Predicting Quadruple Semitendinosus Graft Size for Anterior Cruciate Ligament Reconstruction by Patient Anthropometric Variables: A Cohort Study of 280 Cases

@#Introduction: Pre-operative identification of patients with inadequate hamstring graft for anterior cruciate ligament reconstruction is still a subject of interest. The purpose of this study is to correlate dimension of a harvested dimensions graft with patient physical anthropometric variables. Materials and methods: This cohort study included 280 patients (male = 226, female = 54) scheduled for primary anterior cruciate ligament (ACL) reconstruction. Interrelationships between quadruple semitendinosus (ST) graft and anthropometric parameters (age, sex, height, weight, and BMI) were assessed using Pearson Correlation test and regression analysis. Difference among gender was analysed using Mann Whitney and t test. The observed graft diameter was also compared with the literature using Bland – Altman plot. Results: Mean age of cohort was 29 years (range, 17-50 years), mean height was 1.69m (range, 1.6-1.9m), mean weight was 75 kg (range, 50-116kg) and mean BMI was 26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6- 8.8cm) and mean diameter was 8mm (8.2±0.8mm, range, 6.5-10mm). Only height and weight were significantly correlated with graft length and diameter in both sex (p value <0.05). Female, compared to male, had significantly smaller (p<0.0001) and thinner graft (p<0.0001). There was a strong agreement between the literature and our observed graft diameter, but with an overestimated graft diameter in 18.5% of the cases. Conclusion: Among anthropometric parameter, only height and weight had moderate positive correlation with graft diameter. Males had longer and wider ST graft in contrast to age-matched female group.

Incidental detection of tracer avidity in meningioma in 68Ga-PSMA PET/CT during initial staging for prostate cancer / Detección incidental de avidez de trazador en meningioma en 68Ga-PSMA PET/TC durante la estradificación inicial de un cáncer de próstata

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Diagnostic dilemma of urinary leak vs. perirenal abscess on skeletal scintigraphy: The added value of SPECT/CT and renal scintigraphy / Dilema de diagnóstico de fuga urinaria versus absceso perirrenal en la gammagrafía esquelética: el valor añadido de SPECT/TC y gammagrafía renal

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Inflammatory markers in patients with rheumatoid arthritis

BACKGROUND: Autoimmune diseases such as rheumatoid arthritis (RA) are the consequence of a persistent imbalance between pro- and anti-inflammatory immune mechanisms, leading to chronic inflammation. The objective of this study was to determine whether the high sensitive C-reactive protein (hs-CRP) and cytokines are elevated in RA patients and to investigate the relationship between these markers and disease activity in RA, measured by disease activity score 28 (DAS28). METHODS: We studied 110 RA patients according to American College of Rheumatology revised criteria for RA, and 55 controls matched by age and sex. Serum levels of hs-CRP and cytokines interleukin (IL)-6, IL-10 and tumour necrosis factor- (TNF-) were estimated and correlated with the DAS28. Serum hs-CRP was assayed immunoturbidimetrically and cytokines were analysedby commercially available ELISA kit. RESULTS: We found that RA patients had significantly higher levels of serum hs-CRP (p < 0.001),IL-6 (p < 0.001), TNF- (p < 0.001), and IL-10 (p < 0.01) as compared to healthy controls. hs-CRP, IL-6 and TNF- correlated positively (p < 0.001) and IL-10 correlated negatively (p < 0.01) with DAS28. CONCLUSIONS: These results demonstrate that RA patients have high levels of inflammatory markers, and these levels are correlated with the DAS28. These findings suggest a possible role of these markers in the pathogenesis of RA. Moreover, these biomarkers can be used as markers of disease activity in the diagnosis and treatment of RA

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Thyroid function tests in cases of polymorphic light eruption: A case-control study.

BACKGROUND: Polymorphic light eruption (PLE) has been found to be associated with thyroid function abnormalities. AIM: To study clinicoepidemiological features of PLE and to study and compare thyroid function tests (TFTs) in cases of PLE. MATERIALS AND METHODS: The study included 100 cases of PLE and age- and sex-matched controls attending a skin outpatient department. The clinical and epidemiological features were recorded. Both cases and controls were tested for thyroid-stimulating hormone (TSH). In case of abnormality in TSH, triiodothyronine (T3) and tetraiodothyronine (T4) levels were estimated. RESULTS: TFT was abnormal in 25 cases and 7 controls. TSH was elevated in 24 cases and 6 controls and decreased in 1 case and 1 control. T3 and T4 were decreased in 18 cases and 6 controls and elevated in 1 each in case and control. Hypothyroidism was significantly high among cases than controls. DISCUSSION: TFT abnormality was significantly higher among cases than controls. Hypothyroidism has a significant association with PLE. Genetic basis or immune dysfunction may be the cause of both the diseases. PLE may be considered as a clinical presentation of thyroid function disorder and vice versa. CONCLUSION: Cases of PLE should be examined clinically for thyroid disorder and also tested for TSH or TFT to find any association and prevent serious consequences.

Sacro-coccygeal teratoma in adult: Two rare case reports and review of literature.

The sacrococcygeal area is the most common site of extragonadal teratomas in infants, but is a challenge to make clinical as well as radiological diagnosis in adults. We herein describe two cases of sacrococcygeal teratoma (SCT) in adult. The clinical, radiological and histopathological characteristics of both the cases with their outcome are described with review of the literature. The standard care for SCTs is complete surgical resection of the tumor. The presence of malignant transformation is associated with a less favorable outcome.

Glued angiocatheter: a rare complication of intrarenal pseudoaneurysm glue angioembolization.

Endovascular management of intraparenchymal renal artery pseudoaneurysms is a reasonable and effective therapeutic technique. Endovascular management preserves the maximum amount of renal tissue and reduces the potential risk of nephrectomy. We present the case of an angiocatheter that became stuck in the renal artery following the injection of cyanoacrylate glue for angioembolization of an intrarenal pseudoaneurysm.

2D map of proteins from human renal stone matrix and evaluation of their effect on oxalate induced renal tubular epithelial cell injury

Purpose Proteins constitute a major portion of the organic matrix of human calcium oxalate (CaOx) renal stones and the matrix is considered to be important in stone formation and growth. The present study evaluates the effect of these proteins on oxalate injured renal epithelial cells accompanied by a 2D map of these proteins. Materials and Methods Proteins were isolated from the matrix of kidney stones containing CaOx as the major constituent using EGTA as a demineralizing agent. The effect of more than 3kDa proteins from matrix of human renal (calcium oxalate) CaOx stones was investigated on oxalate induced cell injury of MDCK renal tubular epithelial cells. A 2D map of >3kDa proteins was also generated followed by protein identification using MALDI-TOF MS. Results The >3kDa proteins enhanced the injury caused by oxalate on MDCK cells. Also, the 2D map of proteins having MW more than 3kDa suggested the abundance of proteins in the matrix of renal stone. Conclusion Studies indicate that the mixture of >3kDa proteins in the matrix of human renal stones acts as promoter of calcium oxalate crystal nucleation and growth as it augments the renal epithelial cell injury induced by oxalate. The effect of promoters masks the inhibitors in the protein mixture thereby leading to enhanced renal cell injury. 2D map throws light on the nature of proteins present in the kidney stones. .

Dissolution enhancement of glimepiride using modified gum karaya as a carrier.

OBJECTIVE: The aim of present investigation is to enhance in vitro dissolution of poorly soluble drug glimepiride by preparing solid dispersions using modified gum karaya. MATERIALS AND METHODS: Solid dispersions of drug were prepared by solvent evaporation method using modified gum karaya as carrier. Four batches of solid dispersion (SD1, SD4, SD9, and SD14) and physical mixture (PM1, PM4, PM9, and PM14) were prepared and characterized by differential scanning colorimetry (DSC), Fourier transform infrared (FTIR) spectroscopy, powder X-Ray diffraction (X-RD), and scanning electron microscopy (SEM) studies. Equilibrium solubility studies were carried out in shaker incubator for 24 h and in vitro drug release was determined using USP Dissolution Apparatus-II. RESULTS: Maximum solubility and in vitro dissolution were observed with Batch SD4. No significant enhancement of dissolution characteristics were observed in the corresponding physical mixture PM4. Low viscosity with comparable swelling characteristics as compared to GK of modified form of gum karaya may lead to improvement in dissolution behavior of solid dispersion batches. Also, the conversion of crystalline form of drug to amorphous form may be a responsible factor, which was further confirmed by DSC, FTIR studies, and X-RD studies. SEM photographs of batch SD4 revealed porous nature of particle surface. CONCLUSION: Modified forms of natural carriers prove beneficial in dissolution enhancement of poorly soluble drugs and exhibited a great potential in novel drug delivery systems.

How do age and tooth loss affect oral health impacts and quality of life? A study comparing two state samples of gujarat and rajasthan.

OBJECTIVE: Age and tooth loss are expected to have a complex relationship with oral health-related quality of life. So the purpose of this study was to explain the impact of age and tooth loss on oral health-related quality of life using the short form 14-item oral health impact profile (OHIP-14) among two population samples of Gujarat and Rajasthan. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey was conducted among 1441 subjects collected from two major cities of Gujarat and Rajasthan. Both questionnaire approaches using OHIP-14 scale and clinical examination were conducted in accordance with WHO criteria using type III procedure on the same day. Chi square test, ANOVA and stepwise multiple regression analysis were applied using SPSS software version 15.0. RESULTS: With the increase of age, OHIP mean score in both states increased, but that among Rajasthan state was higher, depicting poor oral health. Whereas, in the remaining 23-27 number of teeth both states showed higher OHIP mean, however again the score was much higher among Rajasthan subjects showing worse oral hygiene. Hence, overall all mean OHIP score for Gujarat was lower indicating good oral health; whereas, that among Rajasthan was higher indicating poor oral health-related quality of life. CONCLUSION: Both age and tooth loss are associated with each other, but they have an independent effect on the oral health-related quality of life. Thus, all studied populations with complete natural dentition showed good oral health-related quality of life.

Improved bioavailability through floating microspheres of lovastatin.

BACKGROUND AND THE PURPOSE OF THE STUDY: Lovastatin is an antihyperlipidemic agent which has low bioavailability due to the extensive first pass metabolism. It was sought to increase gastric retention of lovastatin by development of a sustained release gastroretentive drug delivery system leading to reduced fluctuation in the plasma concentration and improved bioavailability. MEHODS: Floating microspheres were prepared by emulsion solvent diffusion technique, using various polymers and their blends. The in vitro performance was evaluated for drug-polymer compatibility, percent yield, particle size, drug entrapment efficiency, in vitro onset and duration of floatation, in vitro drug release as well as in vivo determination of serum cholesterol level. RESULTS: The mean particle size of microspheres was observed to be between 6.9 to 9.5 µm and the maximum particle size was around 50 µm. In vivo studies of the selected batches indicated lower level of serum cholesterol compared to the marketed tablet at the same dose but was not significant. MAJOR CONCLUSION: The data obtained in this study suggested that a microparticulate floating dosage form of lovastatin can be successfully designed to yield controlled delivery with improved therapeutic efficacy.

Association of adiposity with pulse pressure amongst gujarati Indian adolescents.

BACKGROUND AND AIM: The current study was conducted to determine the effect of adiposity on vascular distensibility in Gujarati Indian adolescents as research indicating the pathogenesis of hypertension among overweight and/or obese Indian adolescents is scant and ethnic differences exist in the pathogenesis of hypertension MATERIALS AND METHODS: A cross-sectional study was conducted on 488 Gujarati Indian adolescents of 16-19 years age group. Adiposity was assessed in terms of BMI, Body Fat %, Fat Mass, Fat Mass Index and Waist Circumference. Arterial blood pressure was recorded and pulse pressure (PP) was calculated using the standard equation based on the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP). Pearson's correlation coefficient was determined to find the association between the markers of adiposity and SBP, DBP and PP. RESULT: A significant positive correlationship was found between adiposity and PP in boys. However, no significant correlationship was found between adiposity and PP in girls. CONCLUSION: An increase in total as well as visceral adiposity is probably associated with a decrease in vascular distensibility in the Gujarati Indian adolescent boys but not in girls, thus indicating a protective role of female sex hormone estrogen which has been shown earlier to protect the vasculature from atherosclerosis, endothelial dysfunction which occurs with increase in adiposity.

Isolated Systolic Hypertension and its Determinants - A Cross-sectional Study in the Adult Population of Lucknow District in North India.

OBJECTIVES: 1) To determine the prevalence of isolated systolic hypertension (ISH) in the adult population of Lucknow district. 2) To study the determinants of ISH especially the relationship with age. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in four randomly selected areas of Lucknow district. A total of 800 subjects, aged 20 years and above, 400 from urban and 400 from rural area of Lucknow district were included in the study. The statistical tools used for analysis were Pearson's Chi-square test and multiple logistic regression. RESULTS: The prevalence of ISH according to JNC-7 criteria was 4.3%, which was 5.1% in men and 3.6% in women. A significant increase in the prevalence of ISH was seen with an increase in age. Multivariate logistic regression analysis of the determinants showed that age, BMI and smoking were significant independent risk factors of ISH. CONCLUSIONS: Given the risk of cardiovascular disease associated with ISH, the findings of this study emphasize the need for further research to document the impact of modifiable risk factors of ISH and the effect of hypertension screening and specific health promotion in bringing down the burden of ISH and related cardiovascular morbidity.

Association of sleep duration with arterial blood pressure profile of gujarati Indian adolescents.

BACKGROUND AND AIM: Recently, National Health and Nutritional Examination Survey-1 data analysis found short sleep duration as a risk factor for hypertension in the U.S. population. However, since ethnic differences exist in the aetiopathogenesis of diseases, the current study was undertaken to study the effect of sleep duration on the blood pressure profile of Gujarati Indian adolescents. MATERIALS AND METHODS: A cross-sectional study was conducted on 489 Gujarati Indian adolescents of age group 16-19 years studying in school and colleges in the local population. The participants were assessed for their sleep duration, physical activity status, body composition, blood pressure profile and cardiovascular reactivity. The sleep duration was reported by the subjects as the number of hours they slept on most of the nights in a week over the last one year. The observations of the study were then analyzed after grouping them into: 1) Adequate Sleep Duration at Night, ASDN (>/=7 hrs) and 2) Inadequate Sleep Duration at Night, ISDN (<7 hrs) groups. Student's unpaired t-test was used to study if any significant difference (P< 0.05) existed between the groups. RESULTS: No significant difference was found in Systolic blood pressure, Diastolic blood pressure, Pulse pressure and Mean arterial pressure between the ASDN group and the ISDN group. Physical activity status also did not differ between the two groups. However, adolescents of ISDN group showed a significantly higher level of adiposity and cardiovascular reactivity as compared to adolescents of ASDN group. CONCLUSION: Although short sleep duration is associated with a higher level of adiposity and cardiovascular reactivity in Gujarati Indian adolescents, it does not affect the resting blood pressure profile of these adolescents. However, longitudinal studies would be required to observe if the changes in adiposity and cardiovascular reactivity affect these adolescents in later life.

Study on patient satisfaction in the government allopathic health facilities of lucknow district, India.

BACKGROUND: The outcome of any disease is influenced by the decisions to seek care, timely arrival at appropriate diagnostic and treatment services and the receipt of adequate care from service providers. Satisfaction in service provision is increasingly being used as a measure of health system performance. Satisfaction manifests itself in the distribution, access and utilization of health services. OBJECTIVES: To determine the areas and causes of low satisfaction among the patients and suggest methods for improvement. MATERIALS AND METHODS: Multistage stratified random sampling was used to select the government allopathic health facilities of Lucknow district and systematic random sampling for the selection of the patients for the interview. RESULTS: The accessibility was difficult in 42% patients and waiting time more than 30 min for 62.5% of those attending the tertiary level health facility. The satisfaction with the duration of the outpatient department (OPD) (64.6%) and the presence of signboards (46.6%) was also found to be low. The overall satisfaction regarding the doctor-patient communication was more than 60% at all the levels of health care facilities but that with the examination and consultation was less than 60% at the primary level as compared to more than 80% elsewhere. The most important motivating factor for the visit to the tertiary (48.2%) and secondary level (71.9%, 67.1%) of health facilities was the faith on doctors or health facility. CONCLUSIONS: The level of patient satisfaction is severely deficient in several areas and needs improvement for the achievement of optimal health of the people.

Sleep deprivation predisposes gujarati Indian adolescents to obesity.

BACKGROUND AND AIM: Recent studies on various populations indicate that lack of sleep is one of the potential risk factors predisposing the youth to obesity. Since there is a significant rise in obesity among Indian youth and because research indicating the role of sleep in development of obesity among Indian population is scant, the current study was undertaken to assess the effect of sleep duration on adiposity among Gujarati Indian adolescents. MATERIALS AND METHODS: A randomized cross-sectional study was done on 489 voluntarily participating Indian adolescents in the age group of 16-19 years. Participants were grouped into two categories 1). Adequate Sleep Duration at Night (more than seven hours, ASDN) and 2) Inadequate Sleep Duration at Night (less than seven hours, IASDN) as reported by the participants. The participants were later assessed for adiposity in terms of BMI, BF %, FM, FMI and waist circumference, meal frequency per day and physical activity status. RESULTS: In both boys as well as girls, the BMI, BF%, FM and FMI were significantly lower in the ASDN group than the IASDN group. However, there was an insignificant difference in the meal frequency and physical activity status between the ASDN and IASDN group. CONCLUSION: Inadequate sleep duration increases adiposity among Gujarati Indian adolescents but further studies are required to find out the mechanisms through which sleep affects adiposity in this population.

Thermodynamics of Interaction between Some Cellulose Ethers and SDS by Titration Microcalorimetry.

The interaction between certain nonionic cellulose ethers (ethyl hydroxyethyl cellulose and hydroxypropyl methyl cellulose) and sodium dodecyl sulphate (SDS) has been investigated using isothermal titration microcalorimetry at temperatures between 25-50 degrees C. The observed heat flow curves have been interpreted in terms of a plausible mechanism of the interaction of the substituent groups with SDS monomers and clusters. The data have been related to changes occuring in the system at the macro- and microscopic levels with the addition of surfactants and with temperature. The process consists predominantly of polymer-surfactant interactions initially and surfactant-surfactant interactions at the later stages. A phenomenological model of the cooperative interaction (adsorption) process has been derived, and earlier published equilibrium binding data have been used to recover binding constants and Gibbs energy changes for this process. The adsorption enthalpies and entropies have been recovered along with the heat capacity change. The enthalpic cost of confining the nonpolar regions of the polymers in surfactant clusters is high, but the entropy gain from release of hydration shell water molecules as well as increased freedom of movement of these nonpolar regions in the clusters gives the process a strong entropic driving force. The process is entropy-driven initially and converts to being both enthalpy and entropy-driven at high SDS concentrations. An enthalpy-entropy compensation behavior is seen. Strongly negative heat capacity changes have been obtained resulting from the transfer of nonpolar groups from aqueous into nonpolar environments, as well as a reduction of conformational domains that the chains can populate. Changes in these two components cause the heat capacity change to become less negative at the higher binding levels. The system can be classified as exhibiting nonclassical hydrophobic binding at the later stages of binding. Copyright 1999 Academic Press.

Thermodynamics of Interaction between Some Cellulose Ethers and SDS by Titration Microcalorimetry.

A titration calorimetric study of the interaction between nonionic cellulose ethers and ionic surfactant (SDS) has been extended to a larger number of polymers to explore the effect of variation of polymer hydrophobicity on the energetics of the process. "Hydrophobicity" as used here is an overall effect of the nature, degree, and number of substituents and is characterized by the cloud point and (aqueous) surface tension lowering abilities of the polymer. A direct correlation is found between the extent of "hydrophobicity" and the endo-enthalpic peak in the initial SDS concentration region of interaction. However, the overall mechanism of interaction is similar for all the polymers, being dominated by polymer-surfactant interactions initially and converting into a surfactant-surfactant interaction process at higher SDS concentrations. The importance of polymer characteristics thus becomes weaker at the later stages of the process. Differences between the polymers is also reduced by an increase of temperature, leading to a near overlap of observed enthalpy curves at 40 degrees C. The energetics of interaction are also mirrored by the isothermal surfactant binding curves and the changes in macroscopic and microviscosity of the system. Copyright 1999 Academic Press.