Computed tomographic assessment of lung weights in trauma patients with early posttraumatic lung dysfunction

Introduction

Quantitative computed tomography (qCT)-based assessment of total lung weight (M_lung) has the potential to differentiate atelectasis from consolidation and could thus provide valuable information for managing trauma patients fulfilling commonly used criteria for acute lung injury (ALI). We hypothesized that qCT would identify atelectasis as a frequent mimic of early posttraumatic ALI.

Methods

In this prospective observational study, M_lung was calculated by qCT in 78 mechanically ventilated trauma patients fulfilling the ALI criteria at admission. A reference interval for M_lung was derived from 74 trauma patients with morphologically and functionally normal lungs (reference). Results are given as medians with interquartile ranges.

Results

The ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen was 560 (506 to 616) mmHg in reference patients and 169 (95 to 240) mmHg in ALI patients. The median reference M_lung value was 885 (771 to 973) g, and the reference interval for M_lung was 584 to 1164 g, which matched that of previous reports. Despite the significantly greater median M_lung value (1088 (862 to 1,342) g) in the ALI group, 46 (59%) ALI patients had M_lung values within the reference interval and thus most likely had atelectasis. In only 17 patients (22%), M_lung was increased to the range previously reported for ALI patients and compatible with lung consolidation. Statistically significant differences between atelectasis and consolidation patients were found for age, Lung Injury Score, Glasgow Coma Scale score, total lung volume, mass of the nonaerated lung compartment, ventilator-free days and intensive care unit-free days.

Conclusions

Atelectasis is a frequent cause of early posttraumatic lung dysfunction. Differentiation between atelectasis and consolidation from other causes of lung damage by using qCT may help to identify patients who could benefit from management strategies such as damage control surgery and lung-protective mechanical ventilation that focus on the prevention of pulmonary complications.     

FOR WHOM DO WE TOIL?

Indoor workload of a zonal service hospital for one month was studied. Service personnel and their dependents form the bulk of workload. Though the absolute number of ex-servicemen and their dependents is small, the resources spent on them are quite high. The average stay in hospital is 15 days. Rapid turnover of the patients reveals appropriate utilization of resources. Optimization of resources is possible by reducing the number of admissions for administrative purposes.KEY WORDS: Exservicemen, Hospital Admission, Medical facility, Resource Utilisation, Servicemen     

Antioxidant and hepatoprotective activity of Fagonia schweinfurthii (Hadidi) Hadidi extract in carbon tetrachloride induced hepatotoxicity in HepG2 cell line and rats

Ethnopharmacological relevance

The whole plant of Fagonia schweinfurthii (Hadidi) Hadidi (Family: Zygophyllaceae) is used in variety of diseases including hepatic ailments in deserts and dry areas of India.

Aim of the study

To evaluate antioxidant and hepatoprotective activity of ethanolic extract from Fagonia schweinfurthii (Hadidi) Hadidi (FSEE) in carbon tetrachloride (CCl₄) induced hepatotoxicity in HepG2 cell line and rats.

Materials and methods

In vitro antioxidant activity was determined by DPPH, ABTS radicals and hydrogen peroxide methods. In vitro cytotoxicity and hepatoprotective potential of FSEE were evaluated using HepG2 cells. Based on the cytotoxicity assay, FSEE (50, 100, 200 µg/ml) was assessed for hepatoprotective potential against CCl₄ induced toxicity in HepG2 cell line by monitoring cell viability, aspartate aminotransferase (AST), alanine aminotransaminase (ALT), lactate dehydrogenase (LDH) leakage, lipid peroxidation (LPO) and glutathione level (GSH). Further, in vivo hepatoprotective activity of FSEE was evaluated against CCl₄ induced hepatotoxicity in male Wistar albino rats. Rats were pre-treated with FSEE (200 mg, 400 mg kg⁻¹ day⁻¹ p.o.) for 7 days followed by a single dose of CCl₄ (1.0 ml/kg, i.p.) on 8th day. Silymarin was used as positive control. After 24 h of CCl₄ administration, various biochemical parameters like aspartate aminotransferase (AST), alanine aminotransaminase (ALT), alkaline phosphatase (ALP), total bilirubin (TB) and total protein (TP) levels were estimated in serum. The antioxidant parameters like superoxide dismutase (SOD) activity, catalase (CAT) activity, glutathione (GSH) content and malondialdehyde (MDA) level in the liver homogenate were determined. Histopathological changes in the liver of different groups were also studied.

Results

The FSEE possessed strong antioxidant activity in vitro. The results indicated that CCl₄ treatment caused a significant decrease in cell viability. The CCl₄-induced changes in the HepG2 cells were significantly ameliorated by treatment of the FSEE. FSEE significantly prevented CCl₄ induced elevation of AST, ALT, ALP, TB, and CCl₄ induced decrease in total protein in rats. FSEE treated rat liver anti-oxidant parameters (SOD, CAT, MDA and GSH,) were significantly antagonized for the pro-oxidant effect of CCl₄. Histopathological studies also supported the protective effect of FSEE.

Conclusion

The results of this study revealed that FSEE has significant hepatoprotective activity. This effect may be due to the ability of the extract to inhibit lipid peroxidation and increase in the anti-oxidant enzymatic activity.     

Generation of T cells from cytokine-mobilized peripheral blood and adult bone marrow CD34+ cells

The present study compared the T-cell progenitor content of CD34+ lineage (Lin)- cells isolated from normal adult bone marrow (ABM) and mobilized peripheral blood (MPB). Both cell populations were found to differentiate into T cells when injected into human fetal thymi implanted into severe combined immunodeficient mice. Cytokine-MPB cells were less efficient than ABM cells in engrafting in the fetal human thymus, although both gave rise to thymocytes with identical phenotypes based on the analysis of CD1a, CD3, CD4, and CD8 expression. Thymocytes derived from adult CD34+ Lin- cells were capable of fully differentiating into mature CD3+ T cells expressing either the T-cell receptor (TCR) gamma delta or the TCR alpha beta (the later associated with CD4 or CD8), showing that the T-cell progenies of adult CD34+ cells were polyclonal and functional. Our data indicate that human MPB CD34+ cells are qualitatively identical to their BM counterparts, and demonstrate the existence of T-lymphoid progenitor cell activity in MPB.     

Complex infantile and congenital hip dislocation: assessment with MR imaging

Twenty-five magnetic resonance hip studies were performed on 19 infants with congenital hip dislocation. These patients had a poor initial treatment response, a teratologic dislocation, or a late presentation. Detailed images of single hips obtained with small surface coils resulted in excellent visualization of all the clinically important soft-tissue and cartilaginous structures of the hip. No other imaging modality demonstrates all of these structures simultaneously.     

ANEURYSMAL BONE CYST IN THE MANDIBLE (A Case Report)

Aneurysmal bone cyst is commonly seen in the long bones and vertebrae and is rare in the jaws. Its association with other lesions of the bone has been stressed by many workers. Because of its variable radiological appearance, diagnosis of the lesion is established by histopathological examination. A case of aneurysmal bone cyst occurring in the mandible is reported.KEY WORDS: Aneurysmal bone cyst, Mandible     

COMPARATIVE STUDY OF BONE HEALING FOLLOWING BONE CUTS USING SURGICAL BURS AND MICROSAWS

Bone cuts on the tibia of 6 healthy dogs were studied using surgical burs and microsaws arranged in two groups by random selection to assess the speed of cutting, precision and bone healing. Bone cuts in Group A were made with surgical burs of 1.6 mm diameter using micromotor at 40,000 revolutions per minute (RPM) whereas in Group B they were created using Stryker microsaws of 0.75 mm width at the speed of 40,000 RPM. In each group, the dogs were sacrificed at the end of 8, 12 and 16 weeks and a section of the tibia containing the fracture site was removed to assess healing histopathologically. Based on clinical, radiological and histopathological examination, the results of this study indicate that microsaws have their best use in osteotomy procedures in terms of precision and thermal injury to bone whereas ostectomy procedures are more convenient with surgical burs.KEYWORDS: Bone cuts, Bone healing, Microsaws, Surgical burs     

Prenatal growth restriction,retinal dystrophy,diabetes insipidus and white matter disease: expanding the spectrum of PRPS1-related disorders

PRPS1 codes for the enzyme phosphoribosyl pyrophosphate synthetase-1 (PRS-1). The spectrum of PRPS1-related disorders associated with reduced activity includes Arts syndrome, Charcot–Marie–Tooth disease-5 (CMTX5) and X-linked non-syndromic sensorineural deafness (DFN2). We describe a novel phenotype associated with decreased PRS-1 function in two affected male siblings. Using whole exome and Sanger sequencing techniques, we identified a novel missense mutation in PRPS1. The clinical phenotype in our patients is characterized by high prenatal maternal α-fetoprotein, intrauterine growth restriction, dysmorphic facial features, severe intellectual disability and spastic quadraparesis. Additional phenotypic features include macular coloboma-like lesions with retinal dystrophy, severe short stature and diabetes insipidus. Exome sequencing of the two affected male siblings identified a shared putative pathogenic mutation c.586C>T p.(Arg196Trp) in the PRPS1 gene that was maternally inherited. Follow-up testing showed normal levels of hypoxanthine in urine samples and uric acid levels in blood serum. The PRS activity was significantly reduced in erythrocytes of the two patients. Nucleotide analysis in erythrocytes revealed abnormally low guanosine triphosphate and guanosine diphosphate. This presentation is the most severe form of PRPS1-deficiency syndrome described to date and expands the spectrum of PRPS1-related disorders.