Functional Outcome of Isolated Posterior Cruciate Ligament Avulsion Fractures Treated by Open Reduction and Internal Fixation

Isolated Posterior cruciate ligament (PCL) avulsion fractures are uncommon, but are complicated intra-articular fractures.1 In India due to high prevalence of motorcycle transportation, the cause of PCL avulsion fractures was predominantly motorcycle accidents, though sports accidents still remain the most common cause in world over. These injuries are quite often missed in the emergency department and are often neglected. In the long run they cause severe functional disability of the knee joint. There is no consensus concerning the optimal surgical treatment approach for these injuries. Hence, we aimed to study the functional and clinical outcome of isolated PCL avulsion fractures with open reduction and internal fixation.METHODSThis is a prospective study of 28 cases of isolated PCL tibial avulsion fractures, in patients aged between 22-38 years during the period 2014 - 2018 in our hospital. All were treated with open reduction and internal fixation with 4 mm cannulated cancellous screw and washer. Postoperatively, patient leg was immobilized in posterior POP slab for 2 weeks, allowing toe touch weight bearing. All patients were regularly followed-up at 2, 4, 6, 8, 10, and 12 weeks. The functional outcome is assessed by Lyndholm scoring at the end of 12 weeks.RESULTS98% of the cases have shown excellent results with good range of movement in the knee without pain and without knee instability. The other 2% of cases had mild knee arthrofibrosis and pain.CONCLUSIONSPCL Avulsion fractures are rarity but yet need to be managed surgically. Open reduction and internal fixation by Burks and Schaffer approach has resulted in excellent results and good functional outcome.

Role of line probe assay in diagnosis and detection of drug resistance in Mycobacterium tuberculosis

Tuberculosis caused by Mycobacterium tuberculosis has remained a major global health problem worldwide. TB requires prolonged period of time for isolation by conventional culture methods. The emergence and spread of multi drug resistant (MDR-TB) poses great threats and challenges in controlling the infection. MDR-TB is resistant to both first line drugs rifampicin and isoniazid. PCR tests are based on targeting the mutation in rpoB, katG and inhA genes which can detect resistance to these drugs. To compare microscopy, conventional culture and Line probe assay for the detection of M. tuberculosis & detect rifampicin and isoniazid resistance using Lineprobe assay in various clinical samples. A total of 347 suspected patients of tuberculosis were included in the study. Demographic details & clinical presentation was noted. Various samples were received & processed for ZN staining, culture on LJ media and Line probe assay. Out of 347 cases, majority of cases were in the age group of 51-60 years (18.4%). Majority of the population was males (65.1%). Among suspected tuberculosis patients, cough with expectoration (55.9%) was the commonest complaint. Microscopy was positive in 17.3%, conventional culture was positive in 16.1% and line probe assay was positive in 26.2%. Out of 347, 91 were diagnosed with MTB, out of which 85.7% were sensitive to both rifampicin and isoniazid whereas 14.3% showed resistance to either rifampicin / isoniazid or both. LPA & direct microscopy are a good screening method for early diagnosis and detection of drug resistance but are not a complete replacement of conventional culture which is still a gold standard.

High HPV load and sexually transmitted infections increase the risk of abnormal cervical cytology in HIVinfected women in India

Sexually transmitted infection (STI) is a major public health problem in human immunodeficiency virus (HIV)-infected individuals. This study evaluated the effect of STIs, such as herpes simplex virus type-2 (HSV-2) and Chlamydia trachomatis (CT) on human papillomavirus (HPV) copy number and associated cervical cytological abnormalities in context of HIV infection. Cervical cells from 74 HIVseropositive and 50 seronegative women were examined for HPV, HSV-2 and CT DNA by PCR. HIVinfected women had higher HSV-2 (P =0.002) and HPV infection (P=0.001) in cervix. HPV 16 was detected as the most predominant genotype. Combination of HIV and other STIs (HSV-2 and CT) was associated with higher HPV prevalence in cervix (P <0.01). Cervical HPV viral load (VL) was increased in HIVinfected subjects co-infected with STIs compared to those with only HPV infection (P=0.008). Women with abnormal cervical cytology had higher HPV copy number/cell compared to those with normal cytology (P <0.001). In conclusion, STIs may not have direct effect on cervical cytological abnormalities, they increase HPV VL that in turn worsen cervical cytological complications in HIVinfected women. Therefore, screening of STIs in HIVinfected high-risk Indian women may be important to evaluate HPV burden and abnormal cervical dysplasia

Enteral paracetamol or Intravenous Indomethacin for Closure of Patent Ductus Arteriosus in Preterm Neonates: A Randomized Controlled Trial.

Objective: To compare the efficacy of enteral paracetamol and intravenous indomethacin for closure of patent ductus arteriosus (PDA) in preterm neonates. Design: Randomized controlled trial. Setting: Level III neonatal intensive care unit. Participants: 77 preterm neonates with birth weight ≤1500 g and PDA size ≥1.5 mm, with left to right ductal flow with left atrium to aortic root ratio >1.5:1; diagnosed by 2D-Echo within first 48 hours of life. Intervention: Paracetamol drops through the infant feeding tube (15mg/kg/dose 6 hourly for 7 days) or intravenous indomethacin (0.2 mg/kg/dose once daily for 3 days). Outcome measures: Primary: PDA closure rate assessed by echocardiography. Secondary: need for surgical closure of PDA, renal impairment, gastrointestinal bleed, necrotising enterocolitis, hepatotoxicity, pulmonary hemorrhage, sepsis, hypothermia, retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia and mortality. Results: PDA closure rate was 100% (36/36) in enteral paracetamol group as compared to 94.6% (35/37) in intravenous indomethacin group (P=0.13). The secondary outcomes were also similar between the two groups. There was no occurrence of hepatotoxicity. Conclusions: Enteral paracetamol is safe but not superior to intravenous indomethacin in the treatment of PDA in preterm neonates.

Anomalous Origin of Anterior Interosseous Artery.

Background: The Brachial Artery ,usually a continuation of the axillary artery begins at the distal border of teres major and ends about a centimetre distal to the elbow joint by dividing into the radial and ulnar artery. Objectives: A. To document the origin of anterior interosseous artery from brachial artery. B. To establish embryological and clinico-anatomical correlation of such variations. Methods: These findings were observed after meticulous dissection of the upper limbs of both sides of a 43 year old adult male cadaver in the department of anatomy ,R .G .Kar Medical College ,Kolkata. Results: The brachial artery present in the right limb gave a branch in the upper 1/3 of the arm from its lateral aspect. This branch of brachial artery went downwards and became deep to pronator teres and continued as the anterior interosseous artery. The brachial artery itself descended and remained superficial to pronator teres. Just below the elbow joint it underwent bifurcation into radial and ulnar artery.The subsequent course of those two arteries was normal. And there was absence of common interosseous artery. So the anterior interosseous artery instead of arising from the common interosseous artery which was the branch of the ulnar artery took origin from brachial artery. Conclusion: This variation was explained in the light of embryological development and such variations were useful for physicians, surgeons, nephrologists ,radiologists and interventionist in various surgical procedures and also for diagnostic and therapeutic approaches.

Prevalence of diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, and its correlates among police personnel in Bankura district of west Bengal.

A cross-sectional study was conducted among police personnel (N = 1817) in Bankura District, West Bengal, India to estimate the prevalence of diabetes mellitus (DM), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and its correlates during July-November, 2011. Participants were enquired about their age, gender, physical activity, and predominant occupational activity. Diagnosis of DM, IFG, and IGT was based on a history, fasting, and 2-h post-load blood glucose estimation as per World Health Organization (WHO) criteria. Body mass index, waist circumference (WC), and blood pressure (BP) were estimated. Out of 1817 subjects, DM was found in 15%, 1.1% had IFG and 5.7% had IGT. Age >50 years, family history of diabetes, hypertension, and abdominal obesity were found to be significantly associated with DM and IGT, whereas IFG was significantly associated with the family history of diabetes and hypertension. High prevalence of diabetes and pre-diabetic condition warrants early effective intervention to keep the police force healthy and agile.

Olfactory tract transection reveals robust tissue-level plasticity by cellular numbers and neurotrophic factor expression in olfactory bulb.

Nervous system lesions are characterized by the loss of neuronal numbers and types. The neurotrophic factor levels in an injured tissue reflect their potential for regeneration. This hypothesis was investigated in olfactory bulb (OB), where olfactory tract was surgically transected disrupting neuronal migration and turnover. The effects were followed with quantification of mitral cells and three neurotrophic factors mRNA levels for 6 weeks. The neuronal numbers decreased by 3rd- and 4th-week in transected OBs followed by their restoration, comparable with that of controls at 5th- and 6th-week. The endogenous levels of three neurotrophic factors – (brain derived neurotrophic factor, insulin growth factor-1 and fibroblast growth factor-2) using qPCR showed increase at 2nd-week by 136-, 8- and 2-fold respectively. Also, there was a significant increase in specific neurotrophic factors at 5th-week and 6th-weeks. The results propose a temporal link between deployment of neurotrophic factors and the plausible restorative events for mitral cell numbers in OB.

Pulmonary tuberculosis among HIV seropositives attending a counseling center in Kolkata.

The study was carried out to detect the prevalence of pulmonary tuberculosis among HIV-seropositive individuals (HIV/TB co-infection) who attended counseling center of National Institute of Cholera and Enteric Diseases, Kolkata. A total of 109 HIV-seropositive individuals were screened. Of them, 36 (33%) had HIV/TB co-infection diagnosed by chest X-ray and presence of acid fast bacillus (AFB) detected by repeated microscopic examination of sputum. Blood samples were examined for CD4 and CD8 counts and ratio. Findings of blood examination showed that low CD4 count (<50/μl) had statistically significant association (P = 0.007) with HIV/TB co-infection as compared to HIV infection only. However, no significant correlation with CD4:CD8 ratio in HIV/TB co-infection was observed.

Antioxidant effect of ethanolic extract of Piper betle Linn. (Paan) on erythrocytes from patients with HbE-beta thalassemia.

HbE-beta thalassemia is caused by an interaction between HbE and defective b globin gene of thalassemia. Repeated blood transfusions cause an iron overload, triggering an enhanced generation of free radicals. In the present study, the anti-oxidant property of ethanolic extract of the leaves of Piper betle Linn. (PB) was evaluated in the erythrocytes from patients with HbE-beta thalassemia. In patients with HbE-beta thalassemia (n = 30) and age- and sex-matched healthy individuals (n = 30), the baseline level of reactive oxygen species (ROS) and free radical scavenging activity in the erythrocytes was measured by flow cytometry using dihydrodichlorofluorescein diacetate (H2DCFDA), in terms of the geometric mean fluorescence channel (GMFC). The baseline generation of ROS was significantly higher in the erythrocytes from patients with HbE-beta thalassemia, as compared to healthy volunteers, the GMFC being 67.20 ± 4.64 vs. 23.03 ± 1.88 (p<0.001), which was effectively decreased by PB. Similarly, H2O2 (0.5-1.0 mM) induced a higher increase in the GMFC in the erythrocytes from patients with HbE-beta thalassemia, as compared to controls which was effectively reduced by PB. Taken together, PB showed promising anti-oxidant activity against the erythrocytes from patients with HbE-beta thalassemia.

Aumento da replicação do vírus da imunodeficiência humana tipo 1 induzida por Neisseria gonorhoeae na presença de leucócitos polimorfonucleares / Enhancement of human immunodeficiency virus tipe 1 replication induced by neisseria gonorrhoeae in presence of polymorphonuclear leukocytes

Determina a influência da NG associada a leucócitos polimorfonucleares - PMNsobre a replicação do HIV I. Para análise da replicação viral foram utilizadas células monocíticas pré-infectadas pelo HIV I. Para o ensaio bacteriano utilizou-se uma cepa de NG classificada como PorB3 serovar, pilli e opa positivas. A NG , isoladamente ou em associação ao PMN, aumentou significativamente a replicação in vitro do HIV I

Constitutive Heterochromatin Polymorphism In Pediatric Cancer Patients.

Incidence of constitutive C-band heteromorphism (CBH) is reported to be higher in patients with malignancy by some studies, while in others no difference is reported between control and malignant conditions. We have studied incidence of CBH in pediatric cancer patients in terms of > 25% size difference between the homologues of chromosome #1, #9 and #16 and compared it with (i) age-matched controls, (ii) controls with minimum 60 years of age and (iii) parents/siblings of pediatric cancer patients and overall prevalence of CBH was comparable between patients and three groups of control subjects. Statistically significant difference was observed between the total lengths of C-band of chromosome #1 for pediatric cancer patients and first degree relatives group (p < 0.01). 17 families of pediatric cancer patients were studied for the pattern of CBH. In three patients, CBH analysis, more number of cancer families and normal pedigrees will be more informative. The problem still remains unresolved and should be analyzed qualitatively using techniques of molecular cytogenetics.