Ethnomedicinal uses of plants for various diseases in the remote areas of Changa Manga Forest, Pakistan

Abstract This study aims at reporting the indigenous knowledge of the medicinal flora from the inhabitants of surroundings of the World’s largest artificial planted forest “Changa Manga”, Pakistan. Data were collected by direct interviews and group meetings from 81 inhabitants including 32 local healers having information regarding the use of indigenous medicinal plants over a period of one year. Different statistical tools were applied to analyze the data including Frequency citation (FC), Relative frequency citation (RFC), Use Value, Factor of informants consensus and fidelity level. This study reported 73 plant species belonging to 37 plant families and 46 genera. The majority of plant species belong to compositae family. The most commonly used medicinal plants were P. hysterophorus L., P. dactylifera L., S. indicum L, P. harmala L., P. emblica L., and A. indica A.Juss. The greatest number of species was used to cure gastrointestinal disorders. The highest fidelity level (68.18%) was of E. helioscopia to cure gastrointestinal disorders. Maximum fresh uses (17) were reported by C. dactylon (L.) Pars. While the highest number of species reporting fresh uses in similar number was 13. In this study, five novel plants are being reported for the first time in Pakistan for their ethnomedicinal worth. Our data reflect unique usage of the medicinal plants in the study area. The statistical tools used in the study proved useful in pointing the most important and disease category specific plants. High use value plant and the new reported medicinal plants might prove an important source of the isolation of pharmacologically active compounds.

Community based assessment on Knowledge, Attitude and Practices (KAP), Risk Factors and One Health Perspective of Brucellosis in rural and urban settings of Pakistan: A Cross-Sectional Study

Bovine brucellosis is an endemic zoonotic infection of ruminants in Pakistan with detrimental impacts on livestock economy. The major losses caused by brucellosis in animals include abortions, week calves, infertility, and reduced milk production. Regardless of the prevalence of the disease, limited data is available about brucellosis in Pakistan. The present study aimed to access the one health concept in prospective of Brucellosis among small-scale dairy farmers by examining knowledge, attitude and practices at the farms and household level that might pose a risk for humans contracting brucellosis. A community-based cross-sectional survey was conducted among small household dairy farms (n=333) in rural and urban areas of district Rawalpindi and Islamabad. The results revealed almost 74.17% of the participants knew about animal brucellosis and about 69.97% of the participants were able to identify the symptoms of animal brucellosis. 58.26% of participants showed knowledge about the transmission of disease from animals to humans. A majority (70.87%) of participants used the raw milk for making other dairy products. Most household farmers are unaware of routes of transmission and major risk factors of brucellosis. Almost all the participants, except veterinarians, including butchers, dairy farm owners and workers, slaughterhouse owners and workers and farmers were involved in at least one risky practice. The moderate knowledge and poor understanding of the disease emphasize the need to initiate awareness programs to educate the farmers who are at high risk along with the improvement of vaccination programs for animals and strict implementation of brucellosis eradication policy which should be devised by government.

Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan

Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitant's age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.

Mechanism of Anti-bacterial Activity of Zinc Oxide Nanoparticle Against Carbapenem-Resistant Acinetobacter baumannii

Acinetobacter baumannii is a multi-drug resistant opportunistic pathogen, which causes respiratory and urinary tract infections. Its prevalence increases gradually in the clinical setup. Carbapenems (beta-lactam) are most effective antibiotics till now against A. baumannii, but the development of resistance against it may lead to high mortality. Therefore, it is of utmost importance to develop an alternative drug against A. baumannii. In the present study, we have synthesized ZnO nanoparticle (ZnO-NP) and characterized by X-ray diffraction, Fourier transform infrared (FTIR) spectroscopy and UV-Visible spectroscopy. Prepared ZnO-NPs have the size of 30 nm and have different characteristics of ZnO-NPs. Growth kinetics and disk diffusion assay showed that ZnO-NP demonstrated good antibacterial activity against carbapenem resistant A. baumannii. We have also investigated the mechanism of action of ZnO-NPs on the carbapenem resistant strain of A. baumannii. The proposed mechanism of action of ZnO involves the production of reactive oxygen species, which elevates membrane lipid peroxidation that causes membrane leakage of reducing sugars, DNA, proteins, and reduces cell viability. These results demonstrate that ZnO-NP could be developed as alternative therapeutics against A. baumannii.

An empirical model for magnetic field dependent resistivity and magnetoresistance in manganites: application on polycrystalline charge-ordered La0.4Gd0.1Ca0.5MnO3

In this paper, we have investigated the electrical and magnetic response of a La0.4Gd0.1Ca0.5MnO3 polycrystalline sample. This sample seems to exhibit fascinating phenomena like charge ordering, magnetic phase separation, training effects and kinetic arrest. It also shows colossal values of negative magnetoresistance (∼91.7% at 96 K under 1 T applied magnetic field), which raises the possibility of using this sample for technological applications. We have also proposed, in this work, a new empirical model to describe the evolution of resistivity and magnetoresistance as a function of magnetic field. This model was successfully tested on the La0.4Gd0.1Ca0.5MnO3 sample in spite of its complicated magnetic behavior, which suggests the use of this model for other magnetic samples in order to check its validity.

Current-voltage characteristics and electroresistance in LaMnO3-δ/La0.7Ca0.3MnO3/LaAlO3 thin film composites

In this communication, we report results of the electrical transport properties across the interface of composites consisting of n-type LaMnO_3-δ (LMO) and p-type La_0.7Ca_0.3MnO₃ (LCMO) manganites grown on LaAlO₃ (LAO) single crystalline substrates using low cost wet chemical solution deposition (CSD) and sophisticated, well-controlled dry chemical vapor deposition (CVD) chemical techniques. The XRD ϕ-scan studies reveal the single crystalline nature of both bilayered composites, with parallel epitaxial growth of LMO and LCMO layers onto the LAO substrate. The valence states of Mn ions in both layers of both composites were identified by performing X-ray photoelectron spectroscopy (XPS). The I-V characteristics of the LMO/LCMO interfaces show strong backward diode-like behavior at higher applied voltages well above the crossover voltage (V_NB). Below V_NB, the interfaces demonstrate normal diode-like characteristics throughout the studied temperature range. The electric field-induced modulation of the LMO/LCMO junction resistance of the interfaces has been observed. Electric field-dependent electroresistance (ER) modifications at different temperatures have also been studied. The electrical transport properties have been discussed in the context of various mechanisms, such as charge injection, tunneling, depletion region modification and thermal processes across the interface. The effects of structurally and chemically developed sharp interfaces between the LMO and LCMO layers on the transport properties of the presently studied bilayered thin film composites have been discussed on the basis of correlation between the physicochemical characterization and charge transport behavior. A comparison of different aspects of the transport properties has been presented in the context of the structural strain and crystallinity of the composites grown using both wet and dry chemical techniques.

Occlusion in the Flow of New Drugs for Cardiovascular Disease

There is a large misalignment between unmet need and both private and public investment activity in cardiovascular disease. In this paper, we quantify the magnitude of the gap, analyze a range of potential root causes in two main categories (issues of feasibility and valuation), and propose steps toward solutions to close the gap.

Correction: Charge transport mechanisms in sol-gel grown La0.7Pb0.3MnO3/LaAlO3 manganite films

Correction for 'Charge transport mechanisms in sol-gel grown La_0.7Pb_0.3MnO₃/LaAlO₃ manganite films' by Eesh Vaghela et al., Phys. Chem. Chem. Phys., 2017, DOI: 10.1039/c6cp07730g.

Charge transport mechanisms in sol-gel grown La0.7Pb0.3MnO3/LaAlO3 manganite films

In this communication, structural, microstructural, transport and magnetotransport properties are reported for La_0.7Pb_0.3MnO₃/LaAlO₃ (LPMO/LAO) manganite films having different thicknesses. All the films were irradiated with 200 MeV Ag⁺¹⁵ swift heavy ions (SHI). Films were grown using the sol-gel method by employing the acetate precursor route. Structural measurements were carried out using the X-ray diffraction (XRD) method at room temperature, while atomic force microscopy (AFM) was performed for the surface morphology. Temperature dependent resistivity under different applied magnetic fields for all the films shows metal to insulator transition at temperature T_P. In addition to the metal to insulator transition at T_P, the films also exhibit low temperature resistivity upturn behavior. Resistivity, T_P and upturn behavior are highly influenced by the film thickness, applied magnetic field and irradiation. To understand the nature of charge transport for the low temperature resistivity behavior and metallic and insulating (semiconducting) regions, various models and mechanisms have been verified and the most suitable mechanism has been found for each region in the resistivity curves. Magnetoresistance (MR) is affected by temperature, film thickness and irradiation. MR behavior has been understood in terms of combined and separate contributions from grains and grain boundaries in the films.

Transport properties and electroresistance of a manganite based heterostructure: role of the manganite-manganite interface

In this paper, we report the results of the investigations on the transport properties performed across the manganite-manganite interface in the LaMnO3-δ/La0.7Ca0.3MnO3/LaAlO3 (LMO/LCMO/LAO) heterostructure. The bilayered heterostructure was synthesized by a low cost and simple chemical solution deposition (CSD) method by employing the acetate precursor route. The same LMO/LCMO/LAO heterostructure was also grown using the dry metal oxide chemical vapor deposition (CVD) method and the results of transport characterization have been compared on the basis of wet and dry chemical methods used. XRD Φ-scan measurements were carried out to verify the structural quality and crystallographic orientations of LMO and LCMO manganite layers, for both wet and dry chemical method grown heterostructures. For wet and dry chemical methods, the temperature dependent resistance of the LMO/LCMO interface suggests the metallic nature. The asymmetric I-V curves collected at different temperatures show normal diode characteristics which get transformed to backward diode characteristics at high temperatures under high applied voltages at Vtr for both the methods. The values of Vtr are strongly dependent on the chemical method used. I-V data have been fitted using the Simmons model at different temperatures and discussed in terms of the spin-flip scattering mechanism for both wet and dry chemical method grown heterostructures. The electric field dependent electroresistance (ER) behavior of the presently studied LMO/LCMO manganite-manganite interface, grown using wet and dry chemical methods, has been understood on the basis of complex mechanisms including charge injection, formation of the depletion region, the tunneling effect, thermal processes and junction breakdown and their dependence on the applied electric field, field polarity and temperature studied.

Improved Endurance and Resistive Switching Stability in Ceria Thin Films Due to Charge Transfer Ability of Al Dopant

An improvement in resistive switching (RS) characteristics of CeO2-based devices has been reported by charge transfer through Al metal as a dopant. Moreover, density functional theory (DFT) calculations have been performed to investigate the role of Al-layer sandwiched between CeO2 layers by the Vienna ab initio simulation package (VASP). Total density of states (TDOS) and partial electron density of states (PDOS) have been calculated and analyzed with respect to resistive switching. It is established that the oxygen vacancy based conductive filaments are formed and ruptured in the upper region of CeO2 layer, because of the fact that maximum transport of charge takes place in this region by Al and Ti (top electrode), while the lower region revealed less capability to generate conductive filaments because minimum charge transfer takes place in this region by Al and/or Pt (bottom electrode). The effect of Al and Al2O3 on both the electronic charge transfer from valence to conduction bands and the formation stability of oxygen vacancies in conductive filament have been discussed in detail. Experimental results demonstrated that the Ti/CeO2:Al/Pt sandwich structure exhibits significantly better switching characteristics including lower forming voltage, improved and stable SET/RESET voltages, enhanced endurance of more than 10(4) repetitive switching cycles and large memory window (ROFF/RON > 10(2)) as compared to undoped Ti/CeOx/Pt device. This improvement in memory switching behavior has been attributed to a significant decrease in the formation energy of oxygen vacancies and to the enhanced oxygen vacancies generation within the CeO2 layers owing to charge transferring and oxygen gettering ability of Al-dopant.

Gaze shifts and fixations dominate gaze behavior of walking cats

Vision is important for locomotion in complex environments. How it is used to guide stepping is not well understood. We used an eye search coil technique combined with an active marker-based head recording system to characterize the gaze patterns of cats walking over terrains of different complexity: (1) on a flat surface in the dark when no visual information was available, (2) on the flat surface in light when visual information was available but not required for successful walking, (3) along the highly structured but regular and familiar surface of a horizontal ladder, a task for which visual guidance of stepping was required, and (4) along a pathway cluttered with many small stones, an irregularly structured surface that was new each day. Three cats walked in a 2.5-m corridor, and 958 passages were analyzed. Gaze activity during the time when the gaze was directed at the walking surface was subdivided into four behaviors based on speed of gaze movement along the surface: gaze shift (fast movement), gaze fixation (no movement), constant gaze (movement at the body's speed), and slow gaze (the remainder). We found that gaze shifts and fixations dominated the cats' gaze behavior during all locomotor tasks, jointly occupying 62-84% of the time when the gaze was directed at the surface. As visual complexity of the surface and demand on visual guidance of stepping increased, cats spent more time looking at the surface, looked closer to them, and switched between gaze behaviors more often. During both visually guided locomotor tasks, gaze behaviors predominantly followed a repeated cycle of forward gaze shift followed by fixation. We call this behavior "gaze stepping". Each gaze shift took gaze to a site approximately 75-80cm in front of the cat, which the cat reached in 0.7-1.2s and 1.1-1.6 strides. Constant gaze occupied only 5-21% of the time cats spent looking at the walking surface.

Pulmonary hypertensive crisis following ethanol sclerotherapy for a complex vascular malformation

Anhydrous ethanol is a commonly used sclerotic agent for treating vascular malformations. We describe the case of a full-term 15-day-old female with a complex venolymphatic malformation involving the face and orbit. During treatment of the lesion with ethanol sclerotherapy, she suffered acute pulmonary hypertensive crisis. We discuss the pathophysiology of pulmonary hypertension related to ethanol sclerotherapy, and propose that hemolysis plays a significant role. Recommendations for evaluation, monitoring and management of this complication are also discussed.

Nano-engineering by implanting Al2O3 nano particle as sandwiched scattering centers in between the Lao.5Pr0.2Sr0.3MnO3 thin film layers

We report the use of non-magnetic Al2O3 nano particles deposited between two ferromagnetic La0.5Pr0.2Sr0.3MnO3 (LPSMO) manganite layers with an aim to improve the electronic and magnetotransport properties of the layered supper lattice grown on single crystal STO(100) substrate using Pulsed Laser Deposition (PLD) technique. We studied the electronic-transport and magnetotransport properties of this system wherein Al2O3 particles are expected to act as insulating scattering centers between two ferromagnetic LPSMO layers. The scattering due to additional scattering centers (insulating Al2O3 nano particles) could be controlled by application of external field, resulting in high magnetoresistance (MR) approximately 72% as compared to pristine LPSMO film (MR approximately 51%) at temperature close to their T(M) values. In addition, incorporation of nanostructured Al2O3 barrier between the two ferromagnetic LPSMO layers results in a 2-3 fold increase in the values of temperature coefficient of resistance (TCR) and the field coefficient of resistance (FCR) as compared to pristine LPSMO film, suggesting the use of such nanoengineered manganite layered structure for better device application.

The costoclavicular ligament revisited: a functional and anatomical study

INTRODUCTION

The sternoclavicular joint is of clinical importance. However, there is scant information in the literature regarding one ligament of this area, the costoclavicular ligament (CCL).

MATERIAL AND METHODS

In order to further elucidate this structure, 10 adult formalin-fixed cadavers (17 sides) underwent dissection of the CCL. Once the CCL was identified, measurements were made of its dimensions and observations made of its anatomy. Next, ranges of motion were performed of the upper extremity and the CCL observed for tension or laxity.

RESULTS

Of the 17 sternoclavicular regions examined 16 (94%) were found to possess a CCL. The average medial and lateral lengths, width and thickness were 1, 2, 1.2, 0.340 cm, respectively. The width of the CCL was statistically smaller in women that in men. The majority of ligaments were single structures traveling from the inferior surface of the medial clavicle just lateral and sometimes-fused (12.5%) to the lateral edge of the sternoclavicular joint. These fibers then terminated on the medial end of the first rib and first costal cartilage (75%) or exclusively onto the first costal cartilage (25%). Most ligaments were single and not composed of two parts. Arm abduction resulted in tautness of the ligament and increased as the degree of abduction increased. Internal rotation of the arm translated into medial shift of the clavicle, raising the clavicle away from the first rib creating tension on the CCL. Moderate degrees of external rotation were required before the CCL became taut and even began to pull the first rib laterally. Small amounts of protraction and retraction of the scapula both put the CCL under tension.

CONCLUSIONS

The CCL is a constant structure found just lateral to the sternoclavicular joint. This ligament was a single band in the majority of our specimens and limited most ranges of motion of the proximal upper limb thus stabilizing the sternoclavicular region.

Primary hepatic carcinoid tumor presenting as Cushing's syndrome

Hepatic carcinoid tumors are very uncommon; most are clinically non-functional and very few present with the symptoms of carcinoid syndrome. ACTH-producing carcinoid tumors most commonly originate in the lung or thymus and present insidiously with bronchospasm and/or chest mass. Occasionally, ectopic ACTH syndromes have been reported in association with pancreatic islet cell tumors, medullary thyroid cancer, pheochromocytoma, small-cell lung carcinoma, and rarely, ovarian and prostate tumors. We report here a patient with an ectopic ACTH-secreting primary hepatic carcinoid tumor who presented with cushingoid appearance, profound proximal muscle weakness, severe lower extremity edema, and markedly elevated urinary free cortisol. ACTH levels were in the low normal range. A solitary vascular hepatic lesion was found on magnetic resonance imaging, which was isodense with the surrounding liver on octreotide scan and photopenic on an 18-fluorodeoxyglucose (18FDG)-positron emission tomography (PET) scan. Following surgical resection of the hepatic tumor, histopathology confirmed an ACTH-secreting neuroendocrine tumor (NET), the patient had complete resolution of hypercortisolemic symptoms and remains in remission, now 4 yr after hepatic tumor resection. This case reports the first ACTH-secreting primary hepatic NET presenting as ectopic Cushing's syndrome. Interesting aspects of this case include the presence of a pituitary incidentaloma, the low normal ACTH, and photopenia on 18FDG-PET imaging.

Operative management of acetabular fractures. A review of 73 fractures

Between June 1994 and December 2000, 80 displaced acetabular fractures were treated by open reduction and internal fixation, where possible by a single surgical approach. We report our results in 72 patients (73 fractures) who completed a minimum follow-up of 2 years. The average age of patients was 39.5 years (range 15-76 years). Thirty-four fractures were classified as simple and the remaining 39 were complex fractures. Twenty-four patients were recorded to have posterior dislocation of the hip joint at the time of initial presentation and at surgery eight patients were noted to have varying degrees of damage to the head of the femur. The average time to surgery was 11.7 days (range 1-35 days); 80% of cases were operated within 2 weeks period. The average follow-up was 45.5 months (range 24-96 months). In 67 fractures (92%), only a single approach was used (Anterior Ilioinguinal 26 cases; Posterior Kocker-Lagenbach 41 cases). Five fractures needed an extensile triradiate approach and only one case required a combined anterior and posterior approach. Congruent reduction was achieved in 89% of cases. Main complications included deep infection in two patients (2.7%) and severe degenerative changes in three patients (4.2%). A total of four patients (5.5%) required a total hip replacement. There were no cases of deep vein thrombosis or pulmonary embolism. Heterotopic ossification grade III was seen in three (4.1%) cases and none were grade IV. At the latest follow-up the average Harris hip score was 85 (range 20-100). We conclude that in the majority of cases internal fixation is possible through a single approach provided patients are referred early to a specialist unit. This results in satisfactory outcome with reduced morbidity and complication rate.

Cellular automata and its advances to drug therapy for HIV infection

This paper gives an over view of the use of cellular automata (CA) model of drug therapy for HIV infection. Nonuniform CA is employed to simulate drug treatment of HIV infection, where each computational domain may contain different CA rules, in contrast to normal uniform CA models. Ordinary (or partial) differential equation models are insufficient to describe the two extreme time scales involved in HIV infection (days and decades), as well as the implicit spatial heterogeneity. Zorzenon and Coutinho [Phy Rev Lett, 16 (2001) 1] reported a cellular automata approach to simulate three-phase patterns of human immunodeficiency virus (HIV) infection consisting of primary response, clinical latency and onset of acquired immunodeficiency syndrome (AIDS). But here we present a related model, based on non-uniform CA to study the dynamics of drug therapy of HIV infection. The main aim in this model is to simulate the four phases (acute, chronic, drug treatment responds and onset of AIDS). The results shown here indicate that both simulations (with and without treatments) evolve to the relatively same steady state (characteristics of Wolfram's class II behavior). Different kinds of drug therapies can also be simulated in this model, which can be found useful for developing a proper drug therapy.

Identification of a mammalian long chain fatty acyl elongase regulated by sterol regulatory element-binding proteins

Fatty acids are synthesized de novo from acetyl-CoA and malonyl-CoA through a series of reactions mediated by acetyl-CoA carboxylase (ACC) and fatty acid synthase (FAS). In rodents, the principal fatty acid produced by FAS is palmitic acid (16:0). Sterol regulatory element-binding proteins (SREBPs) enhance the transcription of many genes responsible for fatty acid synthesis. In transgenic mice that overexpress SREBPs in liver, the rate of fatty acid synthesis is markedly increased, owing to the activation of these biosynthetic genes, which include ATP citrate lyase, ACC, FAS, and stearoyl-CoA desaturase. The fatty acids that accumulate in livers of SREBP transgenic mice are 18 carbons rather than 16 carbons in length, suggesting that the enzymes required for the elongation of palmitic to stearic acid may be induced. Here, we report the cDNA cloning of a murine long chain fatty acyl elongase (LCE) that was identified initially by oligonucleotide array analysis of mRNA from SREBP transgenic mouse livers. LCE mRNA is highly expressed in liver and adipose tissue. The cDNA encodes a protein of 267 amino acids that shares sequence identity with previously identified very long chain fatty acid elongases. Cells that overexpress LCE show enhanced addition of 2-carbon units to C12-C16 fatty acids. We provide evidence that LCE catalyzes the rate-limiting condensing step in this reaction. The current studies suggest that mouse LCE expression is increased by SREBPs and that the enzyme is a component of the elusive mammalian elongation system that converts palmitic to stearic acid.

High-throughput variation detection and genotyping using microarrays

The genetic dissection of complex traits may ultimately require a large number of SNPs to be genotyped in multiple individuals who exhibit phenotypic variation in a trait of interest. Microarray technology can enable rapid genotyping of variation specific to study samples. To facilitate their use, we have developed an automated statistical method (ABACUS) to analyze microarray hybridization data and applied this method to Affymetrix Variation Detection Arrays (VDAs). ABACUS provides a quality score to individual genotypes, allowing investigators to focus their attention on sites that give accurate information. We have applied ABACUS to an experiment encompassing 32 autosomal and eight X-linked genomic regions, each consisting of approximately 50 kb of unique sequence spanning a 100-kb region, in 40 humans. At sufficiently high-quality scores, we are able to read approximately 80% of all sites. To assess the accuracy of SNP detection, 108 of 108 SNPs have been experimentally confirmed; an additional 371 SNPs have been confirmed electronically. To access the accuracy of diploid genotypes at segregating autosomal sites, we confirmed 1515 of 1515 homozygous calls, and 420 of 423 (99.29%) heterozygotes. In replicate experiments, consisting of independent amplification of identical samples followed by hybridization to distinct microarrays of the same design, genotyping is highly repeatable. In an autosomal replicate experiment, 813,295 of 813,295 genotypes are called identically (including 351 heterozygotes); at an X-linked locus in males (haploid), 841,236 of 841,236 sites are called identically.

The Lubinus patellofemoral arthroplasty. A five- to ten-year prospective study

We present a prospective review of the outcome of 76 Lubinus patellofemoral arthroplasties carried out in 59 patients between 1989 and 1995. At a mean follow-up of 7.5 years, 62 knees in the 48 patients were reviewed; 11 patients (14 knees) had died. None was lost to follow-up. The clinical outcome using the Bristol Knee Scoring system was satisfactory in 45% of the cases. Maltracking of the patella, resulting in lateral tilt, subluxation and polyethylene wear, was the most common complication (32%). Revision surgery was carried out in 21 knees (28%) giving a cumulative survival rate of 65% (confidence interval (CI) 49 to 77) at eight years. The survival rate for revision and moderate pain was 48% (CI 36 to 59) at six years. Progression of arthritis was seen in seven cases (9%). In five of these (6.5%), the symptoms were severe enough to need revision surgery. Due to the high proportion of unsatisfactory results, we have discontinued the use of this prosthesis.

The Lubinus patellofemoral arthroplasty

We present a prospective review of the outcome of 76 Lubinus patellofemoral arthroplasties carried out in 59 patients between 1989 and 1995. At a mean follow-up of 7.5 years, 62 knees in the 48 patients were reviewed; 11 patients (14 knees) had died. None was lost to follow-up.

The clinical outcome using the Bristol Knee Scoring system was satisfactory in 45% of the cases. Maltracking of the patella, resulting in lateral tilt, subluxation and polyethylene wear, was the most common complication (32%). Revision surgery was carried out in 21 knees (28%) giving a cumulative survival rate of 65% (confidence interval (CI) 49 to 77) at eight years. The survival rate for revision and moderate pain was 48% (CI 36 to 59) at six years. Progression of arthritis was seen in seven cases (9%). In five of these (6.5%), the symptoms were severe enough to need revision surgery. Due to the high proportion of unsatisfactory results, we have discontinued the use of this prosthesis.

Copper, zinc, and magnesium levels in non-insulin dependent diabetes mellitus

A relationship has been reported between trace elements and diabetes mellitus. This study evaluated the role of such a relationship in 83 patients with non-insulin dependent diabetes mellitus (40 men and 43 women), with a mean duration of diabetes of 3.9 +/- 3.6 years. Patients with nephropathy were excluded. Thirty healthy non-diabetic subjects were studied for comparative analysis. Subjects were subdivided into obese and non-obese. Diabetic subjects were also subdivided into controlled and uncontrolled groups; control was based on fasting blood glucose and serum fructosamine levels. Plasma copper, zinc and magnesium levels were analysed using a GBC 902 double beam atomic absorption spectrophotometer. Plasma zinc and magnesium levels were comparable between diabetic and non-diabetic subjects, while copper levels were significantly elevated (p < 0.01) in diabetic patients. Age, sex, duration and control of diabetes did not influence copper, zinc, or magnesium concentrations. We conclude that zinc and magnesium levels are not altered in diabetes mellitus, but the increased copper levels found in diabetics in our study may merit further investigation of the relationship between copper and non-insulin dependent diabetes mellitus.

Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis

We randomised 102 knees suitable for a unicompartmental replacement to receive either a unicompartmental (UKR) or total knee replacement (TKR) after arthrotomy. Both groups were well matched with a predominance of females and a mean age of 69 years. Patients in the UKR group showed less perioperative morbidity, but regained knee movement more rapidly and were discharged from hospital sooner. At five years, two UKRs and one TKR had been revised; another TKR was radiologically loose. All other knees appeared to be clinically and radiologically sound. Pain relief was good in both groups but the number of knees able to flex > or =120 degrees was significantly higher in the UKR group (p < 0.001) and there were more excellent results in this group. Our findings have shown that UKR gives better results than TKR and that this superiority is maintained for at least five years.

Unicompartmental or total knee replacement?

We randomised 102 knees suitable for a unicompartmental replacement to receive either a unicompartmental (UKR) or total knee replacement (TKR) after arthrotomy. Both groups were well matched with a predominance of females and a mean age of 69 years.

Patients in the UKR group showed less perioperative morbidity, but regained knee movement more rapidly and were discharged from hospital sooner.

At five years, two UKRs and one TKR had been revised; another TKR was radiologically loose. All other knees appeared to be clinically and radiologically sound.

Pain relief was good in both groups but the number of knees able to flex ≥ 120° was significantly higher in the UKR group (p < 0.001) and there were more excellent results in this group.

Our findings have shown that UKR gives better results than TKR and that this superiority is maintained for at least five years.

Diet and lifestyle guidelines and desirable levels of risk factors for the prevention of diabetes and its vascular complications in Indians: a scientific statement of The International College of Nutrition. Indian Consensus Group for the Prevention of Diabetes

BACKGROUND

There has been a rapid increase in the prevalence of diabetes and cardiovascular disease in India, in association with rapid changes in diet and lifestyle. In adults, the prevalence of diabetes, hypertension and coronary artery disease is two- to threefold greater in the urban population than in rural populations; it is associated with modest insulin resistance in urban groups.

METHODS

In response to a proposal by the International College of Nutrition that specialist experts should develop consensus recommendations for the prevention of chronic diseases, Indian specialists in diabetes and vascular disease have collaborated to produce guidelines relevant to the population of India.

RECOMMENDATIONS

Because Indian urban populations have a modest increase in overweight and low rates of obesity in association with the rapid emergence of diabetes and cardiovascular risk, a body mass index of 21 kg/m2 should be considered safe, with a range of 19-23 kg/m2 acceptable; > 23 kg/m2 should be considered overweight, and > 25 kg/m2 should be taken to indicate obesity. A waist:hip ratio > 0.88 in males and > 0.85 in females should be considered to indicate central obesity, because the prevalence of coronary disease, hypertension and associated disturbances of insulin resistance are more common above these limits. For the prevention of vascular disease, there is general international consensus that the desirable serum concentration of cholesterol should be < 170 mg/dl (> 4.42 mmol/l), which may also be optimal for Indians; values between 170 and 200 mg/dl (4.42-5.2 mmol/l) should be considered borderline. The critical values for low density lipoprotein cholesterol may be < 90 mg/dl (ideal), 90-110 mg/dl (borderline high) and > 110 mg/dl (high) (< 2.32, 2.32-2.84 and > 2.84 mmol/l, respectively). Fasting triglycerides should be < 150 mg/dl (< 1.69 mmol/l) and high-density lipoprotein cholesterol > 35 mg/dl (> 0.9 mmol/l). The limit for the total energy derived from fat intake should be < 21%/day (7% each for saturated, polyunsaturated and mono-unsaturated fatty acids). The carbohydrate intake should provide more than 65% of daily energy, mainly from complex carbohydrates. A daily dietary intake of 400 g fruits, vegetables and legumes, 400 g cereals, in conjunction with 25 g soya bean or mustard or canola oils (rich in n-3 fatty acids) in place of fats rich in saturated fat, may be protective against diabetes and vascular disease. Moderate physical activity with the aim of burning 300 Kcal/day (> 1255 KJ/day), and cessation of tobacco and alcohol consumption, may provide an effective programme for prevention of diabetes and its vascular complications in Indians.

Prevalence of goitre in school children in Baramulla (Kashmir valley)

1,876 school children were surveyed in Baramulla district of Kashmir for the presence of goitre. There were 964 boys and 912 girls in the age group of 5-15 years. An overall goitre prevalence of 52.08 per cent was found (54.77% in boys and 49.23% in girls). Iodine content was assayed in urine samples of 44 randomly selected subjects. The mean +/- SEM urinary iodine was 41.85 +/- 2.52 micrograms/g of creatinine (Range 6.25-69.41).

Profile of neurological problems in diabetes mellitus retrospective analysis of data from 1294 patients

Data from 1294 patients with diabetes mellitus admitted to the Endocrinology Department of the Institute of Medical Sciences, Srinagar, Kashmir, from 1986 to 1994, were analyzed for frequency of various neurological problems. Of 1294 patients, 46.29% had clinical evidence of one or more neurological problems. The frequency of neurological problems was significantly more in patients with type II diabetes mellitus (P<0.001). Predominant neurological problems included peripheral neuropathy (96.66%), stroke (5.51%), Parkinsonism (1.50%), seizure disorder (1.17%) and dementia (1%). Mean (+/- SD) age of patients with neurological problems was significantly more (P<0.001) than those without neurological problems (52.07+/- 9.52 versus 47.45+/- 12.87 years for type II diabetes mellitus; 26.73+/- 8.40 versus 18.0+/- 3.62 for type I diabetes mellitus). Mean duration of diabetes in patients with neurological problems was significantly more than those without neurological problems (6.70+/- 6.04 versus 3.95+/- 4.22 years for type II diabetes mellitus; 5.63+/- 3.67 versus 1.89+/- 2.57 for type I diabetes mellitus). At the time of admission, fasting blood glucose was lower in patients without neurological problems as compared to patients with problems (9.08+/- 2.22 versus 11.05+/- 4.91 mmol/L for type II diabetes mellitus; 9.44+/- 2.80 versus 13.01+/- 5.01 mmol/L for type I diabetes mellitus; P7lt;0.001).

Fibricalculous pancreatic diabetes from the Kashmir Valley

Diabetes mellitus secondary to chronic nonalcoholic pancreatic calcification has been described from several tropical countries, including India. We describe the existence of this entity in the subtropical region-the Kashmir Valley of the Indian subcontinent. Fibrocalculous pancreatic diabetes constituted 2.55% of patients admitted with diabetes mellitus. Ketoacidosis was not seen in any patient, and some patients showed evidence of chronic microvascular complications. The majority of patients required insulin for control of blood glucose and none had consume cassava.

Superiority of transoesophageal echocardiography in detection of multichambered multiple myxoma

We describe a rare case of a sporadiac form of multiple myxoma and highlight the unusual combination of left atrial and right ventricular tumors. Transoesophageal echocardiography proved superior to precordial imaging in detecting all four masses (two in left atrium and two in right ventricle).

Orbital cysticercosis

Orbital cysticercosis is a rare condition. We report here 3 cases with orbital cysticercosis who presented with proptosis and ptosis (Case no. 1 and 2) and focal seizures (Case no. 3). All of them had a vision of 6/6. Diagnosis of cysticercosis was made on CT Scan. The lesions isolated in Cases 1 and 2 and were excised. Drug therapy was given to treat any persisting infestation. Case no 3 had multiple brain cysticerci in addition to the orbital one. However, the patient was lost to follow-up.

Pars plana vitrectomy in vitreous haemorrhage due to Eales' disease

Repeated vitreous haemorrhage is a common occurrence in Eales disease. 25 eyes of unresolving vitreous haemorrhage were subjected to pars plana vitrectomy. 18 eyes improved to 1/60 or better. Vitreous rebleed was the commonest problem encountered. We discuss our experience, complications and limitations.

Results of pars plana vitrectomy in 62 cases of vitreous haemorrhage

62 Cases with unresolving Vitreous Haemorrhage due to varied etiology, underwent pars plana Vitrectomy. A vitreous rebleed on the table and post-operatively, was the main complication encountered. Despite limited equipment, a visual improvement was obtained in 59.68% eyes with visual acuity greater than FC 6 meters in 33.87% eyes. This is far better than not being able to offer any treatment at all.

Intra-ocular lens implantation after vitreous loss

Vitreous loss is a dreaded complication of cataract surgery, especially so with IOL implant which then may have to be abandoned. Thirty three cases of IOL implants, either anterior chamber or posterior chamber, after vitreous loss done in the past 3 years were studied. Of these, 18 (55%) had a final visual acuity of 6/18 or better and none was worse than 6/60. The postoperative complications and findings and a review of literature are discussed.

Results of pars plana vitrectomy in 24 cases of endophthalmitis

Twenty four cases of endophthalmitis were subjected to pars plana vitrectomy. A final vitreous clearance was obtained in 62.50% cases. Visual improvement occurred in 41.67% cases. It was concluded that prompt detection and early and vigorous therapy--medical and surgical--is the mainstay in the management of endophthalmitis.