Syndrome of ventricular septal defect and aortic regurgitation - A 22-year review of its management

Abstract Introduction: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. Methods: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). Results: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. Conclusion: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

3D Rapid Prototyping Heart Model Validation for Teaching and Training - A Pilot Project in a Teaching Institution

Abstract Introduction: Rapid prototyping is a process by which three-dimensional (3D) computerized surface models are converted into physical models. In this study, a 3D heart bio model was created using the rapid prototyping method and the accuracy of this heart model was assessed by clinicians. Methods: The two-dimensional images of normal heart from gated computed tomography scan datasets were used to create a 3D model of the heart. The slices were then processed using the software BioModroid and printed with the 3D printer. The evaluation of the model was performed by a questionnaire answered by four cardiothoracic surgeons, 12 cardiologists, five radiologists, and nine surgical registrars. Results: Eighty-six percent of the anatomy structures showed in this model scored 100% accuracy. Structures such as circumflex branch of left coronary artery, great cardiac vein, papillary muscle, and coronary sinus were each rated 77%, 70%, 70%, and 57% accurate. Among 30 clinicians, a total of 93% rated the model accuracy as good and above; 64% of the clinicians evaluated this model as an excellent teaching tool for anatomy class. As a visual aid for surgery or interventional procedures, the model was rated excellent (40%), good (50%), average (23%), and poor (3%); 70% of the clinicians scored the model as above average for training purpose. Overall, this 3D rapid prototyping cardiac model was rated as excellent (33%), good (50%), and average (17%). Conclusion: This 3D rapid prototyping heart model will be a valuable source of anatomical education and cardiac interventional management.

Accumulation and translocation of heavy metals in soil and plants from fly ash contaminated area.

The present investigation deals with the accumulation of heavy metals in fields contaminated with fly ash from a thermal power plant and subsequent uptake in different parts of naturally grown plants. Results revealed that in the contaminated site, the mean level of all the metals (Cd, Zn, Cr, Pb, Cu, Ni, Mn and Fe) in soil and different parts (root and shoots) of plant species were found to be significantly (p<0.01) higher than the uncontaminated site. The enrichment factor (EF) of these metals in contaminated soil was found to be in the sequence of Cd (2.33) > Fe (1.88) > Ni (1.58) > Pb (1.42) > Zn (1.31) > Mn (1.27) > Cr (1.11) > Cu (1.10). Whereas, enrichment factor of metals in root and shoot parts, were found to be in the order of Cd (7.56) > Fe (4.75) > Zn (2.79) > Ni (2.22) > Cu (1.69) > Mn (1.53) > Pb (1.31) > Cr (1.02) and Cd (6.06) ~ Fe (6.06) > Zn (2.65) > Ni (2.57) > Mn (2.19) > Cu (1.58) > Pb (1.37) > Cr (1.01) respectively. In contaminated site, translocation factor (TF) of metals from root to shoot was found to be in the order of Mn (1.38) > Fe (1.27) > Pb (1.03) > Ni (0.94) > Zn (0.85) > Cd (0.82) > Cr (0.73) and that of the metals Cd with Cr, Cu, Mn, Fe; Cr with Pb, Mn, Fe and Pb with Fe were found to be significantly correlated. The present findings provide us a clue for the selection of plant species, which show natural resistance against toxic metals and are efficient metal accumulators.

Fine particles (PM2.5) in ambient air of Lucknow city due to fireworks on Diwali festival.

People burn crackers world over on different occasions in different countries to express their happiness. Fireworks in large amounts aggravate the level of air pollutants and cause significant short-term air quality degradation with possible impact on human health. Fine particles (PM2.5 <2.5 μm), which may pose detrimental effects on human health and ecosystems were monitored in a residential area of Lucknow city to assess the elevated level due to bursting of firecrackers during Diwali festival. The 24 hr mean PM2.5 of normal day, pre Diwali day, Diwali day and post Diwali day was found to be 124, 154, 352 and 174 μg m-3 respectively and much above the US-EPA limit (65 μg m-3). The 12 hr mean concentration of PM2.5 on Diwali night (591 μg m-3) increased 3.9 fold than the respective night of normal day (159 μg m-3) and was significantly higher (p<0.01) than normal day and pre and post Diwali night. Mean comparison showed that Diwali day was significantly (p<0.01) different from others (except post Diwali day) and for this high accumulation during night time, after fireworks (suspension) was found to be more responsible than the period of lighting of crackers (formation). This study indicated that there is high accumulation of PM2.5 generated due to fireworks on Diwali festival which remains suspended in the air for upto 20 hr. During this period, extra mass burden of 289 μg m-3 equivalent to 1.9 normal day (of this study) was imposed in the environment. The short-term high accumulation of PM2.5 is a matter of serious concern for city dwellers as it can penetrate deep into the lungs and cause many respiratory and cardiovascular diseases.

Metals concentration associated with respirable particulate matter (PM10) in industrial area of Eastern U.P. India.

The present study deals with the assessment of ambient air quality with respect to respirable suspended particulate matter (RSPM or PM10 < or = 10 microm) and trace metals (Fe, Zn, Cu, Cr Ni, Cd, Mn and Pb) concentrations in RSPM at five locations of Renukoot, an industrial area of Eastern Uttar Pradesh. The 24 hr mean concentrations of PM10 ranged between 69.3 to 118.9 microg m(-3), which is well within the permissible limit (150 microg m(-3)) of national ambient air quality standards (NAAQS) but found higher than the prescribed annual daily limit of US EPA (50 microg m(-3)). The ambient air was mostly dominated by the Fe and least by the Cd among the metal analysed. Murdhawa, a commercial place influenced by vehicular population, is found to be the most polluted area of Renukoot and Dongia nalla (forest area) the least. The ambient air of Murdhawa is rich in Cu and Ni, indicating contribution of mobile sources. The Rammandir a residential place near the industry, is rich in Cd and Cr suggesting contribution of point sources. The Ni concentration is found to be alarmingly high in the air at all the locations except Dongia nallah, when compared with the EC (European Commission) limit (20 ng m(-3)). The Cd concentration is found to be higher only at Rammandir as compared with the EC limit (5 ng m(-3)). Mean concentrations of Zn, Pb and Mn are found to be almost equal in the ambient air of all the locations, suggesting the significance of sources contributing to presence of these metals. Zn, Cu, Pb and Ni having a significant correlation with PM10 indicate the same source contributing these metals as well as PM10. The present study has focused on the quantitative variation in different metals in the PM10, which is extremely harmful due to their toxic and carcinogenic nature.

Treatment of inferior patellar pole avulsion fractures with pole resection and patellotibial cerclage wire.

The ideal treatment for avulsion fractures of the inferior pole of the patella has not yet been identified. The options include internal fixation of the pole fragment and resection of the avulsed fragment along with the repair of patellar ligament to the patella. The purpose of the present study was to evaluate the result of pole resection with repair of patellar ligament with augmentation by patellotibial cerclage. We retrospectively studied 13 of patients who had operative treatment of an avulsion fracture of the inferior patellar pole by pole resection with trans-osseous suture fixation of the tendon to the patella and reinforcement of ligament patella with patellotibial cerclage wire. Thirteen patients who had had pole resection were followed for an average of 3 years. The average patellofemoral score (maximum, 100 points) was 88.8 points. Normal patellar height was found in thirteen patients. In patients who have sustained an avulsion fracture of the inferior patellar pole, the normal height of the patella can be maintained by transosseous suture fixation of the tendon to the patella and patellotibial cerclage after pole resection. The present study indicates that patellotibial cerclage can provide better clinical results and avoid prolong postoperative immobilization.

Analytical study of the management of supracondylar fracture of children in our setup.

We performed a clinical-radiological audit of 142 children with consecutive upracondylar fractures of the humerus over a period of 5 years (1996-2001). The fractures were classified according to the Gartland system; 58 types I, 44 type II and 40 type III. And 87.0% were extension and 13.0% flexion types. These cases were managed by closed reduction and posterior cast application (n= 120) and open reduction with internal fixation (n=22). All the stable fractures irrespectable of types were managed by closed method and all the unstable or failed manipulation cases were operated upon. In total 38 required re manipulation in the cast group and twelve (n= 12) had a varus deformity (ten from closed group and two from operation group). Failure to follow the treatment according to the guidelines led to an unsatisfactory result in 12 patients. We have devised a protocol for the management of these difficult injuries in our setup for optimal outcome.

Profile of noise pollution in Lucknow city and its impact on environment.

Automobiles, construction, festivals, factories, stations, diesel shades, garages and workshops are sources of noise. Vehicles are increasing enormously beyond the carrying capacity of the road. Study was carried out at 12 locations with sound level meter to assess day time and night time noise levels of Lucknow city. In residential areas, noise ranged between 67.7 to 78.9 and 52.9 to 56.4; in commercial cum traffic areas 74.8 to 84.2 and 68.2 to 74.9 and in industrial areas 76.9-77.2 and 72.2-73.1 dB(A) during day and night time respectively. Values were higher than their prescribed standards which may pose a significant impact on quality of life.

Thyroid gland and tissue respiration in the fresh-water snake, Xenochrophis piscator (Serpentes, Colubridae)

Foi estudado o efeito da tireoidectomia e da L. tiroxina nas taxas de respiraçäo de tecidos relacionados (fígado, coraçäo, rim, músculo) da serpente de água doce, Xenochrophis piscator. A taxa de absorçäo de oxigênio variou nos diferentes tecidos. Um declínio significativo (p < 0,01) no consumo de oxigênio, ocorreu em todos os tecidos após a tireoidectomia, que foi recuperado pela terapia com L. tiroxina in vivo. A administraçäo de L-tiroxina ter efeito estimulador sobre o consumo de oxigênio. O tratamento com L-tiroxina in vivo também estimulou a taxa de respiraçäo tecidual, independentemente da condiçäo tireoideana do animal