Correlation of Foot Bimalleolar Angle and Ultrasonography in Assessing the Severity of Club Foot in Neonates Treated by the Ponseti Method.

Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method. Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression. Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05). Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.

Correlation of Foot Bimalleolar Angle and Ultrasonography in Assessing the Severity of Club Foot in Neonates Treated by the Ponseti Method

@#Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method. Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression. Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05). Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.

QRS detection using adaptive filters: A comparative study.

Electrocardiogram (ECG) is one of the most important physiological signals of human body, which contains important clinical information about the heart. Monitoring of ECG signal is done through QRS detection. In this paper, an improved QRS detection algorithm, based on adaptive filtering principle, has been designed. Enumeration of the effectiveness of various LMS variants used in adaptive filtering based QRS detection algorithm has been done through fidelity parameters like sensitivity and positive predictivity. Whole family of LMS algorithm has been implemented for comparison. Sign-sign LMS, sign error LMS, basic LMS and normalized LMS are re-implemented, while variable leaky LMS, variable step-size LMS, leaky LMS, recursive least squares (RLS), and fractional LMS are novel combination presented in this paper. After analysis of the obtained results, performance of leaky-LMS algorithm is found to be the best with sensitivity, positive predictivity, and processing time of 99.68%, 99.84%, and 0.45s respectively. Reported results are tested and evaluated over MIT/BIH arrhythmia database. Presented study also concludes that the performance of most of the variants gets affected due to low SNR but the Leaky LMS performs better even under heavy noise conditions.

Fertility suppression in male albino rats by administration of methanolic extract of Opuntia dillenii.

To control growing world population, there is a need for male contraceptive methods that are comparable to female contraceptives, but due to lack of knowledge or investigation, no sufficient safe and effective contraceptives were developed till now. In the present investigation, the effect of 100% methanol extract of Opuntia dillenii phylloclade on reproduction in male rats was studied. A first group (I) received vehicle alone to serve as control. The second group (II) was further divided into treated and recovery groups, and the plant extract at 50 mg kg body weight(-1) was administered orally for 30 days. Biochemical, haematological and histopathological analyses were carried out to reveal the effects on reproductive organs in the male rats. The weights of reproductive organs were recorded. It was found that the number of fertile males, number of inseminated females, number of litters delivered and testosterone levels were reduced significantly. Epididymal sperm count and motility were also significantly decreased. Biochemical parameters support the antifertility activity of O. dillenii i.e. decreases in protein, glycogen content and elevation in cholesterol level. Testes and sperm morphology were altered significantly. Haematological parameters have not shown any significant changes. It is concluded that 100% methanol extract of O. dillenii possesses antifertility effects on male reproduction without change in general physiology.

Surgical excision of acne keloidalis nuchae with secondary intention healing.

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that presents clinically as follicular papules and pustules. These can coalesce into firm hypertrophic plaques and nodules on the nape of the neck, most commonly affecting young adult men. Treatment includes topical steroids/antibiotics and oral antibiotics, but often has disappointing results. Surgical approaches include excision with primary closure or skin grafting, and hair-removal lasers. Another surgical approach is excision with secondary intention healing. This can result in good cosmesis with little or no recurrence. We report two men with AKN where treatment by excision with secondary intention was successful.

High-Field Dynamic Nuclear Polarization for Solid and Solution Biological NMR.

Dynamic nuclear polarization (DNP) results in a substantial nuclear polarization enhancement through a transfer of the magnetization from electrons to nuclei. Recent years have seen considerable progress in the development of DNP experiments directed towards enhancing sensitivity in biological nuclear magnetic resonance (NMR). This review covers the applications, hardware, polarizing agents, and theoretical descriptions that were developed at the Francis Bitter Magnet Laboratory at Massachusetts Institute of Technology for high-field DNP experiments. In frozen dielectrics, the enhanced nuclear polarization developed in the vicinity of the polarizing agent can be efficiently dispersed to the bulk of the sample via (1)H spin diffusion. This strategy has been proven effective in polarizing biologically interesting systems, such as nanocrystalline peptides and membrane proteins, without leading to paramagnetic broadening of the NMR signals. Gyrotrons have been used as a source of high-power (5-10 W) microwaves up to 460 GHz as required for the DNP experiments. Other hardware has also been developed allowing in situ microwave irradiation integrated with cryogenic magic-angle-spinning solid-state NMR. Advances in the quantum mechanical treatment are successful in describing the mechanism by which new biradical polarizing agents yield larger enhancements at higher magnetic fields. Finally, pulsed methods and solution experiments should play a prominent role in the future of DNP.

Use of oral glycopyrronium bromide in hyperhidrosis.

BACKGROUND: Idiopathic hyperhidrosis may be a disabling condition causing emotional stress and negative impact on a patient's quality of life. Oral anticholinergics are one of the treatments available. There are few published data on the use of the anticholinergic drug glycopyrronium bromide (glycopyrrolate) given orally in the treatment of hyperhidrosis. OBJECTIVES: To report a retrospective analysis describing the treatment responses, doses and side-effects of oral glycopyrrolate in the treatment of idiopathic hyperhidrosis. METHODS: Review of case notes in a series of 24 patients, nine with generalized and 15 with localized hyperhidrosis. RESULTS: Fifteen of 19 evaluable patients (79%) responded to oral glycopyrrolate. However, treatment was limited by side-effects in around one third of patients. CONCLUSIONS: A prospective clinical study to compare the efficacy and side-effects of oral anticholinergics is warranted.

Dynamic nuclear polarization at 9T using a novel 250GHz gyrotron microwave source.

In this communication, we report enhancements of nuclear spin polarization by dynamic nuclear polarization (DNP) in static and spinning solids at a magnetic field strength of 9T (250 GHz for g=2 electrons, 380 MHz for 1H). In these experiments, 1H enhancements of up to 170+/-50 have been observed in 1-13C-glycine dispersed in a 60:40 glycerol/water matrix at temperatures of 20K; in addition, we have observed significant enhancements in 15N spectra of unoriented pf1-bacteriophage. Finally, enhancements of approximately 17 have been obtained in two-dimensional 13C-13C chemical shift correlation spectra of the amino acid U-13C, 15N-proline during magic angle spinning (MAS), demonstrating the stability of the DNP experiment for sustained acquisition and for quantitative experiments incorporating dipolar recoupling. In all cases, we have exploited the thermal mixing DNP mechanism with the nitroxide radical 4-amino-TEMPO as the paramagnetic dopant. These are the highest frequency DNP experiments performed to date and indicate that significant signal enhancements can be realized using the thermal mixing mechanism even at elevated magnetic fields. In large measure, this is due to the high microwave power output of the 250 GHz gyrotron oscillator used in these experiments.

p53 and related proteins in epithelial ovarian cancer.

We conducted a retrospective immunohistochemical evaluation of the prognostic significance of the expression of p53 and the related proteins Bax, Bcl-2, growth arrest and DNA damage (Gadd45), murine double minute 2 (Mdm2) and p21(WAF1/CIP1) in chemonaive tumours taken from 66 patients with ovarian cancer. Ki-67 expression (a marker of cell proliferation) was also evaluated immunohistochemically, while apoptosis within malignant cells was determined with the terminal deoxynucleotidyltransferase-mediated dUTP nick-end labelling (TUNEL) assay. The expression of each of the following proteins was significantly associated in the tumours (P < 0.05 unless otherwise stated): Bax with Bcl-2 (P < 0.01); Bax with Mdm2; p21(WAF1/CIP1) with Gadd45 (P < 0.01); p21(WAF1/CIP1) with p53; p53 with Mdm2. Univariate analysis showed that expression of p53, Bax, bulk residual disease and International Federation of Gynecology and Obstetricians (FIGO) stage were all strongly correlated with response to chemotherapy (P < 0.01). Similarly, the FIGO stage and Ki-67 expression (P < 0.01), as well as pathological subtype and bulk residual disease (P < 0.05), were prognostic factors for disease progression. The FIGO stage and Ki-67 expression were significant prognostic factors for overall survival (P < 0.01), with Gadd45 expression and pathological subtype also significant (P < 0.05) in a univariate analysis. Multivariate analysis for response to chemotherapy showed that expression of p53, Bax and FIGO stage were all independent prognostic factors (P < 0.01). The FIGO stage was the most important independent prognostic factor for progression and survival on multivariate analysis (P < 0.01). However, Ki-67 expression was also an independent prognostic factor for disease progression (P < 0.05) and approached significance for survival (P = 0.055). Taken together, these data suggest that determination of Ki-67 expression could supplement established prognostic factors.

The cis requirements for transcriptional activation by HilA, a virulence determinant encoded on SPI-1.

In several models of pathogenesis, Salmonella requires genes encoded on Salmonella pathogenicity island 1 (SPI-1) for virulence. In Salmonella enterica serovar Typhimurium (S. typhimurium), most SPI-1 genes are arranged in operons and are co-ordinately regulated in response to environmental signals via the SPI-1-encoded protein HilA. In order to understand how HilA controls the transcription of SPI-1 genes, we have analysed the invF and prgH promoters. We have reconstituted HilA-dependent activation of both promoters in Escherichia coli by supplying hilA on a plasmid, strongly suggesting that HilA acts directly on the promoters. By analysing the HilA-dependent activity of deletions and mutations in PinvF, we identified cis elements necessary for HilA-dependent activation. Through biochemical studies, we have defined a probable HilA-binding sequence in the invF promoter. This 'HilA box' is intact in the minimal promoter identified through deletion analysis, and it is disrupted in one class of PinvF mutants that has reduced activation by HilA. The prgH promoter also contains a HilA box in the same position relative to the +1 of transcription. This work is the first to connect HilA-dependent environmental regulation with a specific sequence in a SPI-1 virulence gene promoter.

Minocycline-induced hepatitis with autoimmune features and neutropenia.

Minocycline can cause various types of hepatotoxicity. We report an 18-year-old male who developed a delayed onset of minocycline-induced cholestatic hepatitis with autoimmune features and neutropenia. He responded to withdrawal of the drug and a short course of corticosteroids. If minocycline is to be administered, then periodic monitoring for hepatoxicity is recommended.

Co-ordinate regulation of Salmonella typhimurium invasion genes by environmental and regulatory factors is mediated by control of hilA expression.

During infection of their hosts, salmonellae enter intestinal epithelial cells. It has been proposed that when Salmonella typhimurium is present in the intestinal lumen, several environmental and regulatory conditions modulate the expression of invasion factors required for bacterial entry into host cells. We report here that the expression of six different S. typhimurium invasion genes encoded on SPI1 (Salmonella pathogenicity island 1) is co-ordinately regulated by oxygen, osmolarity, pH, PhoPQ, and HilA. HilA is a transcriptional activator of the OmpR/ToxR family that is also encoded on SPI1. We have found that HilA plays a central role in the co-ordinated regulation of invasion genes by environmental and regulatory conditions. HilA can activate the expression of two invasion gene-lacZY fusions on reporter plasmids in Escherichia coll, suggesting that HilA acts directly at invasion-gene promoters in S. typhimurium. We have found that the regulation of invasion genes by oxygen, osmolarity, pH, and PhoPQ is indirect and is mediated by regulation of hilA expression by these environmental and regulatory factors. We hypothesize that the complex and co-ordinate regulation of Invasion genes by HilA is an important feature of salmonella pathogenesis and allows salmonellae to enter intestinal epithelial cells.

Salmonella typhimurium secreted invasion determinants are homologous to Shigella Ipa proteins.

Salmonella typhimurium secreted proteins (Ssp) were previously implicated in epithelial cell invasion. Here we describe four genes (SspB, sspC, sspD, and sspA), located between spaT and prgH, which encode proteins of 63, 42, 36, and 87 kDa, respectively. These Ssp are homologous to Shigella flexneri secreted proteins IpaB, IpaC, IpaD and IpaA. A non-invasive mutant with a transposon insertion in sspC lacks Ssp of 87, 42 and 36 kDa. Complementation and analyses show that sspC and sspD encode the 42 and the 36 kDa Ssp, while the 87 kDa Ssp is encoded by sspA. sspC and sspD, but not sspA, are required for invasion. Amino-terminal sequencing shows that SspC and SspA are secreted without amino-terminal processing. We further demonstrate that Ssp secretion requires proteins encoded by prgHIJK, homologous to the Shigella Ipa secretion system, since SspA is abundantly secreted by wild-type bacteria but is completely retained within the cellular fraction of a prgHIJK mutant. A precipitate containing abundant SspC and three other major Ssp of 63, 59 and 22 kDa was isolated from culture supernatants of wild-type bacteria. These data indicate that major secreted invasion determinants of S. typhimurium are structurally and functionally homolgous to S. flexneri Ipa proteins.

hilA is a novel ompR/toxR family member that activates the expression of Salmonella typhimurium invasion genes.

During infection of its hosts, Salmonella enters intestinal epithelial cells. Many Salmonella typhimurium genes required for bacterial entry into host cells are encoded on a 40 kb 'pathogenicity island'. We report here the identification of hilA, a gene within the 'island' that appears to encode an activator of invasion gene expression. By using a set of lacZY transcriptional fusions to S. typhimurium invasion genes, we found that hilA activates the expression of invasion genes located on the 'pathogenicity island'. hilA is required for efficient entry into HEp-2 cells in vitro. The predicted amino acid sequence of hilA shares significant homology with the DNA-binding domains of the OmpR-ToxR family of transcriptional activators. However, unlike OmpR and ToxR, HilA contains neither a phosphoryl acceptor nor a membrane-spanning domain, and, therefore, its activity may be modulated by a novel mechanism. Many environmental conditions modulate the ability of Salmonella to enter non-phagocytic mammalian cells. It has been proposed that induction of Salmonella invasion proteins in response to a combination of environmental cues ensures that bacterial entry is limited to specific sites and times during infection. Our results are consistent with the hypothesis that hilA plays a key role in the regulation of Salmonella invasion during infection.

A 40 kb chromosomal fragment encoding Salmonella typhimurium invasion genes is absent from the corresponding region of the Escherichia coli K-12 chromosome.

Many Salmonella typhimurium genes are required for bacterial entry into host cells. P22 transduction analysis has localized several invasion loci near minute 59 on the S. typhimurium chromosome. To further characterize the 59-60 min chromosomal region, we determined the physical and genetic map of 85 kb of S. typhimurium DNA between srl and cysC. It was previously shown that some of the invasion genes from this region are not present in Escherichia coli K-12. We examined whether other S. typhimurium genes on the 85 kb of DNA were similarly absent from E. coli. We found that a contiguous 40 kb fragment of the S. typhimurium chromosome which encodes invasion genes is absent from the corresponding region of the E. coli K-12 chromosome and may represent a 'pathogenicity island'. We speculate that acquisition of the 40 kb region must have significantly advanced the evolution of Salmonella as a pathogen.