A review on cardiovascular risk in rheumatoid arthritis

A systemic inflammatory disease known as rheumatoid arthritis (RA) is distinguished by excessive cardiovascular disease (CVD) morbidity and death. Traditional CV risk factors may partially contribute to CV disease in RA. Shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, changes in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction are some of the mechanisms that link RA and CVD. The detailed pathogenetic pathway by which this association between RA and CVD might be explained is still not entirely known. It is crucial for controlling cardiovascular risk in people with RA. Optimizing care of traditional risk factors in addition to those inherent to RA is necessary to lessen the burden caused by CVD. The potential effect of planned Cardiac risk management in these individuals is highlighted by findings for under diagnosis and inadequate treatment of conventional CVD risk factors in RA. Present cardiovascular standards suggest RA patients to be examined for and treated for CVD risk factors without appropriate treatment goals. Utilizing potent anti-rheumatic medications that can reduce disease activity and treating the conventional CV risk factors should both be part of the therapy of CV risk in RA. There is currently insufficient scientific data to develop therapy targets for RA-related CVD risk factors. Thus, more study is required on the traditional CVD risk factor screening and management in RA patients.

Review on stroke induced depression

One of the frequent and dangerous aftereffects of stroke is post-stroke depression (PSD). About one in three stroke survivors had depression following their stroke. It had a significant impact on functional recovery, which resulted in a low standard of living. Even worse, there is a clear correlation between it and a high death rate. Our goal in doing this evaluation was to come up with a thorough and cohesive knowledge of PSD based on both recently released research and well-known works. We discovered that the incidence of PSD varies from 11 to 41% within a two-year period, based on a significant number of researches. The severity of the stroke, the location of the lesion, past history of depression, and other factors all has a role in the development of PSD. The DSM criteria are currently the primary basis for diagnosing PSD, and they are often coupled with different depression scales. However, there isn't a single, cohesive process that explains PSD which now include aberrant neurotrophic response, elevated inflammatory markers, lowered monoamine levels, glutamate-mediated excitotoxicity, and dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis. Pharmacotherapy and psychosocial therapies are currently used in the treatment of PSD. Even though researchers have made significant progress, many problems still need to be solved. In particular, the PSD's mechanism is not entirely understood.

Is domestic polyester suitable for plastination of thin brain slices?

Plastination is a technique used to preserve biological tissues while retaining most of their original appearance. In the technique, developed by Dr. Gunther von Hagens in 1977, specimens were impregnated with a polymer, such as silicone, epoxy, or polyester. Considered the most suitable material for brain plastination, polyester has a wide application in teaching and research compared with imaging techniques. The materials for plastination are usually imported from Germany and more expensive than domestic products. If domestic polymers were to enter the market it would favor the expansion of plastination in Brazil. Hence, this study evaluated the feasibility of using domestic polyesters to replace the usual Biodur® (P40) in plastination of brain slices. For this evaluation, 2-mm-thick sections of bovine brains were prepared and plastinated with domestic polyester. Slices were compared before impregnation and after curing using standardized photographs taken after dehydration and after curing. Plastination followed the standard protocol: fixation, dehydration, forced impregnation, and curing. Fifteen brain slices were plastinated with each polyester (P40, P18, and C1-3). There was no significant difference in the percent shrinkage between groups after plastination of P18 and P40, but the curing time of Cristalan© polymer was too short for impregnation. Therefore, no initiator was used for C polymers impregnation. Thus, domestic polyester P18 was a viable option for the process.

FUNCTIONAL EVALUATION OF PROXIMAL HUMERUS FRACTURES TREATED BY PHILOS PLATING

Introduction Proximal humeral fractures are now recognized as an increasingly common fracture, accounting for 4%–5% of all fractures and 45% of all humeral fractures [1,2]. It is the third most common fracture, in people above 65 years of age, after fractures of the hip and distal radius [3]. These fractures have a bimodal distribution occurring either in young people after high energy trauma or in those older than 50 years with low- velocity injuries like simple fall [3]. 85% of these fractures are minimally displaced and are effectively treated with immobilization followed by early motion. The remaining 15% of these are either displaced or unstable. These fare poorly with non-operative treatment and are better treated with surgical intervention. Surgical treatment is necessary especially in young patients and active elderly people in order to prevent minimal dislocations of tuberosity or articular surface from compromising the long-term articular function. This study was planned to evaluate the outcome of proximal humerus fractures managed with PHILOS plate after approval by the Institutional Ethical Board. To evaluate the ef?cacy of PHILOS plate in the treatment of Aims And Objectives proximal humeral fractures and assess its functional outcome. To assess any complications that could arise postoperatively Early rehabilitation of the patient Hospital Based Prospective study. Methods And Materials Study Design: Study Period: October 2019 to September 2022. Study is conducted in Department of Orthopaedics, Andhra Medical College, Study Setup: Visakhapatnam. Patients attending emergency/orthopaedic OP and admitted in department of Study Population: orthopaedics in King George Hospital, Visakhapatnam with proximal humerus fractures and are classi?ed according to Neer's Classi?cation 30 patients admitted in the Department of Orthopaedics, King George Hospital, Visakhapatnam Sample Size: with proximal humerus fractures in the above said period. We have included 30 proximal humeral fractures in our Results study. Males dominated and left side is more common than right. Domestic falls are common than road traf?c accidents. 2-part fractures are more common than 3- and 4-part fractures. All of them are treated with PHILOS stable angled plate. Complications like stiffness, screw penetration and super?cial infection occurred in our study which are dealt appropriately. Signi?cantly, we could prevent varus malunion which is notable in our study. Rehabilitation started early with pendulum exercises and could achieve good range of useful movements for most of the cases. Average range of radiological union is 13.5 weeks PHILOS plate, stable, angled construct is used in all our cases and the results evaluation done with . Conclusion Constant Murley score which ranged 54 to 87. Our average score is 67.43 which is in concurrence with few of the studies. The rehabilitation after operation started early with pendulum exercises as soon as the patients compliance within the limits of pain. The range of movements in our study, abduction maximum range obtained is 120 to 150 degrees and forward ?exion 90 to 120 degrees and rotations average score is 7. Though we have few complications like stiffness of shoulder (5), AVN (1), intra- articular screw penetration (1), super?cial infection (1) and subacromial impingement (1), we have dealt with all these complications appropriately. Signi?cantly, varus malunion did not occur in our study

Plastination with low viscosity silicone: strategy for less tissue shrinkage

Plastination is an anatomical technique for preserving biological tissues based on the principle of replacing body fluids with a curable polymer. An inconvenient aspect of this technique is the tissue shrinkage it causes; several studies seek ways to reduce or avoid this shrinkage. Additionally, there are no studies in the literature that quantitatively evaluate the use of low viscosity silicones in plastination having shrinkage of tissue as a parameter. Therefore, this study aimed to evaluate the use of Silicones S10 (Biodur) and P1 (Polisil) in the plastination of different types of biological tissues of a sliced human body, having as a parameter the tissue shrinkage caused in the forced impregnation stage. Human cardiac, pulmonary, splenic, renal, hepatic, muscular, and bone tissues were analyzed. For such purpose, a male human body was used, sliced in 13-15-mm-thick pieces, having as a parameter the before and the after plastination with the different silicones. The standard protocol of the plastination of the slices was followed: dehydration, forced impregnation, and curation. Half of the pieces obtained were plastinated with silicone P1 (group P1) and the other half with S10 (group S10). All tissues and anatomical segments analyzed in this study showed less or equal shrinkage when plastination of the control group (S10) was compared with that of the P1 group. Therefore, we concluded that the lower viscosity silicone promoted less tissue shrinkage, making it a viable alternative to the reference.

An open-label multicentric study of the tolerability and response to escitalopram treatment in Indian patients with major depressive disorder.

To evaluate the tolerability and response to escitalopram in Indian patients with major depression, over an 8-week open-label multicentric study was carried out among 18-65 years old Indian patients suffering from DSM IV major depressive disorder with Montgomery-Asberg depression rating scale (MADRS) total score> or =22. Patients received a fixed dose of escitalopram 10 mg daily for 2 weeks, followed by flexible dose of 10 to 20 mg daily for 6 weeks. Patients were evaluated for depression and rated on MADRS score and clinical global impressions-severity (CGI-S) and--improvement (CGI-I) scores. They were monitored for treatment-emergent adverse effects. A total of 119 patients were enrolled and 103 completed the trial. There was a decrease from baseline in the MADRS total score after one week of treatment continuing until 8 weeks. By week 8, 76.9% patients had responded to treatment (> or =50% or more reduction of MADRS total score). A similar pattern of improvement to that seen with the MADRS total score was seen with CGI-S and CGI-I scores. Escitalopram was well tolerated, with only 2 patients (1.7%) withdrawing from the study due to adverse events. There were no serious adverse events.

Transplante de fígado em dominó com técnica de duplo piggy back / Domino liver transplantation with the double pigg back technique

Os autores apresentam um caso de transplante hepático em dominó realizado com nova técnica cirúrgica. A paciente, portadora de Polineuropatia Amiloidótica Familiar Tipo I (PAF) foi submetida a hepatectomia pela técnica piggback, recebendo fígado de cadáver. O segundo paciente com cirrose vírus B e carcinoma hepatocelular, receptor dominó, também foi submetido a hepatectomia com preservação da veia cava recebendo enxerto após reconstruções vasculares (venosa e arterial). Ambos tiveram alta sem intercorrências. Os relatos demonstram que a modalidade de transplante hepático dominó é factível com a técnica de duplo piggback, prescindindo do desvio porto-cava-axilar