Variations of Nutrient Foramen of Femur and its Clinical Implications

Introduction: Nutrient foramen is the largest opening on the shaft of the femur that conveys nutrient artery into the marrow cavity. Knowledge on locations of nutrient foramina is essential during surgical procedures as well as to rule out if the fracture line passes through the foramina. The purpose of the study was to determine the number and position of nutrient foramina in relation to length and topography of the femur. Methods: The study model was descriptive, cross-sectional study that included 151 femurs (71 right and 80 left side). The total number, location, and direction of nutrient foramina were investigated. Total length of femur and distance of foramen from the proximal end was measured with the 500mm 20" Digital Vernier Nib Jaw Caliper Metric/ Imperial Machine-DRO and finally Foraminal Index was calculated. Results: The analysis revealed 119(78.81%) of the femurs with single nutrient foramen, 31(20.52%) with double and 1(0.67%) with triple nutrient foramina. Foraminal Index II was found in 74(86.05%) on right side and 90(91.84%) on left side. The most common location of nutrient foramen was the medial lip of linea aspera (n= 77, 41.85%). All of the foramina were directed towards the proximal end. Conclusion: The present study has reported the majority of nutrient foramina located in the middle third of femur along the linea aspera. Thus, linea aspera should not be stripped off during surgical procedures to avoid damage to the nutrient arteries

Bicondylar Angle and its Relation with Length and Neck Length of Human Femur

Introduction: Femoral bicondylar angle has immense importance from anatomical and clinical (forensic and anthropometric) point of view and is the characteristic feature of bipedal gait in humans. It is the angle between axis of femoral shaft and a line perpendicular to its transcondylar axis. The study was carried out to assess bicondylar angle and its relationship with femur length and neck length. Methods: Bicondylar angle, length, and neck length of available dry human femurs of unknown sex and age were measured using osteometric board and vernier caliper. Bicondylar angle between two sides were compared. Similarly, relation between the angle and femoral length and length of femoral neck was studied. Result: Bicondylar angle on right side was 8.65° (SD = 2.03) and on left side was 9.35° (SD = 2.05) and the different was not statistically significant (p = 0.08). On both sides, no significant correlation was found between bicondylar angle with femoral length and length of femoral neck. Conclusion: Mean bicondylar angle of right femur was 8.65° and that of left was 9.35° and the difference was not statistically significant. There was no significant relation between the angle and other two parameters

Cardio-respiratory Fitness in Medical Students by Queen’s College Step Test: A Cross-sectional Study

Introduction: Cardio-respiratory fitness indicates the ability of circulatory system to supply oxygen toworking muscles during continuous physical activity. Maximum oxygen uptake (VO2max) is a single bestmeasure of cardio-respiratory fitness and is considered gold standard to quantify aerobic capacity. Methods:Eighty students of age group 18-25 years were taken by simple random sampling. VO2max was estimatedindirectly by following the protocol of Queen’s College Step Test (QCST) method. Results: Mean value ofVO2max for male (51.61±6.26 ml/Kg/min) and female (36.02±3.71 ml/Kg/min) was compared, which wasfound significantly higher in males than in females (p<0.001). There was negative correlation of gender(r = -0.838), body mass index (BMI) (r = -0.339), obesity category (r = -0.275), obese vs non-obese (r =-0.264) and basal pulse rate (r = -0.456) with VO2max and positive correlation of height (r = 0.592) and hoursof study(r = 0.309) with VO2max. Conclusion: This study showed that increased BMI is associated withdecreased level of VO2max in young adults. One can improve VO2max by maintaining BMI within normallimits

Hemispheric Brain Preference and Academic Parameters in Medical Students: A Cross-sectional Study

Introduction: Hemispheric brain preference means using one side of the brain over the other to learn. Hemispheric brain preference may influence one’s learning style. This study aimed to investigate hemispheric brain preference and its relation with academic parameters in medical students. Methods: Four hundred participants were included in the study by cluster random sampling. Using self-administered questionnaires, data on personal profile (name, age, sex, handedness, academic score, study method, study hours per day and study pattern) and hemispheric brain dominance was collected. Open Hemispheric Brain Dominance Scale 1.0 (2015) was used to determine the hemispheric brain dominance. Result: Participants having no clear hemispheric brain preference (46.75%) were in majority followed by those with left hemispheric brain preference (29.25%) and then those with right hemispheric brain preference (24%). There was a statistically significant difference in academic score of students with different hemispheric brain preference (p=0.021). Students with left brain preference had the highest academic score (63.85±11.78) and those with no clear preference had the lowest (59.96±11.64). Also, students with left hemispheric brain preference would study more regularly and would spend more time in study per day. Conclusion: In our sample, participants with left hemispheric brain preference were found to have the highest mean academic score but they also spent more time in study and also studied regularly throughout the semester. As this study shows diversity in brain preference among medical students, we recommend a good mix of various teaching learning methods for better learning of the entire class

Isolation, Identification and Screening of Bacillus species with Antimicrobial Activity from Different Soil Samples of Kathmandu Valley

Bacillus species are one of the predominant soil bacteria that are able to produce essential secondary metabolites that have antagonistic effects on other microorganisms. They are Gram-positive, endospore-forming, chemoheterotrophic, aerobic or facultative anaerobic rods usually consisting of peritrichous flagella for motility. The major aim of this study was to isolate the antimicrobials producing Bacillus spp. from soil samples of different parts of the Kathmandu Valley, identify them and to assess their antimicrobial activity against different pathogenic bacteria. The test organisms used were Staphylococcus aureus (ATCC 25923), E. coli (ATCC 25922), Pseudomonas spp., Salmonella spp., methicillin-resistant Staphylococcus aureus (MRSA) and extended spectrum beta-lactamase (ESBL) producing E. coli. Twenty four isolates from 9 soil samples identified as Bacillus spp. showed the zone of inhibition around their growth on Nutrient agar during isolation. These 24 isolates were chosen for primary screening of production of antimicrobial by perpendicular streaking method using four test organisms. . Of these 24 isolates, six isolates showing a significant zone of inhibition (≥1mm) against two or more test organisms from the primary screening were chosen for secondary screening which was further tested with six test organisms including ESBL E.coli and MRSA. They were further characterized through different physiological and biochemical tests. All 6 isolates showed inhibitory action against MRSA and the largest zone of inhibition (30mm) was shown by isolate U6. Isolate U3 was found to have broad spectrum antimicrobial activity with inhibitory effect against gram negative organisms- Pseudomonas and Salmonella and gram positive organism S. aureus (ATCC 25923). Isolate U5 showed a zone of inhibition of about 25mm against S. aureus which was comparable to that of erythromycin. Hence, this study determines the soil in Kathmandu Valley as a potential source of antimicrobial producing Bacillus spp. and recommends isolation and further characterization of Bacillus isolates as a possible source of novel drug to combat with the emergence of multidrug resistant strains

Supplementary material for Phylogenomic analysis supports Mycobacterium tuberculosis transmission between humans and elephants

Supplementary information: Table S1: Detailed information on the 94 whole genomes retrieved from GenBank and used in this study.Peer reviewe

Phylogenomic analysis supports Mycobacterium tuberculosis transmission between humans and elephants

[Introduction]: Tuberculosis is an infectious disease caused by a group of acid-fast bacilli known as Mycobacterium tuberculosis complex (MTC), which has a major impact on humans. Transmission of MTC across the human-animal interface has been demonstrated by several studies. However, the reverse zoonotic transmission from humans to animals (zooanthroponosis) has often been neglected.[Methods]: In this study, we used Nanopore MinION and Illumina MiSeq approaches to sequence the whole genome of M. tuberculosis strains isolated from two deceased Asian elephants (Elephas maximus) and one human in Chitwan, Nepal. The evolutionary relationships and drug resistance capacity of these strains were assessed using the whole genome data generated by the stand-alone tool Tb-Profiler. Phylogenomic trees were also constructed using a non-synonymous SNP alignment of 2,596 bp, including 94 whole genome sequences representative of the previously described M. tuberculosis lineages from elephants worldwide (lineages 1 and 4) and from humans in Nepal (lineages 1, 2 and 3).[Results and discussion]: The new genomes achieved an average coverage of 99.6%, with an average depth of 55.67x. These M. tuberculosis strains belong to lineage 1 (elephant DG), lineage 2 (elephant PK) and lineage 4 (human), and none of them were found to have drug-resistant variants. The elephant-derived isolates were evolutionarily closely related to human-derived isolates previously described in Nepal, both in lineages 1 and 2, providing additional support for zooanthroponosis or bidirectional transmission between humans and elephants. The human-derived isolate clustered together with other published human isolates from Argentina, Russia and the United Kingdom in the lineage 4 clade. This complex multi-pathogen, multi-host system is challenging and highlights the need for a One Health approach to tuberculosis prevention and control at human-animal interface, particularly in regions where human tuberculosis is highly endemic.This work was supported by National Funds through FCT-Fundação para a Ciência e a Tecnologia in the scope of the project UIDP/50027/2020.Peer reviewe

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Multibacillary Leprosy Presenting as Anetoderma in a Young Teenager

Anetoderma presents as a circumscribed area of slack skin. It can present as either primary or secondary, if associated with other conditions. Leprosy is one of the causes of secondary anetoderma, but it is not commonly reported, especially in multibacillary leprosy. Here, we report a case of a 16-year-old young girl who presented with fever, joint pain, and only three anetodermic plaques. A slit skin smear from the lesion showed multiple acid-fast bacilli with a bacillary index of 3+, thus confirming the diagnosis of leprosy. This case is unique since multibacillary leprosy presented with only few anetoderma lesions in a young teenager girl from a leprosy-eliminated country