Preparation and evaluation of cytotoxic potential of paclitaxel containing poly-3-hydroxybutyrate-co-3-hydroxyvalarate (PTX/PHBV) nanoparticles

Paclitaxel (PTX) is a potent anticancer drug. In the present study, PTX was loaded in poly-3-hydroxybutyrate-co-3-hydroxyvalarate (PHBV) to fabricate the PTX/PHBV (drug-loaded) nanoparticles via the nanoprecipitation method. Blank PHBV nanoparticles were also prepared. The drug-encapsulation efficiency of PTX/PHBV nanoparticles was 45±0.4%. The PTX/PHBV nanoparticles exhibited a pH-sensitive release profile and followed a quasi-Fickian diffusion mechanism. Cytotoxic properties of PHBV and PTX/PHBV nanoparticles were checked against the MCF-7 and Caco-2 cell lines. The PHBV nanoparticle did not inhibit the proliferation of MCF-7 and Caco-2 cell lines, thus depicting their non-toxic and biocompatible nature. On the other hand, the PTX/PHBV nanoparticles demonstrated 1.03-fold higher cytotoxicity and 1.61-fold enhanced apoptosis after treatment with the PTX/PHBV nanoparticles versus free PTX. In summary, the PHBV nanoparticles could be a potential candidate for the delivery of PTX for cancer treatment.

Synergy of silica sand and waste plastics as thermoplastic composites on abrasive wear characteristics under conditions of different loads and sliding speeds

The diverse nature of polymers with attractive properties has replaced the conventional materials with polymeric composites. The present study was sought to evaluate the wear performance of thermoplastic-based composites under the conditions of different loads and sliding speeds. In the present study, nine different composites were developed by using low-density polyethylene (LDPE), high-density polyethylene (HDPE) and polyethylene terephthalate (PET) with partial sand replacements i.e., 0, 30, 40, and 50 wt%. The abrasive wear was evaluated as per the ASTM G65 standard test for abrasive wear through a dry-sand rubber wheel apparatus under the applied loads of 34.335, 56.898, 68.719, 79.461 and 90.742 (N) and sliding speeds of 0.5388, 0.7184, 0.8980, 1.0776 and 1.4369 (m/s). The optimum density and compressive strength were obtained to be 2.0555 g/cm3 and 46.20 N/mm2, respectively for the composites HDPE60 and HDPE50 respectively. The minimum value of abrasive wear were found to 0.02498, 0.03430, 0.03095, 0.09020 and 0.03267 (cm3) under the considered loads of 34.335, 56.898, 68.719, 79.461 and 90.742 (N), respectively. Moreover, the composites LDPE50, LDPE100, LDPE100, LDPE50PET20 and LDPE60 showed a minimum abrasive wear of 0.03267, 0.05949, 0.05949, 0.03095 and 0.10292 at the sliding speeds of 0.5388, 0.7184, 0.8980, 1.0776 and 1.4369 (m/s), respectively. The wear response varied non-linearly with the conditions of loads and sliding speeds. Micro-cutting, plastic deformations, fiber peelings, etc. were included as the possible wear mechanism. The possible correlations between wear and mechanical properties, and throughout discussions for wear behaviors through the morphological analyses of the worn-out surfaces were provided.

Lymphangiogenesis Guidance Mechanisms and Therapeutic Implications in Pathological States of the Cornea

Corneal lymphangiogenesis is one component of the neovascularization observed in several inflammatory pathologies of the cornea including dry eye disease and corneal graft rejection. Following injury, corneal (lymph)angiogenic privilege is impaired, allowing ingrowth of blood and lymphatic vessels into the previously avascular cornea. While the mechanisms underlying pathological corneal hemangiogenesis have been well described, knowledge of the lymphangiogenesis guidance mechanisms in the cornea is relatively scarce. Various signaling pathways are involved in lymphangiogenesis guidance in general, each influencing one or multiple stages of lymphatic vessel development. Most endogenous factors that guide corneal lymphatic vessel growth or regression act via the vascular endothelial growth factor C signaling pathway, a central regulator of lymphangiogenesis. Several exogenous factors have recently been repurposed and shown to regulate corneal lymphangiogenesis, uncovering unique signaling pathways not previously known to influence lymphatic vessel guidance. A strong understanding of the relevant lymphangiogenesis guidance mechanisms can facilitate the development of targeted anti-lymphangiogenic therapeutics for corneal pathologies. In this review, we examine the current knowledge of lymphatic guidance cues, their regulation of inflammatory states in the cornea, and recently discovered anti-lymphangiogenic therapeutic modalities.

Therapeutic Strategies for Restoring Perturbed Corneal Epithelial Homeostasis in Limbal Stem Cell Deficiency: Current Trends and Future Directions

Limbal stem cells constitute an important cell population required for regeneration of the corneal epithelium. If insults to limbal stem cells or their niche are sufficiently severe, a disease known as limbal stem cell deficiency occurs. In the absence of functioning limbal stem cells, vision-compromising conjunctivalization of the corneal epithelium occurs, leading to opacification, inflammation, neovascularization, and chronic scarring. Limbal stem cell transplantation is the standard treatment for unilateral cases of limbal stem cell deficiency, but bilateral cases require allogeneic transplantation. Herein we review the current therapeutic utilization of limbal stem cells. We also describe several limbal stem cell markers that impact their phenotype and function and discuss the possibility of modulating limbal stem cells and other sources of stem cells to facilitate the development of novel therapeutic interventions. We finally consider several hurdles for widespread adoption of these proposed methodologies and discuss how they can be overcome to realize vision-restoring interventions.

Efficacy and safety of combination of empagliflozin and metformin with combination of sitagliptin and metformin during Ramadan: an observational study

BACKGROUND

Management of diabetes during fasting is a clinical challenge. Sodium glucose co-transporter -2 inhibitors (SGLT2i) are considered safe with a low risk of hypoglycemia. However, studies on SGLT2i are scarce. This study was designed to compare the efficacy, safety, and tolerability of empagliflozin with metformin during Ramadan in comparison with sitagliptin and metformin.

METHODS

It was a prospective, observational study, conducted at 11 different sites all across Pakistan on an outpatient basis during Ramadan (May 2021-June 2021). including 132 patients, 88 who received metformin and sitagliptin, and 44 patients who received metformin and empagliflozin.

RESULTS

Patients of the SGLT-2i group experienced similar symptomatic hypoglycemic episodes (15.9%) as the sitagliptin group. There was an improvement in blood sugar levels after the use of SGLT-2i (RBS 181 ± 64 before Ramadan vs 162 ± 53 after Ramadan). HbA1c also improved after the use of SGLT-2i before and after Ramadan (7.2 ± 0.8 vs 6.9 ± 0.9 for Metformin + Empagliflozin and 7.8 ± 1.5 vs 7.6 ± 1.6 for Metformin and sitagliptin). Weight and BMI improved after the use of SGLT-2i (BMI 36.5 ± 4.8 before Ramadan and 33.7 ± 2.4 after Ramadan). There were no reported cases of urinary tract infection in the empagliflozin group.

CONCLUSION

SGLT-2 inhibitors combined with metformin for patients with diabetes during Ramadan fasting is as effective, safe and well tolerated as DPP4 combined with metformin.

State of the art review: coronary artery disease in patients with inflammatory bowel disease: mechanisms, prevalence, and outcomes

Extraintestinal disease manifestations of inflammatory bowel disease (IBD), such as arthritis and uveitis, have been well described in the medical literature. However, there has been growing evidence suggesting an association between IBD and both coronary artery disease (CAD) and acute myocardial infarctions (AMI). In this critical review, the pathogenesis of proatherogenic inflammatory markers (CD40-CD40L, IL-6, and TNF-α) are summarised along with clinical evidence that supports the association of these makers with CAD. Moreover, clinical data are examined that suggest an increased risk of AMI and CAD in IBD patients along with recent analyses of in-hospital and post-MI outcomes of AMI in IBD patients. This comprehensive review summarises and expands upon our understanding of the growing association between both CAD and AMI in IBD patients that potentially identifies IBD as a risk factor for developing CAD.

Updating the approaches to define susceptibility and resistance to anti-tuberculosis agents: implications for diagnosis and treatment

Approximately 85 000 deaths globally in 2019 were due to drug-resistant tuberculosis (TB), which corresponds to 7% of global deaths attributable to bacterial antimicrobial resistance [1]. Yet concerns have been mounting that drug-resistant TB was being underestimated because the approaches to define susceptibility and resistance to anti-TB agents had not kept up with those used for other major bacterial pathogens [2–9]. Here, we outline the recent, evidence-based initiatives spearheaded by the World Health Organization (WHO) and others to update breakpoints (traditionally referred to as critical concentrations (CCs)) that are used for phenotypic antimicrobial susceptibility testing (AST), also called drug susceptibility testing in the TB literature.

Inappropriately high breakpoints have resulted in systematic false-susceptible AST results to anti-TB drugs. MIC, PK/PD and clinical outcome data should be combined when setting breakpoints to minimise the emergence and spread of antimicrobial resistance. https://bit.ly/3i43wb6

Lymphatic Vessel Regression and Its Therapeutic Applications: Learning From Principles of Blood Vessel Regression

Aberrant lymphatic system function has been increasingly implicated in pathologies such as lymphedema, organ transplant rejection, cardiovascular disease, obesity, and neurodegenerative diseases including Alzheimer's disease and Parkinson's disease. While some pathologies are exacerbated by lymphatic vessel regression and dysfunction, induced lymphatic regression could be therapeutically beneficial in others. Despite its importance, our understanding of lymphatic vessel regression is far behind that of blood vessel regression. Herein, we review the current understanding of blood vessel regression to identify several hallmarks of this phenomenon that can be extended to further our understanding of lymphatic vessel regression. We also summarize current research on lymphatic vessel regression and an array of research tools and models that can be utilized to advance this field. Additionally, we discuss the roles of lymphatic vessel regression and dysfunction in select pathologies, highlighting how an improved understanding of lymphatic vessel regression may yield therapeutic insights for these disease states.

High throughput interrogation of human liver stellate cells reveals microenvironmental regulation of phenotype

Liver fibrosis is a common feature of progressive liver disease and is manifested as a dynamic series of alterations in both the biochemical and biophysical properties of the liver. Hepatic stellate cells (HSCs) reside within the perisinusoidal space of the liver sinusoid and are one of the main drivers of liver fibrosis, yet it remains unclear how changes to the sinusoidal microenvironment impact HSC phenotype in the context of liver fibrosis. Cellular microarrays were used to examine and deconstruct the impacts of bio-chemo-mechanical changes on activated HSCs in vitro. Extracellular matrix (ECM) composition and stiffness were found to act individually and in combination to regulate HSC fibrogenic phenotype and proliferation. Hyaluronic acid and collagen III promoted elevated collagen I expression while collagen IV mediated a decrease. Previously activated HSCs exhibited reduced lysyl oxidase (Lox) expression as array substrate stiffness increased, with less dependence on ECM composition. Collagens III and IV increased HSC proliferation, whereas hyaluronic acid had the opposite effect. Meta-analysis performed on these data revealed distinct phenotypic clusters (e.g. low fibrogenesis/high proliferation) as a direct function of their microenvironmental composition. Notably, soft microenvironments mimicking healthy tissue (1 kPa), promoted higher levels of intracellular collagen I and Lox expression in activated HSCs, compared to stiff microenvironments mimicking fibrotic tissue (25 kPa). Collectively, these data suggest potential HSC functional adaptations in response to specific bio-chemo-mechanical changes relevant towards the development of therapeutic interventions. These findings also underscore the importance of the microenvironment when interrogating HSC behavior in healthy, disease, and treatment settings. STATEMENT OF SIGNIFICANCE: In this work we utilized high-throughput cellular microarray technology to systematically interrogate the complex interactions between HSCs and their microenvironment in the context of liver fibrosis. We observed that HSC phenotype is regulated by ECM composition and stiffness, and that these phenotypes can be classified into distinct clusters based on their microenvironmental context. Moreover, the range of these phenotypic responses to microenvironmental stimuli is substantial and a direct consequence of the combinatorial pairing of ECM protein and stiffness signals. We also observed a novel role for microenvironmental context in affecting HSC responses to potential fibrosis therapeutics.

Modeling, Optimization and Performance Evaluation of TiC/Graphite Reinforced Al 7075 Hybrid Composites Using Response Surface Methodology

The tenacious thirst for fuel-saving and desirable physical and mechanical properties of the materials have compelled researchers to focus on a new generation of aluminum hybrid composites for automotive and aircraft applications. This work investigates the microhardness behavior and microstructural characterization of aluminum alloy (Al 7075)-titanium carbide (TiC)-graphite (Gr) hybrid composites. The hybrid composites were prepared via the powder metallurgy technique with the amounts of TiC (0, 3, 5, and 7 wt.%), reinforced to Al 7075 + 1 wt.% Gr. The microstructural characteristics were investigated by optical microscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD) and energy dispersive X-ray spectroscopy (EDS) elemental mapping. A Box Behnken design (BBD) response surface methodology (RSM) approach was utilized for modeling and optimization of density and microhardness independent parameters and to develop an empirical model of density and microhardness in terms of process variables. Effects of independent parameters on the responses have been evaluated by analysis of variance (ANOVA). The density and microhardness of the Al 7075-TiC-Gr hybrid composites are found to be increased by increasing the weight percentage of TiC particles. The optimal conditions for obtaining the highest density and microhardness are estimated to be 6.79 wt.% TiC at temperature 626.13 °C and compaction pressure of 300 Mpa.

Laboratory Exercise to Measure Plasmid Copy Number by qPCR

Quantitative PCR (qPCR) has numerous applications in biology. In an educational setting, qPCR provides students an opportunity to better understand the PCR mechanism by providing both quantitative information about the reactions and also data to troubleshoot PCRs (e.g., melt curves). Here, we present a relatively short (2-h) laboratory activity to demonstrate qPCR to quantify plasmid copy number (CN) by measuring the cycle threshold (C_T ) values for a genomic gene and a plasmid gene using transformed cells as a template. The activity can be combined with additional laboratory exercises, including bacterial transformation, to create the template to be used in the qPCRs. This lab activity is ideal for undergraduate laboratory courses that include recombinant DNA technology. (This work was presented at the 2020 Biomedical Engineering Society annual meeting).

Profiling and identification of novel rpoB mutations in rifampicin-resistant Mycobacterium tuberculosis clinical isolates from Pakistan

INTRODUCTION

Rifampicin (RIF) is one of the most effective anti-tuberculosis first-line drugs prescribed along with isoniazid. However, the emergence of RIF resistance Mycobacterium tuberculosis (MTB) isolates is a major issue towards tuberculosis (TB) control program in high MDR TB-burdened countries including Pakistan. Molecular data behind phenotypic resistance is essential for better management of RIF resistance which has been linked with mutations in rpoB gene. Since molecular studies on RIF resistance is limited in Pakistan, the current study was aimed to investigate the molecular data of mutations in rpoB gene behind phenotypic RIF resistance isolates in Pakistan.

METHOD

A total of 322 phenotypically RIF-resistant isolates were randomly selected from National TB Reference Laboratory, Pakistan for sequencing while 380 RIF resistance whole-genome sequencing (WGS) of Pakistani isolates (BioProject PRJEB25972), were also analyzed for rpoB mutations.

RESULT

Among the 702 RIF resistance samples, 675 (96.1%) isolates harbored mutations in rpoB in which 663 (94.4%) were detected within the Rifampicin Resistance Determining Region (RRDR) also known as a mutation hot spot region, including three novel. Among these mutations, 657 (97.3%) were substitutions including 603 (89.3%) single nucleotide polymorphism, 49 (7.25%) double and five (0.8%) triple. About 94.4% of Phenotypic RIF resistance strains, exhibited mutations in RRDR, which were also detectable by GeneXpert.

CONCLUSION

Mutations in the RRDR region of rpoB is a major mechanism of RIF resistance in MTB circulating isolates in Pakistan. Molecular detection of drug resistance is a faster and better approach than phenotypic drug susceptibility testing to reduce the time for transmission of RIF resistance strains in population. Such insights will inform the deployment of anti-TB drug regimens and disease control tools and strategies in high burden settings, such as Pakistan.

Various treatment options for the management of Campanacci III giant cell bone tumor

e23509

Background: To assess the treatment effectiveness of Campanacci III giant cell bone tumours. Methods: This prospective cohort study was done using a non-probability purposive sampling technique in the orthopaedic surgery and traumatology unit-I department from February 2013 to October 2017. The sample size of 21 patients aged 33 to 60year Campanacci III giant cell bone tumour diagnosed on biopsy were included, and all patients with uncontrolled diabetes mellitus, decompensated liver disease, chronic renal failure, previously treated for giant cell tumours and malignant transformation were excluded. Treatment options included wide margin excision with fibular vascular graft with plating, mega prosthesis, and chirolin prosthesis. Treatment effectiveness was observed in terms of superficial & deep infection, limb length discrepancy, implant failure and function using musculoskeletal tumour society rating scale (MSTS). Follow-p of the patients was five years. All patients were followed up for six months in the first year and yearly till five years. Results: Out of the total 21 patients, male were 11 (52.4%) and female were 10 (47.6%). The mean age of the patients was 34.8±14.6 years, with a median age was 30year. Four (19.1%) had proximal humerus, o5 (23.8% had distal radius, 09 (42.8% had distal femur, and 03 (14.3%) had proximal thigh involvement. The MSTS was 21.8±6.8 with a median score of 22 till the last follow-up. Kaplan Meier curve was plotted, and median survival rate was 50% at 54 months for the patients treated with fibular vascular graft, 57 months for mega prosthesis and 58 months for the patients treated with chirolin prosthesis. Conclusions: Treatment of Campanacci III with mega prosthesis, fibular vascular graft and chirolin prosthesis is a good outcome except with implant failure in mega prosthesis and limb length inequality with fibular vascular grafts. [Table: see text]

Complications and Management of Eptifibatide-Induced Thrombocytopenia

BACKGROUND

Eptifibatide is used in acute coronary syndromes to reversibly block platelet aggregation by inhibiting the platelet glycoprotein IIb/IIIa receptor. A serious adverse effect of eptifibatide is a profound drop in platelet count, termed eptifibatide-induced thrombocytopenia (EIT).

OBJECTIVE

To provide insight into the types of complications and management of EIT.

METHODS

Cases of EIT submitted to the Food and Drug Administration adverse event reporting system were evaluated. Data analyses included management of EIT, complications of thrombocytopenia, initial platelets, and platelet nadir following eptifibatide.

RESULTS

103 cases of EIT were reported from January 2010 to 2019; 57 cases met the Naranjo scale and were included. Only 37 of those cases contained information on how EIT was managed. Eptifibatide administration was withheld in all 37 of those cases. Platelet transfusions were administered in 20 cases (54%). Two cases were managed with steroids (5.4%), and 1 case used intravenous immunoglobulin G to reverse EIT (2%). The median initial platelet count prior to administration of eptifibatide was 207 000 cells/mm³ (SD = 69 000; n = 27), and median platelet nadir was 9000 cells/mm³ (SD = 19 000; n = 35) The majority of complications of EIT included bleeding events (16/28, 57%). Delayed procedures, prolonged stay, allergic reactions, and thrombosis were each reported in 3 patients (10.75%).

CONCLUSION AND RELEVANCE

Most cases of EIT were managed by withholding eptifibatide with platelet transfusion if necessary. The majority of complications included bleeding. However, significant procedure delays, prolonged hospital stay, thrombosis, and allergic reactions were also reported.

Effectiveness of Treatment in Children With Cerebral Palsy

OBJECTIVE

 The objective of this study was to assess the effectiveness of conservative and surgical treatment in cerebral palsy children by evaluating the Medical Research Council (MRC) grading system, modified Ashworth scale, and Barthel Activities of Daily Life (ADL) scale.

METHOD

This prospective case series was performed using a non-probability consecutive sampling technique at the Department of Orthopedic Surgery and Traumatology, King Edward Medical University/Mayo Hospital, Lahore from October 2011 to November 2013. Two hundred children of all ages, having cerebral palsy diagnosed on history and clinical examination were enrolled in the study. Children were treated with conservative and surgical treatment. Pre- and post-treatment, all children were classified based on movement disorder (spastic, athetoid, ataxic, and mixed), parts of the body involved (paraplegic, tetraplegic, diplegic, hemiplegic, monoplegic, double hemiplegic, and triplegic), and gross motor function (GMFCS level I-IV). Their muscle power and tone were assessed using the MRC grading system and modified Ashworth scale, respectively. Assessment of disability and daily function was done by ranking disability grading and Barthel ADL, respectively. The range of motion (ROM) of each joint was assessed clinically. Children were divided based on the treatment method as non-surgical versus surgical treatment.

RESULTS

Out of a total of 200 children, the mean age of the children was 7.86±4.17year. There were 134 (67.0%) males and 66 (33.0%) female children. Classification on basis of movement disorder, body part involved, and gross motor function at three-month intervals till twelve months was performed. From the first presentation of children till the last follow-up time period, i.e., 12th month there was no change in the movement disorder (a type of CP, body parts involved, and GMFCS). The final rating of overall treatment results shows that there were 84 (42%) patients who had a poor outcome, and only 35 (17.50%) patients had a fair treatment outcome and 81 (40.50%) patients had good treatment outcomes.  Conclusion: The conservative and surgical management showed no effect on movement disorder of the child although, on the final rating scale fair to good treatment outcome was observed in all children. There was an improvement in muscle power grading on the ADL, but no significant improvement was seen on the improvement of type, parts of the body involved, gross motor function classification, modified Ashworth, and ranking disability grading of the children.

De-novo acute myeloid leukemia in a BRCA positive female with locally treated ductal carcinoma In Situ

Acute myeloid leukemia (AML) is primarily a disease of older adults and can arise de novo, in relation to previous treatment or in the setting of underlying hematological disease. While it is known to arise from chemoradiation in the setting of breast cancer, little is known about the association between BRCA carriers and AML. We report a case of a young female BRCA carrier who develops de novo AML without prior chemoradiation treatment, and examine if there is a link between BRCA and developing leukemia.

Development and Implementation of a Virtual Cell Culture Lab Practical for an Introductory BME Lab Course

The transition to remote learning in response to the COVID-19 pandemic necessitated the adaptation of an in-person cell culture lab practical to a virtual assessment in an introductory biomedical engineering lab course. The virtual lab practical was administered in the course LMS and implemented video, data analysis, and multiple-choice questions. Average student scores and grade distributions were comparable across in-person and virtual lab practical formats. Instructors observed fewer grading concerns for the virtual practical compared to previous in-person offerings. The virtual lab practical may be preferred over in-person lab practical in future offerings due to decreased student stress, lower cost, reduced required instructor time, and limited availability of equipment. Resources developed for the virtual practical, including video tutorials and a hemocytometer simulator to practice calculations, can be used by other educators and as supplements to existing course material.

Dermotraction as a Simple and Effective Technique for Fasciotomy Wound Closure

Background| Fasciotomy is the best treatment option of acute compartment syndrome, but it results into large wounds which are difficult to manage. Different techniques have been utilized to manage the fasciotomy wounds which have their respective merits and demerits. This study was conducted to evaluate yet another novel technique which requires skin stapler and Prolene #1 sutures. Methods| This descriptive cases series was done using non-probability convenient sampling technique from January 2015 and June 2017 at Department of Orthopedics Surgery, King Edward Medical University / Mayo Hospital, Lahore. We included 24 fasciotomy wounds. They were managed with Dermotraction technique. We excluded patients with vascular injury. All wounds were successfully closed within an average time of seven days. The procedure was found to be cost effective, easy to execute and with minimal complications. Results| Amongst the total 13 patients, all were males of age ranging from 14 to 45year with mean age of 28.46±9.97. Majority, 10 patients (77 %) had acute compartment syndrome of leg and each patient managed with two fasciotomy wounds (N= 20). All fasciotomy wounds were closed with serial traction technique and the average time of closure was 07 days ranging from 3 days to 17 days 8.61±2.63. Conclusion| We concluded from the study that dermotraction technique has good outcome in fasciotomy wound closer and healing and it is a cost effective.

Faisal’s Technique to Closely Manage Volar Barton’s Fracture: A Pilot Study

This study was conducted to establish the efficacy of closed reduction and percutaneous pinning (CRPCP) in management of volar Barton’s fracture by Faisal Technique. Methods: A total of 10 cases of volar Barton’s fracture fulfilling our inclusion and exclusion criteria were included in our study from August 2015 to August 2016. These cases, presented at our department, were managed with closed reduction under image intensifier by dorsiflexing the wrist and reducing the fragment by ligamentotaxis and percutaneous pinning in anti-glide fashion from dorsal proximal (intact cortex) aspect of distal radius and engaging the volar fragment aiming the subchondral cortex and were supplemented with short arm cast application in volar flexion. The outcome was evaluated using Pattee and Thompson functional criteria at 6 month. Also the percentage of union and time to union were evaluated. Results: The mean age of total ten patients was 29.8± 3.20 years (25-35 years). We achieved union in 100% of the patient at mean time of 8.20 ± 0.92 weeks (7-10 weeks). There were 20% (n=2) cases with excellentand 80% (n=8) cases with good outcome according to Pattee and Thompson criteria. We had two cases (20%) with pin-tract infection that were managed with dressing and oral antibiotics according to culture and sensitivity. There were no loss of reduction Conclusion: Our pilot study demonstrates good result with CRPCP (Faisal’s Technique) in volar Barton’s fracture and warrants further randomized control trial study to establish its efficacy in such cases.

Dietary Genistein Influences Number of Acetylcholine Receptors in Female Diabetic Jejunum

BACKGROUND

Intestinal dysfunction in the ob/ob mouse model of diabetes mimics that seen clinically.

METHODS

We determined the effects of a 4-week genistein diet (600 mg genistein/kg food) on intestinal function (contractility, morphology, AChR, and motility) in female ob/ob and lean mice.

RESULTS

Contractility of the jejunum in response to incrementally increasing concentrations of KCl was comparable in ob/ob females and lean controls regardless of a genistein-diet. There were no changes in the wall thickness measured. We assessed the number of clusters of AChR in the jejunum wall; AChR were decreased by 48% in ob/ob mice versus leans, and the genistein diet reversed this. In utilizing a video-imaging system to evaluate gastrointestinal motility, we determined that the distance between consecutive contractile events was significantly increased by 1.87-fold in ob/ob mice versus leans, and the genistein diet was without effect.

CONCLUSIONS

These data suggest that slowed intestinal transit in the diabetic ob/ob mouse may be due in part to decreased AChR and decreased contraction events occurring per unit time. A genistein diet rescues the number of AChR to levels of leans yet did not change the number of contractile events. Feeding ob/ob mice a genistein-rich diet has potential therapeutic benefits towards improving the debilitating diabetes-related gastrointestinal dysfunction.

Dietary Genistein Rescues Reduced Basal Chloride Secretion in Diabetic Jejunum via Sex-Dependent Mechanisms

BACKGROUND/AIMS

The goal of this study was to determine the effect of dietary genistein (naturally occurring phytoestrogen) on jejunal secretory function in a clinically relevant model of diabetes and obesity, the leptin-defIcient ob/ob mouse.

METHODS

We measured transepithelial short circuit current (Isc), across freshly isolated segments of jejunum from 12-week old male and female ob/ob and lean C57Bl/6J mice fed a genistein diet (600 mg genistein/kg diet) for 4-weeks. Separate segments of jejunum were frozen for western blot determination of key proteins involved in secretory transport.

RESULTS

Basal Isc was signifIcantly decreased (by 33%, P<0.05) in ob/ob females versus leans, and genistein-diet reversed this. Similarly, in males, basal Isc was decreased (by 47%, P<0.05) in ob/ob mice versus leans, and genistein-diet reversed this. Inhibition with either clotrimazole (100 µM, bilateral) or ouabain (100 µM, basolateral) was signifIcantly reduced in ob/ob mice compared to leans (P<0.05), and genistein-diet reversed clotrimazole-sensitive inhibition in ob/ob females, and reversed the ouabain-sensitive inhibition in males (indicating sex-dependent mechanisms). Our data suggested that PDE3 levels were dysregulated in ob/ob females and genistein reversed this. Expression of total CFTR (normalized to actin) was signifIcantly decreased ∼80% (P<0.05) in all ob/ob mice compared to leans, and genistein-diet was without effect. Expression of total NKCC1 (normalized to actin) was signifIcantly decreased ∼80% (P<0.05) in ob/ob male mice versus leans, and genistein-diet reversed this.

CONCLUSIONS

Our data suggests that the reduced basal jejunal Isc in ob/ob female mice is a consequence of reduced CFTR expression, decreased activities of the basolateral KCa channel and Na+/K+-ATPase, and in male mice reduced basal jejunal Isc is a consequence of reduced CFTR and NKCC1 expression, along with decreased activities of the basolateral KCa channel and Na+/K+-ATPase. Genistein-diet has beneficial effects on basal Isc mediated by sex-dependent mechanisms in diabetic mice: in females via increased KCa-sensitive Isc and in males via increased Na+/K+-ATPase activity and increased NKCC1 expression. Improved understanding of intestinal dysfunctions in the ob/ob jejunum, may allow for the development of novel drug targets to treat obesity and diabetes, and may also be of benefit in CF-related diabetes.

Improvement in Harris Hip Score after cementless total hip arthroplasty in young active adults with secondary hip arthritis- A short-term follow-up result

OBJECTIVE

To determine the improvement in Harris Hip Score after non-cemented total hip replacement in younger patients with secondary hip joint arthritis.

METHODS

The quasi-experimental study was conducted at Unit I, Department of Orthopaedic Surgery and Traumatology, Mayo Hospital, Lahore, and comprised patients diagnosed clinically and radiologically as secondary hip joint arthritis from September 2009 to December 2014. Harris Hip Score was calculated pre-operatively. All patients were operated by the same surgical team. One dose of second-generation intravenous cephalosporin after test dose was given at induction of anaesthesia followed by 3 times daily postoperatively along with aminoglycosides twice daily for three days followed by oral quinolones for 2 weeks. Patients were followed up for 6 months. The improvement in hip score was classified as poor, fair, good and excellent. Data entry and analysis was done using SPSS 11.5.

RESULTS

Of the 65 patients in the study, 43(66%) were male and 22(34%) were females. Right hip was involved in 40(62%) patients and 25(38%) had pathology in the left hip. Overall mean age of male and female patients was 35.69±5.55 years and 35.72±5.95 years respectively. Harris Hip score improved over 6 months from poor to fair.

CONCLUSIONS

The use of non-cemented total hip arthroplasty conferred a significant improvement in function in young patients with arthritis of the hip joint.

Xpert(®) MTB/RIF under routine conditions in diagnosing pulmonary tuberculosis: a study in two hospitals in Pakistan

Xpert(®) MTB/RIF testing was offered to consecutive patients with presumptive tuberculosis (TB) attending two hospitals in Pakistan during April-May 2012, in addition to routine diagnostic protocol (smear microscopy, chest radiography and clinical judgement). We assessed the relative contribution of each tool in detecting pulmonary TB under routine conditions. Of 606 participants, 121 (20%) were detected as pulmonary TB: 46 (38%) by microscopy, 38 (31%) by Xpert alone and 37 (31%) on clinical and radiological grounds; 41 (65%) were detected by both Xpert and microscopy. One patient had rifampicin resistance. Although Xpert detected approximately twice as many TB cases as microscopy (n = 79, 65%), clinical judgement remained favoured by clinicians even when smear and Xpert were negative.

An immunohistochemical study of neurotransmitter profiles in developing human visual cortex

The temporal pattern of development and distribution of gamma aminobutyric acid, serotonin, substance P and neuropeptide Y immunoreactive profiles was studied in the human visual cortex from 16 to 26 weeks of gestation, using an immunohistochemical technique. The immunoreactive profiles showed an increase in number and a change in their morphology and distribution pattern over the time period studied. A large number of neurons, fibers and terminals were stained with GABA antibody at 17-18 weeks and were distributed throughout the five zones of the developing visual cortex. GABA neurons were non-pyramidal and bipolar in form at 17-18 weeks while at 18-19 and 20-21 weeks the cells of subplate and intermediate zones were multipolar. Substance P and serotonin immunopositive fibers were present mainly in the intermediate zone at 16 and 17-18 weeks, where they were oriented in a horizontal manner. At subsequent ages they invaded the other zones also. Substance P positive neurons could be visualized only at 26 weeks of gestation in the intermediate, subventricular and ventricular zones; no cell bodies, however, stained with serotonin antibody. Neuropeptide Y immunoreactive cells and fibers were first seen in the intermediate zone but later were found to be distributed in other zones too. The observations indicate that the intermediate zone of the visual cortex in which the transmitters and peptides appear earlier assumes importance in the normal development as also noted in other mammals.

Early development of visual cortex in human fetuses

Prenatal development of visual cortex (area 17) was studied in human fetuses of 8-9, 13-15 and 16-18 weeks of gestation, with a view to analyse the early critical events. Under light microscope, five zones of development were seen in all the age groups. The total thickness of cortex of area 17 as well as that of its cortical plate was measured with the help of camera lucida. It was observed that the total thickness of the cortex increased with increase in age. Diversity in the shape, size, staining intensity and arrangement of neurons was noted in the different zones. Most of the cells were found to have a thin rim of cytoplasm and a prominent nucleus with multiple nucleoli. The cells in subventricular zone and cortical plate were regularly arranged in vertical rows while in other zones, they were irregularly scattered. Several mitotic figures were seen in the ventricular zone at 8-9 weeks but later they were also noticed in subventricular and intermediate zones. In the later ages the mitotic figures were observed to be fewer in the ventricular zone. No mitosis was seen in cortical plate at any age period.