Influence of body mass index on low back pain

Low back pain (LBP) is a common problem affecting 70% of the population in the developed countries and prevalence is also increasing in the developing countries. We conducted a clinic based cross-sectional study in the city of Dhaka and Chittagong during the period of January 2009 to December 2011. Participants (n=357) were interviewed and examined through a structured questionnaire after a non purposive sampling to explore the influence of body mass index (BMI) on LBP. BMI was assessed by the equation weight (Kg)/hight² (m²) and LBP was assessed by modified visual analogue scale. Association between LBP and BMI was tested by Chi-square test. Among 357 patients the incidence of LBP was common in the age group between 40-59 years and it was 172(48.17%) followed by 60-79, 20-39 and ≥80 years group with 21.29%, 17.65% and 12.89% respectively. Female presented more with LBP, i.e. 196(54.91%) than the male 161(45.09%). The more study population was found to have BMI within normal range, i.e. 167(46.78%). This was followed by overweight group which amounted 137(38.37%) while the obese group was the least, i.e. 53(14.85%). Maximum study population presented with severe LBP which amounted 140(39.22%) while others presented with moderate and mild LBP and amounting 118(33.05%) and 99(27.73%) respectively. Among the normal BMI group most patient presented with mild pain (n=82) followed by moderate (n=55) and severe (n=30) pain. Participants with overweight presents with severe pain mostly (n=58) but obese participants presented with severe low back pain (n=25). Statistically the association of LBP with BMI was found to be highly significant (p<0.0001). In this study, 137(46.78%) participants of normal BMI presented with LBP but majorities (n=82) presented with mild LBP and overweight and obese participants mostly presented with severe LBP. On the basis of these findings, careful evaluation of risk factors and deliberate assessment of the therapeutic as well as preventive measure for the management of patient of LBP is highly recommended.

A primary spinal hydatid cyst

Hydatid disease occurs in humans as a result of faeco-oral contamination. Spinal hydatid cyst is a rare entity and a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. Neural compression is common in vertebral hydatidosis where prognosis is always considered as very poor. Difficulty in management due to recurrence of this rare entity makes it a challenging disease to eradicate entirely. Efficacy of use of anthelminthic even after complete surgical removal is yet to be established. We are reporting diagnosis and management of a case of primary extradural and paraspinal hydatid cyst (HC) in an otherwise healthy patient who did not show any other evidence of systemic hydatid disease. The diagnosis was recognized preoperatively by magnetic resonance imaging (MRI) and confirmed postoperatively by histopathology. Surgical removal of the cysts/lesions was followed by anti-helminthic medication and recovery was satisfactory until the patient had recurrence after one year. The patient underwent surgery for the second time and was given anti-helminthic again for a longer period and was recurrence free for the next one year.

Anterior cervical discectomy and fusion without instrumentation for cervical spondylosis

This prospective study included 50 patients receiving anterior cervical discectomy and fusion (ACDF) was conducted at Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The study period was 1st July 2006 to 30th June 2010. This study was done to see the functional outcome of surgery in relation to duration of symptoms and age of the patient. The clinical information and relevant imaging of 50 consecutive patients, 41 male and 9 female, was reviewed at 1 year after surgery. All surgery was performed at no more than 2 contiguous levels, by one surgeon. After anterior discectomy alone, or combined with posterior vertebral body margin osteophytectomy, anterior bone grafting was performed at each level using a tricortical autogenous iliac crest bone block inserted under compression. All surgery was completed without internal fixation. A postoperative semirigid cervical collar was prescribed for 2 months. In 50 patients, there were 4 pseudarthroses (8%). Only 4% of the 50 patients had pain related to the donor site. The functional outcome was excellent to good (87.5%) when duration of symptoms less than 1 year and outcome was excellent to good (85.29%) when the age less than 50 years. These results tend to confirm published reports of most expected outcome related to young age and short duration of symptoms. Patients with technically successful fusions were less likely to have postoperative neck pain. Donor site pain was not a significant postoperative complication. ACDF is a safe, cheap and effective procedure for cervical spondylosis. In this series no major operative complications have occurred. No extra expenditure for plate and screw in this procedure.

Large calcified subdural empyema

Subdural empyema is a known disease entity; however, calcified subdural empyema is uncommon. The authors present a case of an 11-year-old boy in whom there was diagnosed a chronic calcified subdural empyema 10 years after an attack of meningitis. The patient had suffered from generalized tonic clonic seizures occurring 2-6 times in a month. A large fronto-temporo-parietal craniotomy was carried out and the subdural empyema filled with numerous uncharacteristic tissue fragments with thick pus together with the partially calcified and ossified capsule was removed. The empyema mass was found to be sterile for bacteria. After the operation, no epileptic seizure occurred and the boy is on sodium valporate. We must emphasize the unusual occurrence of the chronic subdural empyema presenting with calcification-ossification and large size as observed in our case.

Patterned organosilane monolayers as lyophobic-lyophilic guiding templates in surface self-assembly: monolayer self-assembly versus wetting-driven self-assembly

Monolayer self-assembly (MSA) was discovered owing to the spectacular liquid repellency (lyophobicity) characteristic of typical self-assembling monolayers of long tail amphiphiles, which facilitates a straightforward visualization of the MSA process without the need of any sophisticated analytical equipment. It is this remarkable property that allows precise control of the self-assembly of discrete, well-defined monolayers, and it was the alternation of lyophobicity and lyophilicity (liquid affinity) in a system of monolayer-forming bifunctional organosilanes that allowed the extension of the principle of MSA to the layer-by-layer self-assembly of planed multilayers. On this basis, the possibility of generating at will patterned monolayer surfaces with lyophobic and lyophilic regions paves the way to the engineering of molecular templates for site-defined deposition of materials on a surface via either precise MSA or wetting-driven self-assembly (WDSA), namely, the selective retention of a liquid repelled by the lyophobic regions of the pattern on its lyophilic sites. Highly ordered organosilane monolayer and thicker layer-by-layer assembled structures are shown to be ideally suited for this purpose. Examples are given of novel WDSA and MSA processes, such as guided deposition by WDSA on lyophobic-lyophilic monolayer and bilayer template patterns at elevated temperatures, from melts and solutions that solidify upon cooling to the ambient temperature, and the possible extension of constructive nanolithography to thicker layer-by-layer assembled films, which paves the way to three-dimensional (3D) template patterns made of readily available monofunctional n-alkyl silanes only. It is further shown how WDSA may contribute to MSA on nanoscale template features as well as how combined MSA and WDSA modes of surface assembly may lead to composite surface architectures exhibiting rather surprising new properties. Finally, a critical evaluation is offered of the scope, advantages, and limitations of MSA and WDSA in the bottom-up fabrication of surface structures on variable length scales from nano to macro.

Contact electrochemical replication of hydrophilic-hydrophobic monolayer patterns

Contact electrochemical replication (CER) is a novel pattern replication methodology advanced in this laboratory that offers the unprecedented capability of direct one-step reproduction of monolayer surface patterns consisting of hydrophilic domains surrounded by a hydrophobic monolayer background (hydrophilic @ hydrophobic monolayer patterns), regardless of how the initial "master" pattern was created. CER is based on the direct electrochemical transfer of information, through aqueous electrolyte bridges acting as an information transfer medium, between two organosilane monolayers self-assembled on smooth silicon wafer surfaces. Upon the application of an appropriate voltage bias between a patterned monolayer/silicon specimen playing the role of "stamp" and a monolayer/silicon specimen playing the role of "target", the hydrophilic features of the stamp are copied onto the hydrophobic surface of the target. It is shown that this electrochemical printing process may be implemented under a variety of experimental configurations conducive to the formation of nanometric electrolyte bridges between stamp and target; however, using plain liquid water for this purpose is, in general, not satisfactory because of the high surface tension, volatility, and incompressibility of water. High-fidelity replication of monolayer patterns with variable size of hydrophilic features was achieved by replacing water with a sponge-like hydrogel that is nonvolatile, compressible, and binds specifically to the hydrophilic features of such patterns. Since any copy resulting from the CER process can equally perform as stamp in a subsequent CER step, this methodology offers the rather unique option of multiple parallel reproduction of an initially fabricated master pattern.

Wetting driven self-assembly as a new approach to template-guided fabrication of metal nanopatterns

Wetting driven self-assembly (WDSA) of appropriate materials in their liquid state on organic monolayer nanopatterns consisting of wettable (lyophilic) surface features surrounded by a nonwettable (lyophobic) monolayer background is shown to provide the basis of a versatile new approach to template-guided fabrication of metal nanopatterns. Monolayer nanopatterns with planned distributions of lyophilic/lyophobic surface regions are conveniently generated by constructive nanolithography upon local electrochemical oxidation of the top -CH3 groups of a highly ordered OTS (n-octadecyltrichlorosilane) monolayer self-assembled on silicon to -COOH (Adv. Mater. 2000, 12, 725-731). Retraction of such a patterned monolayer from a liquid that does not wet its nonpolar -CH3 surface (lyophobic) results in selective, site-defined immobilization of nanosized volumes of the liquid on the locally generated polar -COOH groups (lyophilic). Examples are given of WDSA of organic materials that offer further options for post-assembly chemical processing, such as nonvolatile low-melting olefins, acids, or thiols, the former being in situ reacted to generate polar functions like -COOH or -SH. Loading surface patterns created in this manner with silver or gold ions followed by further chemical processing results in elemental metal nanoparticles generated within the ion-binding organic material, which thus functions as a guiding template for planned metal deposition at predefined surface sites. WDSA is particularly versatile, as any nonvolatile material with appropriate melting temperature and surface wetting characteristics or solubility in a liquid displaying such properties may in principle be utilized to fabricate potentially useful surface nanostructures.

Approach to a case of autonomic peripheral neuropathy

Autonomic neuropathy is the term used to describe autonomic disturbances resulting from diseases of the peripheral autonomic nervous system. This is a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibers are selectively targeted. Most often, autonomic neuropathies occur in conjunction with a somatic neuropathy (i.e. with motor weakness and/or sensory loss), but they can occur in isolation. Causes of autonomic neuropathies are immune-mediated, paraneoplastic, infectious, toxic and drug-induced, hereditary, nutritional and idiopathic. Amongst all, diabetes mellitus is the most common cause. Autonomic features, which involve the cardiovascular, gastrointestinal, urogenital, sudomotor, and pupillomotor systems, occur in varying combination in these disorders. Orthostatic hypotension is often the first recognized and most disabling symptom. Noninvasive, well-validated clinical tests of autonomic functions along with a host of laboratory tests are of immense value to diagnose the presence and to demonstrate the distribution of autonomic failure. Treatment aims to treat specific cause of the autonomic neuropathy (if possible) and to control symptoms of autonomic dysfunction. Present review attempts to outline clinical approach to a case of autonomic peripheral neuropathy.

Cytokine response in children undergoing surgery for congenital heart disease

Pediatric cardiac surgery with cardiopulmonary bypass (CPB) induces a complex inflammatory response that may cause multiorgan dysfunction. The objective of this study was to measure postoperative cytokine production and correlate the magnitude of this response with intraoperative variables and postoperative outcomes. Serum samples from 20 children (median age, 15 months) undergoing cardiac surgery with CPB were obtained preoperatively and on postoperative days (POD) 1-3. Serum levels of interleukin (IL)-6, IL-8, and IL-10 increased significantly on POD 1 (p < 0.01) vs pre-op values to 271 +/- 68, 44 +/- 9, 7.5 +/- 0.8 pg/ml, respectively, whereas serum IL-1beta, IL-12, and tumor neurosis factor -alpha were not significantly changed. The serum IL-6 and IL-8 levels correlated positively (p < 0.01) with the degree of postoperative medical intervention as measured by the Therapeutic Interventional Scoring System and indicated a greater need for inotropic support (p = 0.057). A negative correlation (p < 0.01) between IL-6, IL-8, and mixed venous oxygen saturation suggested compromised cardiopulmonary function. Patients with single ventricle anatomy had the highest levels of IL-6 and IL-8 (629 +/- 131 and 70 +/- 17 pg/ml, respectively), with a mean CPB time of 106 +/- 23 minutes. Thus, the proinflammatory response after surgery with CPB was associated with postoperative morbidity with increased need for medical intervention.

Solid-state storage of Ag nanoparticles in anion exchange resin beads and their recovery

This paper reports the idea and describes a method of reversible storage and recovery of silver nanoparticles (NPs) in anion exchange resin beads based on the principle of ion exchange. We also report that similar exchange of NPs was not possible with cation exchange resins. The Ag NPs were stored by simple exchange of anions of the resins, which were activated with OH- and NO3- ions. FTIR spectroscopic measurements support that the Ag NPs were exchanged with NO3- ions in the resins. The so-stored NPs could be regenerated by addition of NaBH4 solution to the resins. These NPs were recovered and subsequently utilized for catalytic reduction of an organic dye (eosin). Powder X-ray diffraction (XRD) pattern indicated storage of the NPs in the form of various oxides of silver in the resin, with the peak value of intensity corresponding to XRD of the NPs not changing with time. Scanning electron microscopic measurements show that the NPs in the beads were stable for over a month without the formation of any apparent agglomeration.

Vitamin B12 deficiency: a clinical and electrophysiological profile

OBJECTIVE

The present study was conducted to evaluate the clinical and electrophysiological profile of vitamin B12 deficiency syndrome and whether a correlation exists between the disease process and the various electrophysiological parameters.

METHODS

40 patients with vitamin B12 deficiency neurological syndromes with low serum vitamin B12 and high homocysteine levels were subjected to a detailed motor and sensory nerve conduction studies and pattern reversal VER (P100), SSEP (P37) after stimulation of the posterior tibial nerve and median nerve (N 20) were obtained bilaterally. MR cervical spine was done in all the patients and MR brain in those who presented with neuro-psychiatric symptoms. The patients were followed up at three months, six months and one year after treatment.

RESULTS

On the basis of clinico-electrophysiological profile, 31 patients had myeloneuropathy, 5 isolated myelopathy, 4 isolated neuropathy. Four of the patients with myeloneuropathy, had concomitant dementia. MR imaging revealed abnormality in 12.5% of cases. Prolongation of P37 latency was observed in 39 (97.5%) patients, N 20 latency in 22 (55%), and P100 latency in 19 (47.5%) patients. Peripheral neuropathy was seen in 18 patients; optic neuropathy in 8; and combination of peripheral and optic neuropathy in 9 patients. The peripheral neuropathy was axonal in 19, and demyelinating in 6 patients. There was a significant correlation of the duration of the disease with N 20 latency (P < 0.04). Serum vitamin B12 level correlated well with the latencies of P37 (P < 0.005) and sural SNAP (P < 0.006). On treatment, normalization of P100, MRI signal, N 20 and partial recovery of P37 latencies was seen at 6 months, 9 months and one year respectively.

CONCLUSION

Differential recovery of central and peripheral syndromes was seen. This correlated with the underlying demyelinating and axonal processes, which was well reflected by the electrophysiological studies, and has an important bearing on the outcome.

Photocatalytic polypyrrole-TiO2-nanoparticles composite thin film generated at the air-water interface

Herein, we report a new method of generation of TiO(2) nanoparticles (NPs) incorporated thin films of polypyrrole (PPy) at the air-water interface. Aqueous TiO(2) NPs when treated with H(2)O(2) and left in a chamber of pyrrole vapor resulted in the formation of a film at the interface, in addition to bulk precipitate. Spectroscopic, X-ray diffraction, and electron microscopic measurements establish the formation of a thin film of PPy with the incorporation of TiO(2) NPs. The TiO(2)-containing PPy films when transferred onto glass substrates were able to photo catalyze the decomposition of aqueous organic dyes: methyl orange and methylene blue. Further, these films could also photo catalyze the oxidation of iodide to triiodide ions in aqueous potassium iodide solution. We find that the PPy-TiO(2) composite films catalyze the reactions in the presence of light more efficiently than a suspension of TiO(2) NPs.

A polyaniline-containing filter paper that acts as a sensor, acid, base, and endpoint indicator and also filters acids and bases

In this paper we report a new idea for synthesizing polyaniline in an ordinary filter paper. The synthesis was carried out by a process in which aqueous acidic aniline solution and the oxidizing agent H(2)O(2) was added to the paper drop by drop and in sequence. Uniform polymerization could be obtained with the addition of reagents in either sequence. The polymer formation led to a green coloration of the paper. Formation of the emeraldine salt of polyaniline was confirmed by UV-vis and FTIR spectroscopy. Scanning electron microscopic measurements were made for surface characterization of the polymer formed in the paper. The same paper was used as a sensor for ammonia in vapor and in solution, for acid and base as well as endpoint indication, and also to filter acids and bases. We found that, using the polymer-containing paper, ammonia concentrations in a solution as low as 14 ppm could be measured.

Are multiple acute small subcortical infarctions caused by embolic mechanisms?

OBJECTIVE

To seek evidence of potential embolic sources or other stroke mechanisms in patients who, on chance observation, had several apparently recent small subcortical infarcts on diffusion weighted magnetic resonance imaging (DWI).

METHODS

Patients presenting with stroke and multiple hyperintense subcortical infarcts visible on DWI were identified prospectively. Detailed clinical and radiological assessments were done independently and blinded to each other.

RESULTS

Of 10 patients with multiple hyperintense subcortical infarcts on DWI, a definite embolic source was identified in only one. Most patients were hypertensive and smoked. The DWI appearance suggested that the subcortical lesions had occurred within several weeks rather than at exactly the same time. Most patients also had significant white matter hyperintensities and four had microhaemorrhages.

CONCLUSIONS

Embolic sources were not identified in most patients but they did have systemic vascular risk factors and brain imaging features of "small vessel disease." A more generalised intrinsic process affecting many small cerebral vessels contemporaneously could explain multiple acute small subcortical infarcts. White matter hyperintensities, microhaemorrhages, and multiple small subcortical infarcts may share a common pathophysiological mechanism such as a diffuse cerebral microvascular abnormality which requires further exploration.

Brachial plexopathy: a clinical and electrophysiological study

BACKGROUND

A retrospective study to evaluate the clinical and electrophysiological profile of brachial plexus lesions in a tertiary care center of India.

METHODS

Thirty eight patients with brachial plexopathy (idiopathic or traumatic) with detailed electrophysiological studies were sampled. This included detailed motor and sensory nerve conduction studies of the conventional median, ulnar and radial nerves of the upper limbs, CMAP from deltoid, biceps and triceps on stimulating the ERB's point, needle EMG in the appropriate muscles and paraspinal muscles. The electrophysiological studies were performed on both sides irrespective of the clinical involvement and were recorded within 1.61 +/- 2.89 months in idiopathic group and 2.11 +/- 2.65 months in traumatic plexopathy group. The severity of involvement was assessed on MRC scale. ADL scale was used to assess the disability at presentation and subsequent follow up.

RESULTS

12 patients (11 male and 01 female) had idiopathic brachial plexopathy and 26 patients (all male) had traumatic brachial plexopathy. In the idiopathic group the lesion was localized to upper trunk in 58.3% of patients and middle trunk (posterior cord) in 41.66% and none had lower trunk or diffuse involvement. 25% had bilateral involvement. Two patients (16.6%) with idiopathic plexitis had recurrence involving the opposite side during the follow up. In the traumatic group the lesion was localized to the upper trunk in 11.53%, middle trunk (posterior cord) in 57.69% and 30.76% of patients had diffuse involvement. All the patients in traumatic plexopathy group had severe disability while in idiopathic group 91.66% had severe disability and 8.33% had moderate disability. Low amplitude CMAP and F wave abnormality were seen in 16.6% of patients in idiopathic group. On needle EMG 83.3% had fasciculation or fibrillations while none had paraspinal EMG abnormality. In traumatic group low to absent CMAP was seen in 69.2% and 76.92% had F wave abnormality. SNAPs were not recordable in 53.8%. On Needle EMG all the patients showed fasciculation or fibrillations and only 6 (23.0%) had paraspinal muscle fibrillations. Root avulsion could be documented in only four of these cases on MR imaging.

CONCLUSIONS

Recovery in the traumatic group correlated well with the electrophysiological abnormalities while no such correlation was evident in the idiopathic group.

Spreading and recoil of a surfactant-containing water drop on glass-supported alcohol films

In this paper we report the experimental observation of spreading and recoil of surfactant-containing water drops on various alcohol films supported on glass slides. The time evolution of spreading and recoil behavior was recorded by placing a web camera above the drop. We observed that the drop spread the fastest on CH3OH, followed by C2H5OH, and the slowest on i-PrOH. On the other hand, the recoil behavior was just the opposite. The drop recoiled the slowest on CH3OH and fastest on i-PrOH, while it recoiled in an intermediate time on C2H5OH. In addition, concentration of surfactant in the drop played a prominent role in the spreading and recoil time of the drop, with higher surfactant concentration making the drop spread and recoil faster. The time evolution of spreading velocity of the drop on different alcohol films at various surfactant concentrations occurred with a Gaussian distribution and the peak velocity was reached earliest on CH3OH followed by C2H5OH, while on i-PrOH it took the longest time. The recoil behavior was similar. The variation of velocity as a function of radius exhibited oscillatory behavior, indicating the existence of an interfacial phenomenon. We also report the observation that spreading of the drop occurred without observable fingering instability. Further, we observed by Fourier transform infrared (FTIR) spectroscopic measurements that the drop had mixed with the alcohol films as it spread. Miscibility of the alcohol in the film with the drop, alcohol evaporation cooling-induced temperature gradient, and Marangoni effect probably play important roles in the spreading and recoil behavior of the drop.

Macroscopic and mesoscopic patterns observed in thin films formed due to polymerization of aniline at the air-water interface

We report two-dimensional mesoscopic and macroscopic patterns observed in thin films formed due to polymerization of aniline at the air-water interface. The polymerization at the interface was coupled to a reaction in the bulk medium that was either an iron (ferroin)-catalyzed Belousov-Zhabotinsky (BZ) reaction or another reaction condition where the ferroin component of BZ reaction was replaced by FeSO(4) or Mohr's salt [(NH(4))(2)SO(4).FeSO(4).6H(2)O]. Also, a simple mixture of KBrO(3) and KBr in aqueous acidic solution produced patterned polymers at the interface, observed with aniline introduced from both the vapor phase and the bulk phase (by dissolving in H(2)SO(4)). Observation under an optical microscope revealed that the macroscopic patterns consisted of mesoscopic patterns of various geometrical shapes. In one case, regular circular mesoscopic patterned polymer growth was observed when the reaction was carried out in the presence of 2.02 mM sodium dodecyl sulfate. On the other hand, when the film was grown in an ultrasonicator bath there were no observable mesoscopic or macroscopic patterns in the film.

Fabrication of submicron scale patterned plastic thin film fluidic devices with controllable thickness

We present a soft-lithography based method to fabricate plastic thin film fluidic devices on glass and plastic substrates. Principles of soft-lithography and spin casting were used to generate the films. The thickness of these films is controllable and the patterns we have generated have submicron scale dimensions. By using commercially available compact disc (CD) components as molds, we have been able to generate parallel line and cross patterns on these thin films. These patterned films could be lifted from the substrates and further folded into rolls.