A review of wound dressing materials and its fabrication methods: emphasis on three-dimensional printed dressings.

A wound is a trauma caused by some adverse external or blunt forces that can damage the body tissues. Wound healing is a complex process that occurs post-injury which involves the revamping of the structure and function of damaged tissues. Scaffolds are engineered tissue structures manufactured using different materials and methods for facilitating the wound healing process. For external wounds, the antimicrobial property and ability to absorb moisture play an important role in the material selection of the scaffold. Among different methods that exist for designing scaffolds, three-dimensional printing has emerged as a promising technique wherein customised scaffolds can be designed. However, the literature on three-dimensional printed dressings is very much limited compared to conventional ones. Therefore, this review specifically focuses on the methods used to design the scaffolds with special emphasis on different three-dimensional printing techniques. It covers the process of external wound healing, different materials used in the fabrication of scaffolds, and their advantages and drawbacks.

Pheochromocytoma Presenting with Acute Abdomen.

Pheochromocytoma, a neuroendocrine tumor of the adrenal medulla, arising from chromaffin cells, usually presents with the clinical triad of paroxysmal headache, profuse sweating and palpitations, associated with labile hypertension. Here, we present the case of an adult male with an unusual manifestation of pheochromocytoma in the form of acute pain abdomen with nausea and abdominal guarding, mimicking acute peritonitis. He had fluctuating blood pressure recordings. On subsequent investigation, a mass lesion in the left suprarenal area on an abdominal CT scan and a 24-hour urinary metanephrine assay confirmed the diagnosis of pheochromocytoma.

COSMIC: High-Resolution Cancer Genetics Using the Catalogue of Somatic Mutations in Cancer.

COSMIC (http://cancer.sanger.ac.uk) is an expert-curated database of somatic mutations in human cancer. Broad and comprehensive in scope, recent releases in 2016 describe over 4 million coding mutations across all human cancer disease types. Mutations are annotated across the entire genome, but expert curation is focused on over 400 key cancer genes. Now encompassing the majority of molecular mutation mechanisms in oncogenetics, COSMIC additionally describes 10 million non-coding mutations, 1 million copy-number aberrations, 9 million gene-expression variants, and almost 8 million differentially methylated CpGs. This information combines a consistent interpretation of the data from the major cancer genome consortia and cancer genome literature with exhaustive hand curation of over 22,000 gene-specific literature publications. This unit describes the graphical Web site in detail; alternative protocols overview other ways the entire database can be accessed, analyzed, and downloaded. © 2016 by John Wiley & Sons, Inc.

Hysterolaparoscopy in the Evaluation and Management of Female Infertility.

OBJECTIVE: To study the role of hysterolaparoscopy in the evaluation and management of female infertility. MATERIALS AND METHODS: A retrospective study of the 94 case files of all the patients who underwent diagnostic hysterolaparoscopy for infertility between January 2014 to June 2015 in the department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interventions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized. RESULTS: Out of 94 cases, 53.1 % patients had primary, 17.1 % patients had secondary infertility, and 29.8 % came for tubal recanalization. As a whole pelvic pathology was confirmed in 51.7 % and intrauterine pathology in 18.1 % patients by hysterolaparoscopy. The most common laparoscopic abnormality detected was ovarian pathology (20.8 %), followed by pelvic inflammatory disease (17.5 %). Tubal block comprised 7.7 % whereas distorted uterus by fibroid in 6.6 % and pelvic endometriosis in 5.4 %. In hysteroscopy, the incidence of uterine anomaly was 13 (13.8 %). Septate uterus is the most common with a mean incidence of approximately 7 (53.8 %). CONCLUSION: Diagnostic hysterolaparoscopy is an effective diagnostic and therapeutic modality for certain significant and correctable abnormalities in pelvis, tubes and uterus which are missed by other imaging modalities.

Role of macular hole angle in macular hole closure.

AIM: To evaluate correlation of various spectral-domain optical coherence tomography (SD-OCT) parameters including macular hole angle as well as various indices with anatomical and visual outcomes after idiopathic macular hole repair surgery. METHODS: Retrospective study of 137 eyes of 137 patients who underwent idiopathic macular hole repair surgery between January 2008 and January 2014 was performed. Various qualitative parameters such as presence of vitreomacular traction, epiretinal membrane and cystic edges at the macular hole as well as quantitative parameters such as maximum diameter on the apex of the hole, minimum diameter between edges, nasal and temporal vertical height, longest base diameter and macular hole angle between the retinal edge and the retinal pigment epithelium were noted. Indices including hole form factor, Macular Hole Index (MHI), Diameter Hole Index and Tractional Hole Index (THI) were calculated. Univariate and multivariate regression analysis was performed separately for final visual acuity (VA) and type of closure as dependent variable in relation to SD-OCT parameters as independent variables. RESULTS: On multivariate regression only minimum diameter between edges (p≤0.01) and longest base diameter (p≤0.03) were correlated significantly with both, type 1 closure and final VA. Among the indices, significant correlation of MHI (p=0.009) was noted with type of closure and that of THI with final VA (p=0.017). CONCLUSIONS: Our study shows no significant correlation between macular hole angle and hole closure. Minimum diameter between the edges and longest diameter of the hole are best predictors of hole closure and postoperative VA.

Retinal ganglion cells thinning in eyes with nonproliferative idiopathic macular telangiectasia type 2A.

PURPOSE: To analyze the changes in retinal ganglion cells (RGCs) in eyes with nonproliferative macular telangiectasia type 2A (MacTel), by evaluating macular ganglion cell-inner plexiform layer (GCIPL) thickness and macular retinal nerve fiber layer (RNFL) thickness in comparison to age-matched healthy volunteers. METHODS: We performed a retrospective analysis of 99 eyes (53 subjects) with nonproliferative MacTel who underwent fundus fluorescein angiography and spectral domain optical coherence tomography using Cirrus HD-OCT. We also included 44 eyes of 33 age-matched healthy Indian volunteers as control group. Average, minimum, and sectoral GCIPL and RNFL thicknesses were collected. Comparison of GCIPL and RNFL thicknesses between MacTel and control groups was performed using Wilcoxon rank sum test. RESULTS: Eighty-eight eyes of 47 MacTel subjects were included after ensuring good quality of the retinal layers' segmentation. Macular GCIPL thickness was constantly and diffusely reduced in MacTel eyes compared with controls (P < 0.0001 for each GCIPL sector). The mean reduction in "average" GCIPL thickness was 11%, and the mean reduction in "minimum" GCIPL thickness was 23%. Similarly, macular RNFL thickness was diffusely reduced in MacTel eyes compared with controls (P < 0.0001 for each RNFL sector), with 13% of mean reduction. CONCLUSIONS: Our study demonstrated that in eyes with nonproliferative MacTel type 2A there was significant and consistent RGCs degeneration, leading to diffuse thinning of RGCs' dendrites, cell bodies, and axons. These findings are suggestive of neurodegeneration in MacTel type 2A.

Natural antisense transcripts in Plasmodium falciparum isolates from patients with complicated malaria.

Mechanisms regulating gene expression in malaria parasites are not well understood. Little is known about how the parasite regulates its gene expression during transition from one developmental stage to another and in response to various environmental conditions. Parasites in a diseased host face environments which differ from the static, well adapted in vitro conditions. Parasites thus need to adapt quickly and effectively to these conditions by establishing transcriptional states which are best suited for better survival. With the discovery of natural antisense transcripts (NATs) in this parasite and considering the various proposed mechanisms by which NATs might regulate gene expression, it has been speculated that these might be playing a critical role in gene regulation. We report here the diversity of NATs in this parasite, using isolates taken directly from patients with differing clinical symptoms caused by malaria infection. Using a custom designed strand specific whole genome microarray, a total of 797 NATs targeted against annotated loci have been detected. Out of these, 545 NATs are unique to this study. The majority of NATs were positively correlated with the expression pattern of the sense transcript. However, 96 genes showed a change in sense/antisense ratio on comparison between uncomplicated and complicated disease conditions. The antisense transcripts map to a broad range of biochemical/metabolic pathways, especially pathways pertaining to the central carbon metabolism and stress related pathways. Our data strongly suggests that a large group of NATs detected here are unannotated transcription units antisense to annotated gene models. The results reveal a previously unknown set of NATs that prevails in this parasite, their differential regulation in disease conditions and mapping to functionally well annotated genes. The results detailed here call for studies to deduce the possible mechanism of action of NATs, which would further help in understanding the in vivo pathological adaptations of these parasites.

An in vivo transcriptome data set of natural antisense transcripts from Plasmodium falciparum clinical isolates.

Antisense transcription is pervasive among biological systems and one of the products of antisense transcription is natural antisense transcripts (NATs). Emerging evidences suggest that they are key regulators of gene expression. With the discovery of NATs in Plasmodium falciparum, it has been suggested that these might also be playing regulatory roles in this parasite. However, all the reports describing the diversity of NATs have come from parasites in culture condition except for a recent study published by us. In order to explore the in vivo diversity of NATs in P. falciparum clinical isolates, we performed a whole genome expression profiling using a strand-specific 244 K microarray that contains probes for both sense and antisense transcripts. In this report, we describe the experimental procedure and analysis thereof of the microarray data published recently in Gene Expression Omnibus (GEO) under accession number GSE44921. This published data provide a wealth of information about the prevalence of NATs in P. falciparum clinical isolates from patients with diverse malaria related disease conditions. Supplementary information about the description and interpretation of the data can be found in a recent publication by Subudhi et al. in Experimental Parasitology (2014).

Multifocal electroretinography in type 2 idiopathic macular telangiectasia.

BACKGROUND: To characterize the electroretinographic response of the macula by multifocal electroretinography (mfERG) in patients with type 2 idiopathic macular telangiectasia (MacTel). METHODS: A prospective study of mfERG in patients with type 2 MacTel was conducted from April 2009 to November 2009. mfERGs were recorded using a visual evoked response imaging system (MonElec2, Metrovision, Perenchies, France). The International Society for Clinical Electrophysiology of Vision (ISCEV) guidelines were followed. Patients with type 2 MacTel confirmed by fundus fluorescein angiography without subretinal neovascularisation were included. For recording purposes, 61 stimulus hexagonal elements were used. The first-order kernel mfERG responses were analyzed. Individual mfERG responses for the hexagons were grouped into concentric rings centered on the fovea for analysis (< 2, 5-10, 10-15 and >15°). Student's t-test and Mann-Whitney U test and linear regression analysis was performed with STATA ver 11.1 (StataCorp, College Station , TX, USA). RESULTS: Twenty eight eyes of 14 patients and 20 eyes of ten normal controls were included in the study. The mean logMAR visual acuity of the patients was 0.51 (Snellen equivalent 20/63). The mean N1 amplitude (nv/deg(2)) of patients were significantly reduced compared to controls and were as follows: 8.91 ± 14.00 vs 43.44 ± 9.55 (p < 0.0001) in less than 2°, 9.24 ± 10.47 vs 22.00 ± 3.87 (p < 0.0001) in 5-10°, 8.57 ± 10.02 vs 15.24 ± 1.89 (p < 0.0001) in 10-15°, and 7.03 ± 6.52 vs 12.47 ± 2.62 in > 15° (p < 0.001). The mean P1 amplitude (nv/deg(2)) was also significantly reduced in patients compared to controls and was as follows: 27.66 ± 37.44 vs 96.20 ± 12.41 (p < 0.0001) in less than 2°, 22.61 ± 19.38 vs 53.78 ± 9.79 (p < 0.0001) in 5-10°, 18.75 ± 20.21 vs 35.22 ± 4.16 (p < 0.001) in 10-15°, and 17.10 ± 12.54 vs 25.71 ± 3.93 (p < 0.001). The implicit time of N1 and P1 were also delayed significantly in all the rings. The mean central foveal thickness assessed by optical coherence tomography (OCT) scan was 84.78 ± 45.12 µm. There was poor correlation between mfERG amplitudes or implicit times with either the visual acuity or OCT central thickness. CONCLUSION: mfERG showed significant reduction in amplitudes and implicit times of the waveforms in patients with type 2 MacTel in all the rings, suggesting a more generalized affection of the macula. The maximum reductions were seen in the <2(o) rings. Although there was poor correlation between the visual acuity and the amplitudes a of the waveforms, mfERG is a useful investigative modality for functional assessment of macula in type 2 MacTel patients.

Unusual case of acute renal failure following multiple wasp stings.

The wasp stings usually cause local reactions and rarely anaphylaxis. However the multiple wasp stings may cause multisystem involvement. We report a case of acute renal failure (ARF) following multiple wasp stings. A middle aged healthy gentleman presented with pain and swelling of the upper part of the body following multiple wasp stings. After 2 days, he developed progressive decrease in urine output with high colored urine. Physical examination revealed the edematous and tender affected part. On investigating, it was found to have sequential elevations in renal function tests. The markers of muscle injury were grossly elevated and liver enzymes were deranged. These findings suggest multisystem involvement predominantly ARF secondary to rhabdomyolysis. With the initiation of the intense hemodialysis, all the above parameters became normal. Timely intervention of multiple wasp stings causing ARF with multiorgan involvement by hemodialysis not only prevents mortality but also other complications.

Granulomatous dermatitis due to Malassezia sympodialis.

A 67-year-old man, with multiple skin lesions that appeared over 2 years, had biopsies that disclosed granulomatous dermatitis with associated small yeasts. The urinary antigen test results were negative for Histoplasma infection; cultures from the biopsies did not grow any fungi or other potential pathogens. The chest roentgenogram results were normal. Morphologic examination revealed features of a Malassezia species. Broad-range fungal polymerase chain reaction and DNA sequencing disclosed that the infecting fungus was Malassezia sympodialis , a lipid-dependent yeast. This report supports one other case report that Malassezia species may cause granulomatous dermatitis; in the previous case, the etiologic agent was Malassezia pachydermatis , a nonlipid-dependent species. We recommend the use of lipid-supplemented culture media for specimens from patients with granulomatous dermatitis because several Malassezia species are dependent on lipid; the absence of lipid supplementation in routine cultures likely explains the negative culture results for this patient. This, to our knowledge, is the first report of granulomatous dermatitis caused by M sympodialis.

Unusual presentation in Axenfeld-Rieger syndrome.

We report an unusual presentation of a case of Axenfeld-Rieger (A-R) syndrome. A 14-year-old male presented with gradual dimness of vision for 1 year and redness of left eye for 3 days. The patient had megalocornea with Haab's striae in the right eye and posterior embryotoxon in both the eyes. In the left eye, there was a white cord-like structure traversing the anterior chamber with adhesions to iris tissue along its course. On two antiglaucoma medications, his intraocular pressure (IOP) was 22 mm Hg in the right eye and 18 mm Hg in the left eye. Gonioscopy revealed a cord-like structure originating at the level of Schwalbe's line. He underwent right eye trabeculectomy with mitomycin-C. This case highlights a rare presentation of a strange cord-like structure, a rare presentation of A-R syndrome.

Clinicomicrobiological profile of children with acute pharyngitis with special reference to streptococcol grouping.

A total of 100 patients of acute pharyngitis were evaluated clinically and investigated microbiologically. Eighty patients proved culture positive acute pharyngitis, among them 17 patients proved positive for beta-haemolytic streptococci, 14 patients for Staphylococcus aureus, 24 for pneumococci, 13 patients for Streptococcus viridans, 3 for Brahmanella catarrhalis, 4 for coagulase negative staphylococci, 5 had mixed infection. Further streptococcal grouping was carried out on these isolates. Out of 17 isolates of beta-haemolytic streptococci 13 (76.47%) belonged to group A and 2 each (11.76%) belonged to group C and group G.

Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: a case series.

The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.

Prevalence and risk factors for primary glaucomas in adult urban and rural populations in the Andhra Pradesh Eye Disease Study.

PURPOSE: To compare the prevalence of and risk factors for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in urban and rural populations in the Andhra Pradesh Eye Disease Study. DESIGN: A population-based, cross-sectional study using a stratified, random, cluster, and systematic sampling strategy. PARTICIPANTS: Between 1996 and 2000, participants from 94 clusters in 1 urban and 3 rural areas representative of the population were included. METHODS: We performed a detailed eye examination, including applanation tonometry, gonioscopy, and dilated fundus evaluation after ruling out risk of angle closure. Humphrey threshold 24-2 visual fields were performed when indicated. MAIN OUTCOME MEASURES: Glaucoma was diagnosed and categorized using International Society of Geographical and Epidemiological Ophthalmology criteria. The prevalence and risk factors for POAG and PACG in subjects aged > or = 40 years were compared between the urban and rural cohorts. RESULTS: There were 3724 subjects > or = 40 years, with 934 in the urban and 2790 in the rural cohort. The prevalence of POAG was greater in the urban compared with the rural cohort (4% vs 1.6%; P<0.001). Age and intraocular pressure (IOP) were risk factors for POAG in both cohorts. Blindness owing to POAG was 11.1% in the rural and 2.7% in the urban cohort. The prevalence of PACG (1.8% vs 0.7%; P<0.01), primary angle closure (PAC) (0.8% vs 0.2%; P = 0.02) and primary angle closure suspect (PACS; 3.5% vs 1.5%; P<0.01) were significantly different between the urban and rural cohorts. Increasing age was a risk factor in the urban cohort. Intraocular pressure was a risk factor in both the populations. Blindness owing to PACG was equal (20%) in both the populations. Female gender was a risk factor in the rural cohort (P = 0.032). CONCLUSIONS: The prevalence of both POAG and PACG was greater in urban than in the rural population. Intraocular pressure was a significant risk factor for both POAG and PACG in both cohorts. Increasing age was a significant risk factor for POAG in both cohorts and for PACG in the urban cohort. Female gender was a risk factor for PACG in the rural cohort. There was more blindness owing to PACG than to POAG. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Clinical measurement and categorization of optic disc in glaucoma patients.

BACKGROUND: Assessment of optic disc size is an important component of optic nerve head examination. Agreement between different methods of disc size measurements is not very good. PURPOSE: To assess the agreement between the disc size assessed by Heidelberg retina tomograph (HRT) and stereobiomicroscopy with a 90 diopter (D) lens. To report the clinical (measured by biomicroscopy) disc diameters of small, average and large optic discs categorized by HRT disc areas. SETTING AND DESIGN: Observational study of subjects examined in the glaucoma clinic of a tertiary eye institute. MATERIALS AND METHODS: Seventy-five eyes of 75 glaucoma subjects were studied. Disc diameter was measured using stereobiomicroscopy and HRT. The agreement between the two sets of measurements was assessed by intraclass correlation coefficient (ICC). Discs were classified into small (<1.6 mm(2)), average (1.6-2.6 mm(2)) and large (>2.6 mm(2)) depending on cutoffs provided by the manufacturers of HRT. The means (95% CI) of the corresponding vertical disc diameter in these groups were assessed. STATISTICAL ANALYSIS: ICC, Bland and Altman plots. RESULTS: ICC for measurements of clinical and HRT horizontal disc diameter was 0.518 and for vertical disc diameter measurement was 0.487. The mean difference between the clinical and HRT measurements as analyzed by the Bland and Altman plot was 0.17 (95% CI, 0.13- 0.47) for horizontal and 0.22 (95% CI, 0.11- 0.54) for vertical disc diameter. Of the 75 eyes, 3 eyes had small discs, 54 average and 18 large discs. The mean clinical vertical disc diameter for small discs was 1.55 mm (95% CI, 1.2-1.7), for average discs was 1.91 mm (95% CI, 1.87-1.96) and for large discs was 2.15 mm (95% CI, 2.03-2.27). CONCLUSION: The agreement between clinical and HRT disc diameter measurements is moderate. Disc diameter measurement on stereobiomicroscopy can be used to categorize discs into small, average and large discs.

Use of autogenous cranial bone grafts in maxillofacial surgery: a preliminary report.

In conventional reconstruction of the facial skeleton, bone grafts are usually harvested from distant sites such as the ilium or ribs. Because of the morbidity associated with the use of these sites, the calvarium was studied as an alternate donor site. Twenty-three patients underwent bone grafting using autogenous calvarial bone. Reconstructive procedures included alveolar cleft grafts, Le Fort I osteotomies, midface onlay grafts, and grafting of a mandibular continuity defect. Intraoperative and postoperative morbidity associated with the bone donor site was minimal, and there was good incorporation of all the grafts. Long-term follow up is necessary before definitive conclusions about the response of the grafted bone can be made, but short-term results were promising.