Atherogenic dyslipidemia and diabetes mellitus: what’s new in the management arena?

When compared with the general population, the diabetic population is at higher risk of cardiovascular disease (CVD), as predicted by the Framingham Risk Score calculations (10-year risk 20%). For this reason diabetes is considered a “coronary disease equivalent” condition, as classified by the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III. Furthermore, patients with diabetes who experience a myocardial infarction have a poorer prognosis than nondiabetic patients, which contributes to their overall higher mortality. Dyslipidemia is a major underlying risk factor contributing to the excess CVD risk, and is usually more atherogenic in the presence of diabetes. It is uniquely manifested by raised levels of triglycerides, low levels of high-density lipoprotein cholesterol, and smaller, denser, and more atherogenic low-density lipoprotein particles. Recent trials have suggested the need for more aggressive treatment of dyslipidemia in this subpopulation than the current recommendations by the NCEP-ATP III. This review addresses the newer developments in the diabetes arena in terms of our current understanding of atherogenic dyslipidemia in diabetes and data from the latest randomized trials addressing its management

Modified supracondylar dome osteotomy: our experience in 11 children

Background: The present retrospective study was done with 11 children having cubitus varus following supracondylar fractures to access the stability of modified domeosteotomy and its fixation with k-wires in older children.Methods: 11 children, 7 males & 4 females were included in the study. The osteotomy was performed through posterior approach. The triangular wedge rotated inside the notch was inherently stable and also fixed with k-wires. Patients were followed at regular intervals. K wires were removed at 6 weeks and the physiotherapy started.Results: The correction obtained under vision was well maintained post operatively in 10 out of 11 cases. In only one case there was back out of k-wires and loss of correction. 5 cases had excellent result followed by 4 good and one fair result. Conclusions: Modified dome osteotomy performed through posterior approach and fixed with k-wires gives good results. Removal of the k-wires is simple. However, in children above 14 years plate fixation might be better to prevent loss of correction

Low high-density lipoprotein cholesterol: current status and future strategies for management

Atherosclerotic cardiovascular disease is the foremost cause of death and disability in the Western world, and it is rapidly becoming so in the developing nations. Even though the use of statin therapy aiming at the low-density lipoprotein cholesterol (LDL) has significantly reduced cardiovascular events and mortality, substantial residual cardiac events still occur in those being treated to the currently recommended targets. In fact, residual risk is also seen in those who are treated “aggressively” such as the “high risk” patients so defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). Consequently, one must look for the predictors of risk beyond LDL reduction. High-density lipoprotein cholesterol (HDL) is the next frontier. The protectiveness of elevated HDL against atherosclerosis is well described in the literature. HDL subdues several atherogenic processes, such as oxidation, inflammation, cell proliferation and thrombosis. It also helps mobilize the excess LDL via reverse cholesterol transport. Low levels of HDL have been shown to be independent predictors of risk. Thus, therapies to raise the HDL hold promise for additional cardiac risk reduction. In this regard, several randomized trials have recently tested this hypothesis, especially in patients at high risk. In addition to the use of aggressive lifestyle modification, clinical outcomes have been measured following augmentation of HDL levels with various treatment modalities, including aggressive statin therapy, combination therapy with fibrates and niacin, and direct HDL-raising drug treatments. These data for low HDL as an independent risk factor and as the new treatment target are reviewed in this paper

Locking compression plate used as external fixator in open (Grade || to |||b) tibia fracture

Purpose :  Open fractures are one of the most difficult condition to treat in orthopaedics. Locking plates can be used as an external fixator in case of open  fracture particularly of tibia  as soft tissue around it (especially distal ) are easily compromised by trauma and subsequent  treatment by open reduction and internal fixation. The purpose of our study is to evaluate the functional outcome of locking compression plate used as an external fixator in Gustilo  and Anderson’s grade II to III B  open  fracture shaft of tibia. Method :  This was a prospective study in which we treated a total of 8  patients  of Open fracture shaft of tibia with “supracutaneous plating” using a metaphyseal locking  plate or simple locking plates. There were 5 Male and 3 female patients, with average age of 40 years (Range, 28 to 60 years). 3 patient was having grade II injury,2patients were of grade IIIAwherea as 3 patients were having Grade IIIB injury.   After 4 weeks, patients were  allowed toe- touch weight bearing for next 6 weeks, followed by partial weight bearing for next 4 weeks. Full weight bearing was allowed once fracture healed clinically as well as radiologically. Plate removal was done once fracture consolidated radiologically. Result:  The  plate was kept in place for average 32 weeks (Range,28 to 40 weeks) .No significant screw tract infection was found in any patients in our series. In 1 patients flap coverage of wound was done, in others, wound healed with debridement, dressing and partial thickness skin grafting when required. (2). Two patients showed delayed union at 24 weeks for which bone grafting was done and fracture union was achieved.  Average period of follow-up was 16 months (Range, 12 to 20 months). In 7 patients, plate was placed in situ until full consolidation both clinically and radiologically was seen but in one patient plate has to be removed in 2 weeks because of loosening due highly osteoporotic bone and persistence of infection. She was planned for ring fixator but patient refused and we lost the follow up. At latest follow up all the7 patients were full weight bearing with fully healed tibia.Conclusion : Locked Supracutaneous plating of open fracture of long bones have many advantages over conventional tubular uniaxial fixator. Non bulky implant, stable configuration, less risk of pin tract infection, suitability of application even with small fragments and less chances of joint stiffness makes this method a viable option for treatment of open long bone fractures especially tibia. Keywords: Open fracture, Supracutaneous plating, External fixator, Locking plate

Prediction of rock load emphasizing excavation damage of in situ rockscaused by blasting in coal mines

Roof failure in coal mines is strongly related to the frequency of laminations and their movement when the load acts upon them. Detachment of roof bolts from mine roof due to improper estimation of extent of weak zone is one of the major problems in underground coal mines, thus affecting the safety and productivity of workings. The most popular and practiced method for roof support design in Indian coal mines is the Central Mining Research Institute-ISM geomechanical classification system. Irrespective of such an established system of support design, accidents due to roof fall still persist. Here we review various available classification systems for rock load estimation and identify their limitations. The study has been extended taking into consideration the case study of KTK-6 incline of Singareni Collieries Company Limited by proposing a modified rock mass classification system based on seismic wave velocity as a key descriptor. A modified rock mass rating (RMR) system (RMRdyn) with inclusion of seismic velocity as one of the parameters is proposed for the estimation of rock load. Enhancement in rock load by 20% has been found for RMRCMRI-ISM values less than 40 according to the new rock load relation. This resulted in under-supporting of the roof and thus might have caused failures. For cases with RMRCMRI-ISM values more than 60, the earlier equation overestimates rock load by about 25% resulting in over-supporting. Thus, estimation of rock load from the proposed new equation appears to be more rational as it takes into account the actual damage zone

Tropical Forage Legumes in India: Status and Scope for Sustaining Livestock Production

Livestock contributes enormously in food and nutritional security apart from livelihood security to rural population all over the world. India has the largest number of livestock, representing over 17% of world population. Availability of forage legumes is essential for better animal health, production and increasing the nutritive value of forage-based rations, besides providing a source of biological nitrogen fixation for enriching soil, reducing land degradation and mitigating climate change. However, supply of quality green fodder in India is extremely precarious, and the gap is huge against demand. The major fodder legume crops cultivated in India are Medicago sativa, Trifolium alexandrinum, Vigna unguiculata, Vigna umbellate and range legumes are Stylosanthes spp., Desmanthus virgatus, and Clitoria ternatea. Indian subcontinent represents wide spectrum of eco-climates and reported diversity of 21 forage legumes genera viz., Desmodium, Lablab, Stylosanthes, Vigna, Macroptelium, Centrosema and browse plants Leucaena, Sesbania, Albizia, Bauhinia, Cassia, Grewia, etc. Diversity of forage legumes were collected (>3200 accessions), evaluated and sources for different biotic and abiotic stress tolerance were identified, apart from >50 cultivars developed. Considering these aspects, tropical legumes for livestock production, soil health and ecosystem services, diversity, evaluation and breeding for improved varieties are discussed in this chapter

Forage from Trees and Grasses of Silvipasture System in Degraded Land of Semiarid India

Rainfed agro-ecosystem has a distinct place in Indian Agriculture, occupying 67% of the cultivated area and supporting 65% of the livestock population (Venkateswarlu, 2005). The silvipasture systems involving suitable multi-purpose trees specially fodder trees and range grass species provide resilience by ensuring continued and multiple outputs such as, forage, fuelwood, fodder, fibre and industrial raw material, besides other positive environmental effects. Incorporation of fodder trees with grasses is perceived as a climate change-resilient cropping system for farmers linking climate change mitigation with adaptation (Mbow et al., 2014). The synergies of tree-grass association need to be explored and exploited by evaluating different fodder tree species with combination of grass species under degraded land and climatic condition. In many low input agro-ecosystems grasses are intercropped with legumes since legumes have an importance as a primary source of nitrogen (Thomsen and Haugaard-Nielsen, 2008). This study was planned to develop a silvipasture system with suitable tree and grass species on degraded land of semi arid condition to ensure the availability of quality fodder round the year

LARGE SCALE BIOREMEDIATION OF PETROLEUM HYDROCARBON CONTAMINATED WASTE AT INDIAN OIL REFINERIES: CASE STUDIES

ABSTRACT The petroleum industry effluents, oily sludge and oil spills cause a serious threat to the environment as their constituents are toxic, mutagenic and carcinogenic. Safe disposal of these wastes is serious problem. None of the available conventional disposal methods are environment friendly. Biological methods have been well reviewed and acknowledged for remediation of petroleum hydrocarbon contaminated waste (oily waste). An indigenous microbial consortium was developed by assemble of four species of bacteria, isolated from various oil contaminated sites of India, which could biodegrade different fractions of total petroleum hydrocarbon (TPH) of the oily waste to environment friendly end products. The said consortium was applied on field scale at different oil refineries in India and successfully bioremediated 48,914 tons of different types of oily waste. In 44 field case studies of different batch size of ex situ bioremediation process, the initial TPH content varying from 83.50 to 531.30 gm/kg of oily waste, has been biodegraded to < 10 gm/kg of oily waste in major cases in 2 -12 months. In one refinery due to coastal climate, the bioremediation time was > 20 months. The bioremediated soil was non-toxic and natural vegetation was found to be grown on the same. Bioremediation technology has helped various oil industries for the management of their hazardous oily wastes in environment friendly manner

Overexpression of Prothymosin Alpha Predicts Poor Disease Outcome in Head and Neck Cancer

In our recent study, tissue proteomic analysis of oral pre-malignant lesions (OPLs) and normal oral mucosa led to the identification of a panel of biomarkers, including prothymosin alpha (PTMA), to distinguish OPLs from histologically normal oral tissues. This study aimed to determine the clinical significance of PTMA overexpression in oral squamous cell hyperplasia, dysplasia and head and neck squamous cell carcinoma (HNSCC).Immunohistochemistry of PTMA protein was performed in HNSCCs (n = 100), squamous cell hyperplasia (n = 116), dysplasia (n = 50) and histologically normal oral tissues (n = 100). Statistical analysis was carried out to determine the association of PTMA overexpression with clinicopathological parameters and disease prognosis over 7 years for HNSCC patients.<0.001). Chi-square analysis showed significant association of nuclear PTMA with advanced tumor stages (III+IV). Kaplan Meier survival analysis indicated reduced disease free survival (DFS) in HNSCC patients (p<0.001; median survival 11 months). Notably, Cox-multivariate analysis revealed nuclear PTMA as an independent predictor of poor prognosis of HNSCC patients (p<0.001, Hazard's ratio, HR = 5.2, 95% CI = 2.3–11.8) in comparison with the histological grade, T-stage, nodal status and tumor stage.Nuclear PTMA may serve as prognostic marker in HNSCC to determine the subset of patients that are likely to show recurrence of the disease