Gastrointestinal mucormycosis—four cases with different risk factors, involving different anatomical sites

Mucormycosis of the gastrointestinal tract is a rare infection that usually occurs in patients who are immunocompromised and carries a high mortality. We report four cases of gastrointestinal mucormycosis seen over a one year period with different presentations, risk factors and different anatomical sites of involvement. A preoperative diagnosis was made only in one patient. All underwent surgery, three survived and one died postoperatively from multiorgan failure.     

Effect of total knee arthroplasty on type II diabetes mellitus and hypertension: A prospective study

Context:

Advanced osteoarthritis of knee joint if bilateral, severely restricts patient mobility. This acts as an aggravating factor for pre existing comorbid elements of metabolical syndrome (MS) like Type II diabetes mellitus and hypertension as patients are unable to carry out therapeutic walks. Successfully implanted total knee arthroplasty (TKA) increases physical activity and enables to carry out therapeutic walks thus may help in better control of type II diabetes mellitus and hypertension. The objective of this prospective study was to find whether TKA for osteoarthritis knee had any effect to improve blood glucose levels and reduce blood pressure.

Materials and Methods:

A prospective study was done in which patients operated for tricompartmental osteoarthritis of knee with associated comorbidities like Type II diabetes mellitus or hypertension during a period of 2008 and 2009 were studied. One hundred and twenty patients were enrolled (55 diabetics, 65 hypertensives) who met our inclusion criteria. Preoperative knee society score, lower extremity activity scale fasting blood glucose level and systolic and diastolic blood pressure were compared with one year followup values. The KSS and LEAS scores were analysed by the Wilcoxon signed ranked test, while the fasting blood glucose (FBG) levels and systolic and diastolic blood pressure levels were analysed by paired ‘t’ test.

Results:

The reduction of systolic blood pressure by 8 mmHg (t = 5.6, P value < 0.05) and diastolic blood pressure by 6 mmHg (t = 7.6, P value < 0.05) was recorded which was statistically significant. However, no statistically significant effect on fasting blood glucose levels was observed (t = -0.77, P value = 0.442). KSS improved in DM from preoperative 29 to 86 and LEAS improved from 6.7 to 11.3.

Conclusions:

Authors are of the opinion that successful total knee replacement results in increased physical activity and reduces blood pressure (systolic and diastolic) in hypertensives. However, the same is not seen in blood glucose level. Increased physical activity and reduced dependence on NSAIDS postoperatively, may be contributing in reduction of systolic and diastolic blood pressure. Further studies in this aspect are necessary.     

Thigh-length versus knee-length compression stockings for deep vein thrombosis prophylaxis in the inpatient setting

Deep vein thrombosis may be a complication of extended length hospital stays. Immobilized patients, such as patients in the postoperative period, are at particularly high risk of developing a deep vein thrombosis, which can be associated with high levels of morbidity and mortality. Due to this, prevention of deep vein thrombosis is of great importance in the inpatient setting. Compression stockings have proven to play an important role in prophylaxis and may be used in their knee-length or thigh-length variety. Although randomized trials have studied the efficacy of both varieties in prevention of deep vein thrombosis, selection is often made without regard to evidence. This meta-analysis pools the findings of current studies comparing knee-length and thigh-length compression stockings for deep vein thrombosis prophylaxis. A fixed effects model was used for this study with a two-sided α-error less than 0.05 considered to be statistically significant. When both varieties of compression stockings are compared, thigh-length stockings offer a risk reduction in deep vein thrombosis development when compared with knee-length (odds ratio 1.197, confidence interval 0.983-1.458). This, however, is an insignificant finding. This analysis concludes that current data does not favor either thigh-length or knee-length compression stockings when it comes to prophylaxis of deep vein thrombosis.     

Simvastatin Reduces Endothelial NOS: Caveolin-1 Ratio but not the Phosphorylation Status of eNOS In Vivo

In vivo evidence for the pleiotropic effects of simvastatin on the nitric oxide synthase system is limited.Aims: To determine if simvastatin can affect the endothelial nitric oxide synthase cascade.Methods: New Zealand white rabbits (n=15) were divided: Group 1 (control) was fed a normal rabbit diet; Group 2 (MC) received a normal rabbit diet with 1% methionine (M) plus 0.5% cholesterol (C) and 5% peanut oil (atherogenic diet); Group 3 received the same diet as the MC group plus 5 mg/kg/ day simvastatin (S) orally (MCS). After 4 weeks, the abdominal aorta was collected and analyzed.Results: Total cholesterol (TC) and total homocysteine (tHcy) were not significantly different between MCS and MC. Endothelial function was only reduced in MC (p<0.05). Although eNOS significantly increased in MC and MCS (p<0.01), simvastatin treatment significantly reduced endothelial caveolin-1 by 35% (p=0.038), causing a 2.5-fold (p=0.026) increase in the eNOS: caveolin-1 ratio. The phosphorylation of eNOS at the threonine 495 site or serine 1177 site was not affected by diet or treatment; however, a positive correlation between the two phosphorylation sites was observed (r(2)= 0.5, p=0.01).Conclusion: in vivo pleiotropic effects of statin therapy include decreasing endothelial caveolin-1. Other therapies designed to affect eNOS phosphorylation in vivo might be useful in further preventing CVD.     

Ultra-wide field retinal imaging: A wider clinical perspective

The peripheral retina is affected in a variety of retinal disorders. Traditional fundus cameras capture only a part of the fundus even when montaging techniques are used. Ultra-wide field imaging enables us to delve into the retinal periphery in greater detail. It not only facilitates assessing color images of the fundus, but also fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and red and green free images. In this review, a literature search using the keywords “ultra-widefield imaging”, “widefield imaging”, and “peripheral retinal imaging” in English and non-English languages was done and the relevant articles were included. Ultra-wide field imaging has made new observations in the normal population as well as in eyes with retinal disorders including vascular diseases, degenerative diseases, uveitis, age-related macular degeneration, retinal and choroidal tumors and hereditary retinal dystrophies. This review aims to describe the utility of ultra-wide field imaging in various retinal disorders.