Effects of deleting cannabinoid receptor-2 on mechanical and material properties of cortical and trabecular bone

Acknowledgements We thank Dr J.S. Gregory for assistance with Image J and Mr K. Mackenzie for assistance with Micro-CT analysis. Funding ABK was funded by a University of Aberdeen, Institute of Medical Sciences studentship and the Overseas Research Students Awards Scheme.Peer reviewedPublisher PD

Mechanical and material properties of cortical and trabecular bone from cannabinoid receptor-1-null (Cnr1-/-) mice

Funding ABK was funded by a studentship from the University of Aberdeen, Institute of Medical Sciences, and the Overseas Research Students Awards Scheme Acknowledgments We are grateful to Dr J.S. Gregory for assistance with Image J and Mr K. Mackenzie for assistance with Micro-CT analysis.Peer reviewedPostprin

Profile of patients with Thrombosis evaluated in a Tertiary Care Center.

A delicate balance exists between fibrin formation and fibrinolysis in vivo. Reduced blood flow, changes in the vessel wall and changes in blood composition result in disturbance of this balance, which favors fibrin formation and ultimately lead to formation of occlusive thrombi. Venous and arterial thrombosis are common diseases with an estimated incidence of 1 in 1000 individuals per year50 .Despite the growing insight in the pathogenesis of thrombophilia, the cause of many thrombotic episodes remain unknown. Although the causes are not always identified, several risk factors have been studied and it was observed that hypercoagulability is one of the triggers that alters the hemostasis. Hypercoagulability may occur due to defective naturally occurring anticoagulant mechanisms or due to heightened levels of procoagulant factors. Several risk factors have been identified like increased levels of coagulation factors-factor VIII, IX, XI, II and fibrinogen which are cumulatively explored by activated partial thromboplastin time used over the last 50 years as a standard screening test in clinical laboratories throughout the world. Several groups have identified elevated levels of factor VIII as an independent risk. The present study was aimed at examining risk factors involved in the pathogenesis of thrombosis in the Indian population. Review of literature has shown that most of the epidemiology studies to date with reference to thrombophilias, are confined to data derived from the European population. This study was done on 310 patients who presented with different thrombotic disorders. While the clinical utility of diagnostic testing for an inherited or acquired thrombophilia remains controversial, studies such as these hold the potential of further stratifying individual patients into high- and low-risk for incident and recurrent VTE. This in turn will help target prophylaxis to those who benefit the most and ultimately reduce the occurrence of venous thromboembolism. The commonest risk factor identified was increased Factor VIII:C levels, followed by antiphospholipid antibody and shortened activated partial thromboplastin time. Two hemolytic anemias – one genetic (sickle cell anemia) and the other an acquired membrane disorder (paroxysmal nocturnal hemoglobinuria) were also found to be associated with a tendency to thrombosis. 50% of the patients in this study who presented with thrombosis had no identifiable risk factors

Barriers and perceptions regarding code status discussion with families of critically ill patients in a tertiary care hospital of a developing country: A cross-sectional study

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown.Aim: To determine the barriers and perceptions in discussion of code status by physicians.Design: Questionnaire-based cross-sectional study.Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included.Results: A total of 77 (57.4%) physicians responded. Family-related barriers were found to be the most common barriers. They include family denial (74.0%), level of education of family (66.2%), and conflict between individual family members (66.2%). Regarding personal barriers, lack of knowledge regarding prognosis (44.1%), personal discomfort in discussing death (29.8%), and fear of legal consequences (28.5%) were the top most barriers. In hospital-related barriers, time constraint (57.1%), lack of hospital administration support (48.0%), and suboptimal nursing care after do not resuscitate (48.0%) were the most frequent. There were significant differences among opinions of trainees when compared to those of attending physicians.Conclusion: Family-related barriers are the most frequent roadblocks in the end-of-life care discussions for physicians in Pakistan. Strengthening communication skills of physicians and family education are the potential strategies to improve end-of-life care. Large multi-center studies are needed to better understand the barriers of code status discussion in developing countries

Mortality-related resource utilization in the inpatient care of hypoplastic left heart syndrome.

BACKGROUND: Quantifying resource utilization in the inpatient care of congenital heart diease is clinically relevant. Our purpose is to measure the investment of inpatient care resources to achieve survival in hypoplastic left heart syndrome (HLHS), and to determine how much of that investment occurs in hospitalizations that have a fatal outcome, the mortality-related resource utilization fraction (MRRUF). METHODS: A collaborative administrative database, the Pediatric Health Information System (PHIS) containing data for 43 children\u27s hospitals, was queried by primary diagnosis for HLHS admissions of patients ≤21 years old during 2004-2013. Institution, patient age, inpatient deaths, billed charges (BC) and length of stay (LOS) were recorded. RESULTS: In all, 11,122 HLHS admissions were identified which account for total LOS of 277,027 inpatient-days and $3,928,794,660 in BC. There were 1145 inpatient deaths (10.3%). LOS was greater among inpatient deaths than among patients discharged alive (median 17 vs. 12, p \u3c 0.0001). BC were greater among inpatient deaths than among patients discharged alive (median 4.09 × 10(5) vs. 1.63 × 10(5), p \u3c 0.0001). 16% of all LOS and 21% of all BC were accrued by patients who did not survive their hospitalization. These proportions showed no significant change year-by-year. The highest volume institutions had lower mortality rates, but there was no relation between institutional volume and the MRRUF. CONCLUSIONS: These data should alert providers and consumers that current practices often result in major resource expenditure for inpatient care of HLHS that does not result in survival to hospital dismissal. They highlight the need for data-driven critical review of standard practices to identify patterns of care associated with success, and to modify approaches objectively

Treatment of Dental Plaque Biofilms using Photodynamic Therapy

BACKGROUND: Photodynamic therapy (PDT) is a treatment modality involving a dye that is activated by exposure to light of a specific wavelength in the presence of oxygen to form oxygen species causing localised damage to microorganisms. AIM: To determine the most effective bactericidal incubation and irradiation times of erythrosine-based PDT, using a tungsten filament lamp, on in vivo- formed dental plaque biofilms. MATERIALS AND METHODS: The study was a two-phase randomised controlled study consisting of in-vitro and in-situ phases. Phase-1 aimed to determine the most appropriate incubation-time using erythrosine(220μM) based-PDT on lactobacillus species grown in-vitro. Phase-2 was conducted on 18-healthy adult participants wearing intraoral appliances with human enamel slabs to collect dental plaque samples in two separate periods for use in arm-1 and arm-2. For phase-2, accumulated dental plaque samples were tested under different experimental conditions; a) Control-1 (No erythrosine, no light); b) Control-2 (+Erythrosine, no light); c) Treatment-1 (+Erythrosine, +15min continuous light); d) Treatment-2 (+Erythrosine, +30sec light pulses for 5- times separated by 1min dark periods). Incubation-times of 15min and 2min were used in arm-1 and arm-2, respectively; as adapted from the previous pilot study and phase-1. Following treatment, percentage reduction of total bacterial counts were compared between the different groups. Additionally, Confocal Laser Scanning Microscopy(CLSM) was used to investigate the effect of PDT on in vivo-formed plaque biofilms. RESULTS: Significant reductions in the percentage of total bacterial counts (~93-95%) of in vivo-formed biofilms were found when using either 2min or 15min incubation-times and applying 15min continuous light. Whereas, when applying fractionated light, there was more cell death when 15min incubation-time was used (~91%) compared with the 2min incubation-time (~64%). CLSM results supported these findings. CONCLUSION: Improving the clinical usefulness of PDT by reducing its overall treatment time seems to be promising and effective in killing in vivo- formed dental plaque biofilms

Estuarine Macrophytes at Bakkhali, Cox’s Bazar, Bangladesh with Reference to Mangrove Diversity

The diversity and ecosystem significance of macrophyte communities was studied, with emphasis on the mangrove species in the Bakkhali estuary of Cox’s Bazar, Bangladesh. Macrophytes of the Bakkhali river estuary were mainly mangroves (Avicennia marina Forssk Vierh and A. alba Blume and Acanthus ilicifolius Linnaeus) of inundation Class-IV; i.e., the mangroves are inundated 2-20 times per month (Watson, 1928), a wild rice variety of salt marsh (Porteresia coarctata Tateoka), Congon grass (Imperata cylindrica P. Beauv.), seagrass (Halophila beccarii Ascherson), macro-algae (Ulva intestinalis Linnaeus, Catenella nipae Zanardini and Hypnea sp.) and mangrove associates Suaeda maritima Only two individual plants of mangrove, Sonneratia apetala and Aegialitis rotundifolia, were found growing in the inter-tidal area of this estuary. On the eastern side of the estuary, almost 100% of the intertidal area is covered by the salt marsh plant P. coarctata, with patches of seagrass Halophila beccarii. The western portion of the estuary is covered by mangroves, mixed with patchy salt marsh and seagrass in and sheltered by a sand bar. Salt marsh and seagrass grow in mangrove dominated sites as 2nd pioneer species in the newly accreted land at the mouth of Bakkhali estuary. These estuarine macrophytes are of both economic and ecological significance and the macrophyte community plays a principal role directly or indirectly in supporting the local communities as source of food, cash and energy

Response of a single \u27mega intramuscular dose\u27 of vitamin D on serum 25OHD and parathyroid hormone levels

Objective: To determine the changes produced in serum 25OHD and iPTH levels after 600,000 IU of injection cholecalciferol in volunteers. Study Design: Interventional study. Place and Duration of Study: Section of Chemical Pathology, Department of Pathology and Microbiology, the Aga Khan University Hospital, Karachi, from June 2009 - June 2010. Methodology: Volunteers of either gender aged 18-40 years with known 25OHD, calcium (Ca), creatinine (Cr) and phosphorous (P) levels were included in the study. Subjects on therapy like vitamin D and calcium supplements, corticosteroids or anti-epileptic medicines, primary hyperparathyroidism and hypercalcaemia, with co-morbidity like renal failure, liver disease and history of malabsorption, diarrhea or hyperthyroidism were excluded. All volunteers were given an intramuscular injection of vitamin D3 (cholecalciferol, 600,000 IU). After 8 weeks, serum 25OHD, iPTH, Ca and P levels were determined again. For 25OHD level, cut-off of ≤ 50 nmol/l was defined as deficient, 50-75 nmol/l as insufficient and ≥ 75 as optimal level. Results: Mean 25OHD and iPTH levels were 35.06 ± 16.6 nmol/l and 81.15 ± 76.78 pg/ml respectively at baseline. Seventeen volunteers were 25OHD deficient. Five had high iPTH levels (25%) (mean 156 ± 123.7 pg/ml). 25OHD and iPTH showed a significant inverse correlation at baseline (\u3c 0.01). After 8 weeks of injection vitamin D 25OHD levels became optimal in 6 subjects (35%) [mean 92.9 ± 16.6 nmol/l]. It remained low in 5 volunteers (25%) [mean 41.6 ± 9.6 nmol/l] while insufficient levels were seen in 9 volunteers (40%) [mean 63.3±5.8 nmol/l]. Follow-up mean Ca, P and iPTH were 2.25 mmol/l (± 0.09), 1.1 (± 0.1) and 47.52 pg/ml (± 22.56) respectively. A significant increase in mean 25OHD level was seen at follow-up (p \u3c 0.01), while the change in PTH was insignificant (p=0.05). Conclusion: Single mega-dose of cholecalciferol achieved optimal levels of 25OHD in 35% of subjects after eight weeks of supplementation

Subacute dislocation of the elbow following Galeazzi fracture-dislocation of the radius: A case report

<p>Abstract</p> <p>Introduction</p> <p>The Galeazzi fracture-dislocation was originally described by Sir Astley Cooper in 1822 but was named after Italian surgeon Ricardo Galeazzi in 1934. It is an injury classified as a radial shaft fracture with associated dislocation of the distal radioulnar joint and disruption of the forearm axis joint. The associated distal radioulnar joint injury may be purely ligamentous in nature, tearing the triangular fibrocartilaginous complex, or involve bony tissue (that is, ulnar styloid avulsions) or both. We report this case because of the rare association of posterior dislocation of the elbow along with Galeazzi fracture-dislocation. To the best of our knowledge, this has not been previously reported in the English literature.</p> <p>Case presentation</p> <p>A 26-year-old Caucasian man presented to our department after a fall from a motorbike. He sustained a closed, isolated Galeazzi fracture-dislocation of the right forearm and no associated elbow injuries, and this necessitated open reduction and internal fixation of the radius. Post-operative radiographs films were satisfactory. However, clinical and radiological evidence of ipsilateral elbow dislocation was noted at a five-week follow-up, subsequently requiring open reduction of the joint and collateral ligament repair. Our patient was noted to have full elbow and forearm function at three months.</p> <p>Conclusions</p> <p>Although the Galeazzi fracture-dislocation has been classically described as involving only the distal radioulnar joint, traumatic forces can be transmitted to the elbow via the interosseous membrane of the forearm. This can lead to instability of the elbow joint. Therefore, we recommend that, in every case of forearm fracture, both elbow and wrist joints be assessed clinically as well as radiologically for subluxation or dislocation.</p