Correlation of exhaled carbon monoxide level with disease severity in chronic obstruction pulmonary disease.

INTRODUCTION: Amplification of airway inflammation and its destruction due to oxidative stress is a major step in the pathogenesis of chronic obstruction pulmonary disease (COPD). Exhaled carbon monoxide (eCO) may be quantified to evaluate the airway inflammation and oxidative stress in such patients. OBJECTIVES: To assess the disease severity of COPD and treatment response by measuring eCO as a biomarker. MATERIALS AND METHODS: COPD patients diagnosed according to the global initiative for chronic obstructive lung disease guidelines and healthy individuals as controls were selected. One hundred and fifty patients with COPD and 125 controls were included in the study. Participants were further subdivided on the basis of their smoking habits. Clinical examinations and spirometry were done to diagnose COPD by following the standard protocol. eCO was measured using a piCO + Smokerlyzer (Breath CO Monitor, Bedfont Scientific Ltd., Kent, UK). It was a single-center cross-sectional study. RESULTS: Mean (± standard error of mean) CO levels in ex-smokers with COPD were higher (5.21 ± 1.546 ppm; P < 0.05) than in nonsmoking controls (1.52 ± 0.571 ppm) but were lower than in current smokers with COPD (12.55 ± 4.514 ppm; P < 0.05). eCO levels were higher in current smokers with COPD (12.55 ± 4.514 ppm; P < 0.05) compared to healthy smokers (9.71 ± 5.649). There was a negative correlation between eCO and forced expiratory volume in 1 s (FEV1) in COPD (r = -0.28; P < 0.05). The mean eCO level was decreased (6.291-4.332; P < 0.001) with improvement in lung function (FEV1 38.75%-50.65%: P < 0.05) after treatment with inhaled steroid. CONCLUSION: Our study concludes that quantification of eCO level in COPD varies with different grades of airway obstruction and to measure the treatment response. Measuring the level of eCO can be used to assess the indirect assessment of airway inflammation, oxidative stress, and severity of airway obstruction in COPD patients.

Predictive factors determining outcomes in pulseless limb in paediatric supracondylar fractures of humerus.

INTRODUCTION: Amongst all the complications associated with paediatric supracondylar humerus fractures, significant vascular injury is reported in only 1% cases, of which, less than 1% develop Volkmann's ischemic contracture. This study evaluates factors, like delay in presentation of the injury, limb perfusion and pulse, in determining functional outcome in a supracondylar humerus fractures with pulseless limb. MATERIALS & METHODS: Twenty-one paediatric patients with a pulseless supracondylar humerus fracture presenting from 2012 to 2014 were included. The patients were divided into 3 groups with Group A (pulse returned post-reduction, n = 13), Group B (pink pulseless hand, n = 7) and Group C (white pulseless hand, n = 1). 11 patients in group A and 4 patients in Group B presented within 6 h. of injury while the remaining patients presented after 6 h. The primary outcome was vascular status as indicated by radial pulse and perfusion, and secondary outcomes included functional parameters assessed with Mayo Elbow Performance Score and Flynn criteria. RESULTS: Mean peripheral SpO2 in Group A patients was higher than Group B and Group C had a non-recordable oxygen saturation. Mean capillary refill time was more in Group A than Group B whereas in Group C patient had blanching and no capillary refill was seen. Mean Mayo Elbow Performance Score of Group A patients was highest as compared to Group B and Group C. Patients presenting within 6 h. of injury had a higher mean Mayo Elbow Performance score as compared to the patients presenting after 6 h of injury. Functional outcome as measured by Flynn Criteria was excellent in 13 patients. 6 patients had a good, 2 had fair outcome. A moderate negative corrélation (R = -0.5798) was seen between the time elapsed from the injury and the Mayo Elbow Performance score. CONCLUSION: Duration to presentation since injury, limb perfusion and presence of peripheral pulses seem to be important predictive factors determining the outcomes in pulseless supracondylar fracture humerus.

Host plant accessions determine bottom-up effect of snapmelon (Cucumis melo var. momordica) against melon fly (Bactrocera cucurbitae (Coquillett)).

The melon fly, Bactrocera cucurbitae (Tephritidae: Diptera) is an important pest of snapmelon (Cucumis melo var. momordica), leading to significant losses in yield in the hot arid agro-climate of India. The accessions IC- 430190 (11.21%), DKS-AHS 2011/4 (14.97%) and DKS-AHS 2011/3 (18.57%) were found to be novel resistant accessions against melon fly, B. cucurbitae infestation. Free amino acid and total soluble solid (TSS) were in positive correlation with percent fruit infestation whereas phenols, tannin, total alkaloids and flavonoid contents had significant negative correlation with percent fruit infestation. The percent fruit infestation had significant positive correlation with fruit length, fruit diameter and flesh thickness and negative correlation with length of ovary pubescence, rind hardness at immature stage, rind hardness at mature stage and pericarp thickness. Based on Kaiser Normalization method, two principal components (PCs) were extracted explaining cumulative variation of 82.80% in melon fly infestation. PC1 explained 53.41% of the variation while PC2 explained 29.39% of variation. The flavonoid, total alkaloid, tannins, phenols content, length of ovary pubescence and rind hardness were the novel antibiosis and antixenotic characters found in snapmelon resistant melon fly, B. cucurbitae and therefore, could be used as marker traits in plant breeding programs to select resistant accessions.

Anthrax lethal toxin (LeTx) neutralization by PA domain specific antisera.

Anthrax associated causalities in humans and animals are implicated mainly due to the action of two exotoxins that are secreted by the bacterium Bacillus antharcis during the infection. These exotoxins comprise of three protein components namely protective antigen (PA), lethal factor (LF) and edema factor (EF). The protective antigen is the common toxin component required to form both lethal toxin (LeTx) and edema toxin (EdTx). The LeTx is formed, when PA combines with LF and EdTx is formed when PA combines with EF. Therapeutic interventions aiming to neutralize these key effectors of anthrax pathology would therefore, provide an effective means to counter the toxicity imposed by the anthrax toxins on the host. The present work describes the lethal toxin neutralization potential of polyclonal antisera developed against the individual domains of the protective antigen component of the anthrax toxin. The individual domains were produced as recombinant proteins in E. coli and validated with peptide mass fingerprinting by MALDI-TOF analysis and corresponding mice polyclonal antisera by western blotting. Each domain specific antibody titre and isotype was ascertained by ELISA. The isotyping revealed the predominance of IgG1 isotype. The toxin neutralizing potential of these domain specific antisera were evaluated by in-vitro cell viability MTT assay, employing J774.1 mouse macrophage cell line against LeTx (0.25 µg ml-1 PA and 0.125 µg ml-1 LF concentrations). Among the four domain specific antisera, the antiserum against PA domain IV could neutralize LeTx with high efficiency. No significant neutralization of LeTx was observed with other domain specific antibodies. Results indicate that antibodies to r-PA domain IV could be explored further as therapeutic anti toxin molecule along with appropriate antibiotic regimens against anthrax.

Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm.

Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic "Ying Yang" sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT) of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy.

Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases.

BACKGROUND: Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good. MATERIALS AND METHODS: Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system. RESULTS: At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed. CONCLUSIONS: Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate.

Sodium tungstate induced neurological alterations in rat brain regions and their response to antioxidants.

Tungsten, recognized recently as an environmental contaminant, is being used in arms and ammunitions as substitute to depleted uranium. We studied the effects of sodium tungstate on oxidative stress, few selected neurological variables like acetylcholinesterase, biogenic amines in rat brain regions (cerebral cortex, hippocampus and cerebellum) and their prevention following co-administration of N-acetylcysteine (NAC), naringenin and quercetin. Animals were sub-chronically exposed to sodium tungstate (100 ppm in drinking water) and orally co-supplemented with different antioxidants (0.30 mM) for three months. Sodium tungstate significantly decreased the activity of acetylcholinesterase, dopamine, nor-epinephrine and 5-hydroxytryptamine levels while it increased monoamine oxidase activity in different brain regions. Tungstate exposure produced a significant increase in biochemical variables indicative of oxidative stress while, neurological alterations were more pronounced in the cerebral cortex compared to other regions. Co-administration of NAC and flavonoids with sodium tungstate significantly restored glutathione, prevented changes in the brain biogenic amines, reactive oxygen species (ROS) and TBARS levels in the different brain regions. The protection was more prominent in the animals co-administered with NAC. We can thus conclude that sodium tungstate induced brain oxidative stress and the alterations in some neurological variables can effectively be reduced by co-supplementation of NAC.

Peroneus Brevis Attrition & Longitudinal Split Tear without Subluxation and Associated Hypertrophy of Peronal Tubercle" - Treatment of an Uncommon Lesion.

INTRODUCTION: Peroneus brevis tendinitis with its attritional longitudinal split rupture without any subluxation from peroneal groove and associated enlarged peroneal tubercle is un common presentation. CASE REPORT: A 40 year old female presented with moderate swelling and tenderness over the lateral and dorso-lateral aspect of left ankle with history of old trauma to ankle with swelling, persistant pain and difficulty in walking. On physical examination during passive eversion and inversion the excursion of the peroneal tendons was painful. Most tender point was just posterior to the tip of the fibula. During surgery we found the intact superior peroneal ligament with both peroneal tendons placed at normal site without subluxation, tendon sheath was inflamed and swollen, on further dissection we could see the attrition of inner surface of the peroneus brevis and a 2 cm longitudinal split tear of the same. CONCLUSION: Although rare but peroneus brevis tendon attrition and tear can occur without subluxation from peronal groove. Refractory ankle pain on lateral aspect presenting with on and off swelling should arise suspicion of peroneal tendon tear. Correct diagnosis and proper surgical repair can produce excellent results.

Occupational exposure to Aspergillus and aflatoxins among food-grain workers in India.

BACKGROUND: Aflatoxins are a metabolite of Aspergillus molds and are widespread in the natural environment. Workers who handle food grains are at increased risk of exposure to aflatoxins and subsequently certain respiratory conditions. In India, more than half of the employed population is engaged in some type of agricultural work, yet little known about the respiratory problems as a result of exposure to aflatoxins among workers who handle food grains in India. OBJECTIVES: The aim of this study was to determine the risk of occupational exposure to aflatoxins in food-grain workers compared to workers who are not occupationally exposed to food grains. METHODS: Bronchoalveolar lavage (BAL) and serum samples from 46 food-grain workers and 44 non-food-grain workers were analyzed for the presence of aflatoxins. Microscopy and culture of BAL samples were performed to detect Aspergillus species. RESULTS: Aflatoxins were detected in 32·6% of the food-grain workers and 9·1% of non food grain workers (P<0·01). A significant difference was also found in BAL culture for Aspergillus (P<0·01) between the two groups. About 47·8% of the food-grain workers and 11·4% of non-food-grain workers had chronic respiratory symptoms. CONCLUSION: Occupational exposure to aflatoxins in food-grain workers was found to be associated with the increased presence of respiratory symptoms.

Aspergillus colonization in patients with bronchogenic carcinoma.

BACKGROUND: Aspergillus antigens such as galactomannan antigen, a cell wall polysaccharide, can be detected in patient's serum or bronchoalveolar lavage. To study the prevalence of Aspergillus infection in patients with bronchogenic carcinoma, we measured galactomannan antigen in serum and bronchoalveolar lavage samples of patients with bronchogenic carcinoma. METHODS: The study was conducted on 45 bronchogenic carcinoma patients. The diagnosis of lung cancer was confirmed by bronchoscopy, histopathological and radiological examinations. Bronchoalveolar lavage fluid collected from each patient by fiberoptic bronchoscopy was subjected to direct microscopy and culture on Sabouraud's dextrose agar and Czapek-Dox agar, and Aspergillus galactomannan antigen was measured in serum and bronchoalveolar lavage samples. RESULTS: The majority of patients were male (93.3%) in the age group 51-60 years, 88.9% were addicted to gutka chewing, and 82.1% were addicted to smoking. Most patients complained of cough (73%) and shortness of breath (51.1%). Squamous cell carcinoma (64.4%) was the most common malignancy, followed by adenocarcinoma (13.3%). On culture of bronchoalveolar lavage samples, 35.5% showed growth of Aspergillus spp. (Aspergillus fumigatus in 17.8%, Aspergillus flavus in 13.3%, and Aspergillus niger in 4.4%). Galactomannan antigen was detected in 58.3% of bronchoalveolar lavage samples and 47.2% of serum samples. CONCLUSIONS: There is a high prevalence of aspergillosis in patients with lung carcinoma, especially among smokers and gutka chewers.

Pulmonary aspergillosis and aflatoxins in chronic lung diseases.

Fungal infections of lung have become increasingly common during the last few decades. Aspergillosis and the role of aflatoxins in various chronic lung diseases have not been extensively studied. Bronchoalveolar lavage (BAL) samples and sera from 40 patients of chronic lung diseases were analyzed for galactomannan antigen (GM) and aflatoxin by enzyme-linked immunosorbent assay. Direct microscopy and culture of BAL samples were also done to detect the Aspergillus species. Results revealed that 15 (37.5 %) of the 40 patients had growth of Aspergillus on BAL culture. Out of these culture-positive cases, 13 (86.7 %) patients were positive for galactomannan antigen also. About 62.5 % cases did not show growth of Aspergillus in BAL culture. However, galactomannan antigen could be detected in 20 % of these patients. Overall, 20 % patients were diagnosed as proven invasive fungal disease (IFD), 32.5 % were of probable IFD, 17.5 % of possible IFD. Aspergillus growth was observed in 100 % of proven and 53.8 % of probable IFD cases. Galactomannan antigen was found in 100 % cases of proven and 76.9 % of probable IFD. Ten (25 %) patients were found to be positive for aflatoxins. It was detected in 6 (40 %) of culture-positive cases. About 62.5 % of the cases with proven IFD and 46.1 % of probable IFD had aflatoxin in their samples. Aflatoxin positivity was found to be more in patients with proven IFD than in probable IFD, and higher level of aflatoxins was detected in cases with proven IFD. Significant difference was observed in aflatoxin positivity among food grain workers when compared to other occupations.

Platelet rich plasma therapy: A comparative effective therapy with promising results in plantar fasciitis.

Chronic muscle & tendon injuries are one of the problems which are encountered by human being since last long time. These injuries are generally repetitive strain injuries, commonly found in athletes. There are various treatments which include conservative methods in initial stages to surgery in later stages. On minimal invasive aspect Ultrasound-guided fenestration and tenotomy surgery has been used with good results as an effective treatment of chronic tendinopathies.(1,2) There are various injectable agents which were also researched including simple solutions such as hyperosmolar dextrose(3) (prolotherapy) to complex orthobiologic agents such as bone morphogenic protein,(4) but none have achieved uniform success. Platelet rich plasma (PRP) injection has emerged as a treatment alternative for many musculoskeletal conditions. We have done this study on sixty patients to evaluate & compare the effects of platelet rich plasma & steroid injection on patients with planter fasciitis. The results at the 1, 3 & 6 months were evaluated, which showed the good results with platelet rich plasma in comparison to steroid injections.

Broncho pleuro subcutaneous fistula with subcutaneous emphysema: A rare presentation of pulmonary tuberculosis.

Subcutaneous tissue emphysema is observed in a several clinical settings but spontaneous subcutaneous emphysema in the absence of pneumothorax with broncho pleuro subcutaneous fistula is rare. We report a case of spontaneous subcutaneous emphysema secondary to cavitary pulmonary tuberculosis in the absence of pneumothorax.

Influence of age on arsenic-induced oxidative stress in rat.

Influence of age on arsenic-induced (0.05, 0.1, and 0.2 lethal dose to 50 % population (LD(50)) given intraperitoneally) oxidative stress was investigated in young, adult, and old rats at days 7 and 14 post-exposure. A significant dose-dependent effect of arsenic on biochemical variables suggestive of oxidative stress was noted at day 7 following exposure in old rats. The parameters which were significantly altered include an increased reactive oxygen species, thiobarbituric acid reactive substances (TBARS), catalase activity accompanied by a decreased glutathione level. At day 14 following arsenic exposure (0.05 and 0.1 LD(50) dose), we observed a significant oxidative injury as evident from significant depletion of superoxide dismutase (SOD) and catalase activities in blood and tissues in addition to more pronounced accumulation of arsenic in blood and tissues. Interestingly, the toxicity was pronounced in young and old rats compared with adult rats. Accumulation of arsenic found to be more prominent in old rats compared with young and adult, which might be due to impaired metabolism with ageing. We conclude that young and old animals are more vulnerable to the arsenic-induced oxidative injury which is comparable with arsenic accumulation in blood and tissues and duration of exposure.

Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases.

BACKGROUND: Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures. Present indications include all patients with femoral shaft fractures and open physis. Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. We thus undertook a retrospective study of paediatric femoral fractures treated with titanium or stainless steel flexible nails at our institute with a minimum of 5 years follow up. MATERIAL AND METHODS: We included 73 femoral shaft fractures in 69 patients treated with retrograde flexible intramedullary nailing with a minimum follow up of 5 years. Final limb length discrepancy and any angular or rotational deformities were determined. RESULTS: Mean age at final follow up was 15.5 years (10-21 years). Mean follow up was 7.16 years (5.0-8.6 years). Titanium and stainless steel nails were used in 43 and 30 cases respectively. There were 51 midshaft, 17 proximal, and 5 distal fractures.All fractures united at an average of 11 weeks but asymptomatic malalignment and LLD were seen in 19% and 58% fractures respectively. LLD ranged from -3 cm to 1.5 cm. Other complications included superficial infection(2), proximal migration of nail(3), irritation at nail insertion site(5) and penetration of femoral neck with nail tip(1). There were 59 excellent, 10 satisfactory and 4 poor results. CONCLUSION: Flexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures.

Ilizarov hip reconstruction in skeletally mature young patients with chronic unstable hip joints.

PURPOSE: Hip reconstruction with subtrochanteric valgus extension pelvic support osteotomy and distal femoral osteotomy for lengthening and varus correction is one of the options available for salvage of chronic unstable hips and is also known as Ilizarov hip reconstruction (IHR). This study evaluated the outcomes and complications associated with IHR in skeletally mature young patients. METHODS: Twelve patients (7 males, 5 females) with a mean age of 23 years underwent IHR for chronically dislocated hips due to various causes. Preoperative clinical and radiological evaluations were used to determine the site of osteotomies and the required angulations. Postoperatively the patients were followed up clinically and radiologically for a minimum of 36 months. Ilizarov fixator was removed when adequate lengthening was achieved and there was radiological evidence of union. Harris Hip Score was used to document hip function preoperatively and at final evaluation. RESULTS: Significant improvements occurred in limb length discrepancy (LLD) 5.11 cm preoperatively to 0.9 cm at final evaluation, Harris Hip Score 44.33 points preoperatively to 70.83 points (p < 0.0001) at final evaluation. Trendelenberg sign disappeared completely in nine patients and was delayed in three at final evaluation. The abduction at the hip increased from the preoperative mean of 12.08° (range 0°-25°) to 22.5° (range 15°-35°) postoperatively. The fixed flexion deformity at the hip decreased from 22° (range 10°-35°) preoperatively to 3° postoperatively (range 0°-10°). The amount of free flexion at the operated hips decreased from the preoperative mean of 88.33° (range 70°-120°) to 70.42° (range 45°-105°) at final follow up. The mean fixator interval was 7.33 months (5-12 months) and the mean follow up duration was 59.4 months (38-86 months). CONCLUSIONS: IHR is effective in improving the hip biomechanics, correcting the LLD and eliminating the Trendelenberg sign. Lengthy period of fixator wear, knee stiffness and pin tract infections, though minor are known limitations of this procedure.

Anterior cruciate ligament reconstruction using the medial third of the patellar tendon.

PURPOSE: To evaluate the mid-term outcome of anterior cruciate ligament (ACL) reconstruction using the medial third of the patellar tendon as the bone-patellar tendon-bone (BPTB) graft. METHODS: 79 men (34 right knees and 45 left knees) aged 20 to 52 (mean, 28) years underwent ACL reconstruction using the medial third of the patellar tendon with bone plugs and were followed up for a minimum of 3 years. Stability was assessed using the Lachman test and the pivot shift test. The range of motion, donor-site symptoms, Lysholm knee score, and International Knee Documentation Committee (IKDC) score were also recorded. RESULTS: In terms of stability, only 4 patients had a grade-2 laxity postoperatively, compared to all having a grade-2 or -3 laxity preoperatively. Regarding the range of motion, extension loss was <3º in 76 patients and 3º to 5º in 3, whereas flexion loss was <5º in 73 patients, 5º to 15º in 5, and 16º to 25º in one. No patient had patellar tendon rupture/shortening, patellar fracture, or patellar maltracking. The mean Lysholm knee score improved from 48 to 92 (p<0.0001); scores were excellent (>90) in 46 patients and good (83-90) in 32 patients. The overall IKDC score was grade A (normal) in 9 patients, grade B (near normal) in 66, and grade C (abnormal) in 4. Three of the latter patients had osteoarthritic changes and pain on minimal physical activity. Only one patient had a sensation of partial giving way during moderate physical activity. 20% of the patients had anterior knee pain. CONCLUSION: Outcome of ACL reconstruction using the medial third of the patellar tendon was comparable to that using the central third of the patellar tendon. In addition, there were no instances of patellar tendon rupture/shortening, patellar fracture, or patellar maltracking.