采用等温链置换扩增结合纳米金测流层析试纸条检测登革热病毒

目的: 探讨等温链置换扩增结合纳米金测流层析试纸条用于登革热病毒（DENV）快速检测的可行性。方法: 采用磁珠富集法提取病毒总RNA,并逆转录为cDNA用于等温链置换扩增检测体系;等温链置换扩增用于检测DENV,琼脂糖凝胶电泳用于分析等温链置换扩增产物及其检测的敏感度;采用柠檬酸三钠还原法制备用于试纸条的纳米金颗粒;利用核酸碱基互补配对原理设计纳米金测流层析试纸条的检测线与控制线,建立DENV的检测体系。结果: 等温链置换扩增的敏感度为10 fmol/L。基于等温链置换扩增的纳米金测流层析试纸条检测DENV的敏感度也为10 fmol/L,取其检测样品浓度的对数值进行线性分析,检测浓度范围为10~10¹² fmol/L,符合线性回归方程,线性相关系数（R²）为0.98。基于等温链置换扩增的纳米金测流层析试纸条检测DENV的特异性较高,与其他对照组无交叉。结论: 建立了基于等温链置换扩增反应的纳米金试纸条用于DENV的检测方法,检测结果肉眼可见,敏感度高,可用于DENV的快速检测。     

Long-Term Outcomes of a Large Cohort of Patients with Eales’ Disease

Purpose: To analyze the long-term visual outcomes of Eales’ patients.

Methods: A retrospective review of Eales’ patients diagnosed between 1985 and 1995 with >10 years follow-up done.

Results: We included 500 patients (898 eyes) with mean follow-up duration of 15.8 years (10–25 years), and 81% patients had bilateral disease. Patients using oral steroid during acute stage disease had significantly better visual outcome at the final visit [0.42 logMar(6/18) ± 0.723 logMar(6/30)] compared to patients who did not receive oral steroids [(0.5907 logMar(6/24) ± 0.945 logMar(6/48)] (p = 0.004). Patients who received laser therapy had significantly better visual outcome at the final visit [(0.415 logMar(6/18) ± 0.66 logMar(6/30)] compared to those who did not undergo laser treatment [(0.9237 logMar(6/48) ± 1.31 logMar(6/120)] (p < 0.001). Poor presenting visual acuity and late stage of presentation were associated with poor visual outcome. Fifty-two percent of eyes had <5 recurrences over 10 years.

Conclusion: Eales’ disease is a bilateral recurrent retinal vasculitis disorder and timely treatment with steroid and/or laser photocoagulation result in better visual outcomes.     

Parental mosaicism in epilepsies due to alleged de novo variants

Severe early onset epilepsies are often caused by de novo pathogenic variants. Few studies have reported the frequency of somatic mosaicism in parents of children with severe epileptic encephalopathies. Here we aim to investigate the frequency of mosaicism in the parents of children with epilepsy caused by alleged de novo variants. We tested parental genomic DNA derived from different tissues for 75 cases using targeted next‐generation sequencing. Five parents (6.6%) showed mosaicism at minor allele frequencies of 0.8%‐29% for the pathogenic variant detected in their offspring. Parental mosaicism was observed in the following genes: SCN1A, SCN2A, SCN8A, and STXBP1. One of the identified parents had epilepsy himself. Our results show that de novo events can occur already in parental tissue and in some cases can be detected in peripheral blood. Consequently, parents affected by low‐grade mosaicism are faced with an increased recurrence risk for transmitting the pathogenic variant, compared to the overall recurrence risk for a second affected child estimated at approximately 1%. However, testing for parental somatic mosaicism will help identifying those parents who truly are at higher risk and will significantly improve genetic counseling in the respective families.     

Gastrointestinal manifestations of melioidosis: A single center experience

Melioidosis, being increasing, is reported from India. Gastrointestinal manifestations are typically reported as unusual cause of liver and/or splenic abscess. We aimed to describe various gastrointestinal manifestation of melioidosis in the present study. We retrospectively collected data of culture positive melioidosis cases from hospital database during August 2014–October 2016 at Asian Institute of Gastroenterology, Hyderabad. A total of nine culture positive cases (8 male) of melioidosis with median age of 40 years (range 23–66) were analyzed. Median duration of symptoms was 45 days. Two patients were being treated as tuberculosis. Three patients presented with liver abscess with two of them having simultaneous splenic abscess, and one had prostatic abscess. Three patients (43%) with history of acute pancreatitis had infected pancreatic collection, and one patient had left empyema with splenic abscess. One patient had wound infection with left lower limb cellulitis, presented as acute in chronic liver failure and another as spontaneous bacterial peritonitis (SBP). Diabetes and/or alcoholism was present in all patients. Seven patients had disseminated organ involvement. Seven patients underwent percutaneous intervention for drainage of abscess. Induction therapy as ceftazidime (n=4) or meropenem (n=5) followed by continuation therapy as oral cotrimoxazole (n=6) and doxycycline (n=1) was given. Six patients completed therapy and asymptomatic at end of follow up. Two patients died in the study period. One patient died due to acute-on-chronic liver failure (ACLF) with acute kidney injury and the other due to cardiac failure. One patient with SBP had lost to follow up. Apart from being unusual cause of liver/splenic abscess, melioidosis can present with infection of pancreatic collection, SBP, and infection in a compensated cirrhosis which can precipitate ACLF. Early recognition and specific therapy can improve prognosis.     

Coronal shear fractures of distal humerus: Diagnostic and treatment protocols

Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint. Various approaches including extensile lateral, anterolateral and posterior approaches have been described depending on the fracture pattern and complexity. Good to excellent outcome have been reported with internal fixations and poor results are noted in articular comminution with associated articular injuries. Various implants including headleass compression screws, minifragment screws, bioabsorbable implants and column plating are advocated for reconstruction of these complex fractures. Inspite of articular fragments being free of soft tissue attachments the rate of osteonecrosis and osteoarthritis is reported very less after internal fixation. This article summarizes the diagnostic and treatment strategies for these rare fractures and recommendations for management.     

The combined analgesic effect of gabapentin and transdermal fentanyl patch on acute and chronic pain after maxillary cancer surgeries

Abstract

Purpose of this study was to evaluate the combined analgesic effect of gabapentin and transdermal fentanyl patch, on acute and chronic pain after surgery for maxillary cancer.

Study design

The Study was double blind and prospective. 100 subjects belonging to ASA grade I and II, 30–50 years age group, scheduled for maxillary cancer surgery were randomized into two groups; treatment group (GT): to receive gabapentin, transdermal fentanyl patch or control group ©: two placebos. For acute postoperative pain (Visual Analogue Score) and analgesic requirements were assessed 2, 4, 8 hours and 7 days after surgery. Subjects were also assessed for chronic pain 2, 4, 6 months later.

Results

Subjects in treatment group required lesser dose of analgesic, as compared to control group, in the post operative period. Visual Analogue Scores were also significantly lower in the treatment group throughout the post operative period. Occurrence of side effects was non significant between both groups. 2, 4 and 6 months after surgery, 40, 35 and 28 subjects respectively, out of total 45 subjects of the control group, reported chronic pain. In comparison, 25, 10 and 4 subjects out of 42 subjects in the treatment group reported chronic pain 2, 4, 6 months respectively after surgery. 15, 10 and 6 out of 45 of the control group required analgesics, whereas 2, 0 and 0 out of 42 in the treatment group, required analgesics respectively 2, 4 and 6 months after surgery

Conclusion

Acute and chronic pain after maxillary cancer surgery is significantly reduced by multimodal analgesia.