Incidence of coronary artery disease before valvular replacement in isolated severe aortic stenosis patients in Western Rajasthan

Background: The aim of the study was to evaluate the incidence of Coronary artery disease (CAD) and predictors of CAD in patients with severe AS in western Rajasthan population.Methods: Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Udaipur were entered in a prospective registry beginning in 2015. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.Results: Mean age of 55 enrolled patients was 52.64±15.5 years. Diabetes mellitus and hypertension were present in 3.64% and 5.45% of patients, respectively. Moderate and severe Left ventricular ejection fraction (LVEF) was found in 16.36% and 10.91% patients, respectively. Only 5.45% patient had severe CAD and thus underwent AVR and coronary artery bypass grafting, and rest 94.55% patients underwent AVR. Mean age of patients who underwent AVR was 51.75±15.36 years and who underwent AVR and CABG was 68±11.14 years with no significant association (p=0.078). Proportion of patients requiring AVR and CABG was significantly higher in moderate (22.22%) and severe LVEF (16.67%) as compared to normal or mild (p=0.034).Conclusions: Coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients above 68 years of age without risk factors for cardiovascular disease. However, larger studies on heterogeneous population are required to prove our findings.

Management outcomes in pubic diastasis: our experience with 19 patients

<p>Abstract</p> <p>Background</p> <p>Pubic diastasis, a result of high energy antero-posterior compression (APC) injury, has been managed based on the Young and Burguess classification system. The mode of fixation in APC II injury has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the posterior pelvic ring elements in these injuries.</p> <p>Methods</p> <p>The study included a total of 19 patients with pubic diastasis managed by us from May 2006 to December 2007. There was a single patient with type I APC injury who treated conservatively. Type II APC injuries (13 patients) were treated surgically with symphyseal plating using single anterior/superior plates or double perpendicularly placed plates. Type III injuries (5 patients) in addition underwent posterior fixation using plates or percutaneous sacro-iliac screws. The outcome was assessed clinically (Majeed score) and radiologically.</p> <p>Results</p> <p>The mean follow-up was for 2.9 years (6 months to 4.5 years). Among the 13 patients with APC II injuries, the clinical scores were excellent in one (7.6%), good in 6 (46.15%), fair in 4 (30.76%) and poor in 2 (15.38%). Radiological scores were excellent in 2 (15.38%), good in 8 (61.53%), fair in 2 (15.38%) and poor in one patient (7.6%). Among the 5 patients with APC III injuries, there were 2 patients each with good (50%) and fair (50%) clinical scores while one patient was lost on long term follow up. The radiological outcomes were also similar in these. Complications included implant failure in 3 patients, postoperative infection in 2 patients, deep venous thrombosis in one patient and bladder herniation in one of the patients with implant failure.</p> <p>Conclusions</p> <p>There is no observed dissimilarity in outcomes between isolated anterior and combined symphyseal (perpendicular) plating techniques in APC II injuries. Single anterior symphyseal plating along with posterior stabilisation provides a stable fixation in type III APC injuries. Limited dissection ensuring adequate intactness of rectus sheath is important to avoid long term post-operative complications.</p

Znaczenie osi koniuszkowo-mitralnej w trakcie przezskórnej komisurotomii mitralnej

The development of acute severe mitral regurgitation (MR) requiring surgery is one of the most dreaded complications of percutaneous transmitral commissurotomy. We present the case of a 29 year-old female with severe rheumatic mitral stenosis whose mitral valve dilatation was performed using an Accura balloon. Once the balloon catheter had crossed the mitral valve to reach the left ventricle, it was facing away from the apico-mitral axis. It was inflated in distal portion, and mitral valve dilatation was done in the usual fashion. She developed acute severe MR. As it was misaligned with the apico-mitral axis, it caused a chordae rupture of the postero-medial papillary muscle which was identified during surgery. We conclude that a misaligned Accura balloon catheter during balloon inflation can pluck the chordae tendinae and can cause acute severe mitral regurgitation, and therefore can unearth the underlying subvalvular pathology.Rozwój ostrej ciężkiej niedomykalności zastawki mitralnej (MR) wymagającej leczenia chirurgicznego jest jednym z najpoważniejszych powikłań przezskórnej komisurotomii mitralnej. W niniejszej pracy przedstawiono przypadek 29-letniej kobiety z ciężką reumatyczną stenozą zastawki mitralnej, u której zwężoną zastawkę poszerzono za pomocą balonu Accura. Po przejściu przez zastawkę mitralną i wejściu do lewej komory cewnik balonowy odchylił się od osi koniuszkowo-mitralnej. Wypełniono dystalną cześć cewnika i poszerzono zastawkę mitralną stosowaną zwykle techniką. U chorej rozwinęła się ciężka MR. Odchylenie cewnika od osi koniuszkowo-mitralnej spowodowało zerwanie struny ścięgnistej tylno-przyśrodkowego mięśnia brodawkowatego, co stwierdzono w czasie zabiegu chirurgicznego. Autorzy konkludują, że nieprawidłowe ustawienie cewnika balonowego Accura w trakcie napełniania balonu może spowodować zerwanie struny ścięgnistej i doprowadzić do ostrej ciężkiej MR, a tym samym ujawnić wadę podzastawkową

Jurassic frogs and the evolution of amphibian endemism in the Western Ghats

The diversity of frogs and toads (Anurans) in tropical evergreen forests has recently gained importance with reports of several new species1. We describe here a fossorial frog taxon related to the African Heleophrynidae and Seychellian Sooglossidae from the Western Ghats of India. This frog possesses a suite of unique ancient characters indicating that it is a transitional form between Archaeobatrachians and Neobatrachians. Molecular clock analysis based on the nucleotide diversity in mitochondrial 12S and 16S genes dates this frog as a Gondwana relic, which evolved 150–195 Mya during the mid-Jurassic period.With this taxon, the evolution of endemism in the Western Ghats and other Gondwana break up landmasses is now dated much before the Cretaceous–Tertiary boundary. We propose that sea level surges in the late Jurassic2 isolated tablelands creating insular amphibian fauna. Reduction in area may have promoted stochastic extinctions and resulted in amphibian endemism. Our study reinforces the conservation significance of the Western Ghats as major global hotspot of biodiversity. The habitat of this endemic amphibian lineage is currently endangered due to various upcoming dam projects, which is a cause of serious conservation concern

Development of new genomic microsatellite markers from robusta coffee (Coffea canephora Pierre ex A. Froehner) showing broad cross-species transferability and utility in genetic studies

<p>Abstract</p> <p>Background</p> <p>Species-specific microsatellite markers are desirable for genetic studies and to harness the potential of MAS-based breeding for genetic improvement. Limited availability of such markers for coffee, one of the most important beverage tree crops, warrants newer efforts to develop additional microsatellite markers that can be effectively deployed in genetic analysis and coffee improvement programs. The present study aimed to develop new coffee-specific SSR markers and validate their utility in analysis of genetic diversity, individualization, linkage mapping, and transferability for use in other related taxa.</p> <p>Results</p> <p>A small-insert partial genomic library of <it>Coffea canephora</it>, was probed for various SSR motifs following conventional approach of Southern hybridisation. Characterization of repeat positive clones revealed a very high abundance of DNRs (1/15 Kb) over TNRs (1/406 kb). The relative frequencies of different DNRs were found as AT >> AG > AC, whereas among TNRs, AGC was the most abundant repeat. The SSR positive sequences were used to design 58 primer pairs of which 44 pairs could be validated as single locus markers using a panel of arabica and robusta genotypes. The analysis revealed an average of 3.3 and 3.78 alleles and 0.49 and 0.62 PIC per marker for the tested arabicas and robustas, respectively. It also revealed a high cumulative PI over all the markers using both sib-based (10^-6and 10^-12for arabicas and robustas respectively) and unbiased corrected estimates (10^-20and 10^-43for arabicas and robustas respectively). The markers were tested for Hardy-Weinberg equilibrium, linkage dis-equilibrium, and were successfully used to ascertain generic diversity/affinities in the tested germplasm (cultivated as well as species). Nine markers could be mapped on robusta linkage map. Importantly, the markers showed ~92% transferability across related species/genera of coffee.</p> <p>Conclusion</p> <p>The conventional approach of genomic library was successfully employed although with low efficiency to develop a set of 44 new genomic microsatellite markers of coffee. The characterization/validation of new markers demonstrated them to be highly informative, and useful for genetic studies namely, genetic diversity in coffee germplasm, individualization/bar-coding for germplasm protection, linkage mapping, taxonomic studies, and use as conserved orthologous sets across secondary genepool of coffee. Further, the relative frequency and distribution of different SSR motifs in coffee genome indicated coffee genome to be relatively poor in microsatellites compared to other plant species.</p

Genetic heterogeneity in wild isolates of cellular slime mold social groups

This study addresses the issues of spatial distribution, dispersal, and genetic heterogeneity in social groups of the cellular slime molds (CSMs). The CSMs are soil amoebae with an unusual life cycle that consists of alternating solitary and social phases. Because the social phase involves division of labor with what appears to be an extreme form of "altruism", the CSMs raise interesting evolutionary questions regarding the origin and maintenance of sociality. Knowledge of the genetic structure of social groups in the wild is necessary for answering these questions. We confirm that CSMs are widespread in undisturbed forest soil from South India. They are dispersed over long distances via the dung of a variety of large mammals. Consistent with this mode of dispersal, most social groups in the two species examined for detailed study, Dictyostelium giganteum and Dictyostelium purpureum, are multi-clonal

Intra and extraarticular localized pigmented villonodular synovitis

A 28 year old woman had a history of knee trauma and presented with unilateral knee acute swelling and pain symptoms with sudden onset, which was there from last 2 years. She had been treated for seronegative rheumatoid patient for 1 year. Recent expansion of the LPVNS (localized pigmented villonodular synovitis) caused the development of a tender palpable soft tissue mass in the anterolateral aspect of the knee and acute reduced mobility. Preoperative magnetic resonance imaging of the knee revealed the presence of only the soft tissue mass and mild degenerative changes. Open synovectomy was performed successfully to excise the mass. Intraoperatively, macroscopic features of the bright brown inflamed synovium suggested LPVNS, which was confirmed histopathologically. Postoperatively, the symptoms of limited mobility and pain were appreciably relieved. Recurrence was not observed during the clinical follow up at 1, 6 or 18 months after surgery. Here, we reported the unique case of localized pigmented villonodular synovitis of the knee in a misdiagnosed patient with intra and extraarticular lesion, which might be attributed to the history of knee trauma and the focal defect of the lateral patellar retinaculum. Open synovectomy effectively relieved the symptoms of limited mobility and pain and no recurrence was observed prior to 18 months postoperatively. To reduce misdiagnosis, MRI examinations are recommended for all patients suspected of having PVNS, including those who have a history of hyperuricemia