Evaluation of Different Screening Tools for Predicting Femoral Neck Osteoporosis in Rural South Indian Postmenopausal Women

The measurement of bone mineral density by dual-energy X-ray absorptiometry scan is the “gold standard” for the diagnosis of osteoporosis, which has limited availability in many parts of India. This study was done to assess the diagnostic performance of 6 internationally validated tools (Simple Calculated Osteoporosis Risk Estimation [SCORE], age, bulk, one or never estrogen [ABONE], Osteoporosis Risk Assessment Instrument [ORAI] and Osteoporosis Self-Assessment Tool for Asians [OSTA], Fracture Risk Assessment Tool [FRAX®], and calcaneal quantitative ultrasound [QUS]) for the diagnosis of osteoporosis at the femoral neck (FN). This was a cross-sectional study conducted in 2108 ambulatory South Indian rural postmenopausal women who were assessed with SCORE, ABONE, ORAI, OSTA, and FRAX® tools. QUS was performed in 850 subjects. Bone mineral density was estimated by dual-energy X-ray absorptiometry scan at the FN, and sensitivity and specificity were calculated for all tools for predicting FN osteoporosis. The receiver operating characteristic curve was constructed for each tool and the area under the curve (AUC) was calculated. FN osteoporosis was seen in 27%. The sensitivities of SCORE, ABONE, OSTA, ORAI, FRAX®, and QUS were 91.3%, 91.0%, 88.5%, 81.0%, 72.7%, and 81.9%, and the specificities were 36.0%, 33.5%, 41.7%, 52.0%, 60.5%, and 50.3%, respectively, for the FN osteoporosis. When the receiver operating characteristics were constructed, the AUC was good only for SCORE (0.806), and the performance of the rest was under fair category (0.713–0.766). In our large cohort of rural postmenopausal women, the SCORE screening tool was found to be useful with good sensitivity and good AUC for predicting FN osteoporosis. Thus, this tool may be used in resource-limited countries to screen the population at risk and to enable treating physicians to make appropriate management decisions.     

Properties of IncP-2 plasmids of Pseudomonas spp.

Thirty IncP-2 R plasmids from isolates of Pseudomonas spp. of diverse geographical origins were examined for the production of resistance properties. All the plasmids determined resistance to tellurite and all inhibited the propagation of certain DNA phages, although several patterns of phage inhibition were detected. Of the 30 plasmids, 29 determined resistance to streptomycin, 28 determined resistance to mercuric ion, and 24 determined resistance to sulfonamide. Resistance to other antibiotics, to compounds of arsenic, boron, or chromium, and to UV irradiation was less common. The degradative plasmid CAM also belonged to this group. When CAM was introduced into recipients carrying an IncP-2 R plasmid, recombinant plasmids were often formed in which antibiotic resistance and the ability to grow on camphor were transferred together to further recipients or were lost together in a strain in which IncP-2 plasmids were unstable. Such hybrid plasmid formation was rec dependent. CAM and other IncP-2 plasmids that determine UV light resistance demonstrated UV-enhanced, nonpolarized transfer of the Pseudomonas aeruginosa chromosome. By agarose gel electrophoresis, all IncP-2 R plasmids and CAM were ca. 300 X 10(6) in molecular weight.     

Metabolic changes in glutathione and metallothionein in newborn rat liver

Metallothionein (MT) and glutathione (GSH) both contain 30% cysteine and they have distinct developmental profiles in perinatal rat liver. The metabolic relationships between these two cysteine pools were investigated in newborn rats under various experimental conditions. Injection of 2-day-old rat pups with buthionine sulfoximine, phorone or diethylmaleate decreased hepatic GSH levels without any change in high basal levels of MT or zinc. Similarly injection of L-oxothiazolidine carboxylate increased hepatic GSH levels but no changes in MT or zinc levels were observed. Administration of buthionine sulfoximine in drinking water to pregnant rats from day 14 of gestation decreased hepatic GSH concentrations in both the dams and pups with little change observed in neonatal hepatic zinc and MT levels or in gamma-glutamyltranspeptidase activity. The induction of MT synthesis by zinc salts in newborn rats was not affected by the in utero reduction of GSH levels. Although maternal hepatic GSH levels can be decreased by a sulfhydryl-deficient diet, no changes were observed in GSH, MT or zinc levels in newborn rat liver. Reduction of perinatal hepatic MT levels by in utero zinc deficiency had little effect on GSH levels. However, inhibition of the cystathionase pathway in newborn rats with propargylglycine decreased hepatic levels of MT, zinc and GSH. The results suggest that whereas there is little interaction between these two pools of cysteine, inhibition of cystathionase activity can decrease hepatic concentrations of both GSH and MT.     

Neuroprotective effects of L-arginine administration after cortical impact injury in rats: dose response and time window

Administration of L-arginine has been shown to increase cerebral blood flow and reduce neurological damage after experimental traumatic brain injury. The purpose of this study was to examine the optimal dose and time window for these neuroprotective effects. In a dose response experiment, doses of L-arginine ranging from 37.5 to 600 mg/kg were administered 5 min after a 5-m/s, 3-mm, controlled cortical impact in rats. The amount of brain injury found at 2 weeks after injury, both at the contusion site and in the ipsilateral hippocampus, were inversely related to the dose of L-arginine administered. Both 300- and 600-mg/kg doses of L-arginine significantly reduced contusion volume. The 300-mg/kg dose significantly increased the neuron density in the CA1 region of the hippocampus. Physiological effects of L-arginine were also dose-related. The greatest reduction in intracranial pressure occurred with the 300-mg/kg dose of L-arginine. Doses up to 300 mg/kg were well tolerated, but the 600-mg/kg dose resulted in transient hypotension. In another experiment, 300 mg/kg L-arginine was administered at times varying from 5 min to 48 h after injury. Contusion volume was significantly reduced when the L-arginine was given at 5 min and 1 h after injury. The protective effect was less when the same dose was given at the later times, but there was no evidence of an adverse effect even when the L-arginine was administered 48 h after injury.     

Bilateral vocal cord palsy following endotracheal intubation: a case report

The trachea of a 50 year-old woman was intubated for management of respiratory failure following neurotoxic snake bite. She developed bilateral vocal cord palsy following intubation and was managed with tracheostomy and other supportive measures. Vocal cord palsy is a rare complication of intubation, which, in most situations, is preventable.     

Assessment of capacity for surgery,obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool

Objectives To survey infrastructure characteristics, personnel, equipment and procedures of surgical, obstetric and anaesthesia care in 17 hospitals in Ghana. Methods The assessment was completed by WHO country offices using the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, which surveyed infrastructure, human resources, types of surgical interventions and equipment in each facility. Results Overall, hospitals were well equipped with general patient care and surgical supplies. The majority of hospitals had a basic laboratory (100%), running water (94%) and electricity (82%). More than 75% had the basic supplies needed for general patient care and basic intra‐operative care, including sterilization. Almost all hospitals were able to perform major surgical procedures such as caesarean sections (88%), herniorrhaphy (100%) and appendectomy (94%), but formal training of providers was limited: a few hospitals had a fully qualified surgeon (29%) or obstetrician (36%) available. Conclusions The greatest barrier to improving surgical care at district hospitals in Ghana is the shortage of adequately trained medical personnel for emergency and essential surgical procedures. Important future steps include strengthening their number and qualifications.     

Konno法和改良Manougnian法行主动脉瓣置换术的临床结果

目的观察Konno法和改良Manougnian法行主动脉瓣置换术的中期效果。方法 2001年7月～2009年11月对30例小主动脉瓣环青少年患者施行瓣环扩大的主动脉瓣置换术,其中Konno法12例(Konno组),改良Manougnian法18例(Manougnian组),比较术前和出院时、术后3年时超声心动图指标。结果术后住院死亡1例,随访29例,随访率100%,术后左心室厚度、左心室重量指数均较术前明显改善,术后平均随访3年,心功能恢复程度无明显差别。但动态EOAI差异显著,Konno法较改良Manougnian法有较低的迟发性人工瓣膜不匹配现象发生;两组方法术后中期生存率无差异;术后3年左心室重量指数、左心室厚度、跨瓣压差有显著差异,Konno法较改良Manougnian心律失常发生率高。结论两种扩大瓣环方式行主动脉瓣置换术在青少年患者中均能达到满意的短期效果和中期生存率,动态EOAI提示Konno法较改良Manougnian法更能减少人工瓣膜不匹配现象。     

Clinical and radiological instability following standard fenestration discectomy

Background:

Post-surgical lumbar instability is an established complication but there is limited evidence in the literature regarding the incidence of lumbar instability following fenestration and discectomy. We analyzed our results following fenestration discectomy with a special focus on instability.

Materials and Methods:

Eighty-three patients between the age of 17 and 52 years who had undergone fenestration discectomy for a single-level lumbar intervertebral disc prolapse were followed-up for a period of 1–5 years. The criteria for instability included “instability catch,”, “painful catch,” and “apprehension.” The working capacity of the patient and the outcome score of the surgery were assessed by means of the Oswestry disability score and the Prolo economic and functional outcome score. Flexion-extension lateral radiographs were taken and analyzed for abnormal tilt and translation.

Results:

Of the 83 patients included, 70 were men and 13 were women, with an average age of 37.35 years (17–52 years) at 5 years follow-up. Clinical instability was seen in 10 (12.04%) patients. Radiological instability was noted in 29 (34.9%) patients. Only six (60%) of the 10 patients who demonstrated clinical instability had radiological evidence of instability. Twenty (68.96%) patients with radiological instability were asymptomatic. Three (10.34%) patients with only radiological instability had unsatisfactory outcome. The Oswestry scoring showed an average score of 19.8%. Mild disability was noted in 59 (71.08%) patients and moderate disability was seen in 24 (28.91%) patients. None of the patients had severe disability. These outcomes were compared with the outcomes in other studies in the literature for microdiscectomy and the results were found to be comparable.

Conclusion:

The favorable outcome of this study is in good agreement with other studies on microdiscectomy. Clinical instability in 12.04% of the patients is in agreement with other studies. Radiological signs of instability are seen even in asymptomatic patients and so are not as reliable as clinical signs of instability. Standard fenestration discectomy does not destabilize the spine more than microdiscectomy.