Complications following comminuted femoral shaft fractures treated with interlocking nail with or without inter fragmentary screw fixation for butterfly fragment: case series

Background: This case series is to highlight the complications following interfragmentary compression screw fixation for butterfly fragment while treating femoral shaft fractures with interlocking nail.Methods: Twelve cases have been included in this study conducted in institute of orthopaedics and traumatology, MMC & RGGGH, Chennai. All patients had shaft of femur fracture with butterfly fragment for which open reduction and interlocking nailing done. For 6 patients we applied interfragmentary screws for the butterfly fragment and in rest of the patients (6) patients we left the butterfly fragment in situ without disturbing the soft tissue attachment and bone grafting for the bone gap where ever necessary. We followed up the patient at 3 weeks, 6 weeks and 12 weeks, 6 months and 12 months.Results: All the six patients fixed with inter fragmentary screws had wound infection and went for infected nonunion for which appropriate management was done including revision nailing or LRS application. Union was achieved in 12 to 16 months after various surgical interventions. Remaining six patients in whom interfragmentary screws were not applied and primary bone grafting when and where necessary was done, showed radiological union by three months.Conclusions: Blood supply to large butterfly fragment is the main key for the healing process not the near normal anatomical reduction using interfragmentary screw for the butterfly fragment. Relative stability is enough for fracture union. In bone defects arising out of comminution primary bone grafting is essential for the bone healing.

Is It Coincidence or Consequence for a Case with Antiphospholipid Antibody Syndrome Overlapping SLE to Develop an Immune Complex Nephropathy Followed by a Nonimmune Complex Podocytopathy?

Antiphospholipid antibody syndrome (APS) may occur in a primary form or in association with SLE and seldom presents with nephrotic syndrome (NS). We present a case with APS who developed recurrent NS 6 years apart. The first episode of NS occurred with biopsy findings consistent with lupus nephritis (LN) class V (membranous) with no clear evidence of SLE, and responded to a remission with steroids and MMF. On the 2(nd) episode, the biopsy revealed negative immunofluorescent (IF) study for immune complexes and EM findings of complete effacement of foot processes and acellular debris in thickened capillary walls, compatible with healed previous episode of membranous LN and minimal change disease (MCD), a nonimmune complex podocytopathy. The 2(nd) episode responded to a partial remission, primarily with a short-term steroid therapy, and subsequently developed serologic evidence of SLE. Now there is growing evidence that a subset of SLE patients with NS are found to have MCD, likely due to podocyte injury caused by nonimmune complex pathway, called lupus podocytopathy. In LN, serial kidney biopsies often show transformation from one to another class of immune complex-induced glomerular lesions; however there are rare reports describing transformation of an immune complex to a nonimmune complex LN. Since the pathogenic mechanism of lupus podocytopathy is not delineated, and so far there are no reports on transformation of membranous LN, an immune complex nephropathy, to a nonimmune complex lupus podocytopathy, it still remains as a question whether our case with APS overlapping SLE had a concomitant membranous LN and lupus podocytopathy, or consequential membranous LN and lupus podocytopathy 6 years apart

Keratitis due to Chaetomium sp.

Aim. To describe keratitis due to Chaetomium sp. occurring in a 65-year-old woman who presented with a corneal ulcer with hypopyon of the right eye with a history of trauma by vegetable matter. Method. Multiple scrapings were obtained from the ulcer. A lactophenol cotton blue wet mount and a Gram-stained smear of the scrapings were made. Scrapings were also inoculated onto various culture media. Results. Direct microscopy of corneal scrapings revealed moderate numbers of septate fungal hyphae. Greenish-yellow-coloured fungal colonies with aerial mycelium were observed in culture of the corneal scrapes. On the basis of colony characteristics and conidial structure, the fungal isolate was identified as Chaetomium sp. The patient was treated with topical natamycin (5%) hourly and cyclopentolate 1% drops 3 times a day. After 4 weeks of therapy, the hypopyon had disappeared, the epithelial defect had healed, and the stromal infiltration had almost completely resolved; the visual acuity of the eye improved from hand movements to (1/2)/60. Conclusion. Fungi of the genus Chaetomium, which are rare causes of human disease (systemic mycosis, endocarditis, subcutaneous lesions), may also cause ocular lesions

Essential oils in ocular pathology: an experimental study

Introduction: The antimicrobial activity of essential oils (EOs) has been known for ages; in particular, the EOs of Melaleuca alternifolia, Thymus vulgaris, Mentha piperita, and Rosmarinus officinalis have been used for the treatment of fungal and bacterial infections. Methodology: This study focused on the in vitro cytotoxicity to normal human conjunctiva cells and antimicrobial activity of 20 EOs. Results: The oils tested showed no cytotoxic effect at very low concentrations. Rosmarinus officinalis, Melaleuca alternifolia, and Thymus vulgaris L. red thyme geraniol sel oils had good antimicrobial activity against Gram-positive and Gram-negative strains. Conclusions: The results of this study are of great interest and may have a major impact on public health, providing useful tips to optimize the therapeutic use of some natural drugs

Susceptibility of various corneal fungal isolates and <i>Pseudomonas aeruginosa</i> to contact lens disinfecting solutions

Introduction: We aimed to investigate the susceptibility of a combined inoculum of Pseudomonas aeruginosa and different fungal strains to 6 soft contact lens disinfectants. Methodology: One corneal isolate of P. aeruginosa and 13 corneal fungal isolates (9 Aspergillus spp, 3 Fusarium spp, 1 Curvularia sp.) were used. The following solutions were tested: Arion Cronos, Complete RevitaLens, Dua Elite, Opti-Free Express, Regard, Oxysept Comfort, and Oxysept Comfort without catalase. The effect of the solutions was assessed on a combined inoculum of P. aeruginosa plus 1 fungal strain. Suspensions of P. aeruginosa and fungi were made in the solutions (1x106 colony-forming units/mL). After 1 hour (Arion Cronos only), 6, 8, and 24 hours, aliquots of suspension were removed and seeded on Luria-Bertani and Sabouraud agar plates. Results: After 6 hours’ exposure, all the solutions but Dua Elite and Oxysept Comfort eradicated P. aeruginosa. Conversely, apart from 3% hydrogen peroxide-based Oxysept Comfort without catalase, which eradicated all the fungi tested after 6 hours, all the other solutions were partly ineffective at killing some of the fungal isolates, even after 24 hours’ exposure. Conclusions: Most contact lens disinfectants may be ineffective if contact lens care systems become co-contaminated with P. aeruginosa and fungi. In our experiment, only exposure to 3% hydrogen peroxide without neutralizer for at least 6 hours was always able to kill a combined inoculum of P. aeruginosa and different fungal strains.</br

post operative ocular infection due to streptococcus dysgalactiae subspecies equisimilis

Ocular infections due to Streptococcus dysgalactiae subsp. equisimilis are rare. In the present report, three patients with a history of uncomplicated small incision cataract surgery with intraocular lens implantation developed exogenous endophthalmitis due to Streptococcus dysgalactiae subsp. equisimilis. The identification of the organisms was confirmed by PCR for a 16S rRNA sequence specific to the species S. dysgalactiae. Intravitreal treatment of cefazolin and amikacin, in addition to topical ofloxacin and tobramycin, resulted in resolution of infection in all three patients. Our reports indicate the importance of bacterial culture and molecular identification in the diagnosis of S. dysgalactiae subsp. equisimilis infection in the eye