Recurrent anterior instability of the shoulder associated with coracoid fracture - An unusual presentation.

Recurrent anterior shoulder instability following shoulder dislocation has an incidence as high as 68% among the younger population, however its association with coracoid fracture is extremely rare. Majority of coracoid fractures reported earlier have been shown to be associated with seizure disorder. We report a case of displaced coracoid fracture associated with recurrent anterior instability in a patient with no history of seizure disorder and its implications in causation as well as management are discussed. A 28 year old male, paramedic by profession, presented with complaints of multiple episodes of shoulder dislocation of right dominant extremity for last ten months. Pre-operative CT scan showed Hill-Sach's lesion associated with coracoid process fracture. In view of significant engaging Hill-Sach's lesion, bony reconstruction of glenoid to increase the articular arc was planned. However in view of the small coracoid fragment occurred due to fracture, Latarjet's procedure could not be planned and iliac crest bone graft (ICBG) was planned instead. Till date only 10 cases of coracoid fracture with anterior shoulder instability have been reported in English literature. Of the ten cases, six cases had history of seizure disorder while four cases had only traumatic association. In our case as coracoid fragment was small, it could not be used for Latarjet's procedure and instead was fixed to its proximal stump with suture anchors. This case highlight's rare injury pattern and emphasises on good clinico-radiological examination supplemented by high index of suspicion needed to diagnose this unusual presentation.

Gene Expression Profiling of Tuberculous Meningitis Co-infected with HIV.

Tuberculous meningitis (TBM) is a fatal form of Mycobacterium tuberculosis infection of the central nervous system (CNS). The similarities in the clinical and radiological findings in TBM cases with or without HIV make the diagnosis very challenging. Identification of genes, which are differentially expressed in brain tissues of HIV positive and HIV negative TBM patients, would enable better understanding of the molecular aspects of the infection and would also serve as an initial platform to evaluate potential biomarkers. Here, we report the identification of 796 differentially regulated genes in brain tissues of TBM patients co-infected with HIV using oligonucleotide DNA microarrays. We also performed immunohistochemical validation and confirmed the abundance of four gene products-glial fibrillary acidic protein (GFAP), serpin peptidase inhibitor, clade A member 3 (SERPINA3), thymidine phosphorylase (TYMP/ECGF1) and heat shock 70 kDa protein 8 (HSPA8). Our study paves the way for understanding the mechanism of TBM in HIV positive patients and for further validation of potential disease biomarkers.