Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up

Pelvic fractures are uncommon in children and account for between 0.3 and 7.5% of all pediatric injuries. Open pelvic fractures only account for up to 12.9% of all pediatric pelvic fractures. An unusual case of open complete anterior sacro-iliac joint dislocation in a 4-year-old boy is presented with a long-term follow-up. The multidisciplinary approach is reported with review of the current literature. A 4-year-old male presented to our institution in January 2012 after having been run over by a tractor. He presented with gross hemodynamical instability, MISS of 25, and an unstable lateral compression type III pelvic fracture with complete anterior dislocation of the left hemipelvis and a groin wound extending into the left thigh. The patient was managed in accordance with the ATLS and open fracture guidelines. Reduction in the dislocated SI joint was achieved via a posterior approach to the SI joint, followed by fixation with 2K wires in S1 and S2 sacral segments, with an anterior external fixator. Pelvic asymmetry post-reduction was 0.9 cm, compared to 16 cm post-injury, and asymmetry persisted till final follow-up at 5 years. At 5 years, patient regained full function, including recreational sport activities. Patients scored a 96/96 on the Majeed score (after excluding 4 points for sexual function). We believe that posterior reduction in an anteriorly dislocated SI joint in the pediatric population is a viable option. A coordinated, multidisciplinary approach and restoration of pelvic ring stability can lead to optimal outcome.     

Adherence of Randomized Controlled Trials to Consolidated Standards of Reporting Trials 2010 Guidelines: A Survey of Randomized Controlled Trials Published in 2011-2016 in 3 Periodontology Journals

ObjectiveTo assess the quality of reporting of randomized controlled trials (RCTs) in the Journal of Clinical Periodontology (JCP), Journal of Periodontology (JOP), and Journal of Periodontal Research (JPR), published in the years 2011 until 2016, using Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines.MethodsA thorough search of PubMed for RCTs published between January 2011 and December 2016 in the three journals was carried out. The CONSORT 2010 checklist (36 questions) was used to evaluate the adherence of these RCTs to these guidelines. A modified CONSORT score was calculated and categorized as “perfect” (100%), “excellent” (80%-99%), “good” (60%-79%), “modest” (40%-59%), and “poor” (<40%).ResultsA total of 369 RCTs were published in the three periodontology journals from 2011 until 2016. Based on the modified CONSORT score among all the RCTs, title, abstract, and introduction sections of the included RCTs showed good adherence to the CONSORT 2010 guidelines (60%-79%), whereas the adherence was poor for half the items in methodology (<40%), results (<40%), and discussion (40%). The highest modified CONSORT score was obtained for the trials published in the JCP from 2011 to 2016, whereas the lowest score was achieved by the RCTs in the JPR. Overall, none of the RCTs in any of the journals were perfect in reporting the trials as per the guidelines. Almost half of the RCTs in the JCP showed good adherence (51.1%), whereas almost three-fourths of the RCTs in the JOP (72%) and JPR (82.7%) showed modest to poor adherence as per the reporting guidelines (P < .001).ConclusionAmong the three periodontology journals assessed, the JCP showed better adherence than the JOP and JPR from 2011 until 2016.     

Analyses of odontometric sexual dimorphism and sex assessment accuracy on a large sample

Correct sex assessment of skeletonized human remains allows investigators to undertake a more focused search of missing persons' files to establish identity. Univariate and multivariate odontometric sex assessment has been explored in recent years on small sample sizes and have not used a test sample. Consequently, inconsistent results have been produced in terms of accuracy of sex allocation. This paper has derived data from a large sample of males and females, and applied logistic regression formulae on a test sample. Using a digital caliper, buccolingual and mesiodistal dimensions of all permanent teeth (except third molars) were measured on 600 dental casts (306 females, 294 males) of young adults (18–32 years), and the data subjected to univariate (independent samples' t-test) and multivariate statistics (stepwise logistic regression analysis, or LRA). The analyses revealed that canines were the most sexually dimorphic teeth followed by molars. All tooth variables were larger in males, with 51/56 (91.1%) being statistically larger (p < 0.05). When the stepwise LRA formulae were applied to a test sample of 69 subjects (40 females, 29 males) of the same age range, allocation accuracy of 68.1% for the maxillary teeth, 73.9% for the mandibular teeth, and 71% for teeth of both jaws combined, were obtained. The high univariate sexual dimorphism observed herein contrasts with some reports of low, and sometimes reverse, sexual dimorphism (the phenomenon of female tooth dimensions being larger than males'); the LRA results, too, are in contradiction to a previous report of virtually 100% sex allocation for a small heterogeneous sample. These reflect the importance of using a large sample to quantify sexual dimorphism in tooth dimensions and the application of the derived formulae on a test dataset to ascertain accuracy which, at best, is moderate in nature.     

Yeast Rev1 protein promotes complex formation of DNA polymerase ζ with Pol32 subunit of DNA polymerase δ

Yeast DNA polymerase (Pol) δ, essential for DNA replication, is comprised of 3 subunits, Pol3, Pol31, and Pol32. Of these, the catalytic subunit Pol3 and the second subunit Pol31 are essential, whereas the Pol32 subunit is not essential for DNA replication. Although Pol32 is an integral component of Polδ, it is also required for translesion synthesis (TLS) by Polζ. To begin to decipher the bases of Pol32 involvement in Polζ-mediated TLS, here we examine whether Pol32 physically interacts with Polζ or its associated proteins and provide evidence for the physical interaction of Pol32 with Rev1. Rev1 plays an indispensable structural role in Polζ-mediated TLS and it binds the Rev3 catalytic subunit of Polζ. Here, we show that although Pol32 does not directly bind Polζ, Pol32 can bind the Rev1–Polζ complex through its interaction with Rev1. We find that Pol32 binding has no stimulatory effect on DNA synthesis either by Rev1 in the Rev1–Pol32 complex or by Polζ in the Polζ–Rev1–Pol32 complex, irrespective of whether proliferating cell nuclear antigen has been loaded onto DNA or not. We discuss evidence for the biological significance of Rev1 binding to Pol32 for Polζ function in TLS and suggest a structural role for Rev1 in modulating the binding of Polζ with Pol32 in Polδ stalled at a lesion site.     

Missile injuries in head — neck and maxillo-facial region — an experience in eastern nepal

Ballistic injuries to head-neck and maxillofacial region is quite common problem nowadays. Most of the time the injuries seem to be dreadful but the mechanism of the injuries caused by ballistics and the anatomical conditions of maxillofacial and head-neck region mitigate the severity of the injuries. Proper primary management followed by reconstruction and management of associated injuries decreases the mortality and morbidity of missile injuries in head-neck and maxillofacial region. Eleven cases of missile injuries in head-neck and maxillofacial region are included in the present study. The mechanism of the injury and the ideal management strategy for the ballistics injuries in the region has been discussed in the article.     

Pharmacophore-based predictive model generation for potent antimalarials targeting haem detoxification pathway

Pharmacophore hypotheses were developed for molecules having antimalarial activities targeting the haem detoxification pathway of the malaria parasite. A training set consisting of 23 compounds was selected to generate these hypotheses, and their activities were evaluated for haem polymerization inhibition and against chloroquine-sensitive (3D7) as well as chloroquine-resistant (K1) strains of p. falciparum. The models were cross-validated by Fischer’s randomization test at a 95% confidence level. The model developed against chloroquine-resistant malaria parasites was found to yield the best predictions among the three models.     

Maternal and child health services in rural Nepal: does access or quality matter more?

This study seeks to establish the relative importance of service access and quality on utilization of preventive health services in the western and middle-western Hill region of Nepal. Access was measured in terms of travel time to the nearest health post and coverage by outreach workers. The quality of static services was defined in structural terms: physical infrastructure, number of staff, availability of drugs and holding of special maternal and child health clinics. The initial analysis showed that no single indicator of quality was of overriding importance and therefore an overall quality index was constructed. After adjustment for access and for socioeconomic characteristics of families and communities, a very pronounced relationship between overall structural quality of the nearest health post and service uptake persisted. The adjusted odds of using some form of antenatal service were 6.6 times higher in the catchment areas of high quality posts than in areas served by low quality posts. The corresponding figure for receipt of BCG vaccination is 8.1. By comparison, the effects of travel time to the nearest health post are modest. Uptake of services is about twice as high when there is a health post in the community. Regular monthly visits by outreach workers also had a marked effect on service utilization. These results suggest that investment in the quality of health posts is more important than further increases in their number and that a further expansion of outreach services is a priority.