Cast immobilization in fracture distal radius with wrist in dorsiflexion

Background: The purpose of this study was to evaluate the anatomical and functional outcome of cast immobilization in fracture distal radius with wrist in dorsiflexion. Study design selected was prospective cohort study.Methods: The study group comprised 60 patients, with a mean follow-up of 3 month. Patients were evaluated for radial height, radial inclination and volar tilt according to Lindstrom criteria. Functional outcome were assessed with PRWE score.Results: Mean loss of radial height was 4.11 mm. Mean loss of radial inclination was 6.85 degree and mean loss of volar tilt was 7.06 degree at the end of 3 month follow up. As per Lindstrom criteria 88% were excellent to fair and 93% were excellent to fair functional outcome as per PRWE score.Conclusions: Cast immobilization in fracture distal radius with wrist in dorsiflexion produces better anatomical and functional outcome.

Study of microalbuminuria as early risk marker of nephropathy in type 2 diabetic subjects

 Background: Diabetic nephropathy (DN) is a common complication of diabetes mellitus that lead to end-stage of kidney disease (ESKD). Detection of early-stage can slow loss of kidney function and improve patient outcomes with use of diagnostic biomarker detection of DN. Aims and objectives of this study is to evaluate the possible association between glycated hemoglobin and urinary microalbumin as a predictor of diabetic nephropathy in type 2 diabetic patients.Methods: Total 162 subjects were included in this study comprises uncontrolled diabetes 54 cases, controlled diabetes 54 cases and healthy controlled 54 controls. Micro albumin was measured by urinary microalbumin (turbidimetric immunoassay), glycated hemoglobin (HbA1c) measured by ion exchange resin method and fasting blood glucose estimated by GOD-POD method. The inclusion of age group was between 35 to 74 years. Statistical analysis was done by using SPSS, version 16.0. p values were calculated by ANOVA unpaired t-test. The p<0.05 was considered a statistically significant.Results: Urinary microalbumin levels were statistically significant increase in type 2 diabetes mellitus with nephropathy in comparison to uncontrolled diabetes mellitus and controlled diabetes mellitus (138.9±13.7 mg/l vs 67.7±14.1 mg/l and p<0.005**).  HbA1c, which acts as a biomarker of diabetes was significant higher diabetic nephropathy, in comparison to uncontrolled diabetes mellitus, controlled diabetes mellitus and healthy control (8.0±1.1% vs 7.1±0.9% and 5.7±0.4%).Conclusions: The present study was demonstrated impaired glycaemic control is associated with elevations in urinary micro albumin levels and it may be considered as risk marker of diabetic nephropathy

Effect of zoledronic acid on functional outcome in cases of pertrochanteric femoral fractures in elderly patients operated with proximal femoral nailing

Background: Osteoporosis is a very common problem in geriatric population and postmenopausal women. Zoledronic acid injection is a very convenient and effective treatment option available for osteoporosis. Our study aimed to study the effect of zoledronic acid on functional outcome and fracture related complications in elderly patients with low energy pertrochanteric femoral fractures who were operated with proximal femoral nail. Methods: This was a case control study. Elderly patients who underwent surgery in the form of proximal femoral nailing for low energy pertrochanteric femoral fractures were included. Injection zoledronic acid was given to every alternate patient who underwent surgery. Radiological healing was evaluated at six weekly intervals for six months and then 12 weekly intervals for one year. The Harris hip score was used to measure the functional outcome of the patient. Results: Effective study population consisted of total 49 patients (25 cases and 24 controls). The mean union time in the cases and the control was 8.76±9.12 weeks and 7.04±1.57 weeks respectively. The mean Harris hip score was 86.742±7.55 in the cases and 84.339±11.20 in the control group. The p value was 0.3815. This study concluded that the two groups had no statistically significant difference between functional outcome and fracture related complications. Conclusions: Zoledronic acid in patients admitted for surgery with osteoporotic fracture does not improve the functional outcome of the patients. It does not affect the mortality of the patients

Tuberous sclerosis with visceral leishmaniasis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Visceral leishmaniasis, a tropical infectious disease, is a major public health problem in India. Tuberous sclerosis, a congenital neuro-ectodermosis, is an uncommon disease which requires life long treatment.</p> <p>Case presentation</p> <p>A 15-year-old Indian patient, presented to the outpatient department of our institute with a high-grade fever for two months, splenomegaly and a history of generalized tonic-clonic convulsions since childhood. The clinical and laboratory findings suggested visceral leishmaniasis with tuberous sclerosis. The patient was treated with miltefosine and antiepileptics.</p> <p>Conclusion</p> <p>The patient responded well and in a follow up six months after presentation, she was found free of visceral leishmaniasis and seizures. Diagnosis and treatment of this rare combination of diseases is difficult.</p

Simple and Effective Multi-Paragraph Reading Comprehension

We consider the problem of adapting neural paragraph-level question answering models to the case where entire documents are given as input. Our proposed solution trains models to produce well calibrated confidence scores for their results on individual paragraphs. We sample multiple paragraphs from the documents during training, and use a shared-normalization training objective that encourages the model to produce globally correct output. We combine this method with a state-of-the-art pipeline for training models on document QA data. Experiments demonstrate strong performance on several document QA datasets. Overall, we are able to achieve a score of 71.3 F1 on the web portion of TriviaQA, a large improvement from the 56.7 F1 of the previous best system.Comment: 11 pages, updated a referenc

Barium ferrite decorated reduced graphene oxide nanocomposite for effective electromagnetic interference shielding

There is an increased interest in the development of high performance microwave shielding materials against electromagnetic pollution in recent years. Barium ferrite decorated reduced graphene oxide (BaFe12O19@RGO) nanocomposite was synthesized by a high energy ball milling technique and its electromagnetic properties were investigated in the frequency range of 12.4-18 GHz (Ku band). The results showed that barium ferrite (BaFe12O19) nanoparticles with an average particle size of 20-30 nm were well distributed and firmly anchored onto the surface of the reduced graphene oxide sheets. The obtained nanocomposite exhibited a saturation magnetization of 18.1 emu g(-1) at room temperature. The presence of BaFe12O19 nanoparticles in the nanocomposite enhances the space charge polarization, natural resonance, multiple scattering and the effective anisotropy energy leading to a high electromagnetic interference shielding effectiveness of 32 dB (similar to 99.9% attenuation) at a critical thickness of 3 mm. The results suggested that the as-prepared BaFe12O19@RGO nanocomposite showed great potential as an effective candidate for a new type of microwave absorbing material

Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome).

BACKGROUND: Visceral Leishmaniasis (VL; also known as kala-azar) is an ultimately fatal disease endemic in the Indian state of Bihar, while HIV/AIDS is an emerging disease in this region. A 2011 observational cohort study conducted in Bihar involving 55 VL/HIV co-infected patients treated with 20-25 mg/kg intravenous liposomal amphotericin B (AmBisome) estimated an 85.5% probability of survival and a 26.5% probability of VL relapse within 2 years. Here we report the long-term field outcomes of a larger cohort of co-infected patients treated with this regimen between 2007 and 2012. METHODS AND PRINCIPAL FINDINGS: Intravenous AmBisome (20-25 mg/kg) was administered to 159 VL/HIV co-infected patients (both primary infections and relapses) in four or five doses of 5 mg/kg over 4-10 days. Initial cure of VL at discharge was defined as improved symptoms, cessation of fever, improvement of appetite and recession of spleen enlargement. Test of cure was not routinely performed. Antiretroviral treatment (ART) was initiated in 23 (14.5%), 39 (24.5%) and 61 (38.4%) before, during and after admission respectively. Initial cure was achieved in all discharged patients. A total of 36 patients died during follow-up, including six who died shortly after admission. Death occurred at a median of 11 weeks (IQR 4-51) after starting VL treatment. Estimated mortality risk was 14.3% at six months, 22.4% at two years and 29.7% at four years after treatment. Among the 153 patients discharged from the hospital, 26 cases of VL relapse were diagnosed during follow-up, occurring at a median of 10 months (IQR 7-14) after discharge. After accounting for competing risks, the estimated risk of relapse was 16.1% at one year, 20.4% at two years and 25.9% at four years. Low hemoglobin level and concurrent infection with tuberculosis were independent risk factors for mortality, while ART initiated shortly after admission for VL treatment was associated with a 64-66% reduced risk of mortality and 75% reduced risk of relapse. SIGNIFICANCE: This is the largest cohort of HIV-VL co-infected patients reported from the Indian subcontinent. Even after initial cure following treatment with AmBisome, these patients appear to have much higher rates of VL relapse and mortality than patients not known to be HIV-positive, although relapse rates appear to stabilize after 2 years. These results extend the earlier findings that co-infected patients are at increased risk of death and require a multidisciplinary approach for long-term management

Deep Rooting In-Situ Expansion of mtDNA Haplogroup R8 in South Asia

The phylogeny of the indigenous Indian-specific mitochondrial DNA (mtDNA) haplogroups have been determined and refined in previous reports. Similar to mtDNA superhaplogroups M and N, a profusion of reports are also available for superhaplogroup R. However, there is a dearth of information on South Asian subhaplogroups in particular, including R8. Therefore, we ought to access the genealogy and pre-historic expansion of haplogroup R8 which is considered one of the autochthonous lineages of South Asia.Upon screening the mtDNA of 5,836 individuals belonging to 104 distinct ethnic populations of the Indian subcontinent, we found 54 individuals with the HVS-I motif that defines the R8 haplogroup. Complete mtDNA sequencing of these 54 individuals revealed two deep-rooted subclades: R8a and R8b. Furthermore, these subclades split into several fine subclades. An isofrequency contour map detected the highest frequency of R8 in the state of Orissa. Spearman's rank correlation analysis suggests significant correlation of R8 occurrence with geography.The coalescent age of newly-characterized subclades of R8, R8a (15.4+/-7.2 Kya) and R8b (25.7+/-10.2 Kya) indicates that the initial maternal colonization of this haplogroup occurred during the middle and upper Paleolithic period, roughly around 40 to 45 Kya. These results signify that the southern part of Orissa currently inhabited by Munda speakers is likely the origin of these autochthonous maternal deep-rooted haplogroups. Our high-resolution study on the genesis of R8 haplogroup provides ample evidence of its deep-rooted ancestry among the Orissa (Austro-Asiatic) tribes

Identification of Clinical Immunological Determinants in Asymptomatic VL and Post Kala-azar Dermal Leishmaniasis Patients

Background: Visceral Leishmaniasis (VL) caused by protozoa belonging to the genus Leishmania, usually have anthroponotic mode of transmission and is issue of great public health importance in Indian subcontinent. Asymptomatic cases of VL and PKDL are subject of keen interest to find their role in the transmission of VL in epidemic areas. We evaluated the immunological cytokine determinants expressed in most clinical suspects of asymptomatic VL and PKDL (IL-10, IFN-γ, and TNF-α). Methods: Eighty-four participants were included at RMRIMS, Patna, India in 2016-17 out of which 64 asymptomatic individual positive for rK-39, without sign and symptoms of VL; 15 PKDL patient’s with past history of VL and 5 endemic healthy subjects were recruited from VL endemic areas. DAT and quantitative assessment of plasma cytokines was determined from the blood samples collected in a plain and sodium-EDTA vacutainer respectively from the subjects. Results: The mean level of IL-10 in DATposLOW of asymptomatic VL and PKDL was significantly higher than endemic healthy (P<0.05). The cytokine polarization index (IFN-γ versus IL-10) was significantly low in PKDL cases compared with asymptomatic VL cases in DATposLOW titre (P<0.05). This index was low again but statistically not significant in PKDL than in asymptomatic VL when TNF-α was considered against IL-10. The ratio of IFN-γ: IL-10 and TNF-α: IL-10 was observed decreased both in asymptomatic VL and PKDL cases than in healthy from endemic areas. Conclusion: Collectively we surmise from our data that asymptomatic VL can also play an important role like PKDL in transmission of VL

Determination of fungal activity in modified wood by means of micro-calorimetry and determination of total esterase activity

Beech and pine wood blocks were treated with 1,3-dimethylol-4,5-dihydroxyethylen urea (DMDHEU) to increasing weight percent gains (WPG). The resistance of the treated specimens against Trametes versicolor and Coniophora puteana, determined as mass loss, increased with increasing WPG of DMDHEU. Metabolic activity of the fungi in the wood blocks was assessed as total esterase activity (TEA) based on the hydrolysis of fluorescein diacetate and as heat or energy production determined by isothermal micro-calorimetry. Both methods revealed that the fungal activity was related with the WPG and the mass loss caused by the fungi. Still, fungal activity was detected even in wood blocks of the highest WPG and showed that the treatment was not toxic to the fungi. Energy production showed a higher consistency with the mass loss after decay than TEA; higher mass loss was more stringently reflected by higher heat production rate. Heat production did not proceed linearly, possibly due to the inhibition of fungal activity by an excess of carbon dioxide