A study on management of tennis elbow by local platelet rich plasma injection

Background: Lateral epicondylitis (tennis elbow), a familiar term used to describe myriad symptoms around the lateral aspect of the elbow can occur during activities that require repetitive supination and pronation of the forearm with the elbow in near full extension. This condition can cause severe discomfort to the patient resulting in debilitation and impairment of routine activities. The purpose of this study was to evaluate the effectiveness of local autologous platelet rich plasma injection in the treatment of tennis elbow.Methods: This was a prospective observational study conducted on 50 patients of either sex with an average age of 45.92 years, presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, NUH, Haryana between November 2016 and February 2018, with a diagnosis of lateral epicondylitis. All the patients were treated with local platelet rich plasma injection and the results were analysed through the assessment of visual analog score (VAS) and disability of arm shoulder and hand (DASH) score. The patients were followed up for a period of 6 months after the local injection of platelet rich plasma.Results: Majority of the patients had significant relief with this method. The VAS and DASH score improved from the pre-treatment values of 8.7 and 74.6 to 2.6 and 29.8 respectively, which was found to be statistically significant (p<0.001).Conclusions: Thus results of our study demonstrate that the local injection of platelet rich plasma is a safe and effective method of treatment of lateral epicondylitis

A study on management of paediatric supracondylar humerus fractures with lateral percutaneous Kirschner wire fixation

Background: Supracondylar fracture of the humerus in children is a common injury encountered in orthopaedic practice. Undisplaced fractures can be managed conservatively, however displaced fractures need proper reduction and adequate fixation for attainment of optimal functional and cosmetic outcomes. The purpose of this study was to evaluate the effectiveness of lateral percutaneous Kirschner (K) wire fixation in the management of displaced supracondylar fractures in relation to achievement of union and functional results.Methods: This was a prospective observational study conducted on 70 patients of either sex with an average age of 5.98 years, presenting to the Orthopaedic Department of S.H.K.M. Government Medical College Hospital, Nalhar, Nuh, Haryana between February 2016 and February 2018, with displaced supracondylar fractures of humerus. All the patients were managed by closed reduction and percutaneous lateral K wire fixation. The patients were followed up for a period of 1 year. The patients were analyzed for union and functional results.Results: All the fractures united with an average time of union of 3.8 weeks. Functional results were assessed using Flynn’s criteria, which were excellent in 58 (82.86%), good in 7 (10%), fair in 3 (4.28%) and poor in 2 (2.86%) patients.Conclusions: Thus results of our study demonstrate that the lateral percutaneous K wire fixation is a safe and effective method of treatment of displaced paediatric supracondylar humerus fractures

Association of Physical Activity with Co-morbid Conditions in Geriatric Population

To find out association of physical activity with co-morbid conditions in geriatric population, a cross-sectional study was conducted in different cties of Pakistan in 2015. A total of 114 participants were inducted by non-probability convenience sampling technique. Data was collected after informed verbal consent by a validated questionnaire that is Rapid Assessment of Physical Activity (RAPA). Participants were categorized into two groups i.e. physically active and physically inactive. Data was entered and analyzed in SPSS version 20. There were 66 (57.9%) males and 48 (42.1%) females with mean age of 57.04±7.348 years. Among hypertensive individuals (n=43, 37.7%) there were 39 (90.7%) physically inactive, among individuals having angina (n=17, 14.9%) there were 15 (88.2%) physically inactive. Out of 37 (32.5%) diabetics, 35 (94.6%) were physically inactive. Among individuals suffering from arthritis (n=40, 35.1%), there were 38 (95%) physically inactive. A significant association was found between physical activity and diabetes and arthritis with p-value of 0.048 and 0.029 respectively. Physical activity is significantly associated with diabetes and arthritis in geriatric population. Adequate physical activity should be performed to reduce the risk of co-morbid conditions and improve the quality of life in geriatric population

Antioxidant, antimicrobial studies and characterisation of essential oil, fixed oil of Clematis graveolens by GC-MS

The GC-MS, antimicrobial and antioxidant activity of Clematis graveolens was assessed to explore its medicinal importance. Medicinal importance of its genus plants encourages us to undertake the comprehensive investigation of the essential oil and fixed oil of the leaves and stem. GC-MS analysis of essential and fixed oils showed the presence of many compounds in the leaves and stem parts of the plant like 2,2 dimethoxy butane (15.16%) flouroethane (45.14%) undecane (5.16), 1,2-benzenedicarboxylic acid (18.35), 3,8,12-tri-O-acetoxy-7-desoxyingol-7-one (12.74), propanoic acid, 2-(3-acetoxy-4,4,14-trimethylandrost-8-en-17-yl)- (9.14) and vitamine E acetate (4.38). The antimicrobial activity of the essential and fixed oil was resolute by disc diffusion and MIC (Minimum inhibitory concentration) assay and plant showed potent activity. Furthermore the antioxidant potential of essential and fixed oil was assessed by the DPPH, Reducing power and by percentage inhibition in linoleic acid system

Brain tumor classification in MRI image using convolutional neural network

Brain tumor is a severe cancer disease caused by uncontrollable and abnormal partitioning of cells. Recent progress in the field of deep learning has helped the health industry in Medical Imaging for Medical Diagnostic of many diseases. For Visual learning and Image Recognition, task CNN is the most prevalent and commonly used machine learning algorithm. Similarly, in our paper, we introduce the convolutional neural network (CNN) approach along with Data Augmentation and Image Processing to categorize brain MRI scan images into cancerous and non-cancerous. Using the transfer learning approach we compared the performance of our scratched CNN model with pre-trained VGG-16, ResNet-50, and Inception-v3 models. As the experiment is tested on a very small dataset but the experimental result shows that our model accuracy result is very effective and have very low complexity rate by achieving 100% accuracy, while VGG-16 achieved 96%, ResNet-50 achieved 89% and Inception-V3 achieved 75% accuracy. Our model requires very less computational power and has much better accuracy results as compared to other pre-trained models

Customer prioritization integrated supply chain optimization model with outsourcing strategies

Pre-COVID-19, most of the supply chains functioned with more capacity than demand. However, COVID-19 changed traditional supply chains’ dynamics, resulting in more demand than their production capacity. This article presents a multiobjective and multiperiod supply chain network design along with customer prioritization, keeping in view price discounts and outsourcing strategies to deal with the situation when demand exceeds the production capacity. Initially, a multiperiod, multiobjective supply chain network is designed that incorporates prices discounts, customer prioritization, and outsourcing strategies. The main objectives are profit and prioritization maximization and time minimization. The introduction of the prioritization objective function having customer ranking as a parameter and considering less capacity than demand and outsourcing differentiates this model from the literature. A four-valued neutrosophic multiobjective optimization method is introduced to solve the model developed. To validate the model, a case study of the supply chain of a surgical mask is presented as the real-life application of research. The research findings are useful for the managers to make price discounts and preferred customer prioritization decisions under uncertainty and imbalance between supply and demand. In future, the logic in the proposed model can be used to create web application for optimal decision-making in supply chains

Selective sweep and phylogenetic models for the emergence and spread of pyrimethamine resistance mutations in Plasmodium vivax

Pyrimethamine resistance is a major concern for the control of human haemoprotozoa, especially Plasmodium species. Currently, there is little understanding of how pyrimethamine resistance developed in Plasmodium vivax in the natural field conditions. Here, we present for the first time evidence of positive selection pressure on a dihydrofolate reductase locus and its consequences on the emergence and the spread of pyrimethamine resistance in P. vivax in the Punjab province of Pakistan. First, we examined the dihydrofolate reductase locus in 38 P. vivax isolates to look for evidence of positive selection pressure in human patients. The S58R (AGA)/S117N (AAC) double mutation was most common, being detected in 10/38 isolates. Single mutation S117N (AAC), I173L (CTT) and S58R (AGA) SNPs were detected in 8/38, 2/38 and 1/38 isolates, respectively. The F57L/I (TTA/ATA) and T61M (ATG) SNPs were not detected in any isolates examined. Although both soft and hard selective sweeps have occurred with striking differences between isolates, there was a predominance of hard sweeps. A single resistance haplotype was present at high frequency in 9/14 isolates, providing a strong evidence for single emergence of resistance by the single mutation, characteristics of hard selective sweeps. In contrast, 5/14 isolates carried multiple resistance haplotypes at high frequencies, providing an evidence of the emergence of resistance by recurrent mutations, characteristics of soft selective sweeps. Our phylogenetic relationship analysis suggests that S58R (AGA)/S117N (AAC) and S117N (AAC) mutations arose multiple times from a single origin and spread to multiple different cities in the Punjab province through gene flow. Interestingly, the I173L (CTT) mutation was present on a single haplotype, suggesting that it arises rarely and has not spread between cities. Our work shows the need for responsible use of existing and new antimicrobial drugs and their combinations, control the movement of infected patients and mosquito vector control strategies.•Illumina MiSeq deep amplicon sequencing was used to identify pyrimethamine resistance associated SNPs in Plasmodium vivax.•Pyrimethamine resistance was identified in field populations.•Positive selection pressure for resistance in human patients was investigated.•Hard and soft selective sweep models were used for the emergence of resistance.•Both single and multiple recurrent resistance mutations were spread by migration

A novel metabarcoded 18S ribosomal DNA sequencing tool for the detection of Plasmodium species in malaria positive patients.

Various PCR based methods have been described for the diagnosis of malaria, but most depend on the use of Plasmodium species-specific probes and primers; hence only the tested species are identified and there is limited available data on the true circulating species diversity. Sensitive diagnostic tools and platforms for their use are needed to detect Plasmodium species in both clinical cases and asymptomatic infections that contribute to disease transmission. We have recently developed for the first time a novel high throughput ‘haemoprotobiome’ metabarcoded DNA sequencing method and applied it for the quantification of haemoprotozoan parasites (Theleria and Babesia) of livestock. Here, we describe a novel, high throughput method using an Illumina MiSeq platform to demonstrate the proportions of Plasmodium species in metabarcoded DNA samples derived from human malaria patients. Plasmodium falciparum and Plasmodium vivax positive control gDNA was used to prepare mock DNA pools of parasites to evaluate the detection threshold of the assay for each of the two species. The different mock pools demonstrate the accurate detection ability and to show the proportions of each of the species being present. We then applied the assay to malaria-positive human samples to show the species composition of Plasmodium communities in the Punjab province of Pakistan and in the Afghanistan-Pakistan tribal areas. The diagnostic performance of the deep amplicon sequencing method was compared to an immunochromatographic assay that is widely used in the region. The deep amplicon sequencing showed that P. vivax was present in 69.8%, P. falciparum in 29.5% and mixed infection in 0.7% patients examined. The immunochromatographic assay showed that P. vivax was present in 65.6%, P. falciparum in 27.4%, mixed infection 0.7% patients and 6.32% malaria-positive cases were negative in immunochromatographic assay, but positive in the deep amplicon sequencing. Overall, metabarcoded DNA sequencing demonstrates better diagnostic performance, greatly increasing the estimated prevalence of Plasmodium infection. The next-generation sequencing method using metabarcoded DNA has potential applications in the diagnosis, surveillance, treatment, and control of Plasmodium infections, as well as to study the parasite biology.•We reported for the first time the development of Haemoprotobiome technology to quantify the P. falciparum and P. vivax.•P. falciparum and P. vivax mock pools demonstrate the accurate detection ability and to show the proportions of each of the species.•Haemoprotobiome demonstrates better diagnostic performance than immunochromatographic assay

Phylogenetic analysis suggests single and multiple origins of dihydrofolate reductase mutations in Plasmodium vivax

•58R and 173L single mutants and 58R/117N double mutants are present on a single lineage; suggesting a single origin of these mutations.•117N mutant is present on two separate lineages suggesting that there are multiple origins of this mutation.•Single mutation of 117N and double mutations of 58R/117N arise commonly, whereas the single mutation of 173L are less common.Pyrimethamine was first introduced for the treatment of malaria in Asia and Africa during the early 1980s, replacing chloroquine, and has become the first line of drugs in many countries. In recent years, development of pyrimethamine resistance in Plasmodium vivax has become a barrier to effective malaria control strategies. Here, we describe the use of meta-barcoded deep amplicon sequencing technology to assess the evolutionary origin of pyrimethamine resistance by analysing the flanking region of dihydrofolate reductase (dhfr) locus. The genetic modelling suggests that 58R and 173L single mutants and 58R/117N double mutants are present on a single lineage; suggesting a single origin of these mutations. The triple mutants (57L/58R/117N, 58R/61M/117N and 58R/117N/173L) share the lineage of 58R/117N, suggesting a common origin. In contrast, the 117N mutant is present on two separate lineages suggesting that there are multiple origins of this mutation. We characterised the allele frequency of the P. vivax dhfr locus. Our results support the view that the single mutation of 117N and double mutations of 58R/117N arise commonly, whereas the single mutation of 173L and triple mutations of 57L/58R/117N, 58R/61M/117N and 58R/117N/173L are less common. Our work will help to inform mitigation strategies for pyrimethamine resistance in P. vivax

Sentinel surveillance of selected veterinary and public health pathogens in camel population originating from Southern Punjab province, Pakistan

An extended range of host susceptibility including camel has been evidenced for some of the important veterinary and public health pathogens, such as brucellosis, peste des petits ruminants (PPR) and bluetongue (BT). However, in disease endemic settings across many parts of the globe, most of the disease control interventions accounts for small and large ruminants, whereas unusual hosts and/or natural reservoirs, such as camels, remain neglected for disease control measures including routine vaccination. Such a policy drawback not only plays an important role in disease epizootiology particularly in settings where disease is endemic, but also serves an obstacle in disease control and subsequent eradication in future. With this background, using pre-validated ELISA and molecular assays [multiplex PCR, reverse transcriptase (RT)-PCR and real-time (rt)-PCR], we conducted a large-scale pathogen- and antibody-based surveillance for brucellosis, peste des petits ruminants and bluetongue in camel population (n = 992) originating from a wide geographical region in southern part of the Punjab province, Pakistan. Varying in each of the selected districts, the seroprevalence was found to be maximum for bluetongue [n = 697 (70.26%, 95% CI: 67.29–73.07)], followed by PPR [n = 193 (19.46%, 95% CI: 17.07–22.09)] and brucellosis [n = 66 (6.65%, 95% CI: 5.22–8.43)]. Odds of seroprevalence were more significantly associated with pregnancy status (non-pregnant, OR = 2.23, 95% CI: 1.86–5.63, p<0.01), farming system (mixed-animal, OR = 2.59, 95% CI: 1.56–4.29, p<0.01), breed (Desi, OR = 1.97, 95% CI: 1.28–4.03, p<0.01) and farmer education (illiterate, OR = 3.17, 95% CI: 1.45–6.93, p<0.01) for BTV, body condition (normal, OR = 3.54, 95% CI: 1.92–6.54, p<0.01) and breed (Desi, OR = 2.19, 95% CI: 1.09–4.40, p<0.01) for brucellosis, and feeding system for PPR (grazing, OR = 2.75, 95% CI: 1.79–4.22, p<0.01). Among the total herds included (n = 74), genome corresponding to BT virus (BTV) and brucellosis was detected in 14 (18.92%, 95 CI: 11.09–30.04) and 19 herds (25.68%, 95% CI: 16.54–37.38), respectively. None of the herds was detected with genome of PPR virus (PPRV). Among the positive herds, serotype 1, 8 and 11 were detected for BTV while all the herds were exclusively positive to B. abortus. Taken together, the study highlights the role of potential disease reservoirs in the persistence and transmission of selected diseases in their susceptible hosts and, therefore, urges necessary interventions (e.g., inclusion of camels for vaccine etc.) for the control of diseases from their endemic setting worldwide