Results of Posterior Dislocation of Elbow Associated with Bony and Soft Tissue Injury

Elbow trauma is challenging to manage by virtue of its complex articular structure and capsuloligamentous and musculotendinous arrangements. We included 17 patients with elbow dislocation and associated injuries in this study. The study protocol included early elbow reduction and planned fixation of the medial or lateral condyle, coronoid and radial head. The sample was 73% male and 27% female with mean duration follow-up of 8 months, and mean age of 37 years. The mean Mayo Elbow Performance Score was 96 points at conclusion of follow-up, indicating an excellent result in 14 patients. Whenever the radial head was excised, we performed a strong transosseous ligamentous repair of the medial and lateral collateral ligaments. Fixation of the coronoid is essential for elbow stability. A small avulsed fragment can be fixed using an ACL jig. We found this technique very useful. Early planned intervention, stable fixation, and repair provide sufficient stability and enhance functional outcomes

Oxidants induce a corticosteroid-insensitive phosphorylation of histone 3 at serine 10 in monocytes

Oxidative stress enhances inflammation and reduces the effectiveness of corticosteroids, but the inflammatory signalling pathways induced by oxidants remain ill-defined. Phosphorylation of histone 3 at serine 10 (H3-Pser10) marks out a subset of inflammatory genes for transcription, several of which are induced in oxidant-associated inflammation. However, the influence of oxidants or of corticosteroids on this modification remains unknown. We assessed the regulation of H3-Pser10 by oxidants and lipopolysaccharide (LPS) in human blood monocytes and lung macrophages and the effectiveness of its abolition in controlling inflammatory gene expression in cells from asthmatic subjects compared to corticosteroids alone. Both oxidants and LPS promoted the induction of H3-Pser10 which was unaffected by corticosteroids. The induction of H3-Pser10 was mediated through p38α mitogen-activated protein kinase (MAPK) and IκB kinase 2 (IKK-2) signalling. Consequently, inhibitors of p38α MAPK or IKK-2 used in combination with dexamethasone were more effective at controlling inflammatory gene expression from monocytes and lung macrophages from asthmatic patients than the corticosteroid alone. Therefore, reduction of H3-Pser10 by inhibition of p38α MAPK or of IKK-2 may provide greater anti-inflammatory control than corticosteroids alone in oxidant-associated inflammation such as severe asthma

A Polymorphism Affecting MYB Binding within the Promoter of the PDCD4 Gene is Associated with Severe Asthma in Children

A previous genome-wide association study in asthma revealed putative associations that merit further investigation. In this study, the genome-wide significant associations of SNPs at the 5% false discovery rate were examined in independent groups of severe asthmatics. The panel consisted of 397 severe asthmatic adults, 116 severe asthmatic children, and a collection of 207 family-trios with an asthmatic proband. Three SNPs in the PDCD4 gene (rs6585018:G>A, rs1322997:C>A, and rs34104444:G>A) were significantly associated with severe childhood asthma (P values: 0.003, 0.002, 0.004) and total immunoglobulin E (IgE) levels (P values: 0.034, 0.041, 0.052). In an independent group of 234 asthmatic children and 652 controls, PDCD4 SNPs rs1407696:T>G and rs11195360:T>C were associated with total IgE levels (P values: 0.006, 0.014). In silico analysis of PDCD4 locus showed that rs6585018:G>A had the potential to affect MYB transcription factor binding, shown to act as a PDCD4-transcription inducer. Electromobility shift assays and reporter assays revealed that rs6585018:G>A alters MYB binding thereby influencing the expression of PDCD4. SNPs within MYB itself confer susceptibility to eosinophilia and asthma. Our association between a variant MYB binding site in PDCD4 and the severest form of childhood asthma therefore suggests that PDCD4 is a novel molecule of importance to asthmatic inflammatory responses

Modelling for understanding of COVID-19 spread and design of an isolation room in a hospital

We have modelled the transmission of coronavirus 2019 (COVID-19) in the isolation room of a patient suffering from severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) at the Royal Brompton Hospital (RBH) in London. An adaptive mesh computational fluid dynamics (CFD) model was used for simulations of 3D spatial distribution of SARS CoV 2 in the room. The modelling set-up is based on data collected in the room during the patient stay. A number of numerical experiments have been carried out to provide an optimal design layout of the overall isolation room. Our focus has been on (1) the location of the air extractor and filtration rates; (2) the bed location of the patient; and (3) consideration of the health and safety of the staff working area

Clinical and transcriptomic features of persistent exacerbation-prone severe asthma in U-BIOPRED cohort

Background: Exacerbation-prone asthma is a feature of severe disease. Yet, the basis for its persistency remains unclear. Objectives: To determine the clinical and transcriptomic features of the frequent-exacerbator (FE) and of persistent FEs (PFE) in U-BIOPRED cohort. Methods: We compared features of FE (≥2 exacerbations in past year) to infrequent exacerbators (IE, <2 exacerbations) and of PFE with repeat ≥2 exacerbations during the following year to persistent IE (PIE). Transcriptomic data in blood, bronchial and nasal epithelial brushings, bronchial biopsies and sputum cells were analysed by gene set variation analysis for 103 gene signatures. Results: Of 317 patients, 62.4 % were FE of whom 63.6% were PFE, while 37.6% were IE of whom 61.3% were PIE. Using multivariate analysis, FE was associated with short-acting beta-agonist use, sinusitis and daily oral corticosteroid use, while PFE with eczema, short-acting beta-agonist use and asthma control index. CEA Cell Adhesion Molecule 5 (CEACAM5) was the only differentially-expressed transcript in bronchial biopsies between PE and IE. There were no differentially-expressed genes in the other 4 compartments. There were higher expression scores for Type 2 , T-helper type-17 and Type 1 pathway signatures together with those associated with viral infections in bronchial biopsies from FE compared to IE, while higher expression scores of Type 2, Type 1 and steroid insensitivity pathway signatures in bronchial biopsies of PFE compared to PIE. Conclusion: FE group and its PFE subgroup are associated with poor asthma control while expressing higher Type 1 and Type 2 activation pathways compared to IE and PIE, respectively

Retinal changes in pregnancy-induced hypertension

Aims: The aim was to determine the prevalence of retinal changes in pregnancy-induced hypertension (PIH) and any association between the retinal changes and age, parity, blood pressure, proteinuria, and severity of the disease. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: All the patients admitted with a diagnosis of PIH were included in this study. Age, gravida, gestation period, blood pressure, and proteinuria were noted from the case records. Fundus examination was done with a direct ophthalmoscope. The findings were noted and were analyzed using SPSS program. Results: A total of 150 patients of PIH were examined. The mean age of patients was 25.1 years. The gestation period ranged from 27 weeks to 42 weeks; 76 (50.67%) were the primi gravida. 92 (61.33%) patients had gestational hypertension, 49 (32.67%) patients had preeclampsia, and 9 (6%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in 18 (12%) patients - Grade 1 in 12 (8%) and Grade 2 in 6 (4%). Hemorrhages or exudates or retinal detachment were not seen in any patient. There was statistically significant positive association of retinal changes and blood pressure (P = 0.037), proteinuria (P = 0.0005), and severity of the PIH (P = 0.004). Conclusions: Retinal changes were seen in 12% of patients with PIH. Occurrence of hypertensive retinopathy in PIH cases has been decreased due to better antenatal care and early detection and treatment of PIH cases. There is a greater chance of developing retinopathy with increase in blood pressure, severity of PIH, and proteinuria in cases of PIH

Epidemiology and patterns of lower limb injuries at a tertiary care hospital in Ahmedabad

Introduction: In the recent era of trauma, about one million people get seriously injured annually. Majority of them suffer from lower limb injuries. Due to lack of trauma registry in India, prediction models are not much effective. The aim of our study was to derive basic epidemiological parameters for lower limb injuries which can be used to develop better prediction models to reduce morbidities and mortalities. Methods: We conducted an observational study on isolated lower limb injuries without any musculoskeletal disorder at a tertiary care institution in Ahmedabad between January 2013 to October 2014. The lower limb injuries were classified as per the Limb Salvage Index score (LSI) for further management. Results: A total of 1160 patients were included. Mean age was 44.5 years and 75 percent of them were males. Lower limb injuries showed bi-modal age group with first peak between 30 to 40 years and second at 60 to 70 years. Road traffic accidents were the most common cause of injury followed by fall at home. 1.8 percent patients had Limb Salvage Index ranging between 7 to 12 and underwent amputations. Both lower limbs were almost equally affected with left showing a little higher value than right (49 versus 47 percent, p&gt;0.05). Femur was the most commonly affected bone. Conclusion: This study helped us in identifying certain characteristics that may be useful for planning preventive strategies in an attempt to reduce the numbers of accidents and redirect public investment in health

Correlation of preoperative co-morbidities with post-operative outcomes in patients operated for hip fractures

Introduction: As the population ages, disability and death is becoming more common in which hip fracture is one of the commonest cause. The purpose of this study is to analyse the effect of preoperative co-morbidities on postoperative outcomes in patients operated for hip surgery. This would also provide a reference for improved treatment and perioperative planning in order to have better survival chances in postoperative periods. Methods: This is an observational study in elderly patients ranging from 50-110 years of age for isolated hip fractures operated at a tertiary care hospital in Ahmedabad from January 2015 to January 2016. Patients were analyzed for one month mortality after hip fracture fixation. The co-morbidities encountered were then co-related with mortalities and conclusion drawn. Results: A total of 376 patients (54 percent males, 46 percent females) were taken for study. Analysis for one month mortality after hip fracture fixation showed that 7.7 percent deaths (45 percent males, 55 percent females) occurred within one month of operation. 51.7 percent of patients expired in first week. 17.2 percent in second week and 31.1 percent in later half of month. Conclusion: Study showed that postoperative mortality was directly proportional to the number of pre-operative co-morbidities. Patients who had ≥ 3 comorbidities had higher mortality risk, with two co-morbidities moderate risk and those having one or no comorbidity had higher survival chances in postoperative period. The presence of 3 or more comorbidities is the strongest preoperative risk factor for postoperative outcome

Outcome of Calcaneal Platting after fracture: two year follow-up

The present study is aimed to analyse the results of surgical outcome of the intra articular reduction of Calcaneal fractures fixed using better implants. The treatment of Calcaneal fractures have evolved from conservative to operative management during the last few years thanks to better understanding of fracture pattern and availability of better implants. Methods: Thirty intra-articular fractures were prospectively evaluated followed up for mean 18 months. Calcaneum plates and locking reconstruction plates and were used using the lateral approach. McMaster technique was used to measure the final inversion and eversion of the foot. Results: Height and width of the Calcaneum were restored within 0.5-1 cm as compared to the normal side. The results were extrapolated as excellent in 13 patients (43%), good result in 11(37%) patients and fair in 4 (14%) and poor in 02 patients (7%) using Maryland foot and AOFAS scoring system. Conclusion: Surgical management is the treatment of choice for the majority of Calcaneal fractures. Amount of initial injury is the primary determinant of future outcome especially comminution, soft tissue compromise and joint surface destruction. The value of Bohler angle &gt;20 degrees after reduction is good outcome factor. 86% patients have excellent and good results as per AOFAS and Marlyland foot score. The gait and joint range of motion are known to improve gradually with time and exercise