do not appear to suffer participation restriction in southern Nepal.     

Review of dietary recommendations for diabetes mellitus

Previous nutritional guidelines for people with diabetes focused on carbohydrate-based meal planning. Updated guidelines from Europe and North America reflect a more flexible approach to nutritional intervention. New aspects of these most recent recommendations include: (1) increased emphasis on the role of trained dietitians for educating people with diabetes; (2) greater individualization of dietary choices based on cultural, regional and personal preferences; (3) more flexibility for choosing between carbohydrate and monounsaturated fat consumption, but with limitations on intake of polyunsaturated fats (<10% of total energy); (4) broadened allowance of sucrose in the diet (up to 10% of total energy); and (5) greater recognition of physical activity as an important means to control weight and enhance general health. Expert guidelines vary regarding preferential intake of carbohydrates with lower glycemic indices.     

Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature

Intra-articular dislocation of the patella is a rare clinical condition. Only forty-five cases have been reported. Most of them were encountered in adolescents and required an open reduction. We report two cases in an older age group with an incomplete rotation of the patella, which were successfully treated by closed reduction. We discuss the literature and suggest that the management depends on the degree of patellar rotation.     

Diastolic heart failure: recognition, diagnosis and management

A variety of community-based epidemiological studies have suggested that 30-50% of patients with heart failure symptoms appear to have preserved left ventricular (LV) systolic function when assessed by echocardiography or similar techniques suggesting 'diastolic heart failure' (DHF) as its cause. The prognosis of these patients is characterised by morbidity and mortality similar to, but less overt than, patients with systolic dysfunction. However, rates of readmission for symptom control are broadly similar in patients with DHF or in those with systolic impairment. Thus, there are many similarities in the portrayal of both systolic and DHF but equally; there are also many key differences. Certainly, while there are several successful therapies for patients with systolic heart failure, the management of patients with DHF is poorly defined. In this review, the gaps in current knowledge and practice, which is creating this therapeutic void will be addressed.     

A comparison of sonourethrography and retrograde urethrography in evaluation of anterior urethral strictures

AIM: This prospective study was undertaken to evaluate the abnormalities of the male anterior urethra using high-resolution ultrasound (sonourethrography) and to compare the efficacy with that of retrograde urethrography (RGU) using operative findings as the gold standard. MATERIALS AND METHODS: Seventy patients with symptoms of lower urinary tract obstruction underwent RGU followed by sonourethrography. The sonologist was blinded to the findings of RGU. The parameters studied were compared with the intra-operative findings as gold standard, and the sensitivity, specificity and overall accuracy for the procedures were calculated. Chi-square test and kappa statistics were used where appropriate. RESULTS: All patients found to have urethral stricture disease by RGU were also detected by sonourethrography and confirmed intra-operatively. In the estimation of stricture length, RGU showed a lower sensitivity (60-80%) for lengths 1-4 cm, compared with sonourethrography (73.3-100%). Spongiofibrosis was detected by sonourethrography with a sensitivity of 77.3-83.3%. All the false tracts and calculi detected at sonourethrography were confirmed at surgery, whereas RGU showed a low sensitivity in their detection. The complications encountered during the procedures were pain, urethral bleeding and contrast intravasation. The frequency of pain during RGU was greater (p < 0.001); however, the difference in frequency of bleeding after the two procedures was not significant (p < 0.5). CONCLUSION: RGU and sonourethrography are equally efficacious in detection of anterior urethral strictures. Further characterization of strictures in terms of length, diameter and periurethral pathologies, like spongiofibrosis and false tracts, is done with greater sensitivity using sonourethrography as compared with RGU, with the added benefit of lower incidence of complications.     

Phosphodiesterase and thymidine phosphorylase-inhibiting salirepin derivatives from Symplocos racemosa

A re-investigation of the chemical constituents of the stem bark of Symplocos racemosa Roxb. led to the isolation of four new glycosides, symplocomoside (1), symponoside (2), symplososide (3) and symploveroside (4). Benzoylsalireposide (5) and salireposide (6) were re-isolated from this plant. The structures of the new compounds were determined by 1D and 2D-homonuclear and heteronuclear NMR spectroscopy, chemical evidence, and by comparison with the published data of the closely related compounds. The glycosides 1-4 displayed in vitro inhibitory activity against phosphodiesterase I with IC50 values of 122 +/- 0.017, 698 +/- 0.06, 722 +/- 0.03, 909 +/- 0.09 microM, respectively. The compounds 1-6 also showed in vitro inhibitory activity against thymidine phosphorylase with IC50 values of 189.96 +/- 1.02, 195.56 +/- 2.36, 207.61 +/- 1.06, 488.89 +/- 4.10, 427.20 +/- 5.36, 354.2 +/- 5.69 microM, respectively while 1 was also found to be a urease inhibitor with an IC50 value of 54.13 +/- 0.71 microM.     

Isotamarixen - a new antioxidant and prolyl endopeptidase-inhibiting triterpenoid from Tamarix hispida

A new pentacyclic triterpenoid, 3alpha-(3",4"-dihydroxy- trans-cinnamoyloxy)- D-friedoolean-14-en-28-oic acid ( 1) has been isolated along with two known compounds, rhamnocitrin ( 2) and isorhamnetin ( 3) from the aerial parts of Tamarix hispida Willd. Compound 1 was found to be a potent antioxidant. In addition, compounds 1 - 3 showed significant inhibitory activity against prolylendopeptidase (PEP).     

The effect of composition of poly(acrylic acid)-gelatin hydrogel on gentamicin sulphate release: in vitro

Hydrogels based on poly(acrylic acid) and gelatin crosslinked with N,N'-methylene bisacrylamide (0.5mol%) and glutaraldehyde (4%), respectively, forming an interpenetrating network were employed as matrices, for studying the loading and release of gentamicin sulphate. The release kinetics of gentamicin sulphate was evaluated in water (pH approximately 5.8), phosphate buffer (pH 7.4) and citrate buffer (pH 4) at 37+/-0.1 degrees C. The drug release in phosphate buffer was faster as compared to water or citrate buffer. Fitting the data of release studies in Peppas model indicated that the release of drug from full IPNs in phosphate buffer (pH 7.4), water (pH approximately 5.8) and citrate buffer (pH 4) were diffusion controlled. However, semi-IPNs showed both anomalous and Fickian diffusion mechanisms. With increasing gelatin percentage in the polymer, rate of drug release was faster and almost 85% of the loaded drug was released within 7 days in phosphate buffer (pH 7.4).