A randomized trial of once daily versus twice daily dosing of oral iron in CKD

We investigated the effect of two dosing regimens of oral iron on iron status and hematological parameters in patients with CKD. In this single center, open label, randomized, active controlled clinical trial, stable adult patients with CKD stage G3-4 with percentage transferrin saturation (%TSAT) ≤ 30% and serum ferritin ≤ 500 ng/ml were eligible. Participants were randomized to receive either 100 mg of ferrous ascorbate once daily (OD group) or 100 mg of ferrous ascorbate twice daily (BD group, total daily dose 200 mg). The primary outcome was change in %TSAT between groups over 12 weeks. The secondary outcomes were changes in other iron status and hematological parameters, serum interleukin-6 (IL-6) and hepcidin. 80 participants were enrolled out of which 76 completed the study. Change in %TSAT was not significantly different between groups (β = - 1.43, 95% CI - 3.99 to 1.12, BD group as reference). The rise in serum ferritin was less in the OD group as compared to BD group (β = - 0.36, 95% CI - 0.61 to - 0.10) whereas MCHC increased in the OD group as compared to decrease in the BD group (β = 0.37, 95% CI 0.067-0.67). These observations need exploration to ascertain the impact of different oral iron dosing strategies in CKD.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

P–069 microfluidic sperm sorting vs density gradient to yield sperm with reduced DFI for patients undergoing IVF-ICSI

Study question

To compare the effect of sperm preparation methods on the DFI of semen sample for patients undergoing ICSI.

Summary answer

On comparing the results, microfluidic sperm sorting yielded sperms with significantly less DFI as compared to density gradient method of sperm preparation.

What is known already

The DNA integrity of the sperm plays an important role to ensure formation of good quality embryos with increased potential of fertilization, growth and ultimately implantation.. Centrifugation has shown to add stress to the sperm and leading to DNA damage, therefore there is a need to develop techniques of sperm preparation which help in retrieving as many sperms with intact DNA from the unprocessed sample as possible. Microfludic is fluid dynamic based technique of sperm preparation. in this study, we evaluated if microfluidic sperm sorter can recover motile sperm with better DNA integrity compared to density gradient preparation method.

Study design, size, duration

Prospective randomized study conducted in 80 patients undergoing IVF-ICSI with normal semen parameters (based WHO criteria 2010). DFI was done using Sperm Chromatin Dispersion (SCD) test in split semen samples prepared by microfluidic sperm sorter and density gradient method. Sperm morphology and motility were also recorded and evaluated based on the WHO 2010 criteria.

Participants/materials, setting, methods

Semen parameters of the sample were assessed by microscopic examination. DFI of each unprocessed sample was carried out using SCD test, following that the sample was split and sperm preparation was done using microfluidic sperm sorter and density gradient. the recovered sperm were tested for DFI and the results were compared.

Main results and the role of chance

Mean DFI in unprocessed semen samples was 23%. the analysis of split semen samples post preparation showed that the DFI was significantly reduced with the use of microfluidic sperm sorter (mean DFI 0.6%) as compared to density gradient (mean DFI 9%).

Limitations, reasons for caution

A major limitation of the microfluidic sperm sorter is the use sperm concentration and motility of the semen sample. In oligospermic and asthenospermic samples, density gradient is the preferred method of preparation. Lack of data showing improvement in clinical outcomes with reduced DFI is also a major limitation.

Wider implications of the findings: Microfluidics has shown to significantly reduce the DFI of the semen sample, it requires no extra equipment and cost and is relatively easy to pick up. Density gradient method of sperm preparation continues to be the preferred method due to its versatility and recovery of good quality sperm.

Trial registration number

Not applicable

Investigation of groundwater and soil quality near to a municipal waste disposal site in Silchar, Assam, India

Unscientific management of municipal solid waste is one of the direct sources of contamination in developing countries, such as India. The present investigation carried out during Oct–Dec 2019 attempts to assess the parameters, such as quality of groundwater and soil along three depths (0–5, 5–15 and 15–30 cm), in proximity to a dumping site in Silchar, a rapidly evolving city of North-East India. Standard protocols of soil and water quality assessments were carried out. The pH values of the surface soils were found to be slightly acidic. Decrease in acidity with increasing depth was observed in the study site. The relative abundance of the analyzed elements at all soil depths was Zn > Fe > Ni > Cu > Cr. Weak correlation between the concentration of Cu, Fe and Zn, and the bulk density of the soil highlighted the micronutrient status of the soil. The impact of the nearby dumpsite on trace element contamination is indicated by the ‘extremely contaminated’ status of the soils with respect to geo-accumulation index. Majority of the groundwater samples exhibited pH levels below the desired limits, making it unfit for consumption by local communities. While Fe, Cu and Ni levels in groundwater samples exceeded the guideline values, Cr and Zn concentrations were found to be within limits except one sample. Principal Component Analysis of the observed data was carried out to ascertain the predominant sources of contamination. The observations indicate the negative impacts of nearby dumpsite on environmental parameters, such as groundwater and soil quality, as highlighted in this research.

The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

Objectives

The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty.

Methods

The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated.

Results

The mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively.

Conclusion

This method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty.

Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1.

The shift from public to private health care providers and malaria deaths in Jalpaiguri district, West Bengal, India, 2006

We investigated an increase in malaria deaths in order to formulate control measures. A search of records in health care facilities for cases of death following fever, with a blood smear or rapid antigen test positive for Plasmodium falciparum, identified 77 fatalities. Of these, 72 (93%) occurred in hospitals (78% of which in the 24 hours following admission). Of 60 family members of the patients who died interviewed, 70% reported that the patient had received care from unqualified rural private practitioners available round the clock. Among 100 of these rural practitioners assessed, 21% knew anti-malarial dosage and 7% knew malaria severity criteria. There were 65% and 42% vacancies among 240 community health worker and 12 microscopist positions, respectively, in the public sector in the area. As a result, the mean interval between active case search rounds in the community was 35 days (standard: 14) and the median time between blood slide collection and radical treatment was 12 days (standard < 2 days). Deficiencies in the public health system may have led to a shift towards rural practitioners. Poor management of malaria may have contributed to deaths. We posted microscopists and community health workers in the area to restore appropriate malaria management in the public sector.

A very nervous inguinal floor: report of a case

Chronic pain after inguinal hernia repair with prosthetic meshes is recorded in some patients. Although the exact etiology of the pain is not fully understood, it can be related to the trauma to the regional nerves. It is possible to involve these nerves by injuring, suturing, stapling, tacking or compressing them during the operation. Therefore, a delicate surgical approach to the inguinal floor with correct identification of three nerves is necessary for patient comfort at early and late postoperative period. We herein report a surgical view of an inguinal floor which are very rich of neural structures in a patient undergo an elective inguinal hernia repair. The number of the main nerve bundles was excessive, and they were thicker than generally met. This kind of anatomic variations may create a difficulty for repair with prosthetic material. The identification of the nerve structures was hard at first sight and the correct identification was only made by consulting the surgical picture with a senior anatomist.

Management of primary and metastatic triple negative breast cancer: perceptions of oncologists from India

BACKGROUND

In order to document the understanding of current evidence for the management of triple negative breast cancer and application of this knowledge in daily practice, we conducted an interactive survey of practicing Indian oncologists.

MATERIALS AND METHODS

A core group of academic oncologists devised two hypothetical triple negative cases (metastatic and early breast cancer, respectively) and multiple choice options under different clinical circumstances. The respondents were practicing oncologists in different Indian cities who participated in either an online survey or a meeting. The participants electronically chose their preferred option based on their everyday practice.

RESULTS

A total of 152 oncologists participated. Just over half (53.8%) preferred taxane based chemotherapy as first-line chemotherapy in the metastatic setting. In the adjuvant setting, a taxane regimen was chosen by 61%. Over half of respondents (52.6%) underestimated the baseline survival of a patient with node positive triple-negative tumor and 18.9% overestimated this survival compared to the estimate of the Adjuvant! program.

DISCUSSION

This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.

βA3/A1-Crystallin controls anoikis-mediated cell death in astrocytes by modulating PI3K/AKT/mTOR and ERK survival pathways through the PKD/Bit1-signaling axis

During eye development, apoptosis is vital to the maturation of highly specialized structures such as the lens and retina. Several forms of apoptosis have been described, including anoikis, a form of apoptosis triggered by inadequate or inappropriate cell–matrix contacts. The anoikis regulators, Bit1 (Bcl-2 inhibitor of transcription-1) and protein kinase-D (PKD), are expressed in developing lens when the organelles are present in lens fibers, but are downregulated as active denucleation is initiated. We have previously shown that in rats with a spontaneous mutation in the Cryba1 gene, coding for βA3/A1-crystallin, normal denucleation of lens fibers is inhibited. In rats with this mutation (Nuc1), both Bit1 and PKD remain abnormally high in lens fiber cells. To determine whether βA3/A1-crystallin has a role in anoikis, we induced anoikis in vitro and conducted mechanistic studies on astrocytes, cells known to express βA3/A1-crystallin. The expression pattern of Bit1 in retina correlates temporally with the development of astrocytes. Our data also indicate that loss of βA3/A1-crystallin in astrocytes results in a failure of Bit1 to be trafficked to the Golgi, thereby suppressing anoikis. This loss of βA3/A1-crystallin also induces insulin-like growth factor-II, which increases cell survival and growth by modulating the phosphatidylinositol-3-kinase (PI3K)/AKT/mTOR and extracellular signal-regulated kinase pathways. We propose that βA3/A1-crystallin is a novel regulator of both life and death decisions in ocular astrocytes.

A short postgraduate anatomy course may improve the junior surgical residents' anatomy knowledge for the nerves of the inguinal region

BACKGROUND AND AIM

Inguinal hernia repair is one of the most common operations in a junior surgical resident's postgraduate training. Short recall courses can improve junior residents' anatomy knowledge and results in better surgical outcomes. We aimed to investigate the effect of a short course on anatomical competency during inguinal hernia repairs.

METHODS

During the first 25 inguinal hernia repairs, two junior residents were asked to identify iliohypogastric, ilioinguinal, and genital branch of genitofemoral nerves. Then, the residents were given a short recall course by anatomists. Afterwards, the participants were taken into an in-vivo anatomy test again. The same parameters were recorded in another 25 inguinal hernia repairs. In addition to the nerve identification records, case characteristics [body mass index (BMI < or = 25 vs. >25), hernia type (indirect vs. direct), and anesthesia used (general or regional vs. local)] were recorded.

RESULTS

Anatomy education had a clear impact on the correct identification rates for the iliohypogastric and ilioinguinal nerves. The rates increased from 70% to 90% and above. Correct identification rate for the three nerves together significantly increased from 16 to 52% following anatomy education (P = 0.006). All three nerves were identified with significantly higher success rates after anatomy education. The increase in the success rate for identification of the genital branch of genitofemoral nerve was 4-fold.

CONCLUSIONS

Short anatomy courses in specific subjects for junior surgical residents given by formal anatomists may be effective during postgraduate education. The benefit obtained in the present study for the inguinal region nerves may be expanded to more important anatomical structures, such as the recurrent laryngeal nerve in a thyroidectomy, or more complex subjects.

Arterial vascularisation of the anterior perforated substance

INTRODUCTION

The arteries of the anterior perforated substance (APS) are important due to their role in supplying blood to important internal structures such as the internal capsule, putamen and caudate nucleus. The purpose of this study was to investigate in detail the arteries of the APS.

METHODS

The arteries of the APS were investigated in 60 cerebral hemispheres from 30 adult cadaveric brains. The internal carotid arteries were cannulated and perfused with coloured latex. The branches of the middle cerebral artery (MCA) penetrating the APS were investigated. These arteries, known as the lateral lenticulostriate arteries and originating from the M1 segment, early temporal and early frontal branches of the MCA, were recorded.

RESULTS

The branches of the anterior choroidal artery, which reached the APS, were seen in all specimens. We found one to three branches that arose from the A2 segment of the anterior cerebral artery (ACA) to the APS in all hemispheres, and one to three branches that originated from the A1 segment of the ACA in 48 hemispheres. In addition, two accessory MCAs that originated from the A2 segment of the ACA were recorded as variations, and perforating branches to the APS were observed.

CONCLUSION

Serious complications like motor deficits can occur as a result of injury to the arteries of the APS. Hence, neurosurgeons performing operations such as aneurysm or insular tumour surgeries must be aware of the importance of preserving these arteries.

Lateral approach to the ankle and distal leg

Fractures of the distal tibia are usually high-energy injuries and are well known for their soft tissue complications after surgery. Various factors have been studied regarding the possibility of them reducing the incidence of such damage, including timing of surgery, staged surgery, fixation method, and surgical approach. Less invasive surgical techniques with vascularity preserving approaches were proposed as reasonable solutions to this problem. The aim of this study was to investigate the presence of minor vascular structures, which can be preserved during anterolateral approach, possibly contributing to the success of the approach. Lateral approach for the distal tibia was performed in 22 cadaver feet. The mean distance between the lateral malleolus and the superficial peroneal nerve was 12.2 cm. Two different vascular pedicles, from peroneal vessels to muscles of the anterior compartment, were 4.3 and 8.2 cm away from the lateral malleolus, respectively. We conclude that preserving greater vascularity was possible in the lateral approach for the distal tibia, placing the plate in a completely submuscular plane.

Antibody-aptamer functionalized fibre-optic biosensor for specific detection of Listeria monocytogenes from food

AIM

To develop antibody-aptamer functionalized fibre-optic biosensor for specific detection of Listeria monocytogenes from food products.

METHODS AND RESULTS

Aptamer, a single-stranded oligonucleotide ligand that displays affinity for the target molecule, was used in the assay to provide sensor specificity. Aptamer-A8, specific for internalin A, an invasive protein of L. monocytogenes, was used in the fibre-optic sensor together with antibody in a sandwich format for detection of L. monocytogenes from food. Biotinylated polyclonal anti-Listeria antibody, P66, was immobilized on streptavidin-coated optical waveguide surface for capturing bacteria, and Alexa Fluor 647-conjugated A8 was used as a reporter. The biosensor was able to selectively detect pathogenic Listeria in pure culture and in mixture with other bacteria at a concentration of approx. 10(3) CFU ml(-1). This sensor also successfully detected L. monocytogenes cells from artificially contaminated (initial inoculation of 10(2) CFU 25 g(-1) ) ready-to-eat meat products such as sliced beef, chicken and turkey after 18 h of enrichment.

CONCLUSION

Based on the data presented in this study, the antibody-aptamer functionalized fibre-optic biosensor could be used as a detection tool for sensitive and specific detection of L. monocytogenes from foods.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study demonstrates feasibility and novel application of aptamer on fibre-optic biosensor platform for the sensitive detection of L. monocytogenes from food products.

Phospho-ΔNp63α is a key regulator of the cisplatin-induced microRNAome in cancer cells

Head and neck squamous cell carcinoma (HNSCC) cells exposed to cisplatin (CIS) displayed a dramatic ATM-dependent phosphorylation of ΔNp63α that leads to the transcriptional regulation of downstream mRNAs. Here, we report that phospho (p)-ΔNp63α transcriptionally deregulates miRNA expression after CIS treatment. Several p-ΔNp63α-dependent microRNA species (miRNAs) were deregulated in HNSCC cells upon CIS exposure, including miR-181a, miR-519a, and miR-374a (downregulated) and miR-630 (upregulated). Deregulation of miRNA expression led to subsequent modulation of mRNA expression of several targets (TP53-S46, HIPK2, ATM, CDKN1A and 1B, CASP3, PARP1 and 2, DDIT1 and 4, BCL2 and BCL2L2, TP73, YES1, and YAP1) that are involved in the apoptotic process. Our data support the notion that miRNAs are critical downstream targets of p-ΔNp63α and mediate key pathways implicated in the response of cancer cells to chemotherapeutic drugs.

Neurovascular relationship between abducens nerve and anterior inferior cerebellar artery

We aimed to study the neurovascular relationships between the anterior inferior cerebellar artery (AICA) and the abducens nerve to help determine the pathogenesis of abducens nerve palsy which can be caused by arterial compression. Twenty-two cadaveric brains (44 hemispheres) were investigated after injected of coloured latex in to the arterial system. The anterior inferior cerebellar artery originated as a single branch in 75%, duplicate in 22.7%, and triplicate in 2.3% of the hemispheres. Abducens nerves were located between the AICAs in all hemispheres when the AICA duplicated or triplicated. Additionally, we noted that the AICA or its main branches pierced the abducens nerve in five hemispheres (11.4%). The anatomy of the AICA and its relationship with the abducens nerve is very important for diagnosis and treatment.

An insight on the neuropharmacological activity of Telescopium telescopium--a mollusc from the Sunderban mangrove

The present study was carried out to evaluate the biological properties of the tissue extract of a marine snail Telescopium telescopium, collected from the coastal regions of West Bengal India. On extensive pharmacological screening, it was found that the biological extract of T. telescopium (TTE) produced significant central nervous system (CNS)-depressant activity as observed from the reduced spontaneous motility, potentiation of pentobarbitone induced sleeping time, hypothermia and respiratory depression with transient apnoea. The extract significantly decreased both residual curiosity and also muscle coordination. The fraction, obtained following saturation with 60-80% ammonium sulphate (80S), was also found to demonstrate predominant CNS-depressant activity. It was observed that both TTE and the 80S fraction significantly altered the brain noradrenaline and homovanillic acid levels without affecting the brain gamma amino butyric acid (GABA) concentration. Based on the present observations, it can be suggested that the CNS-depressant effects produced by TTE and 80S could be attributable to modified catecholamine metabolism in the brain.

Idiopathic pulmonary haemosiderosis: complete remission with steroids

A 13-year-old boy was diagnosed as a case of idiopathic pulmonary haemosiderosis on the basis of clinical presentation, radiological assessment and open lung biopsy. The patient had a complete clinical and radiological remissions with oral corticosteroids.

Cryptogenic organizing pneumonia: clinical profile in a series of 34 admitted patients in a hospital in India

OBJECTIVES

Cryptogenic Organizing Pneumonia (COP) is a relatively rare disorder which is gratifying to treat due to its prompt steroid responsiveness. There have been only 2 case reports on COP from India but no large series entity reported from this country.

METHODS

The medical records of all patients with biopsy (histopathology) proven COP admitted in a tertiary care hospital in Mumbai (2000-2005) were retrospectively analyzed. We looked at clinical and radiographic profiles, initial diagnosis and treatment, lag period to starting definitive therapy and steroid responsiveness.

RESULTS

When compared to other series of patients with COP, our series showed several similarities and some differences. Distinctive features were the striking female preponderance and the utility of transbronchial biopsies in establishing the diagnosis. Long delays in diagnosis with patients mislabeled as tuberculosis or pneumonia, lead to delays in starting steroids resulting in 21% of our patients continuing to deteriorate.

CONCLUSIONS

This comprehensive review of COP, the first of its kind from India, reveals its varied clinical and radiographic spectrum. A high index of suspicion will lead to prompt steroid therapy which will result in better patient outcome.

Extraction of DNA from soil using nanoparticles by magnetic bioseparation

AIMS

To develop a simple, rapid and inexpensive soil DNA extraction protocol.

METHODS AND RESULTS

The protocol relies on the use of superparamagnetic silica-magnetite nanoparticles for the isolation and purification of DNA from soil samples. DNA suitable for use in molecular biology applications was obtained from a number of soil samples.

CONCLUSIONS

The DNA extracted using the tested method successfully permitted the PCR amplification of a fragment of the bacterial 16S rDNA gene. The extracted DNA could also be restriction endonuclease digested.

SIGNIFICANCE AND IMPACT OF THE STUDY

The protocol reported here is simple and permits rapid isolation of PCR-ready soil DNA. The method requires only small quantities of soil sample, is scalable and suitable for automation.