Gonioscopic angle evaluation and its correlation with graft survival and post-operative ocular hypertension in patients of Descemet’s stripping endothelial keratoplasty

Purpose: To evaluate the gonioscopic changes in patients receiving Descemet’s stripping endothelial keratoplasty (DSEK) without pre?existing ocular hypertension (OHT) and to report its correlation with post?surgery OHT, graft survival, and visual outcomes. Methods: Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow?up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post?DSEK OHT details were documented. Results: A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra?ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid?induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre?operative best corrected visual acuity was 1.62 logMAR (range 1.17–1.77), which gradually improved to 0.79 logMAR (range 0.3–1.77) after 2 years (p < 0.00001). Conclusion: PAS was found to be an important factor associated with post?DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also.

Assessment of stereopsis in pediatric and adolescent spectacle-corrected refractive error – A cross-sectional study

Purpose: To assess the level of stereopsis in school children with spectacle?corrected refractive errors using Titmus fly and Randot stereo tests, evaluate the factors associated with the level of stereopsis, and determine the level of agreement between the two tests. Methods: A cross?sectional study was done on 5? to 18?year?old school?children wearing spectacles for at least 1?month duration. Visual acuity was assessed using Snellen’s visual acuity chart, and their spectacle correction being used currently was measured using an auto lensmeter. The level of stereopsis was assessed using Randot and Titmus fly stereo tests. Data were entered using Microsoft Excel and analyzed using IBM?SPSS version 20, Chicago, IL. The associations between stereopsis and type of refractive error, visual acuity, age, and gender were analyzed. An agreement between Randot and Titmus fly test was done using Kappa statistics. Results: A total of 222 children (101 boys and 121 girls; mean age 13 years) were assessed. Astigmatism was the most prevalent refractive error (60.4%), followed by myopia (24.8%) and hypermetropia (1.4%). Thirty children (13.5%) had anisometropia. All hyperopes had normal stereopsis. Children with spherical myopia had better stereopsis, followed by astigmatism and anisometropia in the same order (P = 0.036). Children with anisometropia ?1.5 D had better stereopsis than anisometropia more than 1.5 D. Stereopsis was also found to have no correlation with the age and visual acuity at the time of testing or the age at which the child first started wearing spectacles. Stereopsis values obtained from Randot and Titmus fly stereo tests showed moderate agreement with Kappa value 0.581. Conclusion: Anisometropia and astigmatism are the most critical factors determining the level of stereopsis in refractive errors

Exploring the Pathway towards Depression among Working Married Women � A Qualitative Study Done In Urban Area of Kancheepuram District, Tamil Nadu

Introduction: Globally, around 264 million people suffer from depression according to World Health Organization (WHO). As per the National Mental Health Survey (NMHS), in the year 2015-2016, one in 20 people over the age of 18 years have ever had depression in India amounting to 45 million persons with depression in the year 2015. This study aimed to find out the self-perceived reasons of depression among married working women residing in an urban area of Kancheepuram district, Tamil Nadu. Methodology: This is a qualitative study done on married working urban women above 18 years of age visiting an UHTC of a private medical college at Anakaputhur. Patient Health Questionnaire (PHQ-9) was used to assess whether they have depression. Data was collected by in-depth interviews, and it was recorded and transcribed verbatim. Results: Based on the responses obtained from the participants the following themes and subthemes are formed like Workplace factors, Factors related to family, social factors and Mental Health seeking behaviour. Among the workplace factors job satisfaction, long working hours and relationship with peers were common reasons elicited. Conclusion: Most of these problems could be overcome only if the society changes their mentality about women and practice gender equality and social justice.

Effect of Vitiligo on Auditory Functions: Is There Any Association?

Abstract Introduction Vitiligo is an acquired pigmentary disorder of unknown etiology, clinically characterized by whitish macules caused by selective loss of melanocytes. There are many melanocytes in the human cochlea. Recent studies have suggested a direct relation between cochlear dysfunction and decreased amounts of melanin. Objective To determine the effect of vitiligo on auditory function. Methods The present prospective, case control study was performed over a period of 1 year in patients between 15 and 40 years old with nonsegmental disease and the same number of controls. Pure tone audiometry (PTA) and Otoacoustic emission (OAE) were performed to analyze the correlation between vitiligo and auditory function. Results The mean pure tone audiometric threshold in the right ear at 0.5, 8 kHz, and in the left ear at the frequency of 8 kHz in the case group were significantly higher as compared with controls. The average band reproducibility (%) in the right and left ear of controls was significantly higher at the frequency of 4 kHz as compared with cases. It has been observed that signal to noise ratio was statistically higher at the frequency of 5kHz in the right ear and at 2, 3, and 5kHz in the left ear in controls as compared with cases. On the basis of disease type and duration of disease; mean pure tone audiometric threshold, average band reproducibility and signal to noise ratio, no significant effect was observed in the present study. Conclusion Vitiligo has an effect on cochlear function irrespective of the duration or distribution of the disease.

Targeted sequencing of the DMD locus: A comprehensive diagnostic tool for all mutations

Background & objectives: Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder and is caused mainly by deletion, duplication and point mutations in the DMD gene. Diagnosis of DMD has been a challenge as the mutations in the DMD gene are heterogeneous and require more than one diagnostic strategy for the validation of the mutation. This study was planned to evaluate the targeted next-generation sequencing (NGS) as a single platform to detect all types of mutations in the DMD gene, thereby reducing the time and costs compared to conventional sequential testing and also provide precise genetic information for emerging gene therapies. Methods: The study included 20 unrelated families and 22 patients from an Indian population who were screened for DMD based on phenotypes such as scoliosis, toe walking and loss of ambulation. Peripheral blood DNA was isolated and subjected to multiplex ligation-dependent probe amplification (MLPA) and targeted NGS of the DMD gene to identify the nature of the mutation. Results: In the study patients, 77 per cent of large deletion mutations and 23 per cent single-nucleotide variations (SNVs) were identified. Novel mutations were also identified along with reported deletions, point mutations and partial deletions within the exon of the DMD gene. Interpretation & conclusions: Our findings showed the importance of NGS in the routine diagnostic practice in the identification of DMD mutations over sequential testing. It may be used as a single-point diagnostic strategy irrespective of the mutation type, thereby reducing the turnaround time and cost for multiple diagnostic tests such as MLPA and Sanger sequencing. Though MLPA is a sensitive technique and is the first line of a diagnostic test, the targeted NGS of the DMD gene may have an advantage of having a single diagnostic test. A study on a larger number of patients is needed to highlight NGS as a single, comprehensive platform for the diagnosis of DMD.

A study of clinical profile of patients with organophosphorus poisoning

Background: Depression, a common mental disorder characterized by persistent unhappiness and lack of interest in daily activities, is one of the major important public health problems that are often comorbid with other chronic diseases like diabetes and can worsen the effect of the disease outcomes. Depression alone and/or as a comorbidity with diabetes is a common condition in the community. Aim of the study: To identify the prevalence of Depression among Type 2 Diabetes Mellitus patients and relationship between Depression and its effect on Drug Compliance among Type 2 Diabetes Mellitus patients, to determine the severity of Depression among Type 2 Diabetes Mellitus patients and the extent to which it affects Drug compliance. Materials and methods: The study was to be conducted in Rajah Muthiah Medical College and Hospital, Chidambaram in the year 2018-2019. A hundred patients with diagnosis of T2DM attending Diabetic OPD above 20 years of age were randomly selected. The Hamilton rating scale for depression by Hamilton is the most widely used rating scale to assess the symptoms of depression. The Ham-D is an observer-rated scale consisting of 17-21 items. Ratings are based on clinical interview. The items are rated on either a 0 to 4 spectrum or a 0 to 2 spectrum. The HAM-D also relies quite heavily on the clinical interviewing skills and the experience of rater in evaluating individuals with depressive illness. The strength of HAM-D is its excellent validation/research base, K.H. Mohamed Ibrahim, R. Gandhi Babu, M. Senthil Velan. Prevalence of psychiatric morbidity (depression) and its effect on drug compliance among patients attending diabetic outpatient clinic. IAIM, 2019; 6(11): 19-28. Page 20 and case of administration. Its use is limited in individuals who have psychiatric disorders other than primary depression. Results: Analyzing with HAMD score, 40 had no depression, mild depression in 24 cases, moderate depression in 21 cases, severe depression in 15 cases. MAQ score scale- low adherence in 41 cases, medium adherence in 37 cases, high adherence in 22 cases. MMAQ score scale and HAMD scorelow adherence with no depression were 9 cases (22.5%) mild depression were 6 cases (25%) moderate were 11(52.4%) severe depression were 15 cases (100%). MMAQ score scale and HAMD score - medium adherence with no depression were 23 cases (57.5%) mild depression were 9 cases (37.5%) moderate were 5(23.8%) severe depression were not seen. MMAQ score scale and HAMD score - Medium adherence with no depression were 8 cases (20%) Mild depression were 9 cases (37.5%) Moderate were 5(23.8%) severe depression was not seen. Pearson Chi-Square = 35.344**, p<0.001. Conclusion: Further, there was a significant association between the depression in Type 2 diabetes patients and medication adherence, where patients with depression had poor medication adherence as compared to those without depression and severity of depression correlates with worse adherence to diabetic medications

Estimation of superoxide dismutase levels in saliva and gingival crevicular fluid among smokers and non-smokers in periodontitis patients - an observational study

Background: Smoking, which is an important risk factor for periodontitis, induces oxidative stress in the body and causes an imbalance between reactive oxygen species (ROS) and antioxidants, such as superoxide dismutase (SOD). The present study was done to quantify and compare the level of SOD enzyme levels in gingival crevicular fluid (GCF) and saliva among smokers and nonsmokers. Methodology: One hundred and thirty-five individuals in the age range of 20­55 years, including 45 light smokers, 45 heavy smokers, and 45 nonsmokers (controls), were selected and the clinical parameters recorded were plaque index, probing depth, and attachment loss. Smokers were divided into light smokers (<10 cigarettes/day) and heavy smokers (>10 cigarettes/day) and into three subgroups: healthy, mild periodontitis, and moderate periodontitis. GCF and saliva samples were collected then SOD levels were analyzed using spectrophotometric assay. Results: The mean levels of SOD in the GCF and saliva of smokers were decreased compared to controls. Intra- and inter-group analyses showed a significant reduction in the levels of SOD in the GCF and saliva of heavy smokers compared to light smokers and the control group. Conclusions: There was a progressive reduction in SOD levels from healthy nonsmokers to light smokers to heavy smokers

Effect of HIV and Antiretroviral Treatment on Auditory Functions

Abstract Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250-8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.

Effect of flavonoid rich fraction of Tephrosia purpurea (Linn.) Pers. on complications associated with streptozotocin-induced type I diabetes mellitus.

Globally, diabetes is a serious health issue affecting one in 11 adults and consumes 12% of global health expenditure. Prevalence of dyslipidemia in diabetes is not uncommon since decades. Further, patients with type II diabetes have 2-4 folds more risk for cardiovascular disease (CVD). Plants with antioxidant potential are known to have beneficial effects in diabetes and its complications. Natural compounds, flavonoids particularly, ameliorate hyperglycemia as well as CVD. Here, we evaluated common wasteland weed Tephrosia purpurea, used traditionally as folk medicine to treat many disorders including diabetes. We studied the effect of 8-wk treatment of flavonoid-rich fraction of T. purpurea (FFTp) (40 mg/kg/day/p.o.) on various biochemical, cardiovascular and lenticular parameters on streptozotocin (STZ) (45 mg/kg, i.v.) induced type I diabetic rats. STZ administration produced significant hyperglycemia, dyslipidemia, and altered cardiac biomarkers like lactate dehydrogenase, creatinine kinase and reduced antioxidants in lenticular tissues of rats. Treatment with FFTp significantly prevented STZ-induced hyperglycemia, dyslipidemia as well as cardiovascular markers. We observed decreased rate of pressure development (+dp/dt) and decay (-dp/dt) in STZ diabetic hearts which was prevented by FFTp. Further, the soluble protein levels and the antioxidants were also elevated in the diabetic rats by the treatment. In conclusion, our data suggest that FFTp produces beneficial effects on diabetes induced cardiovascular complications and cataract. Such beneficial actions may be attributed to the antioxidant property of flavonoids, quercetin or rutin, present in T. purpurea.

Eruption chronology of Primary Teeth in Garhwa district, Jharkhand, India

Introduction: Tooth eruption marks a milestone in a child’s development and is synchronous with growth and development of the craniofacial complex. Thus, the present study was carried to evaluate the timing and sequence of eruption of deciduous teeth among children of India. Materials and methods: The present study was carried out on 60 children (30 boys and 30 girls), aged between 5 till the emergence of II deciduous molar in the oral cavity, who were local residents, born and residing in that area and were visited regularly at monthly intervals at their homes. All the data were compiled and tabulated using the SPSS software package version 18. Comparison was made between the data obtained and the standard tooth eruption table. The Student t’ test was used to assess the significance of difference in the mean age of tooth eruption with p value of <0.005 as significant value. Results: Comparing the maxillary and mandibular arches, mandibular central incisor at 8.85 ± 1.05 was the first tooth to erupt and maxillary second molar was erupted at 28.12 ± 1.5 months were the last deciduous tooth to erupt in the oral cavity. Females showed delayed eruption compared to males in case of anterior teeth, and males showed delayed eruption in case of posterior deciduous teeth. Though the difference was not significant (p> 0.05), there was a systematic tendency for early eruption of left sided primary teeth, though the difference was not significant. K. Vinod, Singh R, Suryavanshi R, Ashok Kumar, Singh RK, Ranjan R. Eruption chronology of Primary Teeth in Garhwa district, Jharkhand, India. IAIM, 2016; 3(5): 81-84. Page 82 Conclusion: The present study found delay in eruption. Hence, studies conducted to evaluate time to time estimation of variation of eruption sequence among different populations is important for general dental practitioners, and pediatric dentists to contend with the anxiety of the parents.

Molecular Dynamics Simulation of Β-Melanotropin Stimulating Hormone (Β-MSH) Docked Onto the Receptor MC4R.

Melanocortin system is composed of four peptide hormones known as α, β, γ and adrenocorticotropic hormone (ACTH), derived from post-translational cleavage of a polypeptide precursor ‘proopiomelanocortin (POMC)’. Among these hormones; β-melanotropin stimulating hormone (β-MSH), an 18 amino acid residue peptide fragment is an important hormone as it is involved in activation of MC4R to induce lean phenotype ‘balance between energy intake and energy expenditure’. In addition to this, MC4R is also involved in the modulation of erectile function, including the spinal cord and pelvic ganglion of rats and the penis of both rats and humans, providing an anatomical basis for melanocortin effects on sexual function. MC4R is one of the five melanocortin receptors (MC1R–MC5R) which have been characterized with tissue-specific expression patterns and different binding affinities for each of the melanocortin hormones to regulate various biological functions. In the present work, 3D models of MC4R and β-MSH have been predicted, followed by docking and molecular dynamics simulation. While the 3D model of MC4R receptor has been predicted through threading approach, structure of β- MSH was built based on ab initio technique. The β-MSH model was later successfully docked onto the MC4R protein. Molecular dynamics (MD) simulation for 15 ns was used to compute the electrostatic solvation energy as well as binding energy between MC4R with β-MSH model under implicit solvent conditions.

Response of aerobic rice to Piriformospora indica.

Rice cultivation under aerobic condition not only saves water but also opens up a splendid scope for effective application of beneficial root symbionts in rice crop unlike conventional puddled rice cultivation where water logged condition acts as constraint for easy proliferation of various beneficial soil microorganisms like arbuscular mycorrhizal (AM) fungi. Keeping these in view, an in silico investigation were carried out to explore the interaction of hydrogen phosphate with phosphate transporter protein (PTP) from P. indica. This was followed by greenhouse investigation to study the response of aerobic rice to Glomus fasciculatum, a conventional P biofertilizer and P. indica, an alternative to AM fungi. Computational studies using ClustalW tool revealed several conserved motifs between the phosphate transporters from Piriformospora indica and 8 other Glomus species. The 3D model of PTP from P.indica resembling “Mayan temple” was successfully docked onto hydrogen phosphate, indicating the affinity of this protein for inorganic phosphorus. Greenhouse studies revealed inoculation of aerobic rice either with P. indica, G. fasciculatum or both significantly enhanced the plant growth, biomass and yield with higher NPK, chlorophyll and sugar compared to uninoculated ones, P. indica inoculated plants being superior. A significantly enhanced activity of acid phosphatase and alkaline phosphatase were noticed in the rhizosphere soil of rice plants inoculated either with P. indica, G. fasciculatum or both, contributing to higher P uptake. Further, inoculation of aerobic rice plants with P. indica proved to be a better choice as a potential biofertilizer over mycorrhiza.

Identification, Isolation and Amplification of BRCA1 Gene Involved on Breast Cancer.

Cancer is a disease that begins in the cells of the body which is characterized by uncontrolled, uncoordinated and undesirable cell division. If a cell accumulates critical mutations in five or six of the protooncogenes, tumour suppressor genes and DNA repair genes are likely to result in a fully malignant cell, capable of forming a tumour. In this work we described the isolation and amplification of the BRCA1 gene. Primers were designed and synthesised later used to amplify the BRCA1 gene. The total new workflow includes all steps from purified DNA to data analysis, and includes PCR for all amplicons covering the gene, PCR cleanup, cycle sequencing, electrophoresis, and data analysis. To simplify workflows and decrease the time-to-result, we focused on the method “one sample, one assay” approach. The success of this workflow was the 24-well plate design, which contained prespotted PCR primers covering the gene and also included multiplex nontemplate controls. The workflow was developed using a Genetic Analyzer and bands were observed.

Lack of association between plasma levels of non-nucleoside reverse transcriptase inhibitors & virological outcomes during rifampicin co-administration in HIV-infected TB patients.

Background & objectives: Among patients with HIV-associated tuberculosis (TB), reduced plasma non-nucleoside reverse transcriptase inhibitors (NNRTI) concentrations during rifampicin (RMP) co-administration could lead to HIV treatment failure. This study was undertaken to examine the association between plasma nevirapine (NVP) and efavirenz (EFV) concentrations and virological outcomes in patients infected with HIV-1 and TB. Methods: This was a nested study undertaken in a clinical trial of patients with HIV-1 and TB, randomized to two different once-daily antiretroviral treatment (ART) regimens along with anti-TB treatment (ATT). Trough concentrations of plasma NVP and EFV were estimated at months 1 (during ATT and ART) and 6 months (ART only) by HPLC. Plasma HIV-1 RNA level >400 copies/ml or death within 6 months of ART were considered as unfavourable outcomes. Genotyping of CYP2B6 516G>T polymorphism was performed. Results: Twenty nine per cent of patients in NVP arm had an unfavourable outcome at 6 months compared to 9 per cent in EFV arm (P<0.08). The mean NVP and EFV levels estimated at 1 and 6 months did not significantly differ between favourable and unfavourable responders. Logistic regression analysis showed CYP2B6 516G>T polymorphism significantly associated with virologic outcome in patients receiving EFV–based regimen. Interpretation & conclusions: Trough plasma concentrations of NVP and EFV did not show any association with response to ART in patients on ATT and once-daily ART. CYP2B6 516G>T polymorphism was associated with virologic outcome among patients on EFV.

Alternaria alternata in a case of mass in the lung.

A 50-year-old woman, an agriculture worker with diabetes and asthma presented to us with complaints of fever with chills, cough with scanty, mucopurulent sputum and dull aching chest pain in right mammary area radiating to axilla. Chest X-ray and computed tomography scan revealed mass in the right lung. Ultrasound guided fine-needle aspiration cytology was done and the greenish fluid on direct wet mount and inoculation on Sabouraud's dextrose agar isolated Alternaria species. Serum specimen was evaluated for immunoglobulin E specific titres for Alternaria species which was high. Patient was treated with fluconazole for 6 weeks after which the symptoms disappeared and chest X-ray was normal.

Predictors of early outcome in unstable pelvic fractures / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures.</p><p><b>METHODS</b>This study was performed prospectively from January 2009 to June 2011 on 36 consecutive patients admitted to the trauma ward of Postgraduate Institute of Medical Education and Research, Chandigarh, with unstable pelvic injuries.</p><p><b>RESULTS</b>In the present study of 36 patients, 29 were managed surgically. Surgical duration was 2 hours in patients operated on within 1 week and 3.4 hours in those operated on after 1 week. The blood loss was 550 ml when surgery was done after a week, but when done within a week it was 350 ml. The average blood loss through Pfanenstial approach was 360 ml, through posterior approach was 408 ml and through combined approach was 660 ml which was significantly high.</p><p><b>CONCLUSION</b>Anterior approach to the pelvis would cause significantly more amount of blood loss than posterior approach and external fixation. Surgical approaches do not have any influence on the surgical duration or the infection rate. The blood loss significantly increases when the surgical time is more than 1 h. The infection rate is not influenced by the duration of surgery. Presence or absence of associated injuries to the head, chest or abdomen is the main determinants of patient's survival and it greatly influences the duration of hospital stay.</p>

Characterization of nasopharyngeal isolates of type b Haemophilus influenzae from Delhi.

Background & objectives: Haemophilus influenzae is an important cause of mortality and morbidity among young children in developing countries. Increasing incidence of antibiotic resistance especially production of extended spectrum beta lactamase (ESBL) has made treatment and management of H. influenzae infection more difficult. Nasopharyngeal H. influenzae isolates are excellent surrogate for determination of antibiotic resistance prevalent among invasive H. influenzae isolates. In this study, we characterized nasopharyngeal H. influenzae isolates obtained from healthy school going children in Delhi. Methods: Nasopharyngeal H. influenzae isolates were collected from healthy school going children and subjected to serotyping, fimbrial typing and antibiogram profiling. ESBL production was recorded using phenotypic as well as molecular methods. Multi locus sequence typing (MLST) of 13 representative nasopharyngeal H. influenzae isolates was performed as per guidelines. Results: A significant proportion (26 of 80, 32.5%) of nasopharyngeal isolates of H. influenzae were identified as serotype b. Fimbrial gene (hifA) was detected in 23 (28.75%) isolates. Resistance against commonly prescribed antibiotics (Amp, Tet, Chloro, Septran, Cephalexin) were observed to be high among the nasopharyngeal commensal H. influenzae. Extended spectrum beta lactamase (ESBL) production was observed in a five (6.25%) isolates by both double disk diffusion and molecular typing. MLST identified several novel alleles as well as novel sequence types. Interpretation & conclusions: Our findings showed high resistance against common antibiotics and detection of ESBL in nasopharyngeal H. influenzae isolates collected from normal healthy school going children in Delhi. Detection of H. influenzae type b capsular gene and the presence of fimbrial gene (hif A) suggest virulence potential of these isolates. Discovery of novel alleles and presence of new sequence types (STs) among nasopharyngeal H. influenzae isolates may suggest wider genetic diversity.

Buttress plating for a rare case of comminuted medial condylar Hoffa fracture associated with patellar fracture / 中华创伤杂志(英文版)

Hoffa fracture is an uncommon injury. In the literature, lateral condylar Hoffa fracture is mentioned as a more common injury pattern than medial condylar Hoffa fracture. The mechanism of injury and method of treatment is not very well described in the literature. We are presenting a rare case of comminuted medial condylar Hoffa fracture with ipsilateral patellar fracture. The mechanism of injury has not been described in the literature. Lag screw fixation, which is the most acceptable method of treatment, is not possible due to comminution. We explain the possible mechanism of injury and fix the fracture with L-buttress plate.