Outcome of three dimensional osteotomy for cubitus varus deformity

Background: Cubitus varus is the most common angular deformity resulting from supracondylar fracture of the humerus in children and adults. There are several options for correcting this deformity, but three dimensional osteotomy is now a popular method for the operative treatment of cubitus varus deformity. Objective of current study was to evaluate clinical and radiological outcome of three dimensional corrective osteotmy for cubitus varus deformity.Methods: This prospective interventional study was conducted in the department of orthopaedic surgery, BSMMU, Shahbag, Dhaka from January 2016 to September 2020. Within this period, total 40 cases of cubitus varus deformity, age ranging from 8-20 years that has the inclusion criteria was enrolled as a study sample with proper consent. All the data were analyzed statistically by using SPSS-22.Results: The results of present study showed significantly improved carrying angle, range of motion, internal rotation angle at the time of final follow-up period of six months or more. The outcome of the subjects was graded as excellent in 16 (40%), good in 18 (45%), fair in 4 (10%) and poor in 2 (5%) patients. Excellent, good and fair results were considered as satisfactory outcome and only poor result was considered as unsatisfactory outcome.Conclusions: After analyzing the results of present study it can be concluded that three dimensional osteotomy is a safe technique with satisfactory outcome in treatment of cubitus varus deformity

Efficacy of expressed breast milk alone or in combination with paracetamol in reducing pain during retinopathy of prematurity screening: A randomized controlled trial

Background: The aim of this study was to determine the efficacy of expressed breast milk (EBM) alone or in combination with oral paracetamol for pain reduction during retinopathy of prematurity (ROP) screening.  Methods: A randomized control trial was conducted in two departments of Bangabandhu Sheikh Mujib Medical University. A total of 60 preterm neonates who underwent ROP screening were randomized into three equal groups. Group A got nesting and swaddling as per institutional protocol (control). Group B received 2 ml EBM two minutes prior to the ROP screening and Group C received 15 mg/kg syrup paracetamol 30 minutes prior to the ROP screening and EBM like Group B. Premature infant pain profile (PIPP) scores was used prior, during and 2 minutes after ROP screening procedure. Results: The three groups were similar in terms of baseline characteristics. The mean (standard deviation) PIPP scores during the procedure were 16.4 (1.1), 15.0 (1.8) and 13.4 (1.8) in control, EBM, and EBM with paracetamol groups respectively. The PIPP scores were significantly lower in the EBM and EBM with paracetamol groups during the procedure compared to control group. In the EBM and EBM with paracetamol groups, the mean difference in PIPP scores (between before and during the procedure) was also substantially lower. Conclusion: Breast milk alone or in combination with paracetamol can reduce significant pain during ROP screening than control group. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(2): 106-11

SARS-CoV-2 B.1.617.2 Delta variant replication and immune evasion

Abstract: The B.1.617.2 (Delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in the state of Maharashtra in late 2020 and spread throughout India, outcompeting pre-existing lineages including B.1.617.1 (Kappa) and B.1.1.7 (Alpha)1. In vitro, B.1.617.2 is sixfold less sensitive to serum neutralizing antibodies from recovered individuals, and eightfold less sensitive to vaccine-elicited antibodies, compared with wild-type Wuhan-1 bearing D614G. Serum neutralizing titres against B.1.617.2 were lower in ChAdOx1 vaccinees than in BNT162b2 vaccinees. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies to the receptor-binding domain and the amino-terminal domain. B.1.617.2 demonstrated higher replication efficiency than B.1.1.7 in both airway organoid and human airway epithelial systems, associated with B.1.617.2 spike being in a predominantly cleaved state compared with B.1.1.7 spike. The B.1.617.2 spike protein was able to mediate highly efficient syncytium formation that was less sensitive to inhibition by neutralizing antibody, compared with that of wild-type spike. We also observed that B.1.617.2 had higher replication and spike-mediated entry than B.1.617.1, potentially explaining the B.1.617.2 dominance. In an analysis of more than 130 SARS-CoV-2-infected health care workers across three centres in India during a period of mixed lineage circulation, we observed reduced ChAdOx1 vaccine effectiveness against B.1.617.2 relative to non-B.1.617.2, with the caveat of possible residual confounding. Compromised vaccine efficacy against the highly fit and immune-evasive B.1.617.2 Delta variant warrants continued infection control measures in the post-vaccination era

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Sinapic acid prevents hypertension and cardiovascular remodeling in pharmacological model of nitric oxide inhibited rats.

Hypertensive heart disease is a constellation of abnormalities that includes cardiac fibrosis in response to elevated blood pressure, systolic and diastolic dysfunction. The present study was undertaken to examine the effect of sinapic acid on high blood pressure and cardiovascular remodeling.An experimental hypertensive animal model was induced by L-NAME intake on rats. Sinapic acid (SA) was orally administered at a dose of 10, 20 and 40 mg/kg body weight (b.w.). Blood pressure was measured by tail cuff plethysmography system. Cardiac and vascular function was evaluated by Langendorff isolated heart system and organ bath studies, respectively. Fibrotic remodeling of heart and aorta was assessed by histopathologic analyses. Oxidative stress was measured by biochemical assays. mRNA and protein expressions were assessed by RT-qPCR and western blot, respectively. In order to confirm the protective role of SA on endothelial cells through its antioxidant property, we have utilized the in vitro model of H2O2-induced oxidative stress in EA.hy926 endothelial cells.Rats with hypertension showed elevated blood pressure, declined myocardial performance associated with myocardial hypertrophy and fibrosis, diminished vascular response, nitric oxide (NO) metabolites level, elevated markers of oxidative stress (TBARS, LOOH), ACE activity, depleted antioxidant system (SOD, CAT, GPx, reduced GSH), aberrant expression of TGF-β, β-MHC, eNOS mRNAs and eNOS protein. Remarkably, SA attenuated high blood pressure, myocardial, vascular dysfunction, cardiac fibrosis, oxidative stress and ACE activity. Level of NO metabolites, antioxidant system, and altered gene expression were also repaired by SA treatment. Results of in vitro study showed that, SA protects endothelial cells from oxidative stress and enhance the production of NO in a concentration dependent manner.Taken together, these results suggest that SA may have beneficial role in the treatment of hypertensive heart disease by attenuating fibrosis and oxidative stress through its antioxidant potential

Sinapic acid prevents deregulated expression of cardiovascular genes.

<p>(A) Relative expression fold changes of TGF-β and β-MHC mRNAs in heart. (B) Relative expression negative fold change of eNOS mRNA in aorta. (C) Differential eNOS protein expression in aorta and its normalized value with β-actin. Values are expressed as means ± SD. All experiments were done in triplicates. ^*<i>P</i><0.05 vs control; ^#<i>P</i><0.05 vs L-NAME.</p

acid decreases total ROS and improves NO level in EA.hy926 cells.

<p>10 µM SA was pre-treated for 24 h prior to incubation of cells with 300 µM of H₂O₂ for 4 h. (A) Intracellular total ROS level was measured by the fluorescent probe DCFH-DA and the images were obtained by fluorescence microscopy. (B) NO level was measured by the fluorescent probe DAR-4M AM and the images were obtained by fluorescence microscopy. The representative images from three independent experiments are shown. (C) Total ROS fluorescence intensity value was calculated using Adobe Photoshop version 7.0. (D) Fluorescence intensity measurement against NO was calculated using Adobe Photoshop version 7.0. RFU: Relative Fluorescence Unit. Values are expressed as mean ± SEM. ^*<i>P</i><0.05 vs control; ^#<i>P</i><0.05 vs H₂O₂.</p

Sinapic acid improved cardiovascular function in experimental hypertensive rats.

<p>(A) Evaluation of ventricular function in heart of various experimental groups. (B) Cumulative concentration-response curves of Ach induced relaxation in endothelium-intact aortic rings. (C) Cumulative concentration-response curves of SNP induced relaxation in endothelium-intact aortic rings. Values are expressed as mean ± SD. n = 6 per group. ^*<i>P</i><0.05 vs control; ^#<i>P</i><0.05 vs L-NAME.</p

Sinapic acid restores nitric oxide metabolites level and ACE activity in experimental hypertensive rats.

<p>(A) Estimation of nitric oxide metabolites level in various experimental groups. (B) Assessment of ACE activity in various experimental groups. Values are expressed as mean ± SD. n = 6 per group. ^*<i>P</i><0.05 vs control; ^#<i>P</i><0.05 vs L-NAME.</p