Repair of cleft lip and simultaneous repair of cleft hard palate with vomer flap in unilateral complete cleft lip and palate: a comparative study

Repair of anterior palate after repairing the cleft lip in complete cleft lip and palate patient is sometimes very difficult. It needs wide, extensive and difficult dissection, and has later chances of wound infection, wound dehiscence, complete wound disruption, recurrent oronasal fistula formation and also maxillary hypoplasia. In this study, we compare the outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP).

METHODS

A prospective study was carried out in 43 patients with UCLP. In Group A, 23 patients underwent cleft lip and cleft hard palate repair with vomer flaps simultaneously, and only cleft lip repair was done in another 20 patients in Group B at the first sitting. After 3 months in both groups, repair of the cleft soft palate and cleft entire palate was done. The gaps of the cleft alveolus and posterior border of the cleft hard palate were measured during the first and second operation, and duration of operations, postoperative complications and requirement of blood transfusion during the operation were also recorded.

RESULTS

The procedure of simultaneous repair of cleft lip and closure of cleft hard palate with a vomer flap is easy to perform. Cleft alveolar and gap of the posterior border of the cleft hard palate were reduced remarkably. No fistula formation occurred and no blood transfusion was needed, but the procedure took some extra operating time. These were compared with simple cleft lip repair.

CONCLUSION

Repairs of cleft lip and simultaneous closure of cleft hard palate with vomer flaps are safe in patients with UCLP, and it makes easy the closure of the soft palate later on and decreases the chance of oronasal fistula.

Crystallization and preliminary structural analyses of glutamate dehydrogenase from Peptoniphilus asaccharolyticus

Glutamate dehydrogenase (EC 1.4.1.2-4) from Peptoniphilus asaccharolyticus has been expressed as a selenomethionine-derivatized recombinant protein and diffraction-quality crystals have been grown that are suitable for structure determination. Preliminary structural analyses indicate that the protein assembles as a homohexameric enzyme complex in solution, similar to other bacterial and mammalian enzymes to which its sequence identity varies between 25 and 40%. The structure will provide insight into its preference for the cofactor NADH (over NADPH) by comparisons with the known structures of mammalian and bacterial enzymes.

Structural basis for targeting of human RNA helicase DDX3 by poxvirus protein K7

Poxviruses are DNA viruses that express numerous proteins to subvert the host immune response. Vaccinia virus protein K7 adopts a Bcl-2 fold and displays structural and functional similarities to Toll-like receptor antagonist A52. Both proteins interact with IRAK2 and TRAF6 and suppress TLR-dependent NF-kappaB activation. However, unlike A52, K7 also forms a complex with RNA helicase DDX3 and antagonizes interferon-beta promoter induction. We have narrowed the K7 binding site to an N-terminal peptide motif of DDX3 ahead of its core RNA-helicase domains. The crystal structure of full-length K7 in complex with the DDX3 peptide reveals a thumblike projection of tandem phenalyalanine residues of DDX3 into a deep hydrophobic cleft. Mutagenesis of these phenylalanines abolishes the effects of DDX3 on interferon-beta promoter induction. The structure of K7-DDX3 reveals a novel binding mode by a viral Bcl-2 protein that antagonizes a key pathway in innate immunity.

The impact of the disease early warning system in responding to natural disasters and conflict crises in Pakistan

The disease early warning system (DEWS) was introduced in the immediate aftermath of the 2005 earthquake in Pakistan, with the objective to undertake prompt investigation and mitigation of disease outbreaks. The DEWS network was replicated successfully during subsequent flood and earthquake disasters as well as during the 2008-09 internally displaced persons' crisis. DEWS-generated alerts, prompt investigations and timely responses had an effective contribution to the control of epidemics. Through DEWS, 1360 reported alerts during 2005-09 averted the risk of disease outbreaks through pre-emptive necessary measures, while the 187 confirmed outbreaks were effectively controlled. In the aftermath of the disasters, DEWS technology also facilitated the development of a disease-surveillance system that became an integral part of the district health system. This study aims to report the DEWS success and substantiate its lead role as a priority emergency health response intervention.

Trace element levels in alopecia areata

BACKGROUND

Alopecia areata (AA) is a recurrent, nonscarring type of hair loss considered to be an autoimmune process. Though its etiopathology is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA.

AIM

The aim of the present study was to assess the levels of zinc, copper, and magnesium in the serum of AA patients.

METHODS

Fifty AA patients (34 men and 16 women), and fifty age and sex matched healthy control subjects were studied. Samples were analyzed using atomic absorption spectrometric methods.

RESULTS

Serum zinc levels were significantly decreased (P < 0.05) in AA patients whose disease was extensive, prolonged, and resistant to treatment, whereas serum copper and magnesium levels showed insignificant rise compared to controls.

CONCLUSION

We conclude that copper and magnesium levels are not altered in AA, but the decreased zinc levels found in our study may merit further investigation of the relationship.

Structural basis for recruitment of Rab6-interacting protein 1 to Golgi via a RUN domain

Small GTPase Rab6 regulates vesicle trafficking at the level of Golgi via recruitment of numerous and unrelated effectors. The crystal structure of Rab6a(GTP) in complex with a 378-residue internal fragment of the effector Rab6IP1 was solved at 3.2 angstroms resolution. This Rab6IP1 region encompasses an all alpha-helical RUN domain followed in tandem by a PLAT domain that adopts a beta sandwich fold. The structure reveals that the first and last alpha helices of the RUN domain mediate binding to switch I, switch II, and the interswitch region of Rab6. It represents the largest Rab-effector complex determined to date. Comparisons with the recent structure of Rab6 in complex with an unrelated effector, human golgin GCC185, reveals significant conformational changes in the conserved hydrophobic triad of Rab6. Flexibility in the switch and interswitch regions of Rab6 mediates recognition of compositionally distinct alpha-helical coiled coils, thereby contributing to Rab6 promiscuity in effector recruitment.

Synthesis of α-Mannosylated Phenolics as α-Glucosidase Inhibitors*

BF3OEt2-catalysed glycosidation of phenolic compounds 3 and 6 with the mannofuranosyl glycosyl donor 2 separately gave the corresponding alpha-mannofuranosyl derivatives 4 and 7 in good yield, and the latter on selective deacetonation (hydrolysis) with 2% aqueous HCl afforded 5 and 8 respectively. Compounds 4 and 7 inhibited rat intestinal alpha-glucosidase more effectively than a standard drug acarbose.

Rab11-FIP3 is critical for the structural integrity of the endosomal recycling compartment

Rab11-FIP3 is an endosomal recycling compartment (ERC) protein that is implicated in the process of membrane delivery from the ERC to sites of membrane insertion during cell division. Here we report that Rab11-FIP3 is critical for the structural integrity of the ERC during interphase. We demonstrate that knockdown of Rab11-FIP3 and expression of a mutant of Rab11-FIP3 that is Rab11-binding deficient cause loss of all ERC-marker protein staining from the pericentrosomal region of A431 cells. Furthermore, we find that fluorophore-labelled transferrin cannot access the pericentrosomal region of cells in which Rab11-FIP3 function has been perturbed. We find that this Rab11-FIP3 function appears to be specific because expression of the equivalent Rab11-binding deficient mutant of Rab-coupling protein does not perturb ERC morphology. In addition, we find that other organelles such as sorting and late endosomes are unaffected by loss of Rab11-FIP3 function. Finally, we demonstrate the presence of an extensive coiled-coil region between residues 463 and 692 of Rab11-FIP3, which exists as a dimer in solution and is critical to support its function on the ERC. Together, these data indicate that Rab11-FIP3 is necessary for the structural integrity of the pericentrosomal ERC.

Inflammatory markers, insulin resistance and carotid intima-media thickness in North-Indian type 2 diabetic subjects

OBJECTIVE

To study the interrelationship of the inflammation, insulin resistance and atherosclerosis in recently diagnosed type 2 diabetes.

METHODOLOGY

Eighty-one newly diagnosed type 2 diabetic patients were compared with 81 healthy age, sex and BMI matched controls. Plasma glucose and insulin (fasting and after 2 hours of 75 gm of oral glucose), lipids and serum levels of C-reactive protein (CRP), fibrinogen and Tumour Necrosis Factor (TNF)-alpha were measured. Carotid (Intima-Medial Thickness) IMT was measured using high "resolution B-Mode ultrasonography. Insulin resistance was calculated using HOMA-IR model. Electrocardiogram (ECG) and exercise ECG were recorded for the evidence of coronary heart disease (CHD).

RESULTS

Carotid IMT was significantly thicker in diabetic patients than in control group across the whole age range (p < 0.01). In merged group of diabetes, composite IMT was significantly correlated with LDL-cholesterol, fasting insulin, serum cholesterol, BMI and HOMA-IR (p < 0.01). After controlling for age and sex, all glycaemic parameters were correlated with IMT in both diabetic and control group. HOMA-IR, waist hip ratio, serum triglycerides, serum cholesterol, fasting serum insulin and CRP were significant predictor of IMT. Concentrations of inflammatory markers were significantly higher in diabetic patients than in control group. Serum levels of CRP (p < 0.05) were found to be higher in diabetic patients with CHD than without CHD. CRP was significantly correlated with IMT (r = 0.603, p < 0.01) in diabetic subjects with and without CHD after controlling for age and sex.

CONCLUSION

Inflammatory markers are associated with type 2 diabetes but only CRP is associated with development of accelerated atherosclerosis and subsequent CHD.

Crystal structure of rab11 in complex with rab11 family interacting protein 2

The small GTPase Rab11 regulates the recycling of endosomes to the plasma membrane via interactions with the Rab11 family of interacting proteins (FIPs). FIPs contain a highly conserved Rab binding domain (RBD) at their C termini whose structure is unknown. Here, we have determined the crystal structure of the RBD of FIP2 in complex with Rab11(GTP) by single wavelength anomalous diffraction methods. The overall structure is a heterotetramer with dyad symmetry, arranged as a Rab11-(FIP2)2-Rab11 complex. FIP2 forms a central alpha-helical coiled coil, with both helices contributing to the Rab11 binding patch on equivalent and opposite sides of the homodimer. Switch 1 of Rab11 is embedded between the two helices, while switch 2 remains flexible and is peripherally associated with the effector. The complex reveals the structural basis for Rab11 recognition by FIPs and suggests the molecular mechanisms underlying endocytic recycling pathways.

Purification, crystallization and preliminary X-ray diffraction studies of Rab11 in complex with Rab11-FIP2

The small GTPase Rab11 regulates the recycling of endosomes back to the plasma membrane. In its active GTP-bound form, Rab11 binds a novel set of effectors termed the Rab11 family of interacting proteins (Rab11-FIPs) which contain a conserved C-terminal Rab-binding domain (RBD) of unknown structure. Here, a complex of Rab11 with the RBD of Rab11-FIP2 has been purified and crystallized in the trigonal space group P3(1)21, with unit-cell parameters a = 64.99, b = 64.99, c = 112.59 angstroms. Static light-scattering analyses of the molecular weight of the complex in solution are consistent with two copies of Rab11 and two copies of Rab11-FIP2 in the complex.

The constipated child: how likely is Hirschsprung's disease?

The incidence of Hirschsprung's disease (HD) was determined in children who presented with constipation to a specialist paediatric surgical unit. During a 5-year period, 355 rectal biopsies were performed on 182 neonates, infants and children presenting with chronic constipation or intestinal obstruction: 25 (14%) were diagnosed HD. One hundred and four patients had suction and 78 had full-thickness rectal biopsies. Haematoxylin-eosin (HE) staining and acetylcholinesterase (AChE) histochemistry was used. In 13 cases (8%) of suction and 2 cases (2.5%) of full thickness rectal biopsies, specimens were inadequate to diagnose HD. The mean age of all patients was 2.9 years and that of patients diagnosed with HD was 3.64 months. Nineteen patients with HD were diagnosed in the first month, 5 in 1-12 months and 1 at 4 years of age (Fig. 1). The authors found that along with onset of constipation convincing indications for rectal biopsy to exclude HD were as follows: those infants and children who do not pass meconium within 48 hours, have low intestinal obstruction of unknown cause, severe constipation, chronic abdominal distension and failure to thrive. A diagnostic accuracy of 94% was achieved with AChE histochemistry for suction rectal biopsy. After this review, referring paediatricians were advised that screening of other common organic causes of constipation with the least invasive investigations, including laboratory, dietary and paediatric gastroenterology advice, should be undertaken to avoid unnecessary rectal biopsy to exclude HD and related disorders.

In hydronephrosis less than 10 % kidney function is not an indication for nephrectomy in children

PURPOSE

To reduce the incidence of nephrectomy or hydronephrosis in children.

MATERIALS AND METHODS

From September 1998 to October 2000, we treated 58 patients with hydronephrosis; their ages ranged from 35 days to 11 years (mean age 4 years 7 months). All patients were subjected to a DTPA renogram with split function. In 12 patients (study group), kidney function was less than 10 % (range 0 - 10 %). Initially, nephrostomy was carried out in all 12 patients followed by Anderson-Hyne's pyeloplasty after 4 - 6 weeks. Postoperatively renal USG, urine r/m/e & c/s (routine and microscopic examination and culture and sensitivity test), blood urea, serum creatinine were assessed and DMSA scan and DTPA renogram with split functions were carried out in all patients.

RESULTS

In the study group, all 12 patients showed improvement of renal function (more than 10 %) after nephrostomy and in all of them pyeloplasty was subsequently carried out within 4 - 6 weeks. There were no significant pre-, peri- or postoperative complications.

CONCLUSIONS

Contrary to common practice we do not recommend nephrectomy for hydronephrotic kidneys which show < 10 % of renal function on renogram. The renal functional status improves significantly after a preliminary nephrostomy, thus avoiding the need for a straightforward nephrectomy in children along with all the possible long-term effects of a single kidney.

Acidogenic fermentation: utilization of wasted sludge as a carbon source in the denitrification process

Laboratory scale batch experiments were conducted at 20 degrees C to investigate the acidogenic fermentation for the conversion of wasted sludge into short chain fatty acids (SCFA) to be utilized as a carbon source in the denitrification process. Hydraulic retention time (HRT), volatile solid (VS) loading rate and pH were studied as these are the important parameters governing the production of volatile fatty acids (VFA). Four different phases were investigated by varying these parameters. HRT was varied from 2.7 to 8.2 days whereas VS loading rate was varied from 1.2 to 3.6 g d(-1). VFA production decreased with the increase in HRT above 2.7 days. 538.37+/-19.39 mg VFA(produced) x d(-1) (0.176+/-0.010 mg VFA(produced) mg(-1) VS(feed) was found as the maximum value of VFA at 2.7 days. The present results based on wasted sludge showed that almost 0.0483+/-0.0016 mg VFA (as COD mg(-1) initial COD) and about 5% of soluble COD production were achieved, which are slightly less than the results reported for primary sludges. The rates of VFA production increased with the increase in VS, however, opposite results were obtained when pH was increased in the reactor. SCFA/FA ratios during fermentation were found in the range of 67-73%. The specific denitrification rates (SDNR) of methanol (2.20+/-0.44 mg NO3-N g(-1) MLVSS x h(-1)) and the fermenter supernatant (2.00+/-0.45 mg NO3-N g(-1) MLVSS x h(-1)) were found to be comparable. Fermenter supernatant, therefore, has the potential to be utilized as a carbon source. However, the results need to be investigated further on a larger scale to ascertain their validity.

Socioeconomic and cultural influence in the causation of burns in the urban children of Bangladesh

This prospective case-control study was conducted on 105 consecutive cases admitted to the burn units of Dhaka Shishu Hospital and Dhaka Medical College Hospital. The same number of controls were selected randomly from the community and matched with respect to age group, sex, and location of residence within the defined metropolitan area during the period January to September 1997. Both the controls and cases were divided into three age groups. Group A (19 controls and 19 cases) included neonates and infants, group B included children from 1 to 4 years, and group C included children from 4 to 12 years. The mean age of the controls in group A was 8.42+/-3.86 months and in group B and C was 5.72+/-4.05 years. The mean age of cases in group A was 4.79+/-4.05 months and in group B and C was 5.08+/-2.87 years. A scoring system was used to analyze 14 socioeconomic and cultural factors, which indicated highly significant differences between controls and cases (P < 0.001), and also between male (P < 0.001) and female (P < 0.001) controls and cases. There were significant differences between controls and cases in group A (P < 0.001), group B (P < 0.01), and group C (P < 0.001). Differences were not significant between males and females within groups A, B, and C for cases or controls (P > 0.05). Regression analysis of the total scores for cases and controls indicated a negative correlation between burns and the socioeconomic variables included in the study. There were highly significant associations between burns and lack of alertness to burns among parents (P < 0.001), clothing of manmade fabrics (P < 0.001), and cooking equipment in the kitchen within reach of children (P < 0.001). There was a significant association between burns and illiteracy of the mother (P < 0.01), housing located in slums and congested areas (P < 0.01), illiteracy of the father (P < 0.02), presence of preexisting impairment in children (P < 0.05), presence of a history of burns among siblings (P < 0.05), and low economic status of the parents (P < 0.05). No significant associations were indicated between controls and cases with respect to number of children in the family (P > 0.1), family pattern (P > 0.1), conjugal bonding between parents (P > 0.5), and sibling's death and disability from burns (P > 0.5). It is evident that an increase in alertness to burns, easy availability of clothing of natural fabrics, keeping cooking equipment beyond the reach of the children, increased literacy among parents and children, and improvement in family income might decrease the incidence of burns in children.

Clinicopathological patterns and distribution of Schistosomiasis in Asir Region

OBJECTIVE

The objective of this study is to report, for the first time, the histopathologic pattern of Schistosomiasis from the Asir Region and to compare it to patterns reported from other regions of the Kingdom of Saudi Arabia. Several studies have reported the patterns of Schistosomiasis in other regions of the Kingdom of Saudi Arabia and other countries where Schistosomiasis is endemic. Schistosomiasis is endemic in certain areas of Asir region, however no data is available concerning the clinicopathological pattern of Schistosomiasis in the Asir Region.

METHODS

This is a retrospective analysis of 217 cases of Schistosomiasis from surgical and biopsy files of Asir Central Hospital during a period from January 1990 to October 1999.

RESULTS

Our study revealed that Schistosomiasis was more common among the expatriate population of Asir Region than Saudi nationals residing in this area. The urinary tract was most commonly involved, and then in descending frequency came the vermiform appendix, liver and large bowel.

CONCLUSION

These findings are somewhat different from those observed in the Riyadh Region where the vermiform appendix was the most commonly affected organ. Based on the histopathologic pattern, our study describes the pattern of Schistosomiasis in the Asir Region and may serve as a base-line for future research work.