A study on peroneus longus autograft for anterior cruciate ligament reconstruction

Background: To compare the clinical outcome and donor site morbidity of ACL reconstruction with Peroneus longus tendon autografts in patients with isolated ACL injury.Methods: This was a prospective study that included patients who underwent ACL reconstruction using Peroneus longus tendon autograft. Results were assessed via physical examination. Donor site morbidity of the foot and ankle after tendon harvesting was assessed using Medical Research Council (MRC) grading of ankle and foot movements.  Post-operative knee function was evaluated by the International Knee Documentation Committee (IKDC) scoring.Results: In this study sample of 25 patients, the ankle functions at the donor site are grossly preserved in almost all the patients, which was elucidated by grading the power of foot eversion. Post operatively knee function (IKDC scoring) were rated as normal in 92% (23 cases).Conclusions: Peroneus longus is an appropriate autograft source for ACL reconstruction in view of ease of harvest, adequate size, cosmetically appealing, considering excellent post-operative knee scores. And removing the Peroneus longus tendon has no effect on gait parameters and does not lead to instability of the ankle. So, it can be used as an autogenous graft in orthopaedic surgeries.

Ligament reconstruction with tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ligament reconstruction tendon interposition (LRTI) is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthritis. The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence.</p><p><b>METHODS</b>From January 2008 to January 2011, 19 patients (21 thumbs) underwent surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis (FCR) in Kleinert Kutz Hand Care Center of Louisville University, USA. The follow-up period was an average of 13.9 months. Pain, grip strength, tip pinch strength, range of motion, and radiographic measurements were recorded. Based on first metacarpal subsidence, the cases were classified in to mild, moderate, and severe. Clinical outcomes of the groups were evaluated and compared.</p><p><b>RESULTS</b>Grip strength improved from 18.6 kg to 20.5 kg, and tip pinch strength increased from 4.4 kg to 4.5 kg after the surgery. Radial abduction and palmar abduction improved after surgery. Radial abduction increased from 55.7° to 60.6° and palmar abduction improved from 56.7° to 63.5° after the procedure. Visual analogue scores (VAS) were significantly reduced, from 6.6 to 0.5. Compared with the preoperative radiographs the first metacarpal had subsided about 54.6% of the arthroplasty space. The height of arthroplasty space and index of the arthroplasty space significantly decreased from 12.4 mm to 5.6 mm and from 0.27 to 0.12 respectively. Between the various groups (mild, moderate and severe metacarpal subsidence), there was no difference in grip strength, tip pinch strength, thumb range of motion, and VAS.</p><p><b>CONCLUSIONS</b>Ligament reconstruction tendon interposition arthroplasty resulted in excellent relief of pain and increase in range of motion. However, LRTI cannot maintain the arthroplasty space. Compared with the preoperative radiographs, the metacarpal subsided more than 50%. The amount of first metacarpal subsidence has no bearing on the results.</p>

Bilateral Acute Anterior Uveitis and Optic Disc Edema Following a Snake Bite

The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.

Induction of DNA damage and GADD45beta gene mutation in zebra fish [danio rerio] due to environmentally relevant concentrations of organochlorine pesticides and heavy metals

Zebra fish were exposed to environmentally relevant concentration of pesticides and metals for a period of 14 days. The individual and the combined toxicity of pesticides and metals were studied. Damage caused to the DNA and induction of mutation in the GADD45beta gene was investigated in this study. The present investigation revealed that exposure of zebra fish to pesticides and metals induced DNA damage and also mutation in the GADD45beta gene. The pesticides treated group [III] showed significantly higher damage followed by metals treated group [II]. The DNA damage was comparatively less in the pesticides and metals exposed group [IV]. GADD45beta gene which is considered to be one of the most important gene involved in G phase arrest, has been found to be mutated in zebra fish when exposed to metals and pesticides. The comparison of amplified gene sequence of GADD45beta gene with the sequence of the zebra fish retrieved from the NCBI confirmed the mutation in the gene sequence of zebra fish treated with pesticides and metals. The induction of DNA damage in fish due to contaminants may lead to mutations, which contribute towards the multistage carcinogenesis process

Comparative Study of Dot Enzyme Immunoassay (Typhidot-M) and Widal Test in the Diagnosis of Typhoid Fever.

We compared the sensitivity and specificity of Typhidot-M and Widal test with blood culture (gold standard) for diagnosing typhoid fever in 105 children aged 1-15 years admitted with clinical suspicion of typhoid fever. Of the 105 cases, blood culture was positive for S.typhi in 41 (39%) children, Widal test was positive in 48 (45.7%) and Typhidot-M was positive in 78 (74.3%) cases. Sensitivity and specificity of Typhidot-M was 92.6% and 37.5% while sensitivity and specificity of Widal test was 34.1% and 42.8%, respectively. In children with fever of less than 7 days duration, Typhidot-M was positive in 97%, compared to 24.2% by Widal test. Typhidot-M is a simple and sensitive test for early diagnosis of typhoid fever in children.

Intermittent Short Course Therapy for Pediatric Tuberculosis.

We conducted this study to assess the efficacy of intermittent short course therapy in all forms of pediatric tuberculosis using a coordinated approach with Revised National Tuberculosis Control Programme (RNTCP). Sixty-five children were treated using RNTCP protocols with some modifications, such as dose adjustments or prolongation of treatment in selected children. Overall response rate was 95% (pulmonary 94% and extra pulmonary 97%). There was one case with possible relapse. With dynamic inputs from both the treating pediatrician and personnel from Directly Observed Treatment – Short-course (DOTS) centers, we could successfully implement RNTCP protocols in childhood tuberculosis.

Association between thyroid hormones, insulin resistance, and metabolic syndrome

To determine the association between thyroid hormones, insulin resistance, and metabolic syndrome in euthyroid women. Forty-five women with no past medical history were studied in this cross-sectional study at the Department of Endocrinology, Medwin Hospitals, Hyderabad, India, from August 2008 to September 2008. The body fat was estimated using bio-impedance method, and fasting blood sample was analyzed for total triiodothyronine [T3], total thyroxine [T4], thyroid-stimulating hormone [TSH], free triiodothyronine [FT3], lipid profile, insulin, and glucose. The mean age of the participants was 32.6 +/- 9.6 years with a body mass index [BMI] of 29.9 +/- 3.8 kg/m[2]. Evidence of homeostasis model assessment index for insulin resistance [HOMA-IR] more than 3 was seen in 34 [75%] and metabolic syndrome in 29 [64%] participants. Total T3 showed a positive correlation with triglycerides, low density lipoproteincholesterol [LDL-C], total cholesterol, insulin, HOMA-IR and negatively with body fat. Thyroid-stimulating hormone correlated positively with BMI, insulin, HOMA-IR, LDL-C and negatively with HDL-cholesterol [p<0.05]. Free triiodothyronine correlated positively with waist circumference and T4 did not correlate with metabolic syndrome parameters. Our preliminary data show an association between thyroid hormones and some components specific of the metabolic syndrome in euthyroid women. Total triiodothyronine and TSH correlated more with variables of metabolic syndrome than FT3 and T4

Bioethics activities in India

The Indian Council of Medical Research formulates, coordinates and promotes biomedical research in India. In 1980, they formulated the first national ethical guidelines. They offer a number of different training programmes, from 1 day to 6 months. The council is developing a core curriculum for teaching bioethics, which would be applied uniformly in medical schools throughout the country. Drug development and ethics is also important in India, particularly now that the local pharmaceutical industry is expanding and so many drugs trials are outsourced to the country. The council is also very active in encouraging the development of ethics review committees

Prevalence of extended spectrum beta lactamase among multidrug resistant gram-negative isolates from a general hospital in Saudi Arabia

To determine the prevalence of extended spectrum b-lactamase [ESBL] among multidrug resistant isolates of enterobacteriaceae and non-fermenting gram-negative bacilli. This study was carried out at the Almana General Hospital, Eastern Province, Kingdom of Saudi Arabia, during the period March 2002 through to June 2003. Multidrug resistant gram-negative isolates from patients admitted to the surgical, medical, pediatric, long-term care and intensive care units were studied for the presence of the ESBL enzyme. A total of 3231 gram-negative organisms were studied for the presence of multidrug resistance and ESBLs. Of these, 197 [6%] isolates were multidrug resistant [MDR], and 156 [4.8%] were positive for ESBL. Seventy nine percent of the MDR strains were positive for ESBL. The most frequent isolates were Escherichia coli [1116] and Klebsiella pneumoniae [687] and ESBL was detected in 72 [6.5%] and 37 [5.4%] of these isolates. The MDR strains that produced ESBL were most commonly isolated from surgical care patients with diabetic fascitis [83%] and patients with indwelling Foley's catheter [79%]. Extended spectrm b-lactamase producing strains showed the highest susceptibility to imipenem and meropenem [86%]. The non-b-lactam antibiotics with greatest activity against these ESBL strains in vitro were ciprofloxacin [72%], amikacin [70%], tobramycin [67%] and gentamicin [56%]. The majority [79%] of the MDR enterobacteriaceae and non-fermenting gram-negative bacilli tested over 15-months were positive for ESBL. Imipenem, meropenem, ciprofloxacin and amikacin showed the highest activity against these ESBL-producing organisms. Due to the growing problem of infection with ESBL-producing bacteria, which are frequently resistant to many classes of antibiotics resulting in difficult-to-treat infections, clinicians need to be familiar with the clinical significance of these enzymes and potential strategies for dealing with them

Neonatal lupus syndrome: the role of maternal SS: a [RO] and SS-B [LA] antibodies: a case report

A patient who developed systemic lupus erythematosus [SLE] five years after she gave birth to a daughter with congenital heart block, is presented. She was clinically normal at the time of that delivery. Her immunological investigations revealed antibodies against SS-A [Ro] and SS-B [La] antigens. The aspects of latency until the development of clinical SLE, the role of such maternal antibodies in the development of fetal congenital heart block and the possibility of its prevention, using Dexamethasone and plasmapheresis during pregnancy are discussed