Median nerve trauma in a rat model of work-related musculoskeletal disorder

Anatomical and physiological changes were evaluated in the median nerves of rats trained to perform repetitive reaching. Motor degradation was evident after 4 weeks. ED1-immunoreactive macrophages were seen in the transcarpal region of the median nerve of both forelimbs by 5-6 weeks. Fibrosis, characterized by increased immunoexpression of collagen type I by 8 weeks and connective tissue growth factor by 12 weeks, was evident. The conduction velocity (NCV) within the carpal tunnel showed a modest but significant decline after 9-12 weeks. The lowest NCV values were found in animals that refused to participate in the task for the full time available. Thus, both anatomical and physiological signs of progressive tissue damage were present in this model. These results, together with other recent findings indicate that work-related carpal tunnel syndrome develops through mechanisms that include injury, inflammation, fibrosis and subsequent nerve compression.     

Prolapse of the rectum associated with spontaneous rupture of the distal colon and evisceration of the small intestine through the anus in an infant

Prolapse of rectum of varying degrees is a well-known entity in children. Spontaneous rupture of the rectum along with massive ileal evisceration because of increased intraabdominal pressure is a rare complication of rectal prolapse in the adults. Rectal prolapse in children is usually a benign condition. Known complications of the rectal prolapse in children include recurrent mucosal ulceration, bleeding, and proctitis. Spontaneous rupture of the rectum with or without ileal evisceration has not been previously reported in infants.     

Targeted exome sequencing in anti-factor H antibody negative HUS reveals multiple variations

Background

Genetic susceptibility to atypical hemolytic uremic syndrome (aHUS) may lie within genes regulating or activating the alternate complement and related pathways converging on endothelial cell activation.

Methods

We tested 32 Indian patients of aHUS negative for antibodies to complement factor H for genetic variations in a panel of 15 genes, i.e., CFH, CFHR1-5, CFI, CFB, C3, CD46, MASP2, DGKE, ADAMTS13, THBD and PLG using next-generation DNA sequencing and for copy number variation in CFHR1-3.

Results

Despite absence of a public database of exome variations in the Indian population and limited functional studies, we could establish a genetic diagnosis in 6 (18.8%) patients using a stringent scheme of prioritization. One patient carried a likely pathogenic variation. The number of patients carrying possibly pathogenic variation was as follows: 1 variation: 5 patients, 2 variations: 9 patients, 3 variations: 5 patients, 4 variations: 9 patients, 5 variations: 2 patients and 6 variations: 2 patients. Homozygous deletion of CFHR1-3 was present in five patients; none of these carried a diagnostic genetic variation. Patients with or without diagnostic variation did not differ significantly in terms of enrichment of genetic variations that were rare/novel or predicted deleterious, or for possible environmental triggers.

Conclusion

We conclude that genetic testing for multiple genes in patients with aHUS negative for anti-FH antibodies reveals multiple candidate variations that require prioritization. Population data on variation frequency of the Indian population and supportive functional studies are likely to improve diagnostic yield.

     

Determinants of gestational diabetes mellitus: A case control study in a district tertiary care hospital in south India

Objective:

To study the determinants of Gestational Diabetes Mellitus (GDM).

Design:

Case-control study. Setting: Sri Avittom Thirunal Hospital, Thiruvananthapuram district, Kerala, South India.

Participants:

300 GDM women as cases and 300 age-matched controls.

Study variables:

Sociodemographic characteristics, pre-pregnancy Body Mass Index (BMI), menstrual history, obstetric history, infertility history, family history of diabetes in first degree relatives, recurrent urinary tract infection (UTI), and moniliasis.

Statistical analysis:

T-test, Fishers Exact Test, Chi square test, Adjusted Odds Ratio with 95% CI. Results: Pre-pregnancy BMI ≥ 25 (P < 0.001, OR = 2.7), irregular menstrual cycle (P = 0.006), treatment for infertility (P = 0.001, OR = 3.3), family history of diabetes (P = 0.001, OR = 4.5), history of diabetes in mother (P = 0.003), previous pregnancy losses (P = 0.04), past GDM (P = 0.035), prematurity (P = 0.01), pre-eclampsia (P = 0.04), polyhydramnios (P < 0.001, OR = 6.0), UTI (P < 0.001, OR = 3.2), and moniliasis (P < 0.001, OR = 7.6) were significantly associated with present GDM.

Conclusion:

Early identification of women at risk of GDM and prompt treatment is recommended to prevent complications.     

Numeracy Skills in CKD: Correlates and Outcomes

Background and objectives: Healthcare providers communicate the risks and benefits of treatments using frequencies, percentages, or proportions. However, many patients lack the numerical skills needed to interpret this information accurately to make informed choices.Design, setting, participants, and measurements: We assessed numeracy, the capacity to use and comprehend numbers, in a prospective cohort study of 187 patients with stage 4 to 5 chronic kidney disease or ESRD. Patients completed a three-item numeracy test and were assessed for global mental status, cognitive function, type of hemodialysis access, and kidney transplant use. We examined the association of numeracy with healthcare use and other cognitive and sociodemographic variables.Results: Over 50% of patients answered one or fewer numeracy questions correctly. Although African Americans (P = 0.0001), women (P = 0.05), and the unemployed (P = 0.0004) demonstrated lower numeracy skills, numeracy deficits were prevalent in every subgroup. In analyses adjusted for demographics and length of follow-up, higher numeracy was significantly associated with receipt of a transplant or active waiting list status. Numeracy was not associated with dialysis modality or hemodialysis vascular access.Conclusion: Similar to prior findings in the general population, these findings indicate that poor numeracy skills are very common in patients with advanced chronic kidney disease and end-stage renal disease. Additional research is needed to further explore whether poor numeracy is a barrier to receipt of a kidney transplant. Clinicians caring for patients with kidney disease should consider using tools to enhance communication and overcome limited numeracy skills.Numeracy, also referred to as quantitative literacy, can be defined as the capacity to use and comprehend numbers in daily life (1,2). In the United States, an estimated 110 million adults lack the quantitative skills needed to complete more than simple, everyday activities (3). Although deficient numeracy skills can coexist with deficient literacy skills, recent findings indicate that many patients have even poorer quantitative skills (1,2). Inadequate numeracy skills appear to be more prevalent in African American, Hispanic American, and elderly populations and may contribute to health disparities (3–5). Numeracy may be particularly important in the setting of chronic kidney disease (CKD) given the disproportionate representation of populations with poor numeracy skills coupled with the integral role that advanced planning plays in optimal CKD care (e.g., pre-emptive transplantation or arteriovenous fistula [AVF] placement).Health numeracy as defined by Golbeck, refers to the degree that individuals can apply numerical, graphical, and statistical skills to understand and act on “health information needed to make effective health decisions” (6). Health numeracy can be classified into categories. A few nonexhaustive examples of these include simple number or quantity recognition (basic health numeracy), the ability to perform one-step manipulations on numbers or to understand proportions (computational health numeracy), the ability to make approximations and deductions (analytical health numeracy), and the ability to convert and meaningfully compare between percentages, proportions, and probabilities (statistical health numeracy) (6). Analytical and statistical health numeracy require a higher-level skill set than other categories of health numeracy.Since healthcare providers often communicate with patients by using numerical information, deficient numeracy skills may be a barrier to care in patients with chronic health conditions. Deficient numeracy skills may limit patient involvement in the decision-making process or result in choices that are not in accordance with the patient’s beliefs and values (7,8). Poorer patient involvement, understanding, or adherence to the medical regimen may contribute to suboptimal outcomes (1,9–11).There are few data characterizing numeracy skills in the CKD and end-stage renal disease (ESRD) populations (11). Yet, these patients regularly interact with the healthcare system due to their frequent coexisting comorbidities and the systemic manifestations of kidney disease. Additionally, many interventions that can significantly improve survival and quality of life in ESRD or advanced CKD are invasive and require weighing risks and benefits (e.g., kidney transplantation and AVF placement). Recent evidence suggests that patients with kidney disease who lack adequate health literacy skills may be disadvantaged by inferior access to kidney transplantation (12). This may play a role in the well-documented disparities in transplantation rates among African Americans, women, and those of lower socioeconomic status (12–16). Preliminary findings also suggest that numeracy deficits may be prevalent in the kidney transplant population (17).Characterization of the relationship between numeracy and cognitive function in the setting of CKD may improve our understanding of factors that contribute to numeracy. While multiple studies have documented the presence of cognitive deficits in CKD and ESRD (18–21) and previous findings in patients with hypertension and congestive heart failure have established an association between cognitive performance and health literacy (22,23), there is a gap in our understanding of cognitive performance and numeracy. In this report, we describe the numeracy skills of an outpatient cohort of ESRD and stage 4 to 5 CKD patients assessed using a measure of analytical and statistical numeracy. We also explore the sociodemographic characteristics associated with numeracy. Second, we examine the relationship between patient numeracy and kidney disease-specific healthcare utilization. Third, we explore the association of numeracy with cognitive function.