Determining the Borderline Anatomical Parameters for Better Functional Outcome of Colles Fracture: A Prospective Study / Determinação dos parâmetros anatômicos limítrofes para melhor desfecho funcional da fratura de Colles: Um estudo prospectivo

Abstract Objective The treatment of Colles fracture can deform the wrist. Some studies claim the resulting deformity rarely hinders daily activities, whereas others report the opposite; thus, anatomical reduction is desirable. Our objective was to analyze the anatomical and functional results of Colles fracture to find out the values of individual parameters corresponding to the best functional outcome. Methods The present prospective study included 70 elderly patients with Colles fracture. All patients were managed conservatively. The anatomical parameters were evaluated by measuring dorsal angulation, radial inclination, and radial height, and they were assessed as per Stewart et al. The functional result was assessed by the Mayo wrist score. The results were analyzed using the chi-squared test of association, and a p-value < 0.001 was considered statistically significant and to examine strengths of associations; we computed odds ratios (ORs) with 95% confidence intervals (CI). Results Excellent and good results were obtained in 68.5% of the cases anatomically and 78.5% functionally, which was statistically significant (p= 0.0009). Out of the three anatomical parameter dorsal angulation < 10° and loss of radial inclination < 9° showed statistically significant association with functional results (p= 0.0006), but loss of radial height < 6 mm did not (p= 0.0568), which became significant when loss of radial height was kept < 4 mm (p= 0.00062). Conclusion Fractures with anatomical reduction have better functional results. The acceptable borderline anatomical parameters for obtaining excellent or good functional results are dorsal angulation < 10°, loss of radial inclination < 9°, and loss of radial height < 4 mm.

Resumo Objetivo O tratamento da fratura de Colles pode deformar o pulso. Alguns estudos afirmam que essa deformidade raramente dificulta as atividades diárias, enquanto outros relatam o contrário; assim, a redução anatômica é desejável. Nosso objetivo foi analisar os resultados anatômicos e funcionais da fratura de Colles para descobrir os valores de parâmetros individuais correspondentes ao melhor desfecho funcional. Métodos Este estudo prospectivo incluiu 70 pacientes idosos com fratura de Colles. Todos os pacientes foram tratados de forma conservativa. Os parâmetros anatômicos foram a angulação dorsal, a inclinação radial e a altura radial, avaliados de acordo com Stewart et al. O resultado funcional foi avaliado segundo a tabela de pontuação de pulso Mayo. Os resultados foram analisados por meio do teste de associação do qui-quadrado, considerando o valor de p< 0,001 estatisticamente significativo. A força das associações foi analisada por razões de possibilidades com intervalos de confiança de 95%. Resultados Excelentes e bons resultados anatômicos e funcionais foram obtidos em 68,5% e 78,5% dos casos, respectivamente, com diferença estatística significativa (p= 0,0009). Dos três parâmetros anatômicos, a angulação dorsal inferior a 10° e a perda da inclinação radial inferior a 9° apresentaram associação estatisticamente significativa com os resultados funcionais (p= 0,0006), mas não a perda de altura radial inferior a 6 mm (p= 0,0568); no entanto, a perda da altura radial inferior a 4 mm foi associada de forma significativa aos desfechos funcionais (p= 0,00062). Conclusão As fraturas com redução anatômica apresentam melhores desfechos funcionais. Os parâmetros anatômicos limítrofes aceitáveis para a obtenção de resultados funcionais excelentes ou bons são angulação dorsal inferior a 10°, perda da inclinação radial inferior a 9° e perda da altura radial inferior a 4 mm.

Status of Lipid Profile in Hypertensive Patients of A, B, O and AB Blood Groups

Background: Hypertension is the most common illness of circulatory system and is a worldwide health challenge affecting both developed and developing nations. The development of hypertension is a multi-factorial process and the risk factors for its development are many such as genetic factors, obesity, age & sex factors, salt sensitivity, dyslipidemia, hyperinsulinemia & insulin resistance, environmental factors, socio economic imbalances, free radicals/reactive Oxygen species, oxidative stress, blood groups etc. The role of blood groups in the etiology of essential hypertension has long been suspected. Methods: The study design was a cohort study consisting of 15 hypertensive patients of the A, B, AB and O each. Anthropometric parameters such as Blood pressure (SBP/DBP) and Body Mass Index (BMI) and Biochemical parameters such as Blood grouping, Blood Glucose levels, Haemoglobin levels, Lipid profile, which included Triglycerides, Total cholesterol, HDL cholesterol and LDL and VLDL cholesterol, were measured using standardized methods. The various parameters were compared between hypertensives of the various blood groups and statistical analysis was done using SPSS. Mean and SD of each group was calculated, and Unpaired student’s t-test was applied (P < 0.05 considered as significant). Results: When BMI was compared among hypertensive groups we observed significant increased level of BMI in group A as compared to group O hypertensives. (10.36%; P<0.05). While comparing SBP between hypertensive groups we observed significant raised level of SBP in group A as compared to group B (9.38%; P<0.01) and O (10.45%; P<0.01). Similarly, DBP was found to be increased significantly in group A as compared to group B ((5.34%; P<0.05) and O hypertensive patients (5.06%; P<0.001). LDL-C and HDL-C were non-significantly altered in these groups however value of VLDL-C was found increased in group A as compared to group O hypertensives (20.38%; P< 0.05). Conclusion: The study concluded that there is a significantly higher SBP and DBP in the hypertensives of the A blood group as compared to the hypertensives of the B and O blood groups. It also found increased levels of serum triglycerides, total cholesterol, LDL-C, VLDL-C along with decreased levels of HDL-C was in hypertensive patients predominantly in group A and AB hypertensive. The hypertensive patients of A blood group have shown a statistically significant increase in BMI as compared to hypertensives of the other blood groups.

The Relation of Vitamin D Status and Presence of Acute Coronary Syndrome in Patients

Background: Cardiovascular disease (CVD) is consists of a variety of heart disease, illnesses and events that impact the heart & circulatory system, including high blood pressure &coronary artery disease (CAD). Vitamin D is one of the fat soluble vitamins also known as sunshine Vitamin due to its synthesis in the body following exposure to ultraviolet (UV) B rays. The aim of the study is to find the status of Vitamin D & there relation to Acute Coronary Syndrome. Materials and Methods:The present study included 50 cases of diagnosed acute coronary artery disease patients aged between 20 to 60 years and 50 apparently healthy controls and TMT negative matched for age and sex. Serum vitamin D was the measurement by ELISA method.Study Design: ProspectiveObservational Study.Results:The present study showed that significantly decreased levels of serum vitamin D (p<0.001) in acute coronary syndrome patients as compared with healthy controls.Conclusion:Decreased levels of vitamin D are a risk factor for the acute coronary syndrome, and also novel marker of CHD.

Antibacterial and Pharmacological Evaluation of Fluoroquinolones: A Chemoinformatics Approach

Fluoroquinolone (FQ) antibiotics are an important class of synthetic antibacterial agents. These are the most extensively used drugs for treating bacterial infections in the field of both human and veterinary medicine. Herein, the antibacterial and pharmacological properties of four fluoroquinolones: lomefloxacin, norfloxacin, ciprofloxacin, and ofloxacin have been studied. The objective of this study was to analyze the antibacterial characteristics of the different fluoroquinolones. Also, the pharmacological properties of the compounds including the Lipinski rule of five, absorption, distribution, metabolism, and excretion, LD50, drug likeliness, and toxicity were evaluated. We found that among all four FQ molecules, ofloxacin showed the highest antibacterial activity through in silico assays with a strong interaction (−38.52 kJ/mol) with the antibacterial target protein (topoisomerase-II DNA gyrase enzyme). The pharmacological and pharmacokinetic analysis also showed that the compounds ciprofloxacin, ofloxacin, lomefloxacin and norfloxacin have good pharmacological properties. Notably, ofloxacin was found to possess an IGC50 (concentration needed to inhibit 50% growth) value of 0.286 μg/L against the Tetrahymena pyriformis protozoa. It also tested negative for the Ames toxicity test, showing its non-carcinogenic character.

Immunohistochemistry: A diagnostic tool for accurate characterization of undifferentiated malignant tumours.

Background: The impact of diagnostic immunohistochemistry for the surgical pathology is legendary especially when it provides true identity of undifferentiated tumours. This not only is important for prognostication & therapy but also provide further insights into the pathobiology of these tumours. Aims & Objective: This study was undertaken to determine the role and significance of immunohistochemistry for accurate diagnosis and subtyping of undifferentiated malignant tumours as it is essential in guiding therapy and prognosis. Material and Methods: Immunohistochemical staining (IHC) performed was based on Peroxidase Antiperoxidase (PAP) method on paraffin sections, using appropriate mono/polyclonal antibodies. Total 74 cases including six consultation cases were studied from August 2008 to November 2011, which were reported as undifferentiated or poorly differentiated malignant tumor using routine hematoxylin- eosin stains. Results: The histopathology and IHC reports of 74 tumours were reviewed and assigned to appropriate categories. It was possible to arrive at a diagnosis in 73 cases (98.65%) with the help of IHC. Carcinoma was the commonest diagnosis (27 cases, 36.50%) followed by lymphoma (18 cases, 24.32%), sarcoma (14 cases, 18.92%), malignant melanoma (3 cases, 4.05%) and neuroblastoma (3 cases, 4.05%). Conclusion: Immunohistochemistry is helpful in the majority of difficulties arising during histological diagnosis of undifferentiated malignant tumours and serves as a diagnostic, prognostic, and predictive tool.

Cutaneous variant of angiokeratoma corporis diffusum: a case report

Angiokeratoma corporis diffusum [ACD] is a rare clinical type of angiokeratoma and has been reported, mostly, in association with various life threatening conditions, of which Fabry disease is the most known. Rarely, it has been reported as an isolated finding without any systemic features. A 23-year-old male presented with numerous red papules of various sizes with a history of intermittent bleeding. Histopathology findings were consistent with angiokeratoma and our case was diagnosed as ACD. We herein present a case of cutaneous variant of ACD without any associated systemic associations. Also, the conditions associated with ACD have been briefly discussed.

Association of alopecia areata with segmental vitiligo and segmental lichen planus: a case report

Alopecia areata [AA] is a chronic inflammatory condition that affects the hair follicles and sometimes, the nails. It is believed that AA is caused by T cell-mediated autoimmune response and increased frequency of other autoimmune diseases in persons suffering from AA supports this hypothesis. A 12-year-old boy presented with extensive alopecia areata with pitting in all nails for 6 years. He had developed lesions of vitiligo and lichen planus on trunk in a segmental manner. While the association of alopecia areata and vitiligo as well as lichen planus is well known, segmental nature of both vitiligo and lichen planus is quite rare

Entropy score, patent ductus arteriosus (PDA), and cardiopulmonary bypass (CPB): Ligation of PDA on CPB can compromise cerebral blood flow.

A patent ductus arteriosus (PDA) is often present in patients undergoing correction of congenital heart disease. It is well appreciated that during cardiopulmonary bypass (CPB), a PDA steals arterial inflow into pulmonary circulation, and may lead to systemic hypoperfusion, excessive pulmonary blood flow (PBF) and distention of the left heart. Therefore, PDA is preferably ligated before initiation of CPB. We describe acute decreases of arterial blood pressure and entropy score with the initiation of CPB and immediate increase in entropy score following the PDA ligation in a child undergoing intracardiac repair of ventricular septal defect and right ventricular infundibular stenosis. The observation strongly indicates that a PDA steals arterial inflow into pulmonary circulation and if the PDA is dissected and ligated on CPB or its ligation on CPB is delayed the cerebral perfusion is potentially compromised.

Pericardial tamponade after left posterolateral thoracotomy for left upper lobectomy for pulmonary aspergilloma.

Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.

Perifollicular hemorrhagic lesions and broken twisted hairs on legs

A 17-year-old girl presented with multiple perifollicular hemorrhagic lesions on legs for 2 weeks. There was history of intermittent gum bleeding for last 2 months. Clinical examination revealed follicular keratosis and broken twisted hair [corkscrew hair], in addition to hemorrhagic lesions. Perifollicular hemorrhagic lesions and corkscrew hair are virtually pathognomonic for scurvy. When specifically asked, mother revealed that the girl was on self-imposed diet with almost no citrus fruits. Based on history and clinical findings, diagnosis of scurvy was made. The response to vitamin C supplementation was very good and all the lesions disappeared within one month. Scurvy has been reported in increasing numbers in recent literature; hence, recognition of scurvy is essential to avoid many serious complications including internal bleeding and even, death

Hypoglycemic effect of Calotropis gigantean linn. leaves and flowers in streptozotocin-induced diabetic rats

To evaluate the hypoglycemic and anti-diabetic activity of chloroform extract of Calotropis gigantean leaves and flowers in normal rats and streptozotocin induced diabetes. The hypoglycemic activity in normal rats was carried out by treatment using chloroform extract of Calotropis gigantea leaf and flower 10, 20 and 50 mg/kg, orally. The oral glucose tolerance test was carried out by administering glucose [2 g/kg, p.o], to non-diabetic rats treated with leaf and flowers extracts at oral doses 10, 20 and 50 mg/ kg, p.o and glibenclamide 10 mg/kg. The serum glucose was then measured at 0, 1.5, 3 and 5 hr after administration of extracts/drug. Streptozotocin-induced diabetic rats were administered the same doses of leaf and flower extracts, and standard drugs glibenclamide was given to the normal rats or 0.5 ml of 5% Tween-80, for 27 days. The blood sample from all groups collected by retro-orbital puncture on 7, 14, 21 and 27th days after administration of the extracts/ drug and used for the estimation of serum glucose levels using the glucose kit. The Calotropis gigantean leaves and flowers extracts were effective in lowering serum glucose levels in normal rats. Improvement in oral glucose tolerance was also registered by treatment with Calotropis gigantean. The administration of leaf and flower extracts to streptozotocin-induced diabetic rats showed a significant reduction in serum glucose levels. It is concluded that chloroform extracts of calotropis gigantean leaves and flowers have significant anti-diabetic activity

Optimization of thermostable á- amylase production by Streptomyces erumpens MTCC 7317 in solid-state fermentation using cassava fibrous residue

Production of á- amylase under solid state fermentation by Streptomyces erumpens MTCC 7317 was investigated using cassava fibrous residue, one of the major solid waste released during extraction of starch from cassava (Manihot esculenta Crantz). Response surface methodology (RSM) was used to evaluate the effect of the main variables, i.e., incubation period (60 h), moisture holding capacity (60 percent) and temperature (50(0)C) on enzyme production by applying a full factorial Central Composite Design. Varying the inoculum concentration (5-25 percent) of S. erumpens showed that 15 percent inoculum (v/w, 2.5 x 10(6) CFU/ml) was the optimum for á- amylase production. Among the different nitrogen sources supplemented, beef extract was most suitable for enzyme production. The application of S. erumpens enzyme in liquefaction of soluble starch and cassava starch was studied. The maximum hydrolysis of soluble starch (85 percent) and cassava starch (70 percent) was obtained with the application of 5 ml crude enzyme (17185 units) after 5 h of incubation.