Wide-awake local anesthesia and no tourniquet (WALANT) in upper limb fractures

Wide-awake local anesthesia and no tourniquet (WALANT), first used for hand surgery, has been sparingly described for use in fracture fixation of the upper limb. We present our experience using this technique. 26 patients with upper limb fractures (3 distal radius, 6 radial shaft, 11 ulnar shaft, and 6 olecranon fractures) were operated on using WALANT by three orthopedic surgeons. We used 35-40ml of 2% Lignocaine with 1:80000 Adrenaline(7mg/kg) diluted with normal saline. Numeric Pain Rating (NPR) scoring was done during injection and per-operatively, and the Likert scale was used for the surgeon's satisfaction. The average NPR score was reported as 0.65 (1-3) during injection and 0.15 (0-2) preoperatively. All three surgeons reported excellent satisfaction in all the cases operated on. No complication occurred due to anesthesia. WALANT is a much simpler option and can be safely used in place of general anesthesia or regional blocks for fixation of fractures of the upper limb, with added advantages of no need for a tourniquet and better intraoperative assessment of fracture fixation.

Impact of Radiation Treatment Delay Due to COVID-19 Pandemic

Purpose/Objective(s)

To study the effect of radiation treatment delay due to COVID-19 infection.

Materials/Methods

This study is a descriptive analysis. We studied all patients who were COVID-19 positive while undergoing radiation treatment. In addition, those COVID-19 positive patients before the start of radiation during their neoadjuvant treatment period or surgery were also analyzed. However, patients detected with COVID-19 infection after the radiation treatment course were excluded. The study period was from June 2020 to May 2021. A radiation treatment delay was defined as a delay in starting the treatment, a break in therapy during their scheduled radiation course, or treatment discontinuation. Patients who had a radiation treatment delay were followed-up till December 2021.

Results

Ninety-four patients who met the criteria were identified for the analysis. Seventy-seven of them had a mild infection, while 17 had a moderate or severe infection. Of the 94 patients identified, 83 patients had a treatment delay. The median treatment delay (MTD) was 18 (6 to 47) days and the median follow-up period was 13 months. In this cohort, 66 patients were treated with a curative intent, of which 51 are on follow-up {34 patients are disease-free (MTD – 18.5, 10 to 43), seven had either a residual disease or locoregional recurrence (MTD – 22, 10 to 32), seven had distant metastasis (MTD – 18, 15 to 47), and three patients died (MTD – 20, 8 to 27)}. Amongst the three patients who died, only one died of COVID-19 infection or sequel (Case Fatality Rate, CFR – 1.06%).

Conclusion

The CFR due to COVID-19 infection amongst those who underwent radiotherapy was low. At the same time, higher MTD might have been the reason for residual or locoregional recurrences. However, a longer follow-up is required to confirm this. Till then, it will remain debatable whether it was worth delaying radiotherapy for mild to moderate COVID-19 infection for a significant time to cause a potential cancer treatment failure.

POS0487 ASSOCIATION OF RHEUMATOID ARTHRITIS WITH MORTALITY IN A COHORT OF CHRONIC KIDNEY DISEASE PATIENTS

Background:

Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease. RA is also associated with increased risk of chronic kidney disease (CKD) (1, 2), which is a known cardiovascular risk factor (3). We hypothesized that RA (compared with no RA) would be associated with increased risk of mortality among a cohort of patients with CKD.

Objectives:

To determine the risk of mortality in RA patients with CKD.

Methods:

This study was conducted using participants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) prospective Chronic Renal Insufficiency Cohort (CRIC) study. Approximately 3600 participants were enrolled from seven US clinical centers. Patients aged 21 – 74 years with mild to moderate CKD were eligible for enrollment. The primary outcome of interest was all-cause mortality. Secondary outcomes of interest included: kidney event defined as end stage renal disease (ESRD) or 50% decline in estimated glomerular filtration rate (eGFR), myocardial infarction (MI), cerebrovascular accident (CVA), heart failure and a composite cardiovascular endpoint. The association of RA mortality over time was examined using Cox multivariate proportional hazards regression, adjusting for potential covariates (age, sex, race/ethnicity, BMI, current smoker, education).

Results:

The study cohort included 492 participants with self-reported RA with a mean follow up of 9.5 years. Compared to the non-RA group, RA patients tended to be older, female, Black. Hypertension, diabetes, use of prednisone was more prevalent among the RA cohort. The unadjusted hazards ratio (HR) for mortality based on RA status was 1.45 (1.26, 1.67) but this association was attenuated after adjusting for the confounding factors [aHR 1.09 (0.94, 1.27)] (Table 1). Participants with RA had a significantly higher risk for heart failure than those without RA [aHR 1.17 (1.02, 1.34)]. We did not observe a statistically significant association between RA status and other secondary outcomes.

Conclusion:

RA was not associated with higher mortality among participants with CKD. However, RA was associated with higher rates of heart failure. Further studies evaluating the mechanisms behind this association are needed.

References:

[1]Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Chronic kidney disease, inflammation, and cardiovascular disease risk in rheumatoid arthritis. J Cardiol. 2018;71(3):277-83.

[2]Sumida K, Molnar MZ, Potukuchi PK, Hassan F, Thomas F, Yamagata K, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018;93(5):1207-16.

[3]Chiu HY, Huang HL, Li CH, Chen HA, Yeh CL, Chiu SH, et al. Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study. PLoS One. 2015;10(9):e0136508.

[4]Muthukumar P, Dhanapriya J, Gopalakrishnan N, Dineshkumar T, Sakthirajan R, Balasubramaniyan T. Evaluation of renal lesions and clinicopathologic correlation in rheumatoid arthritis. Saudi J Kidney Dis Transpl. 2017;28(1):44-50.

Table 1.

Estimated hazard ratios (HR) for various outcomes from Cox proportional hazards regression for RA status

UnadjustedModel 1Model 2HR (95% CI)HR (95% CI)HR (95% CI)Death1.45 (1.26, 1.67)1.09 (0.94, 1.27)1.13 (0.97, 1.32)MI or death1.43 (1.25, 1.63)1.09 (0.95, 1.26)1.15 (0.99, 1.33)CVA or death1.42 (1.24, 1.63)1.07 (0.92, 1.24)1.11 (0.95, 1.29)CHF or death1.54 (1.35, 1.75)1.17 (1.02, 1.34)1.22 (1.06, 1.40)Composite1.49 (1.31, 1.69)1.13 (0.99, 1.30)1.18 (1.03, 1.35)Kidney event1.09 (0.94, 1.27)0.91 (0.78, 1.07)1.01 (0.85, 1.20)

Model 1 adjusted for: age, sex, race/ethnicity, BMI, current smoker, education

Model 2 adjusted for: model 1 + cardiovascular risk factors (urine albumin creatinine ratio, systolic blood pressure, estimated glomerular filtration rate)

Disclosure of Interests:

None declared

COVID-19 vaccination: The impact on the selection criteria of the convalescent plasma donors

Clinical management protocols for COVID-19 are evolving rapidly as more information about the epidemiology and pathophysiological changes in COVID-19 become available. However, no definite treatment of COVID-19 has been found till date. The COVID-19 convalescent plasma (CCP) therapy has emerged as an important investigational therapy in the management of COVID-19 patients. Additionally, the regulatory agencies, in particular, the Indian blood transfusion council must release some interim recommendations for the blood centres on the CCP blood donor eligibility criteria after COVID-19 vaccination. More clinical trials are needed to know the efficacy of the CCP harvested from COVID-19 recovered individuals who have been vaccinated against those COVID-19 recovered individuals who are not vaccinated to understand the vaccine impact on the IgG titres of anti-SARS-CoV-2 antibodies.

COVID-19 vaccination in the Indian blood donors: Adjudging the impact on the deferral period

The only efficacious way to provide people with herd immunity against the novel corona virus [nCoV] is to administer an appropriate vaccine and help check the current pandemic. With the genetic sequence data of the nCoV already available since January 10, 2020, leading pharmaceutical companies, world over, in turn, have started working on the clinical trials to produce vaccines against this nCoV. In fact, many vaccines under the Phase III trial have claimed to demonstrate their efficacy to be as high as 95% against the nCoV. In January, the central drugs standard control organization, India had granted the emergency-use authorization [EUA] to two vaccines namely, Covishield (live vaccine, Oxford-AstraZeneca, United Kingdom being manufactured by the Serum Institute of India, Pune) and Covaxin (inactivated vaccine, Bharat Biotech, India). Although, most of the countries offer no deferral period for the donors who have been administered an inactivated vaccine against this nCoV. However, the national blood transfusion council of India has recently recommended a donor deferral period of 28 days from the last dose of vaccination. This could essentially lead to a massive loss of eligible blood donors and jeopardize the already disrupted blood supply management due to the COVID-19 outbreak. The authors, herein, propose a thorough redefining of this deferral period post-vaccination amongst the Indian blood donors.

Pharmacokinetics of apixaban in patients with end stage renal disease on hemodialysis and atrial fibrillation: results from the RENAL-AF trial

Background/Introduction

Apixaban use is increasing for stroke prevention in patients with atrial fibrillation (AF) and end stage renal disease (ESRD) on hemodialysis. There is uncertainty as to the optimal dose in this population in part related to the limited available pharmacokinetic (PK) data.

Purpose

We comprehensively evaluated the PK of apixaban collected over 1 month of apixaban dosing in 63 patients with AF and ESRD on hemodialysis.

Methods

Patients with AF and ESRD on hemodialysis were randomized to warfarin versus apixaban within the RENAL-AF trial with 5 mg BID dosing, except for 2.5 mg BID in those age ≥80 years or weight ≤60 kg. The 5 mg BID dose could be reduced to 2.5mg BID for minor bleeding. Day 1 PK data was collected on all patients pre- and post-hemodialysis. Day 3 and 1 month pre- and post-hemodialysis PK samples were collected in 49 patients. The timing of apixaban dosing and hemodialysis relative to PK samples was recorded. Dosing history, hemodialysis, and PK samples were chronologically integrated with patient specific data such as body size, age, race and gender. This dataset was combined with the ARISTOTLE dataset, and the published PK model from ARISTOTLE describing exposures in the AF population was updated to incorporate an additional clearance term for hemodialysis. The model estimated apixaban exposures (AUC) in RENAL-AF were compared to ARISTOLTE AUC values.

Results

There were 285 PK concentrations collected among 63 patients in the RENAL-AF trial. Patients had median age 69 years with 41% women (N=26) and a median weight of 84 kg (49, 157). The median AUCs for patients with ESRD on hemodialysis were 5,452 and 2,990 for patients treated with 5mg BID and 2.5mg BID doses, respectively. The median AUCs for patients treated with 5mg BID from ARISTOTLE increased from 2,802 for patients with class 1 CKD to 5,863 for class 4 CKD, while they increased from 2,392 for class 1 CKD to 2,881 for class 4 CKD in patients treated with 2.5mg BID. The median AUC for patients with ESRD on hemodialysis were within 50% of the exposure of patients from ARISTOTLE for all classes of CKD for the 2.5mg BID dose and for classes 2, 3A, 3B, and 4 CKD for the 5mg BID dose (Figure).

Conclusions

The steady state apixaban exposure data in patients with AF and ESRD on hemodialysis were modestly higher but consistent with the results of non-ESRD patients from ARISTOTLE, using 5 mg BID unless patients had age ≥80 years or weight ≤60 kg. Additional clinical outcomes data on the use of apixaban in patients with AF and ESRD on hemodialysis are needed.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator sponsored grant from Bristol-Myers Squibb and Pfizer

The effect of breastmilk and saliva combinations on the in vitro growth of oral pathogenic and commensal microorganisms

Neonates are exposed to microbes in utero and at birth, thereby establishing their microbiota (healthy microbial colonisers). Previously, we reported significant differences in the neonatal oral microbiota of breast-fed and formula-fed babies after first discovering a primal metabolic mechanism that occurs when breastmilk (containing the enzyme xanthine oxidase) and neonatal saliva (containing highly elevated concentrations of the substrates for xanthine oxidase: xanthine and hypoxanthine). The interaction of neonatal saliva and breast milk releases antibacterial compounds including hydrogen peroxide, and regulates the growth of bacteria. Using a novel in vitro experimental approach, the current study compared the effects of this unique metabolic pathway on a range of bacterial species and determined the period of time that microbial growth was affected. We demonstrated that microbial growth was inhibited predominately, immediately and for up to 24 hr following breastmilk and saliva mixing; however, some microorganisms were able to recover and continue to grow following exposure to these micromolar amounts of hydrogen peroxide. Interestingly, growth inhibition was independent of whether the organisms possessed a catalase enzyme. This study further confirms that this is one mechanism that contributes to the significant differences in the neonatal oral microbiota of breast-fed and formula-fed babies.

Factors Affecting Insulin Resistance and Its Relation to Vitamin D Status and Clinical Nutritional Parameters in Dialysis Patients: A Single-center Indian Study

The aim of this study was to measure insulin resistance (IR) in dialysis patients and its relation to Vitamin D status and nutritional parameters. We included patients on maintenance dialysis, both hemodialysis and peritoneal dialysis (HD and PD). IR was measured by homeostatic model assessment (HOMA)-IR index defined as fasting serum insulin (μU/L) × fasting blood sugar (mmol/L)/22.5. Baseline Vitamin D levels were measured by chemiluminescence immunoassay (CLIA) method. HOMA-IR index correlated with nutritional parameters such as 7-point subjective global assessment (SGA) and anthropometric measures, for example, body fat percentage, lean body weight (LBW), mid-arm circumference (MAC), and mid-arm muscle circumference (MAMC). A total of 55 patients were studied, of them 74.55% were male with mean age of the study population being 37.44 ± 14.96 years. The prevalence values of Vitamin D deficiency <30 ngm/ml, <20 ngm/ml, and <10 ngm/ml levels were 96.36%, 70.91%, and 23.64%, respectively. Mean HOMA-IR index was 3.14 ± 3.86. The correlation of HOMA-IR with Vitamin D was negative (r = -0.140, 95% confidence interval [CI] = -0.397-0.138 and P = 0.309); however, in subgroup analysis, patients with Vitamin D level <20 ng/ml had significantly high IR compared to those with Vitamin D >20 ng/ml, i.e., 3.74 ± 4.37 and 1.67 ± 1.47, respectively (P = 0.018). The other measured parameter which had a significant positive correlation with IR was serum uric acid (r = 0.303, 95% CI = 0.021-0.534, and P = 0.025). In nutritional assessment, body mass index, MAC, and MAMC had statistically significant positive correlation with HOMA-IR index (P ≤ 0.001, 0.004, and 0.004, respectively) unlike SGA (P = 0.480). The mode of dialysis did not have a significant effect on IR (HD vs. PD, P = 0.227). The majority of the patients on maintenance dialysis are Vitamin D deficient. Low Vitamin D level, especially <20 ng/ml, muscle mass, and high serum uric acid level are likely to have more IR in dialysis-dependent patients.

Urinary Markers of Fibrosis and Risk of Cardiovascular Events and Death in Kidney Transplant Recipients: The FAVORIT Trial

Cardiovascular risk remains high in kidney transplant recipients (KTRs) despite improved kidney function after transplant. Urinary markers of kidney fibrosis and injury may help to reveal mechanisms of this risk. In a case-cohort study among stable KTRs who participated in the FAVORIT trial, we measured four urinary proteins known to correlate with kidney tubulointerstitial fibrosis on biopsy (urine alpha 1 microglobulin [α1m], monocyte chemoattractant protein-1 [MCP-1], procollagen type I [PINP] and type III [PIIINP] N-terminal amino peptide) and evaluated associations with cardiovascular disease (CVD) events (n = 300) and death (n = 371). In adjusted models, higher urine α1m (hazard ratio [HR] per doubling of biomarker 1.40 [95% confidence interval [CI] 1.21, 1.62]), MCP-1 (HR 1.18 [1.03, 1.36]), and PINP (HR 1.13 [95% CI 1.03, 1.23]) were associated with CVD events. These three markers were also associated with death (HR per doubling α1m 1.51 [95% CI 1.32, 1.72]; MCP-1 1.31 [95% CI 1.13, 1.51]; PINP 1.11 [95% CI 1.03, 1.20]). Higher concentrations of urine α1m, MCP-1, and PINP may identify KTRs at higher risk for CVD events and death. These markers may identify a systemic process of fibrosis involving both the kidney and cardiovascular system, and give new insights into mechanisms linking the kidney with CVD.

DPD epitope-specific glutamic acid decarboxylase (GAD)65 autoantibodies in children with Type 1 diabetes

AIM

To study whether DPD epitope-specific glutamate decarboxylase autoantibodies are found more frequently in children with milder forms of Type 1 diabetes.

METHODS

We prospectively evaluated 75 children with new-onset autoimmune Type 1 diabetes, in whom we collected demographic, anthropometric and clinical data and measured islet autoantibodies. Glutamate decarboxylase 65 autoantibody-positive samples were analysed for epitope specificities using recombinant Fab against the DPD-defined epitope of glutamate decarboxylase 65.

RESULTS

After adjustment for age, positive DPD epitope recognition was significantly associated with higher C-peptide levels at onset (P = 0.02, r² =0.21, n = 35), and high DPD recognition in the highest quartile tended to be associated with HbA_1c ≤ 53 mmol/mol (7%) at the last follow-up [mean (sd) follow-up 1.3 (0.4) years; P = 0.07; for the model, P = 0.044, n = 30)]. Age- and sex-adjusted BMI percentile was significantly correlated with recognition of the DPD-defined epitope (P < 0.03, r² =0.14, n = 34), but this correlation was driven by the older age group (age ≥ 10 years; P = 0.016, r² =0.27, n = 21) and was not significant in younger children (P = 0.93, n = 13). There were no independent associations with sex, race/ethnicity, diabetic ketoacidosis, HbA_1c , HLA DR3-DQ2/DR4-DQ8 or autoantibody number.

CONCLUSIONS

Our findings suggest that recognition of the DPD-defined glutamate decarboxylase 65 autoantibody epitope at Type 1 diabetes onset is directly associated with β-cell function, BMI and age, which supports the hypothesis that immunological factors contribute to the clinical heterogeneity of Type 1 diabetes. Larger studies relating epitope-specific glutamate decarboxylase 65 autoantibody to clinical phenotype in children with Type 1 diabetes are warranted.

Concurrent infection of Bluetongue and Peste-des-petits-ruminants virus in small ruminants in Haryana State of India

Bluetongue (BT) and peste-des-petits-ruminants (PPR) are major transboundary diseases of small ruminant, which are endemic in India. Testing of bluetongue virus (BTV) and peste-des-petits-ruminants virus (PPRV) from recent outbreaks (2015-2016) in different regions of Haryana State of India revealed that 27.5% of the samples showed the presence of dual infection of BTV and PPRV. Analysis of Seg-2 of BTV (the serotype-determining protein) showed the presence of BTV-12w in several isolates. However, analysis of N gene fragment amplicons showed that viruses belong to lineage IV were most closely related to a pathogenic strain of PPRV from Delhi. This is the first report of co-circulation of PPRV lineage IV and bluetongue virus serotype 12 in the state.

Emerging Roles of Epigenetic Regulator Sin3 in Cancer

Revolutionizing treatment strategies is an urgent clinical need in the fight against cancer. Recently the scientific community has recognized chromatin-associated proteins as promising therapeutic candidates. However, there is a need to develop more targeted epigenetic inhibitors with less toxicity. Sin3 family is one such target which consists of evolutionary conserved proteins with two paralogues Sin3A and Sin3B. Sin3A/B are global transcription regulators that provide a versatile platform for diverse chromatin-modifying activities. Sin3 proteins regulate key cellular functions that include cell cycle, proliferation, and differentiation, and have recently been implicated in cancer pathogenesis. In this chapter, we summarize the key concepts of Sin3 biology and elaborate the recent advancements in the role of Sin3 proteins in cancer with specific examples in multiple endocrine neoplasia type 2, pancreatic ductal adenocarcinoma, and triple negative breast cancer. Finally, a program to create an integrative approach for screening antitumor agents that target chromatin-associated factors like Sin3 is presented.

A comparative study of central versus posterior approach for internal jugular hemodialysis catheter insertion

Internal jugular (IJ) catheter insertion for hemodialysis (HD) is an indispensable procedure in the management of patients with renal failure. The central approach is favored over posterior approach to insert IJ catheters. There are no studies comparing the outcomes between the two approaches. The aim of this study was to compare central approach with posterior approach for IJ HD catheter insertion and to analyze various outcomes like procedure-related complication rates, catheter insertion failure rates, interruptions during dialysis due to blood flow obstruction and catheter infection rates between the two methods among patients receiving HD. All patients requiring IJ HD catheter insertion during a 1-month period were randomly assigned to undergo catheter insertion via either conventional central approach or posterior approach. Patients were followed-up till the removal of the catheter. Among 104 patients included in the study, 54 were assigned to the central approach group and 50 to the posterior approach group. The central approach group had higher rate of procedure-related complications (14.81% vs. 6%, P = 0.04). Catheter insertion failure rates were marginally higher in posterior approach group (20% vs. 12.96%, P = 0.07). One or more instance of interruption during HD due to obstruction in blood flow was more common in posterior approach (46% vs. 9.25%, P < 0.01). Catheter infection rates were similar between the two groups; 16.66% (n = 9) in central group vs. 14% (n = 7) in posterior group. Posterior approach is a reasonable alternative to conventional central approach in IJ cannulation for HD catheter. It is, however, associated with a significantly high rate of interruption in HD blood flow and catheter insertion failure rates. The posterior approach can be used in patients with local exit site infection or in failed attempts to cannulate IJ vein via the conventional central approach.

Familial progressive hyper- and hypopigmentation and malignancy in two families with new mutations in KITLG

BACKGROUND

Familial progressive hyper- and hypopigmentation (FPHH) is an autosomal dominant skin condition presenting in childhood with generalized macular dyspigmentation, usually reported in patients of East Asian origin. It overlaps phenotypically with other dyschromatoses, but can now be distinguished by mutations in the KIT ligand gene (KITLG).

AIM

We report two unrelated white families with similar phenotypic presentations of FPHH developing in early childhood in several generations.

METHODS

Sanger sequencing of the exons and flanking introns of KITLG was performed.

RESULTS

This identified a new heterozygous missense mutation in each family (p.Thr34Asn and p.Val37Gly, respectively). Of the six affected individuals examined by us, two had cancer: a 62-year-old man in family 1 had developed two primary melanomas and a pharyngeal carcinoma, and a 42-year-old woman in family 2 had developed thyroid carcinoma. All had unusually sparse lateral eyebrows, a finding not previously reported in this condition.

CONCLUSIONS

We summarize the genetic spectrum of the dyschromatoses and discuss a possible increased risk of malignancy in FPHH.

Outcome analysis of cubital tunnel decompression

Background

Cubital tunnel decompression is a commonly undertaken upper limb procedure. Most studies compare the different techniques of decompression; however, only a few have specifically investigated the outcome of ulnar nerve decompression.

Aim

The aim of this study was to investigate the outcome of ulnar nerve decompression following cubital tunnel syndrome.

Methods and results

A total of 174 ulnar nerve decompression cases were identified from the upper limb surgery database with complete data available for 136 cases. Simple decompression was performed in 110 (80.88%) cases, and in 26 (19.12%), anterior subcutaneous transposition was also supplemented. These operations were performed at three different hospitals by surgeons of different levels of experience. The most common cause of cubital tunnel syndrome was idiopathic. The outcome was satisfactory in 86% of cases. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed.

Conclusion

This is the largest outcome analysis of the results of ulnar nerve decompression at the elbow. Good results following nerve decompression were attained in 86% of cases without any significant effect of duration of symptoms or co-morbidities on the outcome of surgery. It is hoped that the findings of the current study will help general practitioners, junior doctors and surgeons in their management and pre-operative consultation with patients having cubital tunnel syndrome.

Renal cortical necrosis: A rare complication of Plasmodium vivax malaria

A young female with Plasmodium vivax malaria presented with anemia, hyperbilirubinemia, thrombocytopenia, and advanced renal failure. She remained anuric for more than 3 weeks. Kidney biopsy confirmed the diagnosis of acute cortical necrosis. During follow-up, she became dialysis independent, but remained in stage 4 chronic kidney disease (CKD) at 3 month. P. vivax is supposed to be benign in nature, but can lead to rare and severe complication like renal cortical necrosis and progress to CKD.

Correlation of Palatal Rugoscopy with Gender, Palatal Vault Height and ABO Blood Groups in Three Different Indian Populations

Background:

Palatal rugae (PR) are asymmetrical irregular elevations, recorded during maxillary cast fabrication, that can be used for identification purpose if previous comparative sources are available.

Aim:

This study investigated uniqueness of PR patterns in relation to gender, palatal vault forms, and ABO blood groups in three (North-East [N-E], Northern and Western) populations of India.

Subjects and Methods:

The study was conducted on randomly selected 90 students, 30 from each sub population. Design - The palatal vault was recorded as Types I, II, and III. The maxillary casts were analyzed for each subject. The blood group of each subject was also recorded. Pearson's correlation coefficient tests were performed on cross-tabulations to evaluate significant relationship among different variables.

Results:

The PR number was more among females with an insignificant correlation among gender and mean rugae size on both sides. Types I and II hard palate vaults were seen associated with straight forwardly directed PR pattern, while Type III with curved forwardly directed PR. On the right side, straight rugae shape was most common type. On the left side, straight rugae shape was most common in Northern population while in N-E and Western populations curved rugae was the dominating type. A highly significant correlation was found between ABO blood groups and different PR patterns.

Conclusions:

PR possesses unique characteristics and can be used along with palatal vault forms as well as ABO blood groups for racial and individualistic soft tissue oral print in forensic cases.

Observation of Dirac plasmons in a topological insulator

Plasmons are quantized collective oscillations of electrons and have been observed in metals and doped semiconductors. The plasmons of ordinary, massive electrons have been the basic ingredients of research in plasmonics and in optical metamaterials for a long time. However, plasmons of massless Dirac electrons have only recently been observed in graphene, a purely two-dimensional electron system. Their properties are promising for novel tunable plasmonic metamaterials in the terahertz and mid-infrared frequency range. Dirac fermions also occur in the two-dimensional electron gas that forms at the surface of topological insulators as a result of the strong spin-orbit interaction existing in the insulating bulk phase. One may therefore look for their collective excitations using infrared spectroscopy. Here we report the first experimental evidence of plasmonic excitations in a topological insulator (Bi2Se3). The material was prepared in thin micro-ribbon arrays of different widths W and periods 2W to select suitable values of the plasmon wavevector k. The linewidth of the plasmon was found to remain nearly constant at temperatures between 6 K and 300 K, as expected when exciting topological carriers. Moreover, by changing W and measuring the plasmon frequency in the terahertz range versus k we show, without using any fitting parameter, that the dispersion curve agrees quantitatively with that predicted for Dirac plasmons.

Nocardia nova mycetoma over forehead in a lepromatous leprosy patient

We present a case of a 31-year-old male, a known patient with lepromatous leprosy with a type 2 lepra reaction, who presented with a slowly growing asymptomatic swelling with multiple discharging sinuses over the forehead that developed over 6 months. Smears of the serosanguinous discharge on Gram staining showed Gram-positive branching filamentous bacilli, which on culture on blood agar showed chalky-white colonies. Histology of the lesion showed suppurative granulomas with polymorphs surrounding characteristic grains. The isolate was identified as Nocardia nova by gene sequencing and the patient was started on combined antibiotic therapy that resulted in complete resolution of the infection in six months. To the best of our knowledge, this is the first report of mycetoma related to Nocardia nova in association with leprosy.

Novel in situ normal streaming potential device for characterizing electrostatic properties of confluent cells

The characteristics of transport across confluent cell monolayers may often be attributed to its electrostatic properties. While tangential streaming potential is often used to quantify these electrostatic properties, this method is not effective for transport normal to the apical cell surface where the charge properties along the basolateral sides may be important (i.e., confluent cells with leaky tight junctions). In addition, even when cells have a uniform charge distribution, the shear stress generated by the conventional tangential flow device may dislodge cells from their confluent state. Here we introduce a novel streaming potential measurement device to characterize the normal electrostatic properties of confluent cells. The streaming potential device encompasses a 24 mm cell-seeded Transwell(®) with two AgCl electrodes on either side of the cell-seeded Transwell. Phosphate buffered saline is pressurized transversal to the Transwell and the resultant pressure gradient induces a potential difference. Confluent monolayers of HEK and EA926 cells are used as examples. The corresponding zeta potential of the cell-membrane configuration is calculated using the Helmholtz-Smoluchowski equation and the zeta potential of the confluent cell layer is deconvolved from the overall measurements. For these test models, the zeta potential is consistent with that determined using a commercial dispersed-cell device. This novel streaming potential device provides a simple, easy, and cost-effective methodology to determine the normal zeta potential of confluent cells cultured on Transwell systems while keeping the cells intact. Furthermore, its versatility allows periodic measurements of properties of the same cell culture during transient studies.