Malignant melanomatic mass of right heel

Malignant melanoma mostly occurs in sun-exposed areas and is less common in covered areas. We report a patient, who presented with painless gradually increasing mass arising from the right heel, that was found to be a malignant melanoma. Treatment with local excision led to complete resolution of symptoms. To-date, 36 months after the diagnosis, the patient is still in complete remission. The diagnosis of melanoma should be considered in the presence of non-healing skin lesion and should be biopsied and treated according to Breslow thickness and presence or absence of metastases.     

Primary nasal tuberculosis-a rare clinical entity

Primary tuberculosis of the nose is very rare. We report a case of a 35-year-old woman who presented with bilateral nasal obstruction and epistaxis of 3 months' duration but who was otherwise healthy. She was diagnosed with primary nasal septal tuberculosis and was treated with antituberculosis DOTS (directly observed treatment, short course) therapy for 6 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.     

Antidyslipidemic activity of Indigofera tinctoria

Indigofera tinctoria is a perennial shrub, which belongs to the family Papilionaceae. As a part of our drug discovery program we have investigated the antidyslipidemic activity of the alcoholic extract from Indigofera tinctoria as well as its three other components, that is, chloroform, butanol and aqueous fractions in dyslipidemic hamsters that were fed a high fat diet. The chloroform fraction showed a significant decrease in the plasma triglycerides (TG, 52%) (P < 0.001), total cholesterol (TC, 29%) (P < 0.05), glycerol (Gly, 24%) and free fatty acids (FFA, 14%). This decrease was also accompanied by an increase in high density lipoproteins (HDL) by 9% and an increased HDL-C/TC ratio of 52% at the dose of 250 mg/kg of body weight.     

Does a child's mid‐upper arm circumference‐for‐age z‐score represent another nutritional indicator of childhood malnutrition status?

Child wasting is defined as a weight‐for‐height/length z‐score (WLZ/WHZ) < −2, and this indicator of nutritional status is used worldwide. However, a precise measurement is required for the assessment of a child''s nutritional status, which may not always be possible due to expensive instruments, especially in poor resource settings. In some instances, mid‐upper arm circumference‐for‐age z‐score (MUACZ) is also being used for screening purposes, which is a simple and useful nutritional indicator. The objective of this paper is to identify the optimal cut‐off point for the MUACZ to identify wasted children, and also to determine if the same factors are associated with MUACZ and wasting. Data were derived from the Suchana evaluation data. The optimal cut‐off value was estimated via receiver operating characteristic (ROC) curve analysis using acute malnutrition as a gold standard with maximum sensitivity and specificity. Multiple logistic regression was used to assess the associated factors with the MUACZ. Using the gold standard indicator of nonwasting (WLZ ≥ −2), a positive outcome, the optimal cut‐off point for the MUACZ was −1.27. The area under the ROC curve was 0.88, indicating that the model had a power of 88% to differentiate between the positive and negative classes. It implies that a child''s MUACZ was correlated with WLZ, and a MUACZ below −1.27 appeared to accurately identify wasting among children aged 3–23 months. MUACZ < −1.27 might be another useful indicator of childhood wasting than a WLZ < −2.     

A partial atomic structure for the flagellar hook of Salmonella typhimurium

The axial proteins of the bacterial flagellum function as a drive shaft, universal joint, and propeller driven by the flagellar rotary motor; they also form the putative protein export channel. The N- and C-terminal sequences of the eight axial proteins were predicted to form interlocking alpha-domains generating an axial tube. We report on an approximately 1-nm resolution map of the hook from Salmonella typhimurium, which reveals such a tube made from interdigitated, 1-nm rod-like densities similar to those seen in maps of the filament. Atomic models for the two outer domains of the hook subunit were docked into the corresponding outermost features of the map. The N and C termini of the hook subunit fragment are positioned next to each other and face toward the axis of the hook. The placement of these termini would permit the residues missing in the fragment to form the rod-like features that form the core domain of the hook. We also fit the hook atomic model to an approximately 2-nm resolution map of the hook from Caulobacter crescentus. The hook protein sequence from C. crescentus is largely homologous to that of S. typhimurium except for a large insertion (20 kDa). According to difference maps and our fitting, this insertion is found on the outer surface of the hook, consistent with our modeling of the hook.     

Patient decision aids in knee replacement surgery

Arthroplasty is an effective intervention for symptomatic knee osteoarthritis refractory to conservative therapy. However, recent data highlights regional variations in service provision unrelated to disease severity and a low, but not insignificant, rate of patient dissatisfaction. The variation in knee arthroplasty provision is in part also due to the clinical decision-making of orthopaedic surgeons. The management of osteoarthritis is an example of a preference-sensitive clinical pathway, and possible explanations for poor patient satisfaction include unrealistic expectations and poor perception of potential benefits and risks. In addition to the individual impact, this represents an inefficient use of resources by healthcare providers during a challenging economic period. Improved shared-decision making between patients and clinicians would potentially address these issues. Patient decision aids provide relevant personalised evidence-based information to facilitate the shared decision-making process. Orthopaedic surgeons are receptive to the use of patient decision aids to support shared decision-making, but there are a number of issues to overcome before they are routinely adopted. The number of decision aids and the literature supporting their effectiveness is growing rapidly. NHS Direct has launched online patient decision support for knee osteoarthritis. The use of patient decision aids in clinical practice is gathering pace and may soon become the ethical and legal standard. This article provides a narrative review of patient decision aids in the context of knee replacement surgery from a UK perspective.     

Exposure to mild blast forces induces neuropathological effects,neurophysiological deficits and biochemical changes

Direct or indirect exposure to an explosion can induce traumatic brain injury (TBI) of various severity levels. Primary TBI from blast exposure is commonly characterized by internal injuries, such as vascular damage, neuronal injury, and contusion, without external injuries. Current animal models of blast-induced TBI (bTBI) have helped to understand the deleterious effects of moderate to severe blast forces. However, the neurological effects of mild blast forces remain poorly characterized. Here, we investigated the effects caused by mild blast forces combining neuropathological, histological, biochemical and neurophysiological analysis. For this purpose, we employed a rodent blast TBI model with blast forces below the level that causes macroscopic neuropathological changes. We found that mild blast forces induced neuroinflammation in cerebral cortex, striatum and hippocampus. Moreover, mild blast triggered microvascular damage and axonal injury. Furthermore, mild blast caused deficits in hippocampal short-term plasticity and synaptic excitability, but no impairments in long-term potentiation. Finally, mild blast exposure induced proteolytic cleavage of spectrin and the cyclin-dependent kinase 5 activator, p35 in hippocampus. Together, these findings show that mild blast forces can cause aberrant neurological changes that critically impact neuronal functions. These results are consistent with the idea that mild blast forces may induce subclinical pathophysiological changes that may contribute to neurological and psychiatric disorders.