Hip dislocation after modular unipolar hemiarthroplasty

An institutional review board-approved retrospective review of hip fractures in elderly patients treated with a modular unipolar implant was carried out to identify factors predisposing to dislocation of a hemiarthroplasty. The main outcome measure evaluated was dislocation vs nondislocation. Two hundred seventeen patients underwent the surgery, and 174 were available for review at 6 weeks and 144 at 1 year. The incidence of dislocation was 6%. The average time of dislocation after surgery was 19.3 days. Clinical factors significant for dislocation were male sex and mental disease. Radiographic factors in dislocated hips included a smaller femoral neck and contralateral femoral neck offset. The center edge angle was also smaller in the dislocated patients. These patients had a higher mortality rate.     

Is efficacy of repeated intradetrusor botulinum toxin type A (Dysport<Superscript>®</Superscript>) injections dose dependent? Clinical and urodynamic results after four injections in patients with drug-resistant neurogenic detrusor overactivity

Objective

To assess the effects of two different doses of botulinum toxin A (Dysport^®: 500 and 1,000 IU) injected repeatedly into the bladder for the treatment of neurogenic detrusor overactivity (NDO) in terms of safety, durability, and improvement of continence status and urodynamic parameters.

Patients and methods

In this study we analyzed the effects of successive doses of 500 or 1,000 IU of Dysport^®, endoscopically injected into the detrusor muscle. Clinical, urodynamic, and satisfaction assessments were performed at baseline and 6 weeks after each injection. The results of injections and corresponding follow-ups were analyzed and compared with baseline.

Results

Twenty-two patients (13 men and 9 women) with repeated four injections were included, of whom 12 (55%) with mean age 35.7 years (range 16–52 years) received 500 IU of BTX-A and 10 (45%) with mean age 33.8 years (range 18–50 years) received 1,000 IU in each treatment. No statistically significant differences were found in efficacy duration with the two Dysport doses (500 IU: 7.7 months, 1,000 IU: 8.5 months; P > 0.05). Maximum cystometric capacity (MCC), reflex volume (RV), and bladder compliance (BC), and patient satisfaction improved significantly after each treatment compared with baseline values and there were no statistically significant differences after each retreatment for the two treatment groups (P > 0.05).

Conclusions

After repeated injections the effect of BTX-A remained constant. The cause of repeat treatment is relapse of overactive bladder symptoms. Results with the 500 and 1,000 IU doses were interesting and approximately equivalent in terms of duration and efficacy, with better but not significant results when 1,000 IU was used. The optimum dose of Dysport for incontinence secondary to NDO is not yet defined; 1,000 IU probably has a nonsignificant longer effect than 500 IU but may expose the patient to major complications. Further studies evaluating the clinical efficacy of 750 IU of Dysport are necessary.

     

SCA‐LSVD: A repeat‐oriented locus‐specific variation database for genotype to phenotype correlations in spinocerebellar ataxias

Repeat expansion has been implicated in 10 out of 17 candidate genes identified for autosomal dominant cerebellar ataxias (ADCAs)—commonly referred as spinocerebellar ataxias (SCAs). Though genetically distinct, the SCAs share a large number of features that confound their clinical classification. In addition, there is a difference in the prevalence and phenotypic expression of ataxias between different ethnic groups. We have created a new SCA‐locus‐specific variation database (LSVD) that aims to catalog and integrate information on SCAs associated with trinucleotide repeat expansion (SCA1, SCA 2, SCA 3, SCA 6, SCA 7, SCA 8, SCA 12, SCA 17, Friedreich's ataxia [FRDA], and dentatorubral‐pallidoluysian atrophy [DRPLA]) from all over the world. The database has been developed using the Leiden Open (source) Variation Database (LOVD) software (Leiden University Medical Center, Leiden, the Netherlands). The database houses detailed information on clinical features, such as age and symptom at onset, mode of inheritance, and genotype information, pertaining to the SCA patients from more than 400 families across India. All the compiled genotype data conforms to the HGVS Nomenclature guidelines. This would be a very useful starting point for understanding the molecular correlates of phenotypes in ataxia—a multilocus disease in which related molecular mechanisms converge to overlapping phenotypes. The database is accessible online at http://miracle.igib.res.in/ataxia . Hum Mutat 30:1–6, 2009. © 2009 Wiley‐Liss, Inc.     

Mode of attachment and histopathological effects of Macrogyrodactylus clarii, a monogenean gill parasite of the catfish Clarias gariepinus, with a report on host response

A detailed account is given about the mode of attachment and histopathological effects of Macrogyrodactylus clarii Gussev, 1961, a viviparous monogenean from the gills of the catfish Clarias gariepinus. Most parasites attach their haptors to the proximal region of the gill filament (primary gill lamellae), while few specimens were seen attached to the distal region. Attachment of the haptor was achieved mainly by the blade of the hamuli, but no evidence was found indicating the participation of marginal hooklets in the attachment. The hamuli of M. clarii penetrate into the interlamellar epithelium of the gill tissue. Some evidences were found to indicate that M. clarii may also utilize suction force during haptoral attachment. The pathological effects of M. clarii are manifested by breakdown of the coating epithelium, necrosis of the epithelial cells, vacuolations inside and outside the host cells, fusion of the gill lamellae, rupture of blood capillaries, infiltration of erythrocytes and degeneration and fibrosis of the interlamellar epithelium. The host response includes the appearance of lymphocytes, mucoid secretions and hyperplasia of the tissue at the site of attachment.     

A proposed taxonomy for characterization and assessment of avian influenza outbreaks

PURPOSE: The speed and high potential impact of avian influenza's (AI) on local bird populations, poultry economies and human health make timely and coordinated characterization, assessment and response to possible threats essential. To collaborate effectively, stakeholders (public health, medical, veterinary, and agricultural professionals) must be able to communicate and record findings, assessments, and actions in a standard fashion. We seek to discern a taxonomy of concepts and relationships that are important to the stakeholder community when sharing information about the characterization and assessment of an AI outbreak, according to a consistent and common perspective, interpretation, and level of detail. METHODS: To derive concepts relevant to AI characterization and assessment, we reviewed selected journal articles, reporting and laboratory forms, and public health websites associated with AI case reporting. We mapped concepts to existing medical terminologies within the Unified Medical Language System when possible, using the National Library of Medicine's MetaMap program. RESULTS: From 54 distinct information sources, we extracted 1113 concepts, of which 533 mapped to 15 medical terminologies; 580 did not map to specific terminologies. Using a combination of semantic type-relationship matching and expert consensus, we constructed the proposed taxonomy, with linkages to existing terminologies where pragmatic. CONCLUSION: The proposed taxonomy describes core knowledge, data and communication needs for the characterization and assessment of AI outbreaks in the context of existing medical terminologies across different domains. We also describe areas for further work.     

Antenatal depression and suicidal ideation among rural Bangladeshi women: a community-based study

Depression during pregnancy is a significant public health problem because of its negative effects on the health of both mother and infant. Data on its prevalence and determinants are lacking in Bangladesh. To estimate the prevalence of depression during pregnancy and to identify potential contributory factors among rural Bangladeshi women, a community-based study was conducted during 2005 in Matlab sub-district, a rural area of eastern Bangladesh. Three hundred and sixty-one pregnant women were identified through an existing health and demographic surveillance system covering a population of 110,000 people. The women were interviewed at home at 34–35 weeks of pregnancy. Information on risk factors was collected through structured questionnaires, with the Bangla version of the Edinburgh Postnatal Depression Scale (EPDS-B) used to measure their psychological status. Both univariate analysis and multivariate logistic regression were applied using the SPSS 15.0 statistical software. The prevalence of depression at 34–35 weeks pregnancy was 33% (95% CI, 27.6–37.5). After adjustment in a multivariate logistic regression model, a history of being beaten by her husband either during or before the current pregnancy had the highest association with depression followed by having an unhelpful or unsupportive mother-in-law or husband, and family preference for a male child. Of the antenatally depressed women, 17 (14%) admitted to thoughts of self-harm during the pregnancy. This paper further explores the reasons why women have considered some form of self-harm during pregnancy. Depression during pregnancy is common among Bangladeshi women, with about a third being affected. The study highlights the need to allocate resources and develop strategies to address depression in pregnancy.     

Functional outcome of salvage of residual and recurrent deformities of clubfoot with Ilizarov technique

Relapse may occur in severe clubfeet deformities whether treated surgically or nonsurgically. In this study, we evaluate the results of correction of residual and recurrent congenital clubfoot using soft tissue distraction or osteotomy using the Ilizarov external fixation system. This study included 35 feet in 28 patients who were treated between 1999 and 2007. Of these 16 feet in 13 patients with an average age of 13.7 years (range from 11 to 29 years) were treated by percutaneous calcaneal V-osteotomy and gradual correction by the Ilizarov method. Nineteen feet in 15 patients with an average age 10.5 years (range from 4 to 22 years) were treated by soft tissue distraction by the Ilizarov technique. The mean average follow up period was 5.6 years (range from 1 to 8 years). At the time of fixator removal, a plantigrade foot was achieved in 30 feet. Mild residual varus and equinus deformities were present in five feet.At the final follow foot pressure measurement showed recurrent or residual deformity in 10 feet (7 treated by osteotomy and 3 treated by soft tissue distraction). Recurrence may occur with both techniques, depending on many factors such as bone morphology, the number of the pervious operations and the degree of stiffness of the foot prior to the operation.