Safe corridors for K-wiring in phalangeal fractures

Background:Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome.Results:47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept.Conclusion:K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing “on-table active finger movement test” at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.     

Skin cancer detection using non-invasive techniques

Skin cancer is the most common form of cancer and is globally rising. Historically, the diagnosis of skin cancers has depended on various conventional techniques which are of an invasive manner. A variety of commercial diagnostic tools and auxiliary techniques are available to detect skin cancer. This article explains in detail the principles and approaches involved for non-invasive skin cancer diagnostic methods such as photography, dermoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis. The characteristics of an ideal screening test are outlined, and the authors pose several points for clinicians and scientists to consider in the evaluation of current and future studies of skin cancer detection and diagnosis. This comprehensive review critically analyses the literature associated with the field and summarises the recent updates along with their merits and demerits.

Recent advances in non-invasive techniques for skin cancer diagnosis.     

Complete Genome Sequence and Phylogenetic Relatedness of Hepatitis B Virus Isolates in Papua,Indonesia

Each hepatitis B virus (HBV) genotype and subgenotype is associated with a particular geographic distribution, ethnicity, and anthropological history. Our previous study showed the novel HBV subgenotypes C6 (HBV/C6) and D6 (HBV/D6), based on the S gene sequences of isolates in Papua, Indonesia. The present study investigated the complete genome sequence of 22 strains from Papua and subjected them to molecular evolutionary analysis. A phylogenetic analysis revealed that 9 out of 22 strains were classified as HBV/C6, 3 strains as HBV/D6, and 9 strains as HBV/B3. A particular strain positioned between HBV/B3 and HBV/B5 remained unclassifiable into any known subgenotypes. This strain showed high homology with HBV/C5 from the Philippines in the core region and was thought to have undergone genetic recombination with HBV/C5. Further studies are needed to determine whether this strain belongs to a new subgenotype of HBV/B. Based on the amino acid alignment, HBV/C6 has subgenotype specific variations (G18V and V47M) in the S region. HBV/C6 strains were more closely related in terms of evolutionary distance to strains from the east Asia and Pacific regions than those found in southeast Asia. HBV/D6 strains were most closely related to strains from the Western countries (HBV/D3) rather than those from Asia and Papua New Guinea. In conclusion, we have confirmed by complete sequence analysis that two novel HBV subgenotypes, HBV/C6 and HBV/D6, are prevalent in Papua, Indonesia.Hepatitis B virus (HBV) is an etiological agent of chronic liver disease, including chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma, and this poses major health problems worldwide, especially in Asian Pacific countries (7, 10).HBV strains that infect humans show genetic and antigenic heterogeneity, and eight genotypes, designated A to H, have been identified so far by molecular evolutionary analysis (19). The HBV genotypes have distinct geographical distributions, which are associated with anthropological history (4, 13, 20, 31). Furthermore, previous studies have demonstrated the presence of several subgenotypes within the widely spread genotypes. HBV genotype B (HBV/B) is classified into six subgenotypes, B1 to B6, B1 dominating in Japan, B2 in China and Vietnam, B3 in Indonesia, B4 in Vietnam, B5 in the Philippines, and B6 in the Arctic (3, 16, 23, 24, 26, 27). As for HBV/C, C1 is common in southeast Asia, C2 in east Asia, C3 in Oceania, C4 in Aborigines, and C5 in the Philippines (15, 26). HBV/D has a worldwide distribution, with its highest prevalence in the Mediterranean region, and is classified as D1 to D5 (1, 15, 17). Our previous study revealed novel subgenotypes (HBV/C6 and HBV/D6) based on the S gene sequence of HBV isolates in Papua, Indonesia, where HBV infection is endemic (9).HBV genotyping with the S gene sequence is, in general, consistent with the genotyping of the full genomic sequence, and therefore, HBV genotypes can be assigned based upon S gene sequences (11, 16, 19). Subgenotype classification, however, may not be applicable to some HBV strains on the basis of the S region sequence alone (9, 14, 15). Accordingly, complete genome sequences are more reliable for the analysis of genotype and subgenotype classification for HBV (14). The data on the complete genome sequences of the HBV strains found in Papua are scant. The present study aimed to evaluate the HBV genotypes and subgenotypes present among the Papuan population using complete genome sequences. In addition, the phylogenetic relatedness of HBV strains isolated from Papua was assessed.     

Guillain-Barré syndrome associated with Salmonella paratyphi A

A 31-year-old Nepali man was admitted to the intensive care unit with a 3-day history of fever associated with four-limb weakness, followed by difficulty in swallowing. The patient came from Nepal 20 days before admission. On examination the patient was conscious and appeared ill, with a temperature of 38.0 degrees C. His four limbs were weak (grades 2-3) and he was areflexic with mild facial weakness and absent gag reflex. Brain CT and MRI were normal. Cerebrospinal fluid analysis showed high protein. A neurophysiologic study showed data consistent with motor axonal polyradiculopathy. The patient was diagnosed with Guillain-Barré syndrome (GBS), and intravenous immunoglobulin (0.4 g/kg day for 5 days) was administered. On the third hospitalization day, the patient developed respiratory failure for which he was intubated and mechanically ventilated. On the same day, blood samples grew Salmonella paratyphi A (S. paratyphi A), which was sensitive to ceftriaxone. The patient was then diagnosed with GBS associated with S. paratyphi A, and treated with ceftriaxon (2 g administered intravenously, daily for 10 days). On the eleventh hospitalization day the patient was weaned from ventilator and extubated successfully. Subsequently, the patient improved, his fever subsided, and he regained muscle power satisfactorily.