Importance of screening the peripheral smear

A 5-year-old boy presented with history of failure to thrive from infancy. There was a history of one sibling death due to similar problems and history of severe abortions in the mother. Routine examination of peripheral smear revealed more than 50% acanthocytes. Based on this tests were streamlined to doing lipid profile and Lipo protein electrophoresis which revealed hypolipidemia and absent Β hypo protein band. Jejuna) mucosal biopsy confirmed the diagnosis of A Beta Lipo proteinemia which revealed lipid laden enterocytes. This case illustrates the importance of simple tests like peripheral smear examination in streamlining further tests in the diagnosis of major diseases.     

Sino-bronchial syndrome in children with asthma

Thirty children in the age group of 2 to 12 years were brought with a history of recurrent non-seasonal moderate to severe wheezy episodes associated with symptoms of nasal congestion, sneezing and occasional headache. All of them had maxillary or pan sinusitis with 26 having associated right, left or bilateral lower lobe pneumonitis or bronchiectasis. Serum immunoglobulins were normal in 22 and was not done in eight. There was positive (2 to 4+ above negative control) skin test response to dust and dust mite in 15 of the 22 children tested. Throat swabs/sputum or nasal secretions grew B-hemolytic streptococcus or streptococcus pneumoniae in twenty-seven. All the children were put on bactericidal drugs for 6 to 8 weeks and bronchodilators were used when needed. At the end of 6 to 8 weeks follow-up X-ray of sinuses and chest showed significant clearing of the lesions which coincided with marked clinical improvement. Sinus X-ray should be considered in bronchial asthma resistant to medical management since untreated bacterial sinusitis can be an underlying cause of chronic poorly controlled asthma.     

Idiopathic avascular necrosis of the femoral heads in five members of a Moroccan family

Avascular necrosis (AVN) is idiopathic in about 40% of cases. The pathophysiology of avascular necrosis remains incompletely elucidated. Here, we report a case that underlines the role for inherited factors in AVN of the femoral heads. Idiopathic AVN of the femoral heads occurred in five members of the same family (a woman, her two paternal aunts, her male paternal cousin and her female paternal cousin) at a mean age of 42.4 years (range, 33–58 years). Standard pelvic radiographs showed Arlet and Ficat stage 4 AVN in three patients and stage 3 in two patients. None of the patients had a history of glucocorticoid therapy, alcohol abuse, or trauma. All five patients underwent investigations for a cause, including blood cell counts, a lipid profile, coagulation tests, testing for antinuclear antibodies, hemoglobin electrophoresis, ultrasonography of the abdomen, and standard radiographs of the long limb bones. The results were normal or negative, ruling out known hereditary causes of AVN such as sickle cell anemia and Gaucher disease. Many cases of familial AVN of the femoral head have been described in patients with sickle cell anemia or Gaucher disease. However, only five families with idiopathic familial AVN of the femoral heads have been reported (three in the US and two in Taiwan). All the patients in these families had isolated bilateral AVN of the femoral heads without AVN at other sites.     

Leadership Identity Development Through Reflection and Feedback in Team-Based Learning Medical Student Teams

Problem: Studies on leadership identity development through reflection with Team-Based Learning (TBL) in medical student education are rare. We assumed that reflection and feedback on the team leadership process would advance the progression through leadership identity development stages in medical students within the context of classes using TBL. Intervention: This study is a quasi-experimental design with pretest–posttest control group. The pretest and posttest were reflection papers of medical students about their experience of leadership during their TBL sessions. In the intervention group, TBL and a team-based, guided reflection and feedback on the team leadership process were performed at the end of all TBL sessions. In the other group, only TBL was used. The Stata 12 software was used. Leadership Identity was treated both as a categorical and quantitative variable to control for differences in baseline and gender variables. Chi-square, t tests, and linear regression analysis were performed. Context: The population was a cohort of 2015–2016 medical students in a TBL setting at Tehran University of Medical Sciences, School of Medicine. Teams of four to seven students were formed by random sorting at the beginning of the academic year (intervention group n = 20 teams, control group n = 19 teams). Outcome: At baseline, most students in both groups were categorized in the Awareness and Exploration stage of leadership identity: 51 (52%) in the intervention group and 59 (55%) in the control group: uncorrected χ²(3) = 15.6, design-based F(2.83, 108) = 4.87, p = .003. In the posttest intervention group, 36 (36%) were in exploration, 33 (33%) were in L-identified, 20 (20%) were in Leadership Differentiated, and 10 (10%) were in the Generativity. None were in the Awareness or Integration stages. In the control group, 3 (20%) were in Awareness, 56 (53%) were in Exploration, 35 (33%) were in Leader Identified, 13 (12%) were in Leadership Differentiated. None were in the Generativity and Integration stages. Our hypothesis was supported by the data: uncorrected χ²(4) = 18.6, design-based F(3.77, 143) = 4.46, p = .002. The mean of the leadership identity in the pretest, intervention group equaled 1.93 (SD = 0.85) and the pretest, control group mean was 2.36 (SD = 0.86), p = .004. The mean of the posttest, intervention group was 3.04 (SD = 0.98) and posttest, control group mean was 2.54 (SD = 0.74), T = ?4.00, design df = 38, p < .001, and adjusted on baseline and gender T = ?8.97, design df = 38, p < .001. Lessons Learned: Reflection and feedback on the team leadership process in TBL advances the progression in stages of leadership identity development in medical students. Although the TBL strategy itself could have an impact on leadership identity development, this study demonstrates that when a reflection and feedback on leadership intervention are added, there is much greater impact.     

Lower Frequency and Diversity of Antibiotic-Producing Fluorescent Pseudomonads in Rhizosphere of Indian Rapeseed–Mustard (<Emphasis Type="Italic">Brassica juncea</Emphasis> L. Czern.)

Fluorescent pseudomonads are one of the most important microbial communities which play a key role in rhizosphere to enhance plant growth-promotion and protection. The diverse groups of antibiotics viz. 2,4-diacetylphloroglucinol (DAPG), phenazine-1-carboxylic acid (PCA) and pyoluteorin (PLT) are produced by fluorescent pseudomonads inhibiting growth of fungal pathogens which results in health upliftment of plants. The present study, discusses about frequency and diversity of 138 antibiotic-producing fluorescent pseudomonads isolated from eight genotypes of rapeseed mustard rhizosphere (Brassica juncea L. Czern.). The plant growth promoting traits and antibiotics (DAPG, PCA and PLT) production of isolates were examined by using polymerase chain reaction (PCR), thin layer chromatography (TLC) and dot blot-hybridization. Among 138 isolates, 47, 25 and 9 % of isolates were positive in indole production, phosphate solubilization and antagonism potential against Sclerotinia sclerotiorum (causal agent of white mold disease in rapeseed mustard), respectively. PCR amplifications showed that none of the isolates had phlD (DAPG) and phzC (PCA) genes, but four isolates (UKA-2, UKA-8, UKA-11, UKA-66) had pltB (PLT) gene, which was further confirmed by TLC and DNA dot-blot hybridization. BOX profiles of pltB positive isolates were distinct, showing unique genetic diversity in the small population. The four pltB positive fluorescent pseudomonad isolates could be used as promising bio-control and plant growth-promoting inoculants for Indian rapeseed mustard.     

Adulticidal, repellent, and ovicidal properties of indigenous plant extracts against the malarial vector, Anopheles stephensi (Diptera: Culicidae)

Mosquito-borne diseases with an economic impact create loss in commercial and labor outputs, particularly in countries with tropical and subtropical climates. Mosquito control is facing a threat because of the emergence of resistance to synthetic insecticides. Extracts from plants may be alternative sources of mosquito control agents because they constitute a rich source of bioactive compounds that are biodegradable into nontoxic products and potentially suitable for use to control mosquitoes. Insecticides of botanical origin may serve as suitable alternative biocontrol techniques in the future. In view of the recently increased interest in developing plant origin insecticides as an alternative to chemical insecticide, this study was undertaken to assess the adulticidal, repellent, and ovicidal potential of the crude hexane, ethyl acetate, benzene, aqueous, and methanol solvent extracts from the medicinal plants Andrographis paniculata, Cassia occidentalis, and Euphorbia hirta against the medically important mosquito vector, Anopheles stephensi (Diptera: Culicidae).The adult mortality was observed after 24 h of exposure. All extracts showed moderate adulticide effects; however, the highest adult mortality was found in methanol extract of A. paniculata followed by C. occidentalis and E. hirta against the adults of A. stephensi with LC₅₀ and LC₉₀ values of 210.30, 225.91, and 263.91 ppm and 527.31, 586.36, and 621.91 ppm, respectively. The results of the repellent activity of hexane, ethyl acetate, benzene, aqueous, and methanol extract of A. paniculata, C. occidentalis, and E. hirta plants at three different concentrations of 1.0, 3.0, and 6.0 mg/cm² were applied on skin of forearm in man and exposed against adult female mosquitoes. In this observation, these three plant crude extracts gave protection against mosquito bites without any allergic reaction to the test person, and also, the repellent activity is dependent on the strength of the plant extracts. Mean percent hatchability of the ovicidal activity was observed 48 h post-treatment. The percent hatchability was inversely proportional to the concentration of extract and directly proportional to the eggs. Mortality of 100 % with methanol extract of A. paniculata exerted at 150 ppm and aqueous, methanol extract of C. occidentalis and E. hirta were exerted at 300 ppm. These results suggest that the leaf extracts of A. paniculata, C. occidentalis, and E. hirta have the potential to be used as an ideal eco-friendly approach for the control of the A. stephensi. Further detailed research is needed to identify the active ingredient in the extracts and implement the effective mosquito management program.     

Use of knotless barbed sutures for closure of intraoral incisions for maxillofacial trauma: a randomised controlled trial

The objective of this study was to assess the efficacy of knotless barbed sutures in intraoral wound closure for maxillofacial trauma in comparison with conventional (vicryl) sutures. This was a randomised controlled clinical trial involving 40 patients with isolated mandibular angle fractures who required intraoral incisions for open reduction and internal fixation (ORIF). The sample was randomised into the study group (20 patients) and control group (20 patients). Following fracture fixation by a standardised surgical protocol, the wound closure was done with bidirectional knotless barbed suture and vicryl for the study and control groups, respectively. The wounds were closed in layers (periosteum and mucosa). All operations were performed by a single surgeon. Outcome parameters measured were intraoperative wound closure time and wound healing using ‘Landry’s wound healing index’ on the first, third, and seventh postoperative days. Statistically significant difference in suturing time was noted between the study and control group (p value <0.001). The study group demonstrated a mean (SD) suturing time of 9.46 (2.01) minutes, compared with the 17.61 (2.57) minutes in the control group. Wound healing was found to be better and statistically significant in the study group than the control group (p value<0.001). Knotless barbed suture is a promising alternative to vicryl for intraoral wound closure.     

Circumferential Stent Fracture: novel detection and treatment with the use of StentBoost

Circumferential stent fracture is extremely uncommon, and in rare cases, it can cause stent thrombosis. Recognizing stent fracture can be difficult on conventional fluoroscopy because of poor stent radiopacity. We found that StentBoost image acquisition yields improved visibility of stent struts, enabling the identification of stent fracture and the precise positioning of new stents over previously stented segments.We report the case of a 50-year-old man who presented with acute myocardial infarction and subacute stent thrombosis a week after percutaneous transluminal coronary angioplasty and placement of a bare-metal stent. The new lesion was crossed with a guidewire, but multiple attempts to advance a balloon catheter were unsuccessful. Live StentBoost image acquisition revealed circumferential stent fracture into 2 separate sections, with abnormal angulation between the proximal and distal portions of the stent. With StentBoost guidance, the wire and balloon catheter were both easily manipulated to cross the lesion, and angioplasty and restenting were completed with good results.StentBoost can be a useful adjunctive tool for the cardiac interventionist during complex percutaneous transluminal coronary angioplasty, and it was invaluable in this challenging situation. We discuss stent fracture and the benefits of using StentBoost in such situations.     

Effect of Weight Reduction Following Bariatric Surgery on Serum Visfatin and Adiponectin Levels in Morbidly Obese Subjects

ObjectiveAdipokines are signaling and mediator proteins secreted from adipose tissue. A novel adipokine, visfatin, was reported as a protein which was mainly expressed in visceral adipose tissue. Controversial results have been shown regarding the changes of adipokines following weight reduction. So we investigated the effects of weight reduction on serum concentrations of adiponectin and visfatin in morbidly obese subjects.Methods35 severely obese patients (26 females and 9 males), aged 15-58 years, were studied. Anthropometric parameters and biochemical parameters as well as adiponectin and visfatin were analyzed before and 6 weeks after weight reduction.ResultsAnthropometric indices decreased significantly. Blood levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride were reduced significantly. The reduction of visfatin and the elevation of adiponectin were significant as well. However, other parameters like fasting glucose and insulin did not change. Moreover, we could not find any significant correlation between the change of serum visfatin and that of adiponectin. Conclusions: 6-week weight reduction after bariatric surgery resulted in decreased serum visfatin and increased adiponectin levels. However, we cannot find any significant correlation between changes of adiponectin, visfatin, BMI, waist circumference, and insulin resistance. Further studies with different design are suggested to clarify these associations.Key Words: Adiponectin, Visfatin, Morbid obesity, Bariatric surgery, Weight loss