Building capacity for the assessment of HIV drug resistance: experiences from the PharmAccess African Studies to Evaluate Resistance network

The PharmAccess African Studies to Evaluate Resistance (PASER) network was established as a collaborative partnership of clinical sites, laboratories, and research groups in 6 African countries; its purpose is to build research and laboratory capacity in support of a coordinated effort to assess population-level acquired and transmitted human immunodeficiency virus type-1 drug resistance (HIVDR), thus contributing to the goals of the World Health Organization Global HIV Drug Resistance Network. PASER disseminates information to medical professionals and policy makers and conducts observational research related to HIVDR. The sustainability of the network is challenged by funding limitations, constraints in human resources, a vulnerable general health infrastructure, and high cost and complexity of molecular diagnostic testing. This report highlights experiences and challenges in the PASER network from 2006 to 2010.     

Morphometric and Histological Study of Breast Lesions with Special Reference to Proliferative Activity and Invasiveness

Breast carcinoma is the most common cause of carcinoma death in women. Sometimes, difficulty arises to differentiate between premalignant lesions and carcinoma by routine histopathology. Our study was done to establish the role of morphometry and immunohistochemistry to solve this problem. In this study, total 60 cases of different breast lesions were included and 10 controls were also included to compare the results with the normal findings. They were studied by hematoxylin and eosin-stained sections for morphometry and routine histological study; as well as by proliferative markers such as proliferating cell nuclear antigen and p53. Invasiveness was studied using immunohistochemical staining with 34 βE12 monoclonal antibody. Statistically significant differences were found in morphometric parameters and in expression of proliferative markers between most of them. Morphometry and immunohistochemistry help in the proper diagnosis of different breast lesions that lie in the gray zone on routine histopathology.     

Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures.Arterial injury following the operative fixation is a rare but serious event.We...     

Rare double fracture-dislocation of the thumb： a case report and review of the literature

Simultaneous fracture/dislocation of the thumb carpometacarpal (CMC)joint and dislocation of the metacarpophalangeal (MCP)joint is considered as a rare injury pattern.We report an unusual case of dorsa...     

Anesthesia for surgery related to craniosynostosis: a review. Part 2

The management of children with craniosynostosis is multidisciplinary and has evolved significantly over the past five decades. The treatment is primarily surgical. The anesthetic challenges continue to be the management of massive blood transfusion and prolonged anesthesia in small children, often further complicated by syndrome‐specific issues. This two‐part review aims to provide an overview of the anesthetic considerations for these children. The first part described the syndromes associated with craniosynostosis, the provision of services in the UK, surgical techniques, preoperative issues and induction and maintenance of anesthesia. This second part will explore hemorrhage control, the use of blood products, metabolic disturbance and postoperative issues.     

Of Fracture Thresholds and Bone Mineral Density Reference Data: Does One Size Really Fit All?

Men who fracture have greater mean bone mineral density (BMD) than women who fracture, and to some this suggests that BMD fracture “thresholds” are greater in men than women, justifying use of a male BMD reference standard. Others disagree and argue that because BMD distribution in men is right-shifted (higher) compared with women, anything that occurs with equal probability for men and women will occur at a greater mean BMD in men. If the latter is true, it supports using a common (female) BMD reference standard. We directly tested this latter principle and, indirectly, the validity of using a constant BMD reference standard, in 51,326 women (3722 major fractures) and 4691 men (276 fractures), by comparing mean BMD in fracture vs nonfracture groups defined by sex, age, race and body mass index because these 4 factors affect both mean BMD and risk of fractures. Among those who fractured, mean BMD for all measurement sites were significantly greater in men vs women, youngest vs oldest, whites vs Asian, and heaviest vs the lightest (all p < 0.001). However, the same BMD pattern was seen in those who did not fracture and the absolute difference in BMD between those who fractured and those who did not was essentially constant regardless of sex, age, race, or weight class (all p-interaction nonsignificant). This finding suggests that use of a common reference standard for BMD (i.e., young white women) for men, and indeed all subgroups defined by osteoporosis risk factors, is reasonable and consistent with empiric observations.     

Kirschner wire migration from subcapital humeral fracture site, causing hydropneumothorax

Migration of wires or pins around the shoulder is a known complication, though their migration within the chest is uncommon. We report an unusual case of hydropneumothorax due to migration of a bent Kirschner wire from the right proximal humerus in a 63 year-old man. We reviewed his clinical history, physical examination, imaging findings, surgical method and outcome. We also reviewed the literature on orthopaedic wire migration and latest technique in removal of the wires. Chest radiographs and chest computerized tomography are useful in detection and diagnosis of this disorder. Regular radiographic follow-up is needed for patients with internal fixation devices; any fractured or migrated pins or wires must be removed immediately to prevent dangerous complications. It is always important to remove the wires at the end of the treatment. Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.