Effect of duration of sodium valproate therapy on bone mineral density and vitamin D levels

OBJECTIVE

This study aimed to evaluate the impact of prolonged sodium valproate use on bone mineral density (BMD) and Vitamin D levels in pediatric epilepsy patients.

METHODS

In a cross-sectional study conducted at the Epilepsy Clinic of Niloufer Hospital, Hyderabad, India, 50 pediatric patients (aged 4-10 years) were recruited. The cohort comprised 30 epilepsy patients on sodium valproate treatment (cases) and 20 healthy siblings without epilepsy or valproate use (controls). BMD was assessed using dual-energy X-ray absorptiometry to measure height-adjusted total body less head Z-scores (TBLH Z-scores), and serum 25-hydroxyvitamin D levels were measured. Statistical analysis included independent samples t-tests, Mann-Whitney U tests, and Pearson correlation, with a preliminary power analysis ensuring adequate sample size.

RESULTS

Cases exhibited significantly lower BMD TBLH Z-scores (Mean = -1.543) compared to controls (Mean = 0.515, p <.001) and reduced Vitamin D levels (Mean = 9.17 for cases vs. 27.80 for controls, p <.001). A negative correlation was observed between the duration of sodium valproate use and both BMD Z-scores (r = -0.626, p <.001) and Vitamin D levels (r = -0.707, p <.001).

CONCLUSIONS

The findings suggest a significant negative impact of prolonged sodium valproate use on both bone density and Vitamin D levels in pediatric patients. These results underscore the importance of monitoring and managing bone health in children receiving long-term sodium valproate therapy.

A Spectrum of Histomorphological and Immunohistochemical Expression Profiles of S-100, CD56 and Calretinin in Benign Peripheral Nerve Sheath Tumours

INTRODUCTION

 Peripheral nerve sheath tumours comprise benign tumours; namely schwannomas and neurofibromas, and only rarely comprise hybrid benign tumours and their malignant counterpart, malignant peripheral nerve sheath tumours (MPNST). There may be diagnostic difficulties in histopathology analysis, especially in core needle biopsies where there is a limited amount of tissue. Immunohistochemistry (IHC) can play a beneficial role, especially in atypical and cellular histological variants and rarely hybrid tumours.

METHODS

 A total of 45 cases of benign peripheral nerve sheath tumours were included in the study; there were 27 cases of neurofibroma including variants like plexiform and cellular neurofibromas and 18 cases of schwannomas including variants like ancient schwannoma and cellular schwannoma. Immunohistochemical staining (IHC) on these tumour tissues using S-100, CD56 and calretinin was done and scoring was done based on extent and intensity.

RESULTS AND DISCUSSION

 No significant differences were observed between neurofibromas and schwannomas on patient age and anatomical locations of these tumours. IHC results did not show statistically significant patterns of expression of S-100 protein between the schwannoma and neurofibromas groups (p=0.75). CD56 protein was expressed strongly (3+) in 90% of cases of schwannoma and negative in 86% of neurofibromas, the differential expression between the two groups was found to be statistically significant (p <0.0001). Calretinin was positive in 39% of schwannomas including one case of cellular schwannoma and negative in all (100%) cases of neurofibroma while the differential expression of calretinin between schwannoma and neurofibroma groups was found to be statistically significant (p < 0.005).

CONCLUSION

Our study shows that S-100 does not show differential expression between schwannomas and neurofibromas. CD56 could be a potentially useful IHC marker to aid in the diagnosis of peripheral nerve sheath tumours with significantly higher expression in schwannomas compared to neurofibromas. Calretinin was also found to be preferentially expressed in schwannomas, though the difference is statistically significantly lower compared to CD56. A panel of all these markers could be used for accurate diagnosis.

Validating low-fidelity arthroscopic simulation in medical students: a feasibility trial

INTRODUCTION

With surgical opportunities becoming increasingly restricted for orthopaedic trainees, simulation training is a valuable alternative at providing sufficient practice. This pilot study aims to assess the potential effectiveness of low-fidelity simulation in teaching medical students basic arthroscopic skills and the feasibility of its incorporation into formal student training programmes.

METHODS

Twenty-two medical students completed pre- and post-training tests on the Probing (Task 1) and Maze (Task 2) exercises from the Sawbones 'Fundamentals of Arthroscopy Surgery Training' (FAST) programme. Training consisted of practising horizon control, deliberate linear motion and probing within 25min over a period of days. Completion time and error frequency were measured. The difference in performance was assessed using a paired two-tailed t-test. Qualitative data were collected.

RESULTS

Test completion time decreased significantly by a mean of 83s (±46s, 95% confidence intervals [CI] 37 to 129) for Task 1 (p=0.001) and 105s (±55s, 95% CI 50 to 160) for Task 2 (p=0.0007). Frequency of direct visualisation errors decreased significantly by a mean of 1.0 errors (±1.0 errors, 95% CI 0.1 to 2.0) for Task 1 (p = 0.04) and 0.8 errors (±0.8 errors, 95% CI 0.1 to 1.6) for Task 2 (p = 0.04). At post-training, 82% of participants were willing to incorporate FAST into formal training.

CONCLUSIONS

Low-fidelity simulators such as FAST can potentially teach basic arthroscopic skills to medical students and are feasible for incorporation into formal training. They also give students a cost-effective and safe basic surgical training experience.

O099 Position and number of anchors in hip arthroscopy labrum repair: a systematic review

Introduction

Hip labral tears are reported in 22–55% of patients with hip or groin pain. Operative treatment is necessary for most cases, via hip arthroscopy with the use of suture anchors. This systematic review aims to determine the optimal number and position of anchors in hip labral repair.

Methods

Pubmed, Ovid & Embase were searched, and 2 researchers independently screened the 1,304 results. Outcome measures such as procedures performed, number & (clockface) position of anchors, failure & articular involvement of anchors were extracted.

Results

5 studies were included in the analysis: 1 Cross-Sectional Study (1645 Hips, mean age (MA):33.7 years), 3 Retrospective case studies (491 hips, MA:31.0) and 1 Controlled Cadaveric study (32 cadaveric hips, MA:62.7). Chi-squared statistical analysis of 323 hips found a significant difference (X2 (2, N = 323) = 17.88, p &lt; .001) in the risk of articular involvement with the position of anchors at 11°-12° o’clock, 1°-2° and 3°-4°. There is an absolute risk reduction (ARR) of 19% with anchors positioned at 11°-12° compared to anchors positioned at 3°-4° (X2 (1, N=178) =15.79, p &lt; .001) and an ARR of 12% with anchors at 1°-2° compared to anchors positioned at 3°-4° (X2 (1, N = 237) = 15.79, p &lt; .0109). Additionally, by assessing 1645 operations it was found that for tears spanning &gt;2 hours, a minimum of 2 anchors was placed.

Conclusion

Placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and careful placement can be used to minimize articular injury. Preferable positions of anchors are 11°-12°, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.

Take-home message

In Hip Arthroscopy labral repair, placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and 2 hours. flexible anchor instrumentation can be used to minimize articular injury, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.

Characteristics and Impacts of Venous Thromboembolism in Patients with Hepatocellular Carcinoma

INTRODUCTION

Venous thromboembolism (VTE) is a common complication in cancer patients, and is associated with worse prognosis in such population. Hepatocellular carcinoma (HCC) poses high risk for VTE; however, data is scarce regarding the characteristics and consequences of VTE in HCC patients.

METHOD

We retrospectively reviewed the electronic medical records (EMR) of 270 patients diagnosed with HCC from 2000 to 2015 in Cook County Health and Hospitals System. We report the cumulative incidence of VTE in the present cohort, and identified through multivariate logistic regression the independent risk factors of the development of VTE. Overall prognosis of patients with and without VTE were presented and compared.

RESULTS

Sixteen cases (5.93%) of VTE were documented in the present study. In multivariate analysis, obesity, Child B cirrhosis, intra-hepatic lesions more than 3, and multi-organ extrahepatic metastasis were significantly associated with VTE development (p < 0.05). The presence of VTE was an independent risk factor for mortality in multivariate analysis (HR = 3.62, p = 0.021), together with male gender, Child C cirrhosis, and extrahepatic metastasis.

CONCLUSIONS

Obesity, Child B cirrhosis, more intra-hepatic lesions, and multi-organ extrahepatic metastasis are associated with cancer-associated VTE. VTE will adversely affect the prognosis of patients with HCC; therefore, primary thromboprophylaxis may be warranted in such population.

Developing Surgical Oncology Services in Resource Constrained Settings: Results of a Systematic and Motivated Approach

Background: General surgeons trained in surgical oncology and working in a general service hospital can offer and provide a wide variety of oncological services although significant limitations exist compared with a true tertiary cancer care center in developed high income countries. Providing optimal and standard of care surgical oncology services is truly demanding and limitations in ancillary and support services can potentially limit the quality of care provided in resource constrained settings like ours. Aim: The aim of this study was to analyze the patterns of care, surgical outcomes in terms of morbidity and mortality, quality of resection in terms of margins and nodal yield over a period of 08 weeks in a general service hospital with resource constrained setting and with two trained and motivated surgical oncologists. Methods: Data of 22 patients with solid organ cancers who underwent major operative treatment both curative and palliative under the surgical oncology services were analyzed retrospectively. All patients were evaluated clinically, imaging as required and pathologic tissue diagnosis of cancer obtained as was possible and after adequate preoperative preparation were operated upon. Results: Four patients of carcinoma rectum underwent low anterior resection with diverting ileostomy, one patient with rectal cancer had APR with permanent end colostomy, two patients underwent total thyroidectomy for papillary thyroid cancer, eight patients underwent modified radical mastectomy for carcinoma breast, two patients had optimal cytoreductive surgery for carcinoma ovary -one patient upfront and another as interval cytoreduction, two cases of soft tissue tumor underwent limb salvage surgery, one case of carcinoma stomach underwent subtotal gastrectomy, one case of carcinoma cecum underwent classic right radical hemicolectomy. Two patients underwent emergency exploration for acute abdomen who were otherwise metastatic for palliation. All but one case received neoadjuvant therapy prior to surgery in carcinoma rectum, one case of carcinoma ovary and carcinoma breast were operated after neoadjuvant chemotherapy. Overall there was only one margin positive resection after low anterior resection who was operated upfront due to impending obstruction. The average nodal yield in all cases of colorectal carcinomas and breast cancer cases were as per current NCCN standards. Morbidities included seroma collection in 3 patients, minor surgical site infection in 2 patients, peristomal allergy in two patients, there were no deaths in elective cases. Conclusion: Providing quality surgical oncology services in a resource constrained general service hospital is challenging. Through an aggressive, well planned and motivated approach with a good surgical oncology training background and with available resources it is possible to achieve a varied spectrum, quality care and an improved and sustainable healthcare oncology systems for better outcomes even in these settings.

Acute liver failure with amiodarone infusion: A case report and systematic review

WHAT IS KNOWN AND OBJECTIVE

Amiodarone, a commonly used class III antiarrhythmic agent notable for a relatively long half-life of up to 6 months and its pronounced adverse effect profile, is used for both acute and chronic management of cardiac arrhythmias. Chronic use of amiodarone has been associated with asymptomatic hepatotoxicity; however, acute toxicity is thought to be uncommon. There are only six reported cases of acute liver failure (ALF) secondary to amiodarone. In all these cases the outcome of death during the same hospitalization resulted. We aimed to report the only case of acute liver failure secondary to amiodarone infusion in the existing literature where the patient survived.

CASE SUMMARY

A 79-year-old woman admitted with atrial flutter was being treated with intravenous (IV) amiodarone when she abruptly developed coagulopathy, altered mental status and liver enzyme derangement. She was diagnosed with acute liver failure (ALF) secondary to an amiodarone adverse drug reaction, with a calculated score of seven on the Naranjo adverse drug reaction probability scale. Amiodarone was immediately withheld, and N-acetylcysteine (NAC) was initiated. Clinical improvement was seen within 48 hours of holding the drug and within 24 hours of initiating NAC. On post-hospital follow-up visit she was reported to have complete recovery.

WHAT IS NEW AND CONCLUSION

This report emphasizes the importance of monitoring liver enzymes and mental status while a patient is being administered IV amiodarone. N-acetylcysteine administration may have possibly contributed to the early and successful recovery from ALF in our patient. To date, she is the only patient in the existing literature who has been reported to survive ALF secondary to amiodarone administration.

A less energy intensive process for dehydrating onion

Onion powder has an extensive demand and wide application worldwide as flavour additive in convenience foods and medicinal products. Conventionally onion powder is prepared by hot air drying of onion slices followed by grinding. Convective air drying when used alone demands longer drying time and thus has a high expense of energy. As bulk of onion is water (82-87 %), removal of moisture prior to drying can reduce moisture loading on dryer and hence the energy consumption. Keeping this in view, onions were partially dewatered using centrifugal force before convective drying. The effect of partial mechanical dewatering and drying air temperature was studied on drying time, specific energy consumption and onion powder quality (colour and flavour). The combination process was also optimized to achieve increased drying rate and product quality comparable to products obtained using convective drying alone. Onions subjected to 60 % partial mechanical dewatering and hot air drying at 70 °C exhibited significantly (p ≤ 0.5) shortened drying time, decreased energy consumption and maintained colour and flavour of the dried product.

Near white light emission from ZnO nanostructures

We report white light emission from ZnO nanostructures in powder form, prepared by microwave irradiation-assisted chemical synthesis, in the presence of a structure directing agent. Determination of their crystallinity, actual shape, and orientation was made using X-ray diffraction, scanning electron microscopy (SEM) and transmission electron microscopy (TEM), and optical properties have been studied through photoluminescence (PL), measured using He-Cd laser (325 nm) as the excitation source. There is a noticeable variation in the luminescence correlated with variation of process parameters, such as microwave power, duration of irradiation, and the type/concentration of surfactants. The CIE (Commission Internationale l’Eclairage) diagram shows that the luminescence lies in yellow region of the color space. As the luminescence from the powder of ZnO lies in the yellow region, it is possible to produce white light from the powder of ZnO by using a blue laser as the excitation source.

Comprehensive analysis of the molecular basis of oculocutaneous albinism in Indian patients lacking a mutation in the tyrosinase gene

BACKGROUND

Oculocutaneous albinism (OCA) refers to a group of inherited disorders where the patients have little or no pigment in the eyes, skin and hair. Mutations in genes regulating multi-step melanin biosynthesis are the basis of four 'classical' OCA types with overlapping clinical features. There are a few reports on defects in TYR and a single report on SLC45A2 in Indians affected with OCA but no report on OCA2 (a major locus related to the disease) and TYRP1.

OBJECTIVES

To assess and describe a comprehensive picture of the molecular genetic basis of OCA among Indians with no apparent mutations in TYR.

METHODS

Twenty-four affected pedigrees from 14 different ethnicities were analysed for mutations in OCA2, TYRP1, SLC45A2 and SLC24A5 using the polymerase chain reaction-sequencing approach.

RESULTS

Two splice-site and four missense mutations were detected in OCA2 in seven unrelated pedigrees, including four novel mutations. Haplotype analysis revealed a founder mutation (Ala787Thr) in two unrelated families of the same ethnicity. A patient homozygous for a novel SLC45A2 mutation also harboured a novel OCA2 defect. No mutation was detected in TYRP1 or SLC24A5.

CONCLUSIONS

Our results suggest that an OCA2 gene defect is the second most prevalent type of OCA in India after TYR. The presence of homozygous mutations in the affected pedigrees underscores the lack of intermixing between the affected ethnicities. Direct detection of the genetic lesions prevalent in specific ethnic groups could be used for carrier detection and genetic counselling to contain the disease.

Rediscovering cyanobacteria as valuable sources of bioactive compounds

Cyanobacteria are a simple, but primitive and diverse group of microorganisms, with characteristics in common to both bacteria and algae. Their success as a group in a wide range of habitats has been attributed to their unique physiological characters and high adaptive ability under a wide range of environmental conditions. The potential of cyanobacteria as a source of a variety of compounds such as polysaccharides, lipids, proteins, vitamins, sterols, enzymes, pharmaceuticals and other fine chemicals is well recognized, and their demand is now on an increasing trend. This compilation reviews the salient advances in the discovery of bioactive compounds from cyanobacteria and their significance in agriculture and industry.

Influence of biofertilizers and organic amendments on nitrogenase activity and phototrophic biomass of soil under wheat

The role of blue green algal (BGA) biofertilizers has been limited to its relevance and utilization in rice crops, and scanty information is available on their use in conjunction with organic amendments and their influence on wheat (Triticum aestivum) . An experiment was conducted from November 2003 to April 2004 in the fields of the Indian Agricultural Research Institute (IARI), New Delhi, India to evaluate the effect of vermicompost, farmyard manure and biofertilizers (BGA and Azotobacter ) in different combinations with chemical fertilizers (N 40 P 30 K 30 ) in wheat (var. HD 2687). Selected soil biological parameters (cyanobacterial diversity/abundance, nitrogenase activity and the phototrophic biomass of soil cores) were measured. The application of vermicompost in combination with BGA biofertilizer (B+V+N 40 P 30 K 30 ) brought about a significant increase in nitrogenase activity (from 0.1 in N 80 P 30 K 30 to 2.0 nmoles mg chl −1 h −1 ), while Azotobacter + BGA (+N 40 P 30 K 30 ) treatment gave the highest values of chlorophyll (1.19 μg g −1 soil). The addition of vermicompost and farmyard manure (+N 40 P 30 K 30 ) enhanced cyanobacterial abundance, and cyanobacterial genera such as Nostoc, Anabaena, Calothrix, Oscillatoria and Phormidium were the dominant forms observed under the wheat crop. The synergistic effect of organic amendments, biofertilizers and chemical fertilizers, especially BGA inoculants, advocates their utilization in wheat crops to improve soil fertility.

Splenic Syndrome due to Sickle Cell Trait amongst Indian Soldiers Serving in Kashmir

BACKGROUND

Heterozygous transmission of gene for Haemoglobin S leads to sickle cell trait. Mostly the trait remains silent with no additional morbidity or mortality. When these persons migrate to higher altitudes, in times of high oxygen demand, some of them develop splenic infarction. This is a rare phenomenon and only 47 such cases had been reported till 2005.

METHODS

This study was conducted at an Indian military hospital serving the troops deployed in Kashmir valley at altitudes ranging from 5500 ft to 13000 ft. When two consecutive splenectomies for splenic abscesses, turned out to be sickling induced infarction histopathologically, we reviewed splenectomy specimens received in last six years for evidence of sickling.

RESULT

Out of 33 splenectomies performed during the period of study, 22 were due to trauma (gun shot injury 11; splinter injury one and blunt injury 10). Of the rest eleven, who presented without any history of trauma, seven had evidence of vascular occlusion with aggregates of sickled red blood cells. In none, Gram stain or Periodic Acid Schiff stain revealed any bacterial or fungal colonies. One patient of splenic syndrome was found to have unrecognised sickle cell trait and he was managed conservatively.

CONCLUSION

Sickle cell trait should be excluded before considering splenectomy in ethnically vulnerable patients presenting with splenic syndrome. An uncomplicated splenic infarction can be managed conservatively.

Malaria on the Move : Ecological Considerations for the Armed Forces

BACKGROUND

Armed forces personnel deployed in the North Eastern states of India are vulnerable to falciparum malaria. This vulnerability increases during mobilization of troops.

METHODS

Epidemiological case sheet was used for recording individual movement, clinical features and laboratory investigations of each case of malaria. Immunochromotography test (ICT) or Paracheck Pf was used as a rapid test for falciparum malaria at the regimental aid post (RAP). Subsequently, a case control approach was used to ascertain whether the cases of malaria differed significantly from healthy controls in observing antimalaria measures such as the use of mosquito nets, repellants and chemoprophylaxis.

RESULT

Nineteen out of 623 soldiers suffered from falciparum malaria during a short period of ten days during operational mobilization. Use of mosquito nets and repellants was significantly less among the cases as compared to healthy controls. There was no significant difference among the two groups regarding compliance with chemoprophylaxis.

CONCLUSION

A paradigm of "malaria on the move" or "operational malaria" has been proposed.

Stimulation of pigment accumulation in Anabaena azollae strains: effect of light intensity and sugars

The influence of high light intensity on the growth and pigment accumulating ability of Anabaena azollae was investigated. A. azollae responded positively to high light intensity (6 klx) and was further evaluated at higher intensities (10 and 15 klx), in the presence of glucose, sucrose and jaggery +/- DCMU. Significant enhancement in phycobiliproteins and carotenoids was observed in the sugar supplemented cultures at high light intensities. SDS-PAGE profiles of whole cell proteins revealed the presence of unique bands in such treatments. Sucrose supplementation induced a 30-90 % increase in carotenoids, phycocyanin and phycoerythrin content at 10 klx. Molecular analysis of the stimulatory and interactive role of sugars on pigment enhancement at high light intensity may aid in better exploitation of cyanobacteria as a source of pigments.

Development of alternative support system for viable count of cyanobacteria by most probable number method

A technique was developed to evaluate alternative support systems to test tubes used in the standard most probable number technique, for simultaneous isolation and enumeration of cyanobacteria. Five different support systems were tested for their suitability in terms of accuracy, sensitivity, economics and ease of handling. PCR plates with 96 wells and carrying capacity of 300 microL per well were found to be most sensitive, besides being cost- and time-effective. This technique can also be useful for isolation of cyanobacteria, due to immobilization of colonies in the gel matrix and storage of samples at room temperature, without loss of viability for 5-6 weeks. This technique can help to process large sample size with ease--both for enumeration and isolation and can be extended for enumeration of other microorganisms from diverse sources.

Groin abscess: a vesico-cutaneous fistula to the groin. A rare complication of open prostatectomy

In developed countries, open prostatectomy for benign disease is now reserved for large prostates. This is not the case in the developing world where Millin's prostatectomy continues to be an important procedure, perhaps due to lack of endoscopic technology and training. We report a case of vesico-cutaneous fistula as a late complication of open prostatectomy presenting as a groin mass. A review of the English language literature shows this to be the first case of its kind.

The Gene Ontology (GO) database and informatics resource

The Gene Ontology (GO) project (http://www. geneontology.org/) provides structured, controlled vocabularies and classifications that cover several domains of molecular and cellular biology and are freely available for community use in the annotation of genes, gene products and sequences. Many model organism databases and genome annotation groups use the GO and contribute their annotation sets to the GO resource. The GO database integrates the vocabularies and contributed annotations and provides full access to this information in several formats. Members of the GO Consortium continually work collectively, involving outside experts as needed, to expand and update the GO vocabularies. The GO Web resource also provides access to extensive documentation about the GO project and links to applications that use GO data for functional analyses.

Spontaneous pneumothorax: use of aspiration and outcomes of management by respiratory and general physicians

BACKGROUND

Spontaneous pneumothorax is a common problem in hospital practice. Despite the publication of guidelines controversy over its initial management still exists, particularly over the use of simple aspiration.

METHODS

The management of spontaneous pneumothorax by respiratory and general physicians at our hospital was analysed by retrospective case note review. Eighty five patients were identified over the study period (36 managed by respiratory and 49 by general physicians).

RESULTS

There was a significantly greater use of simple aspiration by respiratory (81%) than general physicians (47%, p<0.001) and a higher rate of success in this group. As a result those patients managed by respiratory physicians had fewer intercostal drains inserted and significantly shorter length of stays (mean 5.6 (3.8) days respiratory group and 9.5 (6.8) days in general physicians group, p<0.05).

CONCLUSIONS

The greater and more successful use of simple aspiration by respiratory physicians as an initial treatment for spontaneous pneumothorax resulted in improved outcomes and reduced length of hospital stays.

Plasma fibrinogen levels in stroke

Plasma fibrinogen levels were estimated in 56 patients of stroke, admitted in the hospital within 24 hours of symptoms. The levels were found to be raised significantly (531.73 +/- 74 mg%) compared to those of the age and sex matched control group (445.78 +/- 92.28 mg%). When the levels in stroke group with one risk factor were compared to those of individuals with comparable control group with same risk factor, a significant difference was observed in hypertensive, smokers, alcoholics and atherosclerotic stroke groups, which indicates that the observed rise is related to phenomenon of stroke rather than the associated risk factors. However, the rise observed in hypertensive stroke group (554.26 +/- 47.08 mg%) is significantly more (p. less than 0.01) than that occurring for nonhypertensive stroke group (497.82 +/- 93.12 mg%) indicating that the presence of hypertension does contribute to the rise.