Occurrence and significance of elevated D-dimer levels in different types of osteomyelitis: a clinical study.

OBJECTIVE: Plasma D-dimer levels >0.5 mg/L are encountered in various conditions besides venous thromboembolism (VTE). Recent studies use them as a prognostic indicator for systemic and inflammatory diseases. The clinical significance of abnormal levels is unclear in osteomyelitis patients with baseline elevation. Our study reviews the occurrence and significance of >0.5 mg/L D-dimer levels in different types of osteomyelitis. PATIENTS AND METHODS: This study involved 125 individuals, out of which 94 were male and 31 were female. The patients were divided into two groups based on the results of bacterial culture testing. Group A comprised those who tested positive for bacterial culture, while group B included those who tested negative. Out of 68 samples tested, 56% were found to have Staphylococcus aureus. All 125 patients underwent blood testing, which included measuring the D-dimer levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and MHR monocyte to high-density lipoprotein cholesterol (HDL-C) ratio in different types of osteomyelitis. The statistical analysis of these tests was carried out. RESULTS: Although there were no significant differences in white blood cell (WBC) count, Neutrophil count, Lymphocyte count, or erythrocyte sedimentation rate (ESR) as well as the NLR, PLR, LMR, MHR, HDL-C ratio. The C-reactive protein (CRP) levels were significantly higher in group A (26.13±50.30) than in group B (10.76±18.70) (p<0.05). D-dimer levels were elevated in 40.8% of patients with bacterial culture-positive osteomyelitis, negative culture osteomyelitis, implants with fractures, and no trauma osteomyelitis. No correlation was found between the increase in D-dimer levels and the presence of bacterial culture or implant-related osteomyelitis in patients. CONCLUSIONS: No significant correlation was found between D-dimers and osteomyelitis, including positive bacterial cultures, implant-related osteomyelitis, or osteomyelitis without trauma. However, 40% of the patients had higher D-dimer levels.

Biodegradable grafting cellulose/clay composites for metal ions removal.

Biodegradable bi-functional cellulose derivatives were synthesized to remove widespread underground water cations such as; Ca2+, Mg2+, Fe2+, Pb2+, and Cu2+. Firstly, graft copolymerization of cellulose with binary monomers such as acrylic acid (AA), and 2-acrylamido-2-methylpropanesulfonic acid (AMPS) with acrylamide (Am) were achieved using potassium persulfate as initiator. Then, cellulose/clay composites were prepared by graft copolymerization of cellulose using different montmorillonite concentrations such as 3, 6 and 9% weight/cellulose weight. The obtained Biodegradable grafted cellulose and their composites were used as adsorbents for the removal of Ca, Mg, Fe, Pb, and Cu ions individually from aqueous solutions. A possible reaction mechanism was deduced and the products were characterized by Fourier transfer infrared (FT-IR), scanning electron microscopy (SEM) and thermal degradation by thermogravimetric analysis (TGA). The results obtained from this study revealed that as the content of clay increases, the uptake of cations increasing and the removal order of the composites were Pb2+ > Mg2+ > Fe2+ > Cu2+ > Ca2+. The biodegradability of grafted cellulose was increased by the addition of clay.

Bicondylar tibial plateau fractures involving the posteromedial fragment : morphology based fixation.

The aim of this study is to describe the morphology of the posteromedial fragment in the setting of bicondylar tibial plateau fractures and to use it as a base for selection of the method of fixation. Twenty two -patients with bicondylar tibial plateau fractures -involving the posteromedial fragment were included in this study. Plain X- ray and computed tomogram (CT) were performed in all patients. Thirteen patients were treated by dual plating while nine were treated by single lateral plate. The mean posteromedial fragment height was 39 mm. The cephalad surface area percentage of the posteromedial fragment relative to the entire tibial plateau ranged from 10% to 43%. with an average of 28%. The average knee motion at the final follow up was 110°. Two cases were complicated by implant failure. Morphological study of the posteromedial fragment could help in selection of the proper method of fixation.

Orogen styles in the East African Orogen: A review of the Neoproterozoic to Cambrian tectonic evolution.

The East African Orogen, extending from southern Israel, Sinai and Jordan in the north to Mozambique and Madagascar in the south, is the world́s largest Neoproterozoic to Cambrian orogenic complex. It comprises a collage of individual oceanic domains and continental fragments between the Archean Sahara-Congo-Kalahari Cratons in the west and Neoproterozoic India in the east. Orogen consolidation was achieved during distinct phases of orogeny between ∼850 and 550 Ma. The northern part of the orogen, the Arabian-Nubian Shield, is predominantly juvenile Neoproterozoic crust that formed in and adjacent to the Mozambique Ocean. The ocean closed during a protracted period of island-arc and microcontinent accretion between ∼850 and 620 Ma. To the south of the Arabian Nubian Shield, the Eastern Granulite-Cabo Delgado Nappe Complex of southern Kenya, Tanzania and Mozambique was an extended crust that formed adjacent to theMozambique Ocean and experienced a ∼650-620 Ma granulite-facies metamorphism. Completion of the nappe assembly around 620 Ma is defined as the East African Orogeny and was related to closure of the Mozambique Ocean. Oceans persisted after 620 Ma between East Antarctica, India, southern parts of the Congo-Tanzania-Bangweulu Cratons and the Zimbabwe-Kalahari Craton. They closed during the ∼600-500 Ma Kuungan or Malagasy Orogeny, a tectonothermal event that affected large portions of southern Tanzania, Zambia, Malawi, Mozambique, Madagascar and Antarctica. The East African and Kuungan Orogenies were followed by phases of post-orogenic extension. Early ∼600-550 Ma extension is recorded in the Arabian-Nubian Shield and the Eastern Granulite-Cabo Delgado Nappe Complex. Later ∼550-480 Ma extension affected Mozambique and southern Madagascar. Both extension phases, although diachronous,are interpreted as the result of lithospheric delamination. Along the strike of the East African Orogen, different geodynamic settings resulted in the evolution of distinctly different orogen styles. The Arabian-Nubian Shield is an accretion-type orogen comprising a stack of thin-skinned nappes resulting from the oblique convergence of bounding plates. The Eastern Granulite-Cabo Delgado Nappe Complex is interpreted as a hot- to ultra-hot orogen that evolved from a formerly extended crust. Low viscosity lower crust resisted one-sided subduction, instead a sagduction-type orogen developed. The regions of Tanzania and Madagascar affected by the Kuungan Orogeny are considered a Himalayan-type orogen composed of partly doubly thickened crust.

Immunogenicity of routine vaccination against diphtheria, tetanus, and Haemophilus influenzae type b in Asian infants born in the United Kingdom.

AIM: To determine the immunogenicity of routine vaccination against diphtheria, tetanus, and Haemophilus influenzae type b (Hib) in Asian infants born in the UK, and whether maternal antibody suppression occurs. METHODS: A cohort study with 80% power, within 95% confidence limits, to show that 80% or fewer Asian infants would respond with an anti-PRP antibody concentration >0.15 microg/ml. Infants of South Asian origin born in Berkshire were enrolled at two general practices in Reading: 41 Asian families sequentially asked to participate within 2 weeks of birth; 36 infants were enrolled and 34 completed the study. Main outcome measures were: antibody concentration against diphtheria, tetanus, and Hib expressed as geometric mean titres (GMT) and proportion of infants about a threshold protective antibody concentration. RESULTS: Median age for completing primary vaccination course was 5 months. All 34 achieved anti-PRP antibody concentration of >0.15 microg/ml, 33 were >1.0 microg/ml, and the GMT was 15.0 microg/ml. All infants developed protective antibody concentration >0.1 IU/ml for tetanus and diphtheria; the respective GMTs were 1.94 and 5.57 IU/ml. Infants with high (>0.25 IU/ml) antibody concentrations against diphtheria and tetanus at 2 months achieved lower antibody concentrations after their three dose course than those with low concentrations (<0.1 IU/ml) (p = 0.06 and 0.03, respectively). CONCLUSIONS: Despite evidence for maternal antibody suppression of the response to tetanus and diphtheria vaccination, excellent antibody responses were achieved by routine vaccination according to the accelerated schedule. High vaccine coverage should be encouraged to provide protection against the possibility of imported infection.

Some evidences for the involvement of plasmid in diuron herbicide degradation.

Pseudomonas sp. strain Bk8 was isolated from field soil contaminated with different urea-herbicides. This strain is a plasmid (pBkB)-harbouring organism capable of complete degradation of diuron herbicide. Plasmid-cured strain Bk8M was obtained by treatment of Pseudomonas sp. Bk8 with Mitomycin C. This cured strain is capable of only partial degradation of diuron side chain and accumulated a phenolic compound in the medium during growing on diuron as a sole source of carbon and energy. Conjugation experiment was carried out using Bk8M as a recipient and Bk8 as a donor of pBk8 plasmid. The transconjugant was able to degrade a diuron without accumulation of phenolic compound. It was proposed that plasmid pBk8 is self-transmissible and involved in the degradation of diuron aromatic ring but it is not connected with the transformation of diuron into diuron phenol compound.

Detoxication of the herbicide diuron by Pseudomonas sp.

A strain of bacteria able to detoxicate the herbicide diuron in pure culture was isolated from sites contaminated with different urea herbicides. Diuron was used as a sole source of carbon and energy by this isolate which is a Gram-negative, aerobic, rod-shaped bacterium with a single polar flagellum, and grows at 40 degrees C. The strain has been identified as Pseudomonas sp.

Spontaneous pneumothorax: A retrospective study of twenty-five patients and literature review.

We present a retrospective study of 25 patients with spontaneous pneumothorax (three current), comprising 16 Saudis (nine males and seven females) and nine non-Saudis (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of the patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan, and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient), and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma, and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only method of treatment in 20 out of the 25 patients, with three failures of closed thoracostomy tube drainage needing thoracotomy and resection of blebs/bullae. The only complication was empyema in two of the patients. Two patients were successfully treated conservatively with observation alone.