Comparative study of existing knee prosthesis with anthropometry of Indian patients and other races, a computer tomography 3D reconstruction-based study

Background: Appropriate component sizing plays an important role in determining the functional outcome following total knee arthroplasty. Comparative studies of different populations have shown significant differences in the anthropometric parameters of knees in different race groups which negates the possibility of using a single sized implant system across different ethnic groups. This study evaluates the dimensions of femoral and tibial articular surfaces of Indian patients and compares the parameters with other ethnic groups and correlates the dimensions with five different commercially available knee systems.Material & Methods: Computerized tomography (CT) scans of contralateral normal knees of patients who underwent the scan for various ailments of the knee were retrieved retrospectively from the hospital database and 3D reconstruction of the images was done. Mediolateral dimensions (fML,tML), Anteroposterior dimensions (fAP, tAP) and aspect ratio (fML/fAP, tML/tAP) of the femur and tibia respectively were calculated and compared with the dimensions of different ethnic groups as well as the femoral and tibial components of five different knee prosthesis systems.

RESULTS

The average fML in the study group was less than that of Caucasian knees but was marginally larger than other ethnic groups. The fAP, tML and tAP was found to be smaller than all other ethnic groups but a larger femoral aspect ratio was reported than other ethnic groups. Among the implant systems, only NexGen LPS and Scorpio NRG implant femoral components closely matched the femoral dimensions in the study group whereas all implant systems showed significant mismatch with tibial component dimensions when compared to the study populations.

CONCLUSION

This study concludes that the dimensions of Indian knees are different from other ethnic groups and the use of commercially available knee Implants designed based on measurements in Caucasian populations can lead to significant mismatch between implant and resected bone surfaces.

Breast Anthropometry-Results of a Prospective Study Among Indian Breast Cancer Patients

Breast anthropometry plays an important role in surgical decision-making in the era of breast conservation therapy, oncoplasty and reconstruction. Majority of the currently available breast anthropometry data is from Western countries, and there is a need to evaluate anthropometric data among Indian women to tailor our surgical decision-making and achieve optimum surgical results. Two hundred and thirty-one breast cancer patients were included in this prospective study, and different anthropometric parameters were evaluated to assess and describe the nipple-areola complex, breast shape, size, volume and ptosis. Breast volume was calculated using formula developed by Qiao et al. Outcomes were compared with data available from different countries. Mean breast volume among Indian women was 515 ml. Nearly, 81% of patients had ptosis and up to 40% had grade 3 ptosis. Breast volume among Indian patients can be grouped into three categories based on quartiles (category I-≤ 220 ml, category II-> 220 to ≤ 730 ml, category III-> 730 ml). Overall breast anthropometry data among Indian women was different from the data reported from western studies. Breast anthropometry plays an important role in the surgical decision-making, and results of the study indicate that the anthropometry of Indian women is different from western counterparts.

Measurement of spinopelvic parameters in healthy adults of Indian origin - A cross sectional study

BACKGROUND

Restoration of spinopelvic balance during spinal surgery is very important to ensure a good outcome. Many studies have been conducted to define the normal ranges, examining the correlation between these individual parameters and their relation with spinal parameters of thoracic kyphosis and lumbar lordosis. The ranges, specific to individual ethnicities, is very essential to restore the sagittal balance in patients suffering from spinal degenerative conditions. Hence this study aims to define the average ranges of relevant spinopelvic parameters in the adult population of Indian origin.

METHODS

A observational cross sectional study was conducted in 130 healthy volunteers in Mumbai without having any spine, hip or pelvis pathology. Spinopelvic parameters like Pelvic Incidence(PI), Sacral Slope(SS) and Pelvic Tilt(PT) were studied and compared between various other similar studies with patients of different ethnicities. The correlation of those parameters with each other was also evaluated.

RESULTS

The mean value of PI was 51.50(±6.85°), that of SS was 39.17° (±6.26°) and for PT it was 12.32°(±5.41°). These values were statistically significant between both sexes for PI and PT. The strongest positive correlation among the parameters was between pelvic incidence and sacral slope, with a r-value of 0.668. Comparison of our study with similar studies within the country (Chennai, Delhi and Surat) showed statistically significant differences in PT and SS of all three studies while PI was not significant when compared with the Surat study.

CONCLUSION

There appears to be considerable variation of the values of the spinopelvic parameters as determined by various studies due to ethnic variations. Further studies should be done with larger samples and directed towards early detection of individuals at risk of developing degenerative spinal disorders with sagittal imbalance, so that interventions can be made at an earlier stage.

Indian migrant women's experiences of motherhood and postnatal support in Australia: A qualitative study

BACKGROUND

The postpartum period can be challenging for many women. For migrant women, the arrival of a new baby brings unique issues. This study aimed to explore the experiences of motherhood and postpartum support of Indian migrant mothers.

METHODS

A qualitative descriptive naturalist inquiry was adopted, with data collected through face-to-face, semi-structured, in-depth interviews with a purposive sample of 11 English speaking Indian migrant women over 18 years old, (6 weeks to 6 months postpartum) in 2016. The data were thematically analysed.

FINDINGS

Four themes were found in this study: the role of social support in postpartum care, support from health services, a psycho-emotional journey with socio-cultural expectations and struggling to bridge two cultures. Many of the women felt alone and were distressed with undertaking household duties and caring for older children, as this would not have happened in India. The women expressed needing practical support until they settled back into their normal lives. Women never sought professional advice for their ongoing mental health concerns. Conflicting advice from health professionals left some women confused about their expectations of traditional and modern postnatal care.

CONCLUSION

This study gives a unique insight into the experiences of Indian migrant women following birth. There is a need for culturally sensitive and appropriate postnatal services that encourage Indian men to support their partners and help women to find alternative sources of culturally appropriate support. It is vital that mental health support is a key component of any such program of care.

Bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitor - A case report

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are one of the mainstay drugs in the management of type 2 diabetes mellitus. It has been well-documented that these class of drugs cause allergic reactions. Bullous pemphigoid (BP) is a blistering skin condition commonly associated with many drugs. Here, we report a case of probable DPP-4i-induced BP in an elderly man, which resolved on discontinuation of the drug. Although this adverse drug reaction has been documented in Western world and Japanese ethnicity, this seems to be the first case report of such occurrence in Indian ethnicity.

Evidence for the association between FTO gene variants and vitamin B12 concentrations in an Asian Indian population

BACKGROUND

Low vitamin B12 concentrations have been associated with major clinical outcomes, including adiposity, in Indian populations. The Fat mass and obesity-associated gene (FTO) is an established obesity-susceptibility locus; however, it remains unknown whether it influences vitamin B12 status. Hence, we investigated the association of two previously studied FTO polymorphisms with vitamin B12 concentrations and metabolic disease-related outcomes and examined whether these associations were modified by dietary factors and physical activity.

METHODS

A total of 176 individuals with type 2 diabetes, 152 with pre-diabetes, and 220 normal glucose-tolerant individuals were randomly selected from the Chennai Urban Rural Epidemiology Study. Anthropometric, clinical, and biochemical investigations, which included body mass index (BMI), waist circumference, vitamin B12, homocysteine, and folic acid were measured. A validated food frequency questionnaire was used for dietary assessment and self-reported physical activity measures were collected. An unweighted genetic risk score (GRS) was calculated for two FTO single-nucleotide polymorphisms (rs8050136 and rs2388405) by summation of the number of risk alleles for obesity. Interaction analyses were performed by including the interaction terms in the regression model.

RESULTS

The GRS was significantly associated with increased BMI (P = 0.009) and risk of obesity (P = 0.023). Individuals carrying more than one risk allele for the GRS had 13.13% lower vitamin B12 concentrations, compared to individuals carrying zero risk alleles (P = 0.018). No associations between the GRS and folic acid and homocysteine concentrations were observed. Furthermore, no statistically significant GRS-diet or GRS-physical activity interactions with vitamin B12, folic acid, homocysteine or metabolic-disease outcomes were observed.

CONCLUSION

The study shows for the first time that a genetic risk score using two FTO SNPs is associated with lower vitamin B12 concentrations; however, we did not identify any evidence for the influence of lifestyle factors on this association. Further replication studies in larger cohorts are warranted to investigate the association between the GRS and vitamin B12 concentrations.

Random Blood Glucose Concentrations and their Association with Body Mass Index in Indian School Children

OBJECTIVE AND AIMS

Overweight/obese children are at risk of developing type 2 diabetes mellitus. Random glucose elevations provide early warning signs of glycemic dysregulation. To assess random blood glucose (RBG) concentrations and risk factors associated with prediabetes in children aged 3-18 years from six Indian regions.

METHOD

Multicenter, cross sectional, observational school-based study; multi-stage stratified random sampling was carried out. Height and weight measured; body mass index (BMI) was computed. RBG measured using a glucometer. National sample survey was used for dietary patterns. Data were analyzed using SPSS 25.0 for Windows.

SETTING

Study centers were from Maharashtra, Gujarat, Chhattisgarh, Assam, Tamil Nadu and Punjab from 40 selected schools.

PARTICIPANT

Children aged 3-18 years were measured.

RESULTS

Data on 14339 subjects (7413 boys) were analyzed. Prevalence of obesity was 5.8% and overweight-10.6%. Overall, 1% had low (<3 mmol/L), 93.7% in reference range (3.9-7.2 mmol/L) and 5.3% had elevated RBG (>7.2 mmol/L). With increasing mean BMI, there was increase in RBG concentrations. Children from Tamil Nadu were more likely to have RBG outside reference range compared to other regions (P < 0.05). Assam and Punjab had highest prevalence of RBG and BMI within reference range. Energy intake partly explained regional variations. Multivariate analysis showed male gender, urban residency, age >10 yrs (girls) and 13 yrs (boys), and overweight or obesity were predictive of prediabetes.

CONCLUSION

Increased prevalence of overweight, obesity and prediabetes in Indian children are a matter of concern. Regional differences suggest that strategies to prevent obesity and combat perturbations in blood sugar may have to be customized.

Distribution of heavy metal and macroelements of Indian and imported cigarette brands in Turkey

While Cd contents of cigarettes are determined between 0.44 (C8) and 1.55 mg/kg (C7), Co contents of cigarette samples varied between 0.26 (B5) and 2.19 mg/kg (B3). Also, while Cr contents of tested cigarettes are determined between 0.88 mg/kg (C5) and 1.72 mg/kg (B2), Mo contents of cigarettes ranged from 0.39 (C7) to 1.13 mg/kg (B2). In addition, Cu contents of cigarettes varied between 10.36 (C11) and 30.47 mg/kg (C18), while Fe contents of cigarette samples range between 306.03 (C5) and 595.42 mg/kg (C16). In addition, while Ni contents of cigarettes vary between 1.00 (C7) and 3.17 mg/kg (C1), Pb contents of brands varied between 0.16 (B4) and 7.37 mg/kg (B1). In general, Indian and imported cigarette samples used in Turkey are rich in Ca, K, Mg, P, and S. In Indian samples, B4 and B5 cigarette samples contained lower heavy metals compared with other cigarettes.

Family violence knowledge in culturally diverse communities and organisational preparedness to disseminate information

ISSUE ADDRESSED

Family violence presents a significant threat to the physical and psychological health of individuals and communities, with women from culturally diverse groups experiencing an increased risk of exposure to family violence and barriers to accessing support. It is necessary to examine the knowledge of family violence among these communities and their preferred source of knowledge to facilitate successful family violence prevention strategies.

METHODS

Thirty-one women (19 Indian and 12 Burmese) completed surveys on their knowledge of family violence, while 10 representatives from community organisations completed surveys on their readiness to participate in family violence prevention efforts. This was followed by 54 community organisations disseminating information about family violence through a poster.

RESULTS

Findings showed that the level of knowledge among culturally diverse communities is variable, with Indian women showing a greater understanding of a range of aspects of family violence compared to Burmese women. Findings also indicated a high degree of preparedness within organisations serving these communities to address family violence.

CONCLUSION

The findings from the present study elucidate the state of family violence-related knowledge amongst the Indian and Burmese communities in a large municipality in Melbourne, Australia, and provide insight into community readiness to diffuse family violence-related information. This increased understanding could be used to enhance family violence prevention efforts in culturally diverse communities. SO WHAT?: This study provides justification for the need for educational family violence prevention efforts within the Burmese and Indian communities. It also informs us of the importance of engaging with community organisations to implement family violence prevention strategies.

Prevalence of pigmentary disorders: A cross-sectional study in public hospitals in Durban, South Africa

Background

Pigmentary disorders are common in patients with skin of color and one of the top five most common dermatologic diagnoses in individuals of African descent. Little is known about the spectrum of pigmentary disorders in South Africa’s second largest province, KwaZulu Natal.

Objective

This study aimed to determine the profile of pigmentary disorders in patients at five outpatient public hospital skin clinics in Durban, South Africa.

Methods

We collected data related to age, sex, ethnicity, and skin dyspigmentation diagnosis in a cross-sectional descriptive study of all dermatology patients at five public hospitals in Durban, South Africa between January 1 and March 31, 2015. The diagnosis was made on the basis of clinical grounds, supported by relevant laboratory investigations or histopathology where necessary. Only data relating to patients’ first visit were recorded and captured using a Microsoft Excel 2007 spreadsheet.

Results

A total of 304 patients, the majority of whom were African women (n = 230; 75.8%), were included in the study. The three most common pigmentary diagnoses included vitiligo, postinflammatory hyperpigmentation, and melasma.

Conclusion

Dyschromias are the third most common dermatologic diagnosis in Durban, KwaZulu-Natal province, South Africa. The most common subtypes of pigmentary disorders include (in order of frequency) vitiligo, postinflammatory hyperpigmentation, and melasma.

Mutation profile in Indian primary myelofibrosis patients and its clinical implications

Background:

Primary myelofibrosis (PMF) is a myeloproliferative neoplasm (MPN) characterized by abnormal proliferation of megakaryocytes, bone marrow fibrosis, and extramedullary hematopoiesis. We did mutation profile of 50 patients of PMF and tried to correlate it with initial clinical presentation of these patients.

Materials and Methods:

All new and follow up patients who were diagnosed as PMF based on WHO 2016 definition of PMF were included. Mutation profile of these patients including JAK2 V617F, JAK2 exon 12, CALR and MPL mutations was done and all clinical, demographic and laboratory details were recorded.

Results:

Total 50 patients were enrolled out of which 29 were males and 21 were females. Out of these patients, 32 (64%) were JAK2 positive, 13 (26%) were CALR positive, 1 (2%) were MPL positive and 4 (8%) were triple negative. As compared to JAK2+ve patients and triple negative group, CALR positive patients were younger, had lower total leucocyte count, larger spleen size, lower dynamic international prognostic scoring system (DIPSS) score and higher grade of fibrosis of marrow.

Conclusion:

This study depicts that incidence of JAK2 and CALR mutations in Indian PMF patients is fairly similar to that in rest of the world. CALR positive patients have better clinical parameters at presentation and have better prognosis as compared to JAK2 positive patients.

An observational study on glabellar wrinkle patterns in Indians

Background

Botulinum A exotoxin is an established treatment for glabellar frown lines, crow's feet, and horizontal furrows of the forehead. The glabella is probably the most common site for botulinum toxin treatment in Asians. Five glabellar contraction patterns have been classified in earlier studies based on eyebrow approximation, depression, and elevation. Unfortunately, this was found to be confusing by many practitioners. Indians, as all Asians, have smaller muscles compared to the European population, and there is no consensus on the optimal dosage per injection site or concentration of toxin to be used.

Aims

(a) Identification and classification of glabellar wrinkle patterns in Indians. (b) Optimization of the minimal effective dose of toxin per site.

Materials and Methods

Retrospective photographic analysis of 200 patients who received botulinum toxin for the first time to treat glabellar wrinkles was conducted. The wrinkle patterns were identified and classified by the authors based on the prevalence of perpendicular and transverse glabellar lines, nasal, and forehead wrinkles.

Results

Six patterns were identified: (1) 11 (2) U (3) Pi (4) X (5) W (6) I. The relevant muscles were identified and doses optimized for those sites.

Limitations

The doses mentioned in this study are not universal for all patients and toxin units would have to be altered and individualized according to the bulk of the facial muscles and individual needs.

Conclusion

The investigators classification, injection patterns, and dosage may provide valuable guidance to facial esthetic treatment.

A descriptive pilot study of mitochondrial mutations & clinical phenotype in fibromyalgia syndrome

Background & objectives:

Fibromyalgia syndrome (FMS) is one of the most common chronic pain conditions of unknown aetiology. Mitochondrial dysfunction has been reported in FMS with some studies reporting the presence of mitochondrial mutation namely A3243G, which also causes mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes. This pilot study was conducted to assess this mutation and also detect large deletions in mitochondrial DNA (mtDNA) in patients with FMS.

Methods:

Thirty female patients with FMS participated and 30 matched controls were included. Genomic DNA was subjected to polymerase chain reaction (PCR) amplification using specific primers followed by restriction digestion with ApaI enzyme to detect the specific A3243G mtDNA mutation. Long-range PCR was done in two sets to detect the large deletions in the mtDNA. Biochemical parameters including thyroid-stimulating hormone and vitamin D levels were also looked at.

Results:

None of the patients were found to carry the common mutation or large deletions. Low vitamin D level was a common finding. Hypothyroidism was found in a few patients.

Interpretation & conclusions:

Although the common mutation or large mtDNA deletions were not detected in blood mtDNA in the FMS patients, mutations in the muscle and sequence variation in mtDNA remained a possibility. Future studies in both blood and muscle tissue including mtDNA sequencing are warranted in such patients to determine if a subset of FMS patients have mitochondrial myopathy.

Impact of epilepsy and antiepileptic drugs on health and quality of life in Indian children

BACKGROUND AND OBJECTIVES

Epilepsy affects the physical, cognitive, emotional, social wellbeing, and thereby the overall quality of life (QOL). Epilepsy is the most prevalent neurological disorder in the pediatric age group with a prevalence of 3.13 to 3.73 per 1000 in India. It is imperative for the primary caregiver to look beyond seizure control for improving wellbeing of children with epilepsy (CWE). Hence, there is a need to understand the predictors of QOL in Indian CWE. The objective of this study was to assess the impact of epilepsy and antiepileptic medications on the child's development, health, scholastic performance, and QOL and to identify the predictors of QOL.

METHODS

This study was a cross-sectional hospital-based prospective study with sociodemographic, clinical data collected from 110 children (age 4-18 years). Seizure severity was assessed with the Hague Seizure Severity Scale, and adverse effects of antiepileptic drugs (AEDs) were assessed using the Adverse Event Profile Scale. The QOL was measured employing the Quality of Life in Children with Epilepsy (QOLCE) questionnaire.

RESULTS

The mean total QOLCE score was 72.6 ± 13.6. Among the subscale scores, memory had the highest mean of 86.5, and the lowest mean was observed for QOL item (40.4). There was no significant association of the total QOLCE score with any of the sociodemographic variables such as gender, place, socioeconomic status, paternal/maternal education, or family type. Children with more severe seizures had significantly lower energy and QOL subscale scores and greater depression and anxiety. Prolonged duration of epilepsy, frequent seizures, and recent seizures had a significant negative correlation with the mean total QOLCE score. Children with epilepsy who are on multiple AEDs, prolonged duration of AED intake, or poor adherence to AEDs have significantly lower total QOLCE score. Children manifesting adverse effects to AEDs had significantly lower overall QOL affecting all domains.

CONCLUSION

Overall QOL in CWE is most compromised by polytherapy, poor adherence to medication, adverse effects of AEDs, hospitalization, and presence of developmental delay.

Role of stereotactic body radiation therapy in liver metastasis: A pilot study from tertiary cancer institute in India

Purpose

This trial studies the feasibility and potential utility of stereotactic body radiation therapy in patients with unresectable liver metastasis.

Aims

(1) The aim of this study is to assess the local response of the liver lesions poststereotactic body radiation therapy regarding number and size of lesions and (2) to evaluate the toxicity to organ (s) at risk.

Materials and Methods

A total of 15 patients were enrolled in this study from November 2014 to October 2015. The inclusion criteria for this study were patients having 1-3 liver metastasis from any solid tumor except germ cell tumor or lymphoma with no evidence of progressive disease (PD) outside the liver. A planning four dimensional-computed tomography (CT) scan was taken. Planning target volume was generated by giving margin of 5 mm. Dose prescribed was 36 Gy in 3#. Response was defined by CT abdomen done at 3 and 6 months poststereotactic body radiation therapy as per RECIST guideline (v1.1).

Results

At 3 months poststereotactic body radiation therapy, five patients had partial response, five patients had stable disease, and five patients had PD as per RECIST criteria. Out of 20 assessable lesions, 16 were controlled at 3 months poststereotactic body radiation therapy. The actuarial local control rate was 86% at 3 months and 77% at 6 months poststereotactic body radiation therapy. The median progression free survival was 7 months. Two patients experienced Grade 2 gastric toxicity and one patient experienced Grade 2 small bowel toxicity. No cases of radiation-induced liver disease were observed.

Conclusions

This trial examines the feasibility of stereotactic body radiotherapy to liver metastasis in the Indian scenario. It shows excellent tolerability and is a safe therapeutic option for inoperable patients, showing good local control.

Variations of extensor pollicis brevis tendon in Indian population: A cadaveric study and review of literature

OBJECTIVES

Variations of the tendons of the first dorsal compartment of the wrist may be one of reasons of treatment failure and recurrence in De Quervain's tenosynovitis (DQT). The present cadaveric study was designed to look into the variations of the Extensor pollicis brevis (EPB) tendon in Indian population.

METHODS

Seventy-seven formaldehyde-fixed cadaveric upper limbs of Indian origins were dissected to observe the number of EPB tendons and its variations.

RESULTS

The EPB muscle was found to be absent in one hand (1.3%). The EPB muscle was found with single tendon, two tendons and three tendons in 73 limbs (94.8%), 2 limbs (2.6%) and one limb (1.3%) respectively. The muscle originated from the posterior surface of the radius and the adjacent interosseous membrane. The EPB muscle with single tendon was found to be inserted into the distal part of dorsal surface of the proximal phalanx of the thumb in 44 limbs (57.1%). In limbs with bitendinous EPB, the tendon slips were inserted into the base of proximal phalanx and into the base of distal phalanx of the thumb. An Osseo-fibrous septum separating EPB from Abductor Pollicis Longus (APL) was observed in 45 limbs (58%).

CONCLUSION

EPB in first extensor compartment of Indians is usually monotendinous. It mostly inserts into the distal part of dorsal surface of proximal phalanx of thumb and into the base of distal phalanx. In majority of the wrists, one may find an osseofibrous ridge separating EPB from APL. These anatomical variations may be helpful to guide proper treatment in de Quervain's tenosynovitis.

Impact of preoperative pulmonary arterial hypertension on early and late outcomes in patients undergoing valve surgery for rheumatic heart disease

Background and Aims

There is conflicting evidence on adverse effect of Pulmonary Arterial Hypertension (PAH) on outcomes after cardiac surgery for rheumatic heart disease (RHD). The authors studied Indian patients with RHD and preoperative PAH, who undergo cardiac surgery with a hypothesis that they have poor short and long-term outcomes.

Methods

This was a retrospective observational study of 407 patients. The patients were divided in three groups based on PAH estimated on echocardiograph as; no or mild PAH (pulmonary artery systolic pressure (PASP) <30 mm of Hg); moderate PAH (PASP 31-55 mm of Hg) and severe PAH (PASP >55 mm of Hg). The primary endpoint was in-hospital mortality and major morbidities; while secondary endpoint was long-term survival.

Results

In-hospital mortality was 24 (5.9%); and was not different in patients with severe, (9.1%), moderate (4.5%) or mild PAH (2.8%) (P = 0.09). Patients with severe PAH had higher incidence of prolonged ventilation (P = 0.007). Factors independently associated with mortality were; >2-packed cell transfusion, prolonged ventilation and acute kidney injury but not moderate and severe PAH. Patients with mitral stenosis (MS) and severe PAH had significantly higher mortality as compared to no or mild PAH (P = 0.03) on long-term follow-up [81.37% (mean duration 19.40 ± 14.10 months)], mortality was 8% and not statistically different (P = 0.25) across PAH categories.

Conclusion

Moderate and severe PAH does not affect short and long term outcomes of patients undergoing valve surgery for RHD. Patients with MS with severe PAH had higher mortality compared to those with no PAH.

The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission

BACKGROUND

The world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016.

OBJECTIVE

Among thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital.

METHODS

Thunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed.

RESULTS

We interviewed 1435/2248 (64%) of thunderstorm-affected patients, of whom 164 (11.4%) required hospital admission. Overall, rhinitis was present in 87%, and current asthma was present in 28%. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95% CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95% CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95% CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95% CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95% CI 1.56, 18.83).

CONCLUSIONS

In epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.

Grip and pinch strength: Reference values for children and adolescents from India

PURPOSE

The purpose of the study was to provide reference values for grip and pinch strength for healthy children and adolescents in India.

METHODS

Grip and pinch strength were recorded for 900 participants stratified into 5 chronological age groups (5-6, 7-9, 10-12, 13-15 and 16-18 years). Grip strength was measured using a Jamar Dynamometer and pinch strength using a Martin vigorimeter.

RESULTS

The difference in grip and pinch strength between age groups was significant (p< 0.001 respectively). A linear rise in grip strength was noted from age groups of 5-6 years to 16-18 years. Moderate to strong positive association was observed between grip and pinch strength and upper extremity anthropometric characteristics (i.e., palmar width, hand span, hand length, arm length, forearm length, and upper limb length) from age groups of 5-6 years to 16-18 years. Boys demonstrated greater grip and pinch strength compared to girls in all age groups (p< 0.001). No difference was observed between the dominant and non-dominant hand in all age groups.

CONCLUSIONS

Findings from the present study provide reference values for grip strength, tip to tip, key and tripod pinch for healthy Indian children and adolescents from 5-18 years of age, which will be useful to guide rehabilitation outcomes in routine clinical practice.

Islands as Hotspots for Emerging Mosquito-Borne Viruses: A One-Health Perspective

During the past ten years, an increasing number of arbovirus outbreaks have affected tropical islands worldwide. We examined the available literature in peer-reviewed journals, from the second half of the 20th century until 2018, with the aim of gathering an overall picture of the emergence of arboviruses in these islands. In addition, we included information on environmental and social drivers specific to island setting that can facilitate the emergence of outbreaks. Within the context of the One Health approach, our review highlights how the emergence of arboviruses in tropical islands is linked to the complex interplay between their unique ecological settings and to the recent changes in local and global sociodemographic patterns. We also advocate for greater coordination between stakeholders in developing novel prevention and mitigation approaches for an intractable problem.

Anterior Fontanelle Size in Healthy Indian Late Preterm and Full Term Newborns

OBJECTIVE

To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score.

METHODS

This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns ≥ 34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two.

RESULTS

A total of 1010 neonates were enrolled. The mean AF size was 2.23 ± 0.52 cm (mean ± SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F = 31.30) (P < 0.001) and also by increasing birth weight (F = 20.34) (P < 0.001). There was no significant difference in the mean AF size between males; 2.21 ± 0.54 cm and females; 2.25 ± 0.55 cm (mean ± SD) (P = 0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r) = 0.985. In small for gestational age neonates the AF was larger, 2.27 ± 0.55 (mean ± SD) and a strong correlation between birth weight z-score and AF size was noted (r = 1.012).

CONCLUSIONS

The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23 ± 0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.

Feasibility of Sub-Axial Cervical Laminar Screws, Including C7, in the Indian Population: A Study on 50 Patients Using Computed Tomography-Based Morphometry Measurements

STUDY DESIGN

Observational study of computed tomography (CT) data.

PURPOSE

We performed a CT-based radiographic analysis of sub-axial cervical lamina in the Indian population to assess the feasibility of laminar screws.

OVERVIEW OF LITERATURE

Morphometric studies have been performed for populations of various ethnic groups, but none exist for Indian populations.

METHODS

Cervical spine CT scans of 50 adults with a minimum slice thickness of <2 mm (0.5-2 mm) were obtained from the database of a single center in northern India. Measurements (e.g., length, thickness, and height) were taken in millimeters along the axial, coronal, and sagittal planes. Three measurements were made to assess laminar anatomy, namely, the translaminar/screw length, laminar thickness, and sagittal laminar height.

RESULTS

The final sample comprised 500 laminae in 50 patients, resulting in 1,500 measurements. The mean translaminar lengths of the C3, C4, C5, C6, and C7 laminae were 19.48 mm, 19.60 mm, 19.61 mm, 20.49 mm, and 22.85 mm, respectively. The mean thick- , 19.60 , 19.60 mm, 19.61 mm, 20.49 mm, and 22.85 mm, respectively. The mean thick- mm, 19.61 mm, 20.49 mm, and 22.85 mm, respectively. The mean thick- , 19.61 , 19.61 mm, 20.49 mm, and 22.85 mm, respectively. The mean thick- mm, 20.49 mm, and 22.85 mm, respectively. The mean thick- , 20.49 , 20.49 mm, and 22.85 mm, respectively. The mean thick- mm, and 22.85 mm, respectively. The mean thick- , and 22.85 mm, respectively. The mean thick , and 22.85 mm, respectively. The mean thicknesses of these cervical laminae were 3.12 mm, 2.62 mm, 2.56 mm, 3.47 mm, and 5.20 mm, respectively. The mean sagittal heights of these laminae were 9.38 mm, 9.80 mm, 10.12 mm, 11.31 mm, and 13.84 mm, respectively. Except for the C7 vertebrae, all other levels had a success rate of <10% in the Indian population using the criteria of a laminar height of at least 9 mm and thickness of 4.5 mm. Limited success was achieved at the C5, C6, and C3 levels.

CONCLUSIONS

To the best of our knowledge, the present study is the only series on the feasibility of laminar screws in the sub-axial cervical spine in the Indian population. We found that Indian patients have smaller anatomical dimensions and thus, are not suitable for laminar screws in the sub-axial cervical spine, barring C7, which is contrary to findings for populations in western and south Asian countries.

Microsurgical Anatomy of Medial Temporal Lobe in North-West Indian Population: Cadaveric Brain Dissection

Aim

The medial temporal lobe (MTL) is a highly complex neuroanatomical structure of tremendous neurosurgical importance. It is a common site for epilepsy, vascular lesions, and tumors. Owing to the critical location behind the sphenoid wing, it is more prone for traumatic contusion often with surgical implications. Hence, its microneurosurgical anatomy needs to be evaluated in detail.

Materials and Methods

Twelve formalin-fixed human cadaveric brains from North-west Indian population were dissected under neurosurgical microscope and various dimensions of the MTL and their distance from important neurovascular structures were measured.

Results

The MTL consists of important neural structures such as parahippocampal gyrus, uncus, hippocampus, temporal horn, and choroidal fissure. The average distance of tentorium from the uncus was 1.96 mm. The temporal horn and the inferior choroidal point were located from the anterior temporal pole at 22.9 mm and 30.9 mm, respectively. Important vessels that are intimately related to the MTL were anterior choroidal artery (AchA), posterior communicating artery, the P1 segment of posterior cerebral artery, and the M1 segment of middle cerebral artery.

Conclusion

Complex anatomic and cytostructural organization makes the MTL unique. In this study, along with the descriptive anatomy, morphometric measurements of various structures were performed. The uncus and its relation to other neurovascular structures is well described in literature, but its exact distance from them as determined in this study is particularly helpful in guiding the surgeons while approaching in this area. Knowledge of the distance of the temporal horn from various surfaces is important while opening the temporal horn to avoid unnecessary damage to nearby structures.

Chicago Classification normative metrics in a healthy Indian cohort for a 16-channel water-perfused high-resolution esophageal manometry system

BACKGROUND

High-resolution esophageal manometry (HREM) interpretation by the Chicago Classification (CC) derives its normal values from western volunteers using solid-state catheters. There is no normative data for the 16-channel water-perfused HREM system commonly used in India.

AIMS

To determine normal values for a 16-channel water-perfused HREM catheter in supine posture using healthy volunteers and substitute these normal values (if different from CC values) in the CC v3.0 algorithm.

METHODS

After ethics approval and informed consent, 53 volunteers (31 men) with no gastrointestinal (GI) symptoms or medications affecting GI motility underwent HREM by standard protocol. Age, gender, body mass index (BMI), and manometry parameters analyzed using Trace 1.3.3 software were collected. The median, range, and 5, 10, 75, and 95 percentiles (where applicable) were obtained for all HREM metrics. Normal value percentiles were defined as 95th (integrated relaxation pressure [IRP]), 10th-100th (distal contractile integral [DCI]), and minimum (distal latency [DL]).

RESULTS

The mean age was 30 years and the BMI was 24.2 kg m^-2 . Compared to CC, our normal metrics were lower for IRP (13 mm Hg) and DCI (350-4500 mm Hg s cm). DCI >4500 and <70 (<5th percentile) were defined as hypercontractile and failed contraction, respectively. Abnormal DL (<4.5 s) and peristaltic break size (>5 cm) were similar to CC metrics. Applying these metrics, CC diagnoses changed in 15% (8/53) with downgrading of ineffective motility to fragmented peristalsis or normal, due to lower DCI cutoff used.

CONCLUSIONS

This is the first report of normative data for the 16-channel water-perfused system in supine posture. It revealed lower IRP and DCI, necessitating modification of CC cutoffs for this system.

Comparative genome analysis reveals key genetic factors associated with probiotic property in Enterococcus faecium strains

BACKGROUND

Enterococcus faecium though commensal in the human gut, few strains provide a beneficial effect to humans as probiotics while few are responsible for the nosocomial infection. Comparative genomics of E. faecium can decipher the genomic differences responsible for probiotic, pathogenic and non-pathogenic properties. In this study, we compared E. faecium strain 17OM39 with a marketed probiotic, non-pathogenic non-probiotic (NPNP) and pathogenic strains.

RESULTS

E. faecium 17OM39 was found to be closely related with marketed probiotic strain T110 based on core genome analysis. Strain 17OM39 was devoid of known vancomycin, tetracycline resistance and functional virulence genes. Moreover, E. faecium 17OM39 genome was found to be more stable due to the absence of frequently found transposable elements. Genes imparting beneficial functional properties were observed to be present in marketed probiotic T110 and 17OM39 strains. Genes associated with colonization and survival within gastrointestinal tract was also detected across all the strains.

CONCLUSIONS

Beyond shared genetic features; this study particularly identified genes that are responsible for imparting probiotic, non-pathogenic and pathogenic features to the strains of E. faecium. Higher genomic stability, absence of known virulence factors and antibiotic resistance genes and close genomic relatedness with marketed probiotics makes E. faecium 17OM39 a potential probiotic candidate. The work presented here demonstrates that comparative genome analyses can be applied to large numbers of genomes, to find potential probiotic candidates.