Multiple factors contributing to the metatarsal head eversion in hallux valgus deformity. A prospective study using weight-bearing CT.

PURPOSE: Recently first tarsometatarsal arthrodesis for hallux abducto valgus (HAV) has been advocated as the sole procedure to correct the multiplanar components of the deformity. However, recent debate suggests other factors such as rearfoot pronation and metatarsal torsion affect frontal plane metatarsal eversion and sesamoid positioning. Using weight-bearing CT, 12 feet (12 subjects) with HAV deformities were placed in positions of maximum rearfoot pronation and supination in order to study the effects on metatarsal eversion, sesamoid rotation/displacement, and secondarily the influence of first metatarsal torsion. Sesamoid displacement was quantified by the novel use of the sesamoid displacement angle. PRINCIPLE RESULTS: Although first metatarsal eversion was nearly double in the pronated versus supinated foot, the difference was not statistically significant. Therefore, the bulk of first metatarsal eversion was not secondary to rearfoot eversion. Conversely, a significant positive correlation was found between metatarsal torsion and metatarsal head eversion angles in both supinated and pronated foot positions, with the strongest correlation with rearfoot pronation. Finally, significant increases in sesamoid displacement angles were noted with pronation. MAJOR CONCLUSIONS: The findings of the present study support the contention that multiple factors are associated with frontal plane first metatarsal eversion and sesamoid displacement. Weight-bearing CT scanning can be used to effectively evaluate the frontal plane components in HAV deformities. The sesamoid displacement angle appears to be a useful adjunct to evaluating the hallucal sesamoids. For surgical correction of the deformity, consideration should be given to pre-operative weight-bearing CT evaluation of the foot. This can illuminate the effects of rearfoot/medial column pronation and the potential influence of metatarsal torsion on the frontal plane components of this triplane deformity. In this way the potential for post-operative HAV recurrence can be minimized.

Draft genome sequence of an extended-spectrum ß-lactamase-producing Escherichia coli ST58 isolate from cattle in Pakistan.

OBJECTIVES: Food animals have been recognised as an important reservoir of extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-Ec). This study reports the draft genome sequence of a bovine ESBL-Ec from Pakistan. METHODS: Genomic DNA from a bovine E. coli (PK-1421) was extracted and whole-genome sequencing was performed using an Illumina HiSeq 2500 platform. De novo genome assembly was performed using SPAdes v.3.9 and annotation of the assembled genome was performed using the DDBJ Fast Annotation and Submission Tool (DFAST). In silico tools from the Center for Genomic Epidemiology were used to find out for analysis of antimicrobial resistance genes, sequence type (ST), plasmid replicon type, serotype and phylogenetics. RESULTS: Escherichia coli strain PK-1421 showed multiple drug resistance. The draft genome was calculated at 4 869 610 bp, comprising a total of 131 contigs with a G + C content of 50.6% and 4487 protein-coding sequences. Escherichia coli PK-1412 belongs to ST58 and serotype O75:H9. A large number of antimicrobial resistance genes associated with resistance to ß-lactams (blaCTX-M-15, blaTEM-1B), trimethoprim (dfrA14), aminoglycosides [aph(3')-lb, aph(6)-ld], sulfonamides (sul2), tetracycline (tetA), macrolides (mdfA) and quinolones (qnrS1) were detected. A conjugation experiment showed successful transfer of the blaCTX-M-15 gene to an E. coli J53 recipient strain. The phylogenetic tree indicated that ST58 E. coli PK-1421 was distant from other strains. CONCLUSION: This is the first draft genome of an E. coli of bovine origin in Pakistan. The genome sequence presented here may be helpful to understand the genomic diversity and antimicrobial resistance potential of E. coli from large ruminants.

Drainage discharge impacts on hydrology and water quality of receiving streams in the wheatbelt of Western Australia.

The use of surface and subsurface drainage to manage waterlogging and salinity in dryland (rainfed) and irrigated agricultural systems is common throughout the world. The drainage systems often discharge into natural streams. The same is true for the wheatbelt drainage systems in south-western Australia, where 11,000 km (ABS 2003) of artificial drains have been constructed within the last two decades. Prior to this study, the likely impacts of this discharge on the streambed chemistry and water quality of receiving streams were largely unknown. The study evaluated these impacts in creeks receiving the drainage discharge from engineering options in four river systems in south-western Australia. This study clearly showed elevated levels of metals ions, EC and pH in the stream water at treated sites relative to their levels at untreated sites. At most sites, impacts of drainage discharge were observed on the streambed electrical conductivity (EC) and pH (both in 1:5 extract) in the receiving streams; however, there was little evidence of impact on metal ion content in the streambed soil. The study found no clear differences in the dynamics of the watertable adjacent to streams whether they received drainage discharge or not, irrespective of the size of the artificial drainage systems.

Performance of complement fixation test and confirmatory immunoblot as two-cascade testing approach for serodiagnosis of glanders in an endemic region of South East Asia.

Various serological tests were used for the diagnosis of glanders in the past but still complement fixation test (CFT) is the internationally prescribed test for trading equines. A new immunoblot (IB) technique has recently been introduced to overcome the well known shortcomings of CFT i. e. a considerable number of false positive and negative results and anticomplementary effects of sera. The objective of this study was the comparative evaluation of two glanders CFT antigens commercially available at Central Veterinary Institute ofWageningen UR, Lelystad, NL (CIDC) and at c.c.pro GmbH, Oberdorla, DE (c.c.pro) in a glanders endemic area regarding specificity and sensitivity. A total of 1678 serum samples from the endemic region (Province Punjab, Pakistan) and a non-endemic area (Germany) were analysed. All sera tested positive or suspicious with CFT were analysed by the confirmatory IB to exclude CFT false positive results. Both CFT antigens showed 100% sensitivity. The use of CIDC or c.c.pro antigen resulted in specificities of 77.45% or 75.71% for sera from endemic area and 93.75% or 94.79% for sera from non-endemic areas, respectively. The results demonstrate the different performances of identical tests in different epidemiologically settings. Based on these results, the combined use of CFT and IB is highly suggestive for the serodiagnosis of glanders. Good agreement was calculated between CFT (using either c.c.pro or CIDC antigen) and immunoblot.

Separation of xiphi-omphalo-ischiopagus tetrapus twins with favorable internal anatomy.

Conjoined twinning is a rare occurrence, and ischiopagus variety is even more rare. So far, only 20 cases have been reported. The incidence is 1 in 500,000. Because of its rarity and variable anatomy, no definite line of treatment can be adapted. Time of operation and mode of treatment have to be tailored according to the local circumstances and organ sharing in each individual pair. The twins in this report were xi phi-omphalo-ischiopagus tetrapus conjoined twins. Although several internal organs were fused and shared, they were complete mirror image sets for each twin. In this case report, details of anatomy and more importantly, preoperative investigations, preparations, and organizational aspects that were designed to suit local conditions are described. Operative details, postoperative care, and short and long-term progress also has been highlighted.