Approach to Lower Limb Disabilities in Cerebral Palsy: An Educational Corner

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Immunoinformatics and Similarity Analysis of House Dust Mite Tropomyosin

Background: Dermatophagoides farinae and Dermatophagoides pteronyssinus are house dust mites (HDM) that they cause severe asthma and allergic symptoms. Tropomyosin protein plays an important role in mentioned immune and allergic reactions to HDMs. Here, tropomyosin protein from Dermatophagoides spp. was comprehensively screened in silico for its allergenicity, antigenicity and similarity/conservation.Materials and Methods: The amino acid sequences of D. farinae tropomyosin, D. pteronyssinus and other mites were retrieved. We included alignments and evaluated conserved/ variable regions along sequences, constructed their phylogenetic tree and estimated overall mean distances. Then, followed by with prediction of linear B-cell epitope based on different approaches, and besides in-silico evaluation of IgE epitopes allergenicity (by SVMc, IgE epitope, ARPs BLAST, MAST and hybrid method). Finally, comparative analysis of results by different approaches was made.Results: Alignment results revealed near complete identity between D. farina and D. pteronyssinus members, and also there was close similarity among Dermatophagoides spp. Most of the variations among mites' tropomyosin were approximately located at amino acids 23 to 80, 108 to 120, 142 to 153 and 220 to 230. Topology of tree showed close relationships among mites in tropomyosin protein sequence, although their sequences in D. farina, D. pteronyssinus and Psoroptes ovis are more similar to each other and clustered. Dermanyssus gallinae (AC: Q2WBI0) has less relationship to other mites, being located in a separate branch. Hydrophilicity and flexibility plots revealed that many parts of this protein have potential to be hydrophilic and flexible. Surface accessibility represented 7 different epitopes. Beta-turns in this protein are with high probability in the middle part and its two terminals. Kolaskar and Tongaonkar method analysis represented 11 immunogenic epitopes between amino acids 7-16. From comparative analysis of predicted probable consensus epitope regions by machine learning approaches these epitopes were gained: AA23-48, AA59-80, AA91-110, AA114-143, AA154-168, AA182-200, AA208-225, and AA254-272. Prediction of allergenic proteins by AlgPred server showed 10 matches for IgE epitope, and prediction by hybrid approach showed that IgE epitope is undoubtedly the major allergen.Conclusion: Immunoinformatic approaches in allergenic protein analysis are now reliable tools for explanation/interpretation of clinically observed complexities. Results of present study, would help in HDM immunotherapy against several species of parasites as a wide range epitopic desensitization or prevention (vaccine) regime

Proximal Humeral Fracture; Predictors of Functional and Radiologic Outcome

Background: Despite the high prevalence of proximal humeral fracture, one of the most prevalent osteoporotic fractures, its treatment has always been challenging. Here we are going to determine the factors that affect the outcomes of such fractures. Methods: The present retrograde cohort study was conducted in a tertiary trauma center during 2015-2020. The Neer classification was used to classify fracture severity. Patients’ functional status was measured using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant-Murley ‎Score (CMS). Patients were selected thorough purposive sampling method.   Results: The study participants included 70 patients with a mean age of 50.47 ± 16.73 years. The 3 treatment options of open reduction and internal fixation (ORIF) (39 cases; 52%), hemiarthroplasty (3 cases; 4%), and conservative treatment (33 patients; 44%) were considered. Malunion was the most prevalent complication in the study population (9 cases; 12%). The mean DASH score of the participants was 29.91 ± 20.43. The mean DASH score in patients of over 65 years of age was higher than in those under 65 years (36.97 vs. 28.14; P = 0.136). The score in patients underwent surgery (ORIF and hemiarthroplasty) showed a significant difference compared to the patients who were treated non-surgically (P = 0.050). The mean CMS of participants was 64.09 ± 22.71. The mean age of patients classified as “poor” was significantly higher than the “excellent” group (P = 0.041). The mean visual analogue scale (VAS) score of the participants was 2.80 ± 2.49. The VAS score was significantly higher in patients with more severe fracture based on the Neer classification (P = 0.050).   Conclusion: The present study results showed the significant effect of age, fracture severity, and underlying disease on the proximal humeral fracture outcome. A longer follow-up period was observed in patients who had better functional outcomes. However, more studies with larger sample size are required to evaluate proximal humeral fracture outcomes in order to help us to improve outcomes and reduce complications

Evaluation of wrist arthroscopy outcomes in patients with chronic wrist pain

Background: Wrist arthroscopy is an evolving diagnostic and therapeutic modality which is progressively used by Iranian surgeons. Little data is published about the procedure’s indications, outcomes, complications and prognostic factors. In following study we evaluate the outcome and complications of diagnostic and therapeutic arthroscopy in our patients. Methods: In a prospective study from September 2009 to March 2013, 100 patients entered in the study. All the patients had chronic wrist pain without any sign of improvement despite at list three months non-operative treatment and underwent diagnostic and therapeutic wrist arthroscopy. All patients were evaluated by wrist range of motion, visual analogue scale (VAS), the quick-disabilities of the arm, shoulder and hand (Q-DASH), and Mayo wrist functional score before and after arthroscopy. Patients were visited at 3, 6, 12 weeks intervals after surgery and every six months thereafter. The most frequent diagnoses were triangular fibrocartilage complex (TFCC) injury, dorsal wrist ganglion cyst and Kienbock disease which were treated with accordant arthroscopic methods. Major and minor complications of arthroscopy and prognostic factors were evaluated. Results: Eighty nine patients participated in long term follow-up. The follow-up duration was 19±13 months. At final fallow-up there were 28.6±9.6 degrees improvement in wrist range of motion, 5.1±3.4 reduction in VAS score (P<0.04), 37.9±30 improvement in Mayo functional wrist score (P<0.02) and 47.5±33 reduction in Q-DASH score (P=0.009). 82% of patients were satisfied with postoperative results and 16% experienced recurrence. The preoperative diagnosis was not a prognostic factor for outcome of arthroscopic treatment. The rate of postoperative complications was 31.4%, which most of them were minor and transient complications. The most frequent complication of wrist arthroscopy in our patients was transient hypoesthesia in superficial ulnar nerve territory. Conclusion: According to our results, wrist arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon

Molecular Epidemiology and Phylogeny of Crimean-Congo Haemorrhagic Fever (CCHF) Virus of Ixodid Ticks in Khorasan Razavi Province of Iran

Background: Crimean–Congo hemorrhagic fever (CCHF) is a fatal disease caused by Nairovirus classified within the Bunyaviridae family. The virus is transmitted to humans through the bites of infected ticks or direct contact with viremic animals or humans. The current study aimed to detect the virus genome in ticks from Khorasan Razavi Province. Methods: One hundred hard ticks were collected randomly from 100 sheep in four different areas of the province. Collected ticks were kept alive and identified. All the ticks were analyzed for the presence of CCHF virus genome using reverse transcriptase polymerase chain reactions (RT-PCR). Results: The identified ticks were belonging to Hyalomma marginatum (16% female and 6% male), Rhipicephalus turanicus (52% female and 25% male), and Dermacentor raskemensis (1%). The CCHF virus genome was found in Hyalomma marginatum (5% male from Taibad and Sabzevar region and 1% female from Taibad). Genetic analysis of the virus genome isolated from two regions (Sabzevar and Taibad) showed 100% identity. Conclusion: This study indicated that CCHF should be regarded as a risk-borne infection in this province. Therefore, special health management is needed to control this disease

Comparison and Evaluation of Current Animal Models for Perineural Scar Formation in Rat

  Objective (s): Scar formation in injured peripheral nerve bed causes several consequences which impede the process of nerve regeneration. Several animal models are used for scar induction in preclinical studies which target prevention and/or suppression of perineural scar. This study evaluates the translational capacity of four of physical injury models to induce scar formation around the sciatic nerve of rat: laceration, crush, mince and burn.   Materials and Methods: Functional (Toe out angle), macroscopic, and microscopic evaluations were performed weekly for four weeks and correlation of findings were analyzed. Result: While macroscopic and microscopic findings suggested a well-developed and adhesive fibrosis surrounding the sciatic nerve, functional assessment did not reveal any significant difference between control and experimental groups (P>0.05). Conclusion: Our study suggests that none of the applied animal models reproduce all essential features of clinical perineural scar formation. Therefore, more studies are needed to develop optimal animal models for translating preclinical investigation

Biomechanical analysis of different osteosynthesis configurations in the pin and plate fixation method for distal humerus fractures

Abstract Distal humerus fractures commonly occur in adults with low bone mineral density causing major technical challenges for orthopedic surgeons. Persian fixation method was introduced as a novel technique to stabilize small fragments in comminuted distal humerus fractures using a set of K-wires and a reconstruction plate. The present study aims to measure this technique's stiffness and stability of this technique and analyze the effect of influential parameters with numerical simulation and biomechanical testing on a cadaveric specimen. Validation of the finite element (FE) model was conducted based on results of experiments. The results indicated that Delta configuration mainly led to a higher stiffness in the case of axial loading and anterior bending compared to L configuration. Analyzing the influential factors of this technique suggests that changes in diameter and number of K-wires have a similarly significant effect on the construct stiffness while the height of plate had a slight influence. Also, the diameter of wires was the most effective parameter for implant failure, particularly in the 3-pin construct, which caused a reduction in failure risk by about 60%. The results revealed that the Persian fixation method would achieve suitable stability compared to the dual-plating technique