Prevalence and Clinical Significance of Electrocardiographic Complete Right Bundle Branch Block in Young Individuals

BACKGROUND AND AIMS

There is limited information on the clinical significance of complete right bundle branch block (CRBBB) in young individuals. The aim of this study was to determine the prevalence and significance of CRBBB in a large cohort of young individuals aged 14-35 years old.

METHODS

From 2008 to 2018, 104,369 consecutive individuals underwent a cardiovascular assessment with a health questionnaire, electrocardiogram, clinical consultation, and selective echocardiography. Follow-up was obtained via direct telephone consultations. Mean follow-up was 7.3 ± 2.7 years.

RESULTS

CRBBB was identified in 154 (0.1%) individuals and was more prevalent in males compared with females (0.20% vs. 0.06%; p<0.05) and in athletes compared with non-athletes (0.25% vs. 0.14%; p<0.05). CRBBB-related cardiac conditions were identified in 7 (5%) individuals (4 with atrial septal defect, 1 with Brugada syndrome, 1 with progressive cardiac conduction disease and 1 with atrial fibrillation). Pathology was more frequently identified in individuals with non-isolated CRBBB compared with individuals with isolated CRBBB (14% vs 1%; p < 0.05) and in individuals with a QRS duration of ≥130 milliseconds (ms) compared with individuals with a QRS of <130ms (10% vs 1%; p<0.05).

CONCLUSION

The prevalence of CRBBB in young individuals was 0.1% and was more prevalent in males and athletes. CRBBB-related conditions were identified in 5% of individuals and were more common in individuals with non-isolated CRBBB and more pronounced intraventricular conduction delay (QRS duration of ≥130ms). Secondary evaluation should be considered for young individuals with CRBBB with symptoms, concerning family history, additional electrocardiographic anomalies or significant QRS prolongation (≥130ms).

PRDM16, LRP1 and TRPM8 genetic polymorphisms are risk factor for Pakistani migraine patients

BACKGROUND

Migraine is a chronic neurovascular condition characterized by recurring attacks of pulsating headaches. Genome-wide association studies (GWAS) identified many potential loci associated with migraine. To check the association of polymorphisms of PRDM16 (rs2651899), LRP1 (rs11172113), and TRPM8 (rs10166942) with migraine, the first time a case-control study was conducted in understudied Pakistani population.

METHODS

The study included 127 migraine patients (21 in migraine with aura and 106 with migraine without aura group) and 120 healthy control subjects from different areas of Punjab, Pakistan. Blood samples were collected from all the participants, and DNA was isolated from the lymphocytes by the modified organic method. Sanger's sequencing was done for PRDM16 (rs2651899), LRP1 (rs11172113), and TRPM8 (rs10166942) in all the samples to check the genotype. Logistic regression analysis was done using SPSS 20.0 to check the association of these SNPs with migraine susceptibility.

RESULTS

We found statistically significant differences between case and control group for PRDM16 (rs2651899) at genotypic level (p < 0.001), allelic level (p < 0.001; OR 3.088; 95% CI 2.082-4.579) and for dominant model (p < 0.001; OR 5.437; 95% CI 3.112-9.498). The major findings of this study suggested that PRDM16 rs2651899 is strongly associated with migraine in overall and subgroup analysis of genotypes. LRP1 (rs11172113) showed significant association with migraine except in subgroup comparison. A similar trend of association was found for TRPM8 (rs10166942) however, significant association was found only at the allelic level but no significant difference was seen at the genotypic level between case and control. One novel mutation c.67 + 4436_67 + 4438delA was also identified in the current study near LRP1 (rs11172113) polymorphic site.

CONCLUSION

In this first-ever replication report from Pakistan, PRDM16 (rs2651899) was found as a potential genetic marker in migraine susceptibility while LRP1 (rs11172113) and TRPM8 (rs10166942) showed partial association in subgroup analysis.

Evaluation of economic loss caused by Indian crested porcupine (Hystrix indica) in agricultural land of district Muzaffarabad, Azad Jammu and Kashmir, Pakistan

The Indian crested porcupine (Hystrix indica) is a vertebrate pest of agricultural lands and forest. The study was aimed to report the damage to local crops by the Indian crested porcupine (Hystrix indica) in the Muzaffarabad District. A survey was conducted to identify the porcupine-affected areas and assess the crop damage to the local farmers in district Muzaffarabad Azad Jammu and Kashmir (AJK) from May 2017 to October 2017. Around 19 villages were surveyed, and a sum of 191 semi-structured questionnaires was distributed among farmers. Crop damage was found highest in village Dhanni where a porcupine destroyed 175 Kg/Kanal of the crops. Regarding the total magnitude of crop loss, village Danna and Koomi kot were the most affected areas. More than half (51.8%) of the respondents in the study area suffered the economic loss within the range of 101-200$, and (29.8%) of the people suffered losses in the range of 201-300$ annually. Among all crops, maize (Zea mays) was found to be the most damaged crop ranging between 1-300 Kg annually. In the study area, porcupine also inflicted a lot of damages to some important vegetables, including spinach (Spinacia oleracea), potato (Solanum tuberosum) and onion (Allium cepa). It was estimated that, on average, 511Kg of vegetables are destroyed by porcupine every year in the agricultural land of Muzaffarabad. It was concluded that the Indian crested porcupine has a devastating effect on agriculture which is an important source of income and food for the local community. Developing an effective pest control strategy with the help of the local government and the Wildlife department could help the farmers to overcome this problem.

Molecular classification and comparative phylogeographic study of insectivorous bat species (Pipisitrellus coromandra) from Punjab, Pakistan

Molecular based identification of bat fauna in Pakistan has been relatively less explored. The current study was therefore planned to report for the first time the molecular classification of insectivorous bats (Pipistrellus coromandra) based on mitochondrion gene (COI) from Punjab, Pakistan. Specimens were collected from five different locations followed by DNA extraction with subsequent gene amplification and sequencing. All samples in the study had shown close identity matches with species (Pipistrellus coromandra) from India and (Pipistrellus tenuis) from Vietnam with percentage identity score of 96.11 and 95.58 respectively except one sequence which only revealed 86.78% identity match on Basic Local Alignment Search Tool (BLAST) and could only be assigned to genus level Pipistrellus sp. The results indicated negligible intra-population genetic distance among collected samples whereas the comparison with species from other countries had shown high intraspecific (P. coromandra) and interspecific (P. tenuis) mean genetic distances. The current study hence successfully proved the efficiency of COI gene as a molecular marker for species identification and in analyzing the patterns of genetic variation with species from other countries.

Interaction of tacrolimus through hedgehog signaling pathway: An in vitro evaluation using rat hepatocytes

Tacrolimus (TAC) is the drug of choice in immunosuppressive therapy for organ transplantation; however, adverse effects are still a major concern. The current study aims to decipher the short-term exposure of TAC on rat hepatocytes in relation to activation of hedgehog (HH) signaling pathway. Time dependent study was conducted using primary rat hepatocytes treated with TAC (36 µM) for 6, 12, 24 and 48 h. Western blot analysis was performed using cell lysate in order to analyze the regulation of HH pathway proteins including HHIP, SMO, PTCH, IHH, SHH, and GLI transcription factors. The study revealed change in protein expression of HH signaling molecules with activation of HH pathway, due to downregulation of HHIP, and enrichment of HH ligands with activation of SMO and GLI transcription factors. It is therefore, concluded that short term TAC exposure leads to upregulation of HH pathway in liver, which may initially act to repair the liver damage but can worsen the condition in case of prolonged immunosuppressive therapy. This insight could lead to understand association of off target effects of immunosuppressive drugs and occurrence of other liver diseases in transplant patients when it comes to long term immunosuppressive therapy. These findings also illuminate a novel direction that use of HH inhibitor might provide a therapeutic strategy for immune suppression related liver disorders.

Six-month outcomes of a high intensity exercise programme in young patients with hypertrophic cardiomyopathy: The SAFE-HCM trial

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Cardiac Risk in the Young

Background

Moderate intensity exercise training in older patients with hypertrophic cardiomyopathy (HCM) can improve functional capacity, without significant harm. However, younger patients are attracted to high intensity training (HIT) regimes. The SAFE-HCM study demonstrated that an individually tailored, HIT programme in young patients with HCM was feasible, and provided both health and psychological benefits, without an increase in the burden of arrhythmia.

Purpose

To assess whether observed benefits of a HIT programme in young patients with HCM are sustained at 6 months.

Methods

Eighty patients with HCM (45.7y+/-8.6) underwent baseline clinical and psychological assessment. Individuals were randomised to a 12-week HIT programme (n = 40) or usual care (n = 40). Baseline evaluation was repeated at 12 weeks (T12). Feasibility, safety, health and psychological benefits were assessed. At 12-weeks individuals were encouraged to continue with the frequency and intensity of physical activity (PA) achieved at the end of the cardiac rehabilitation programme. Participants in the exercise arm were invited to follow-up at 6 months (T6m).

Results

The majority (83%) of participants completed the 12-week study. At T12 there was no significant difference between groups in the composite arrhythmia safety outcome (p = 0.99). The indices of exercise capacity were significantly improved in the exercise compared to the control group; peak VO2 (+3.7ml/kg/min [CI 1.1,6.3], p = 0.006), VO2/kg at anaerobic threshold (VO2/kgAT) (+2.44ml/kg/min [CI 0.6,4.2], p = 0.009), time to AT (+115s [CI 54.3,175.9], p &lt; 0.001) and exercise time (max ET) (+108s [CI 33.7,182.2], p = 0.005). The exercise group also demonstrated greater reduction in systolic BP (-7.3mmHg [CI -11.7,-2.8], p = 0.002), BMI (-0.8kg/m2 [CI-1.1,-0.4], p &lt; 0.001), anxiety (-2.6 [CI-3.6,-1.6], p= &lt;0.001) and depression (-1.1 [CI -2.0,-0.2], p = 0.015) scores. At T6m patient reported exercise adherence was comparable to baseline PA in 33/34 of the exercise group attending for follow up. Most exercise gains dissipated with the exception of time to AT (p = 0.002), max ET (p = 0.003), VO2/kgAT (p = 0.04) and anxiety score (p &lt; 0.001) (Figure 1). There were no sustained episodes of atrial or ventricular arrhythmias. The incidence of NSVT did not differ between time points (p = 0.09).

Conclusion

A 12-week HIT programme in young patients with HCM offers considerable gains in fitness and psychological outcomes, with no increase in arrhythmic burden. At T6m exercise levels as well as most physiological adaptations and health benefits returned to baseline, as seen in other studies when formal participation in an exercise programme comes to an end. This highlights the importance of the implementation of strategies to encourage ongoing engagement in PA. Potential solutions include identification of barriers to exercise, as well as adoption of novel tele-rehabilation approaches.

Abstract Figure 1 Sustained benefits at T6m

765 Reducing ‘At Risk’ Skin in Neck of Femur Fracture (NOF) Patients – A Quality Improvement Project Standardising Catheterisation and Peri-Operative Care

Introduction

A service evaluation audit highlighted significant variation in our practice as regards catheterisation in NOF patients. A pilot protocol was developed with real time data monitoring to see if we could improve our patients’ pathway.

Method

The protocol focussed on early catheterisation, monitoring the condition of patients’ skin, documentation around catheter care and removal instructions and surveillance for urinary tract infection rates (UTI)

Results

150 patients were included in the pilot. There was a reduction by more than 50% of patients assessed as having at risk or broken skin. 94.5% of patients were catheterised out of theatres (previously only 4%) saving an average of 14 minutes of theatre time per case. Delays in catheter removal after documented request reduced by 2 days and our UTI rates were relatively unchanged (3.3% compared to 2.7%). Documentation significantly improved. We also noted that overall length of stay was reduced by 2 days.

Conclusions

Standardising our care pathway has improved our patient care and documentation. It has benefitted theatre efficiency and also nursing of fragile skin in 'at risk' patients. Prompting early removal and compliance may have also had a positive impact on overall length of stay. This has been a successful quality improvement project in our department.

759 Maintaining Surgical Education and Team Morale During A Pandemic – Can A Virtual Educational Platform Deliver Effective Engagement and Personal Development of Non-Technical Skills?

Introduction

The COVID 19 pandemic has brought unprecedented challenges in healthcare, leading to a dramatic change in service provision and impacting surgical training.

We developed a new educational timetable to maintain an ethos of education safely; focusing on providing an opportunity to develop non-technical skills and maintain reflective practice.

Method

Microsoft Teams was used in our department with two separate streams of weekly education; journal club with focus on developing critical evaluation skills, and a case based in depth discussion forum to develop presentation skills and evidence based management. A questionnaire was sent out after 10 weeks to evaluate the effectiveness and engagement.

Results

From 53 responses, 72% felt that their engagement in teaching increased with a virtual platform with an overall satisfaction of 88%. Reflective practice increased and 40% felt their non-technical skills improved. Overall, 68% preferred to continue learning virtually and 88% would recommend this to their peers. 92% felt that the platform played a pivotal role in helping maintain team morale during this period.

Conclusions

There has been good engagement with positive reflection and learning at a time of great change in the NHS benefiting training and non-training doctors. We recommend incorporating virtual platforms to provide education in all surgical departments.

In vivo assessment of bisphenol A induced histopathological alterations and inflammatory gene expression in lungs of male Wistar rats

Bisphenol A (BPA), an imperative environmental contaminant used in polycarbonate plastics. Due to limited information concerning the effect of BPA on lungs, this study design to assess whether BPA cause alterations in histopathology and trace metal content in lungs of rats. They were divided into five groups with five rats per group. Group I was named as control group. Group L6 and L12 were received BPA (10 mg/kg body weight/day) for 6 weeks and 12 weeks respectively. Group H6 and L12 were given BPA (25 mg/kg body weight/day) for 6 weeks and 12 weeks respectively. Considerable alteration in Cu, Zn and Fe was detected in experimental groups. BPA also caused significant increase in the expression of tumor necrosis factor α that mediate the pulmonary inflammatory response. Comparative study of resolved proteins i.e. 72 KDa (matrix metalloproteinase 2 fragment) and 109 KDa (nucleolin) on SDS-PAGE showed their altered expression in experimental groups. Histopathology of experimental groups revealed altered architecture of lungs. Special staining of BPA treated groups showed significant number of mast cells in alveoli and bronchioles. Prolonged administration of BPA causes deleterious aggravating lung damage even at extremely low dose, so the use of BPA should be prohibited in plastic synthesizing industries.

Role of myocardial T1 mapping in arrhythmogenic right ventricular cardiomyopathy

Background

T1 mapping by cardiovascular magnetic resonance (CMR) is an accurate tool to assess myocardial extracellular space with wider clinical applications in the aetiological characterization of cardiomyopathies. The aims of the study were to explore a possible role of myocardial T1 mapping in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and in first-degree relatives at risk and to investigate the possible relationship between left ventricular (LV) involvement at CMR and ECG features.

Methods

Thirty patients with ARVC (47% males, mean age 42±22 years) and 59 first-degree relatives who did not fulfil ARVC diagnostic Task Force criteria, underwent full diagnostic work-up including CMR with native and post-contrast T1 mapping.

Results

The CMR was abnormal in 26 (86%) patients with ARVC. The RV was affected in isolation in 13 (43%) patients. Prior to T1 mapping assessment, 2 (7%) patients exhibited isolated LV involvement and 11 (36%) patients showed features of biventricular disease. Left ventricular involvement was manifested as detectable LV late gadolinium enhancement (LGE) in 12 out of 13 cases. According to pre-specified septal T1 mapping thresholds, 11 (37%) patients showed abnormally high native T1 values. Myocardial T1 mapping was higher than normal in 5 (17%) patients who would have been classified as exhibiting a normal LV by conventional imaging. The proportion of patients with abnormal T1 values was similar in patients with or without LGE. Myocardial T1 mapping was higher than normal in 22 (37%) of the 59 first-degree relatives.

Conclusions

Native and/or post contrast myocardial T1 values are raised in almost half of patients with ARVC and in a similar proportion of unaffected first-degree relatives. T1 mapping offers the potential for early detection of LV involvement in patients with ARVC and in first-degree relatives at risk.

Funding Acknowledgement

Type of funding source: None

Safety and outcomes of a structured exercise programme in young patients with hypertrophic cardiomyopathy: the SAFE-HCM trial

Background

Contemporary studies in hypertrophic cardiomyopathy (HCM) suggest that moderate intensity exercise can improve cardiorespiratory fitness without raising significant safety concerns. Although low/moderate intensity exercise may be appropriate for older HCM patients, it is unlikely to attract younger, often asymptomatic patients, who wish to engage in higher intensity regimes.

Purpose

To assess the feasibility, safety and outcomes of an individually tailored, high intensity exercise programme in young patients with HCM.

Methods

In this RCT, 80 patients with HCM, aged 16–60 (mean 45.7, [SD8.6]) underwent baseline testing with ECG, echocardiography, blood testing, exercise testing, 48-hour ECG and psychological assessment. Individuals were randomised to a 12-week supervised exercise programme (HRR increased from 70–85%) (n=40) or usual activity (n=40). Baseline investigations were repeated at 12 weeks.

Feasibility was assessed by a) recruitment, adherence and retention rates; b) staffing ratios and logistics; c) acceptability of the intervention/educational materials. Safety was assessed as a composite of 1) cardiovascular death, 2) cardiac arrest, 3) device therapy, 4) exercise induced syncope, 5) sustained/non-sustained (NS) ventricular tachycardia (VT) or 6) sustained atrial arrhythmias. Secondary outcomes included health and psychological benefits.

Results

67 individuals (82.5%) completed the study. Reasons for refusal included travel, work and family commitments. The majority (64.7%) of exercising individuals progressed to 85%HRR. Resource requirements were similar to other programmes. All individuals felt supported, more confident to exercise, and found educational materials clear and informative.

There was no significant difference between groups for the composite safety outcome. One individual experienced exercise induced syncope due to ventricular standstill (exercise) and another sustained VT (control). Both required device implantation. There was no significant difference between groups in episodes of NSVT (p=0.573) or ectopic burden (p=0.729).

At 12 weeks, exercise group participants demonstrated greater activity levels (+1.1 hours [CI 0.2–2.1], p=0.024). The change in peak aerobic capacity (+255.2ml/min [CI 93.2–417.1], p=0.003), time to anaerobic threshold (AT) (+115s [CI 54.2–176.0], p&lt;0.001), total exercise time (+108.1s [CI 33.1–183.0], p=0.005) and oxygen uptake at AT (+2.44ml/kg/min [CI 0.6–4.2], p=0.009) were all significantly greater in the exercise group. HADS anxiety (p&lt;0.001) and depression (p=0.017) scores demonstrated the greatest reduction in the exercise group.

Conclusions

A high intensity exercise programme is feasible in young patients with HCM, with considerable gains in cardiorespiratory fitness and psychological outcomes. Importantly, arrhythmia burden was not increased in the exercise group. Further research is still required to assess the long-term safety of high intensity exercise in the HCM population.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Cardiac Risk in the Young

A 16 Years Young Girl with Noonan Syndrome

Noonan's syndrome is a developmental disorder characterized by short stature, typical facial dysmorphia, congenital heart defects and skeletal deformity. It may be sporadic or inherited as an autosomal dominant or recessive trait which occurs, one in 1000-2500 live births. We report a case of 16 years young girl presented to the hospital with short stature, Shortness of breath, morphologic features and congenital heart defect of Noonan Syndrome who has no similar history in the family and admitted in Bangabandhu Sheikh Mujib Medical University on 12th August 2018.

Subchronic toxicity of bisphenol A on the architecture of spleen and hepatic trace metals and protein profile of adult male Wistar rats

Bisphenol A (BPA) is one of the widely used chemical as a plasticizer and regarded as endocrine disruptor because of its ability to derail body metabolic functions and adverse effect on the vital organs. The present work outlined the subchronic effect of low-dose BPA (10 mg/kg) on histology of spleen, level of hepatic trace metals, and hepatic protein profile of Wistar rats. To conduct the research work, animals were grouped into two categories (n = 5). Group 1 was labelled as the control group and group 2 was taken as an experimental group. Experimental group was exposed to low-dose BPA for 12 weeks. Histopathology of spleen highlighted dilation in splenic sinuses, follicle activation, followed by depopulation in the area of white pulp and red pulp in the experimental group. Iron staining revealed significant hemosiderosis in the experimental group when compared with the control group. Statistically significant decrease was noted in zinc and copper concentrations, while nonsignificant change was observed for magnesium concentration through atomic absorption spectroscopy. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was run for hepatic protein profiling, and as compared to control, elevated levels of different proteins were observed in the experimental group. It can be concluded from the above results that even low dose of BPA causes changes in the major organs of the body. Hence, it is suggested that BPA alternative should be used, so that public health status can be secured.

Efficacy of direct-acting anti-viral therapy on chronic, naïve hepatitis C virus patients of Punjab, Pakistan: a cross-sectional study

The success of interferon-free regimens using new direct-acting antiviral (DAA) is a revolution and major breakthrough in the development of new therapeutic options against hepatitis C virus (HCV). Accumulating evidence suggest sustained virological response (SVR) with DAA in 95% of patients. To date, however, there are very few data related to efficacy of DAA in the Pakistani population. We aimed to investigate the efficacy of sofosbuvir-based regimen among Pakistani population. A total of 1,913 patients who attained SVR24 after being treated with sofosbuvir and ribavirin from August 2015 to March 2017 were enrolled in this study. We analyzed the demographic, clinical and virological data and screened all patients for HCV in March 2017 to evaluate the response rate. We found an overall response rate of 92.8%. In addition, we also observed lower response rates among older patients. It can be inferred that a large proportion of patients achieved SVR after treatment with sofosbuvir-based regimen.

Turner's syndrome with Severe Coarctation of the Aorta: A Case Report

Cardiovascular abnormalities are frequently encountered in patients with Turner's syndrome. A 12-year-old girl with Turner's syndrome (TS) was referred from the endocrinology department for management of hypertension. After Echocardiography and CT angiography, we confirmed that she had severe coarctation of the aorta, just distal to the left subclavian artery. Due to high-pressure gradient in the coarct segment, in presence of hypertension, we made the decision for percutaneous intervention of coarctation of aorta.

Tacrolimus induced nephrotoxicity and pulmonary toxicity in Wistar rats

Transplantation has evolved into an accepted treatment for end-stage organ failure. The major limitation for solid organ transplantation is organ rejection, which is an adaptive immune response caused by the activation of T-cells. Immunosuppressant drugs are used to overcome this problem. Tacrolimus is a powerful immunosuppressive drug which is used to minimize the risk of organ rejection. The present study was designed to find the toxic effects of tacrolimus on lungs and kidneys. Wistar rats were divided into 4 experimental groups and one control group (n=9). Each rat of the experimental group was orally given the aqueous suspension of tacrolimus powder (3mg/ml) and dissected after 6, 12, 24 and 48 hours of tacrolimus suspension dose. Lungs and kidneys were excised and processed for histopathological and histochemical alterations. Kidney tissues presented signs of toxic potential on tissue architecture such as increased interstitial spaces, necrosis, especially acute tubular necrosis, glomerular shrinkage, dilated blood vessels and enlargement of Bowman’s capsule. Lung sections also confirmed the toxic potential, characterized by bronchiolar wall thickening, alveolar cells necrosis, collapsing of alveolar spaces and interstitial round cell infiltrate. Results of Prussian blue iron staining showed no iron deposition in kidney architecture while in lung sections, iron accumulation was evident. Taken together from these observations we can conclude that tacrolimus may induce toxicity to a certain extent with structural distortion of the kidneys and lungs.

Dose-dependent acute phase response of aqueous leaf decoction of Nerium oleander in Wistar rats

Many studies have been carried out in order to determine the toxicity of medicinal plants. The objective of this study was to compare and analyze the hepatic response against two doses of Nerium oleander, (N. oleander) “kaner” leaf decoction. Aqueous leaf decoction was injected intramuscularly into both hind limbs of male rats (200&#x2213;10g), assigned into three categories (n=4): control group with no treatment; group I, injected with 5 ml/ kg; and group II injected with 10 ml/ kg of leaf decoction, respectively. Animals were sacrificed 6 h after administration and hepato-histological changes were then observed. The decoction induced an acute phase reaction reflected by a more significant recruitment of inflammatory cells in group II than in group I and controls, as observed by histological studies. These results indicated that both doses can induce an acute-phase condition. Hence, traditional practice of medicinal plants without preliminary dose assessment must not be administered.

Alterations in transaminase activity and serum level of leptin and hepcidin induced by high fat diet in albino rats

Obesity is a commonly growing life-threatening problem of the modern world. The present study was aimed to assess alterations in transaminase levels as well as leptin and hepcidin levels of sera through ELISA after high fat diet consumption for sixteen weeks by albino rats (n=5). Three groups were established: experimental groups 1 and 2 and a control group. Group 1 was fed on a high fat diet having a composition of 33% rat chow +33% sucrose +33% milk powder. Similarly, group 2 was fed with another high fat diet with a mixture of rat chow and milk powder ad libitum. The control group was fed on normal rat chow and water ad libitum. After sixteen weeks, the rats were euthanized and blood was collected for serum separation. Serum levels of alanine aminotransferase showed a positive significant increase (P=0.0325) while a significant negative change (P=0.0006) was noted in aspartate aminotransferase levels in both the experimental groups compared to the control group. Serum leptin levels were found to be increased up to 10.06-fold in Group 1 and 6.11-fold in Group 2 when compared to controls. On the other hand, serum hepcidin levels showed up to 1-fold and 2.59-fold changes in Group 1 and Group 2, respectively, compared to controls. Taken together, from these results it can be concluded that a high fat diet not only disturbs normal metabolism, but it also leads to liver inflammation which is obvious by the changes in transaminase activity as well as leptin and hepcidin levels.

Unconstrained metacarpophalangeal joint arthroplasties

Aims

We performed a systematic review of the current literature regarding the outcomes of unconstrained metacarpophalangeal joint (MCPJ) arthroplasty.

Materials and Methods

We initially identified 1305 studies, and 406 were found to be duplicates. After exclusion criteria were applied, seven studies were included. Outcomes extracted included pre- and post-operative pain visual analogue scores, range of movement (ROM), strength of pinch and grip, satisfaction and patient reported outcome measures (PROMs). Clinical and radiological complications were recorded. The results are presented in three groups based on the design of the arthroplasty and the aetiology (pyrocarbon-osteoarthritis (pyro-OA), pyrocarbon-inflammatory arthritis (pyro-IA), metal-on-polyethylene (MoP)).

Results

Results show that pyrocarbon implants provide an 85% reduction in pain, 144% increase of pinch grip and 13° improvements in ROM for both OA and IA combined. Patients receiving MoP arthroplasties had a reduction in pinch strength. Satisfaction rates were 91% and 92% for pyrocarbon-OA and pyrocarbon-IA groups, respectively. There were nine failures in 87 joints (10.3%) over a mean follow-up of 5.5 years (1.0 to 14.3) for pyro-OA. There were 18 failures in 149 joints (12.1%) over a mean period of 6.6 years (1.0 to 16.0) for pyro-IA. Meta-analysis was not possible due to the heterogeneity of the studies and the limited presentation of data.

Conclusion

We would recommend prospective data collection for small joint arthroplasties of the hand consisting of PROMs that would allow clinicians to come to stronger conclusions about the impact on function of replacing the MCPJs. A national joint registry may be the best way to achieve this. Cite this article: Bone Joint J 2017;99-B:100–6.

Radiation Cross-linked Polyethylene Foam: Preparation and Properties

The ability of some additives to increase the efficiency of polyethylene (PE) cross-linking is studied. The results confirm that additives are effective especially at low doses. Formulations of radiation cross-linked PE foam are used, and optimum conditions for the foaming process to prepare desirable final products are obtained. In addition, different properties of the foam, such as tensile properties, density, water absorption, thermal conductivity, and cellular structure, are determined in relation to blowing agent concentration. Finally, a PE foam formula with desirable properties is introduced.

Pediatric Catheterization Protocol

During the last decade, significant technological progress has taken place in the pediatric cardiac catheterization laboratory. Improved noninvasive diagnostic techniques have narrowed down the indications for diagnostic cardiac catheterization, and these techniques are now increasingly being applied to therapeutic procedures. Recently, concern has been raised about the appropriateness of some these applications in pediatric therapeutic cardiac catheterization because of sheer increase in number of techniques being applied, the increase in the number of persons and centers using these techniques, and the increase in the number of lesion types thought to be amenable to catheter therapy. In comparison to diagnostic cardiac catheterization, therapeutic catheterization require more time and resources, involve higher cost and risk, and demand more technical competence and expertise. Higher level of skill and competency is requirement for the operator who performs the various therapeutic catheterization techniques. These procedures should only be performed in institutions equipped with appropriate facilities, personnel, and programs. These considerations, combined with the rapid increase in the number of laboratories and cardiologists performing therapeutic catheterization procedures, raises concern about the safety of patients and human subjects as well as credentials of hospital and level of training and skill of physician involved. Therapeutic catheterization training programs vary in type, extent, and quality. Due to the complexity and potential risks of these procedures, specific skill and competency benchmark should be developed for personnel undergoing training in therapeutic catheterization as well as for those who continue to perform various procedures. Competency in therapeutic catheterization in children requires specific training. Pediatric cardiology fellows should receive therapeutic catheterization training in one or more centers that specializes in angioplasties, valvuloplasties, and/or vascular occlusion procedures. Before performing a therapeutic catheterization as the primary operator, the fellow or practicing pediatric cardiologist should be required to receive procedure-specific training under the supervision of a qualified individual. Credential should be procedure specific. To maintain his or her credentials and skills, the cardiologist should perform or supervise an adequate number of cases annually, and the results must compare favorably with national experience. The cardiologist must keep himself up to date of new trends and progress in the field through scientific reading and attendance of meetings. Interventional pediatric cardiology has grown remarkably over the last two decades. Catheter based interventional procedures have become the treatment of choice for many cardiac lesions, and these procedures serve as alternatives or adjuncts to surgical treatment for many other relevant conditions. Keeping with the pace of development worldwide, catheter based interventional procedures are making good progress in Bangladesh as well.