Evaluation Health Risks and Sorption of Hexavalent Chromium (Cr(VI) by Biochar and Iron Doped Zinc Oxide Modified Biochar (Fe-ZnO@BC) Using Trifolium: A Green Synthesis Technique.

Contamination of aquatic and terrestrial environment with hexavalent chromium Cr(VI) is one of the major hazards worldwide due its carcinogenicity, persistency and immobility. Different research techniques have been adopted for Cr(VI) remediation present in terrestrial and aquatic media, while adsorption being the most advance, low cost, environmentally friendly and common method. The present study discussed the mechanisms of Parthenium hysterophorus derived biochar, iron-doped zinc oxide nanoparticles (nFe-ZnO) and Fe-ZnO modified biochar (Fe-ZnO@BC) involved in Cr(VI) mobility and bioavailability. Pot experiments were conducted to study the effect of Parthenium hysterophorus derived biochar, nFe-ZnO and Fe-ZnO@BC application rates (2%, 2 mg/kg, 10 mg/kg, respectively). The results indicated that the addition of soil amendments reduced Cr(VI) mobility. The findings revealed that the reduction in chromium mobility was observed by P. hysterophorus BC, and Fe-ZnO@BC but nFe-ZnO application significantly (p = 0.05) reduced Cr(VI) and CrT uptake as compared to the control treatments. The results of SEM coupled with EDS showed a high micropores and channel, smooth surface which helped in adsorption, and may enhance soil conditions. The concentration index (CI) by different amendments in trifolium plant was followed the descending order as: nFe-ZnO > Fe-ZnO@BC > P. hysterophorus BC after 30, 60 and 90 days of harvesting, respectively. In addition, human health risk index was found less than one (H1 < 1.0) in amended soils as compared to control treatments.

Activable Photodynamic DNA Probe with an "AND" Logic Gate for Precision Skin Cancer Therapy.

Photodynamic therapy (PDT) has emerged as a promising approach for squamous cell carcinoma treatment but hindered by tumor hypoxia, acquired resistance, phototoxicity, and so on. To address these issues, we developed a smart strategy utilizing activable photosensitizers delivered by an aptamer-functionalized DNA probe (ADP). The ADP incorporated an AS1411 aptamer for tumor targeting and a linear antisense oligonucleotide (ASO) for recognition of Survivin mRNA. In the absence of the target, PDT remained quenched, thereby avoiding phototoxicity during circulation and nonselective distribution. With the aid of the aptamer, ADP achieved selective targeting of tumors. Upon internalization, ADP targeted recognized Survivin mRNA, triggering PDT activation, and releasing ASO to down-regulate Survivin expression and reverse tumor resistance. Consequently, the activable photosensitizers exhibited an "AND" logic gate, combining tumor-targeting delivery and tumor-related gene activation, thus enhancing its specificity. Additionally, the incorporation of hemin into the ADP provided catalase activity, converting tumor-abundant H2O2 into O2, thereby ameliorating tumor hypoxia. The resulting functionalized G-quadruplex/hemin-DNA probe complex demonstrated targeted delivery and activation, minimized side effects, and enhanced PDT efficacy in both xenograft tumor-bearing mice and patient-derived xenograft models. This study offers a unique and promising platform for efficient and safe PDT, thus holding great potential for future clinical translation and improved cancer therapy.

Comparative efficacy of Parthenium hysterophorus (L.) derived biochar and iron doped zinc oxide nanoparticle on heavy metals (HMs) mobility and its uptake by Triticum aestivum (L.) in chromite mining contaminated soils.

In this study we investigated the efficacy of a novel material parthenium weed (Parthenium hysterophorus L.) biochar (PBC), iron doped zinc oxide nanoparticles (nFe-ZnO), and biochar modified with nFe-ZnO (Fe-ZnO@BC) to adsorb heavy metals (HMs) and reduce their uptake by wheat (Triticum aestivum L.) in a highly chromite mining contaminated soil. The co-application of the applied soil conditioners exhibited a positive effect on the immobilization and restricted the HMs uptake below their threshold levels in shoot content of wheat. The maximum adsorption capacity was because of large surface area, cation exchange capacity, surface precipitation, and complexation of the soil conditioners. The scanning electron microscopy (SEM) coupled with energy dispersive spectroscopy (EDS) showed porous smooth structure of parthenium weed derived biochar that helped in HMs adsorption, increase the efficiency of soil fertilizers and nutrients retention which help in the enhancement soil condition. Under different application rates the highest translocation factor (TFHMs) was obtained at 2 g nFe-ZnO rate followed the descending order: Mn > Cr > Cu > Ni > Pb. The overall TFHMs was found <1.0 indicating that low content of HMs accumulation in roots from soil slight transferred to shoot, thus satisfying the remediation requirements.

Wheat is considered as an important staple food which is grown in a chromite mining contaminated soil containing toxic HMs releasing from weathering of mafic and ultramafic rocks in the study area. The present research work is significantly beneficial in identifying the efficiency of treatment technologies to immobilize toxic HMs in soil. Parthenium weed derived biochar and biochar modified with nFe-ZnO (Fe-ZnO@BC) reduce the HMs uptake by wheat plant.

Polydatin Inhibits Hepatocellular Carcinoma Cell Proliferation and Sensitizes Doxorubicin and Cisplatin through Targeting Cell Mitotic Machinery.

Polydatin (PD) is a natural compound with anticancer activities, but the underlying mechanisms remain largely unclear. To understand how PD inhibited hepatocellular carcinoma (HCC), we studied PD treatments in HCC HepG2 and SK-HEP1 cells, and normal liver HL-7702 cells. PD selectively blocked the proliferation of HCC cells but showed low toxicity in normal cells, while the effects of doxorubicin (DOX) and cisplatin (DDP) on HCC and normal liver cells were opposite. In the cotreatment studies, PD synergistically improved the inhibitory activities of DOX and DDP in HCC cells but alleviated their toxicity in HL-7702 cells. Furthermore, RNA-seq studies of PD-treated HepG2 cells revealed multiple altered signaling pathways. We identified 1679 Differentially Expressed Genes (DEGs) with over a 2.0-fold change in response to PD treatment. Integrative analyses using the DEGs in PD-treated HepG2 cells and DEGs in a TCGA dataset of HCC patients revealed five PD-repressed DEGs regulating mitotic spindle midzone formation. The expression of these genes showed significantly positive correlation with poor clinical outcomes of HCC patients, suggesting that mitotic machinery was likely a primary target of PD. Our findings improve the understanding of PD's anticancer mechanisms and provide insights into developing effective clinical approaches in HCC therapies.

Hydrochemical evaluation of groundwater for drinking and irrigation purposes using multivariate indices along Indus Suture Zone, North Pakistan.

The present study is aimed to investigate the hydrochemical characteristics, spatial distribution and suitability of groundwater for drinking and irrigation purposes along the Indus Suture Zone (ISZ), north Pakistan. Physicochemical parameters and hazardous trace elements (HTEs) like Cd, Co, Cu and Mn were determined following standard methods. The mean and median concentrations were found below the World Health Organization (WHO) drinking water guidelines values. Hydrochemical results indicate that groundwater sources were mainly attributed to rock-water interaction category. Piper diagram shows that most of the groundwater samples fall in Ca-HCO3─ class presenting weak-alkaline proportion type. The drinking water quality index (DWQI) ranking was categorized as good to excellent, indicating the overall quality of the groundwater may pose no health hazard concern. Based on irrigation WQI (SAR, Na%, MAR, KR), the groundwater was found fit for irrigation except SAR whereas 36% of the groundwater samples fall within the poor class. The total HI values through dermal contact exceeded the safe non-carcinogenic threshold of HI = 1. Therefore, there is required an effective groundwater monitoring and management facility in the study area to safeguard residents from various illnesses associated with varying HTEs concentrations in drinking water. The major response actions needed for groundwater bodies restoration are including the installation of a continuous groundwater monitoring network and control of agricultural fertilizers that seems to be the most effective and tangible for immediate action.

Current Advances of Nanomedicines Delivering Arsenic Trioxide for Enhanced Tumor Therapy.

Arsenic trioxide (ATO) is one of the first-line chemotherapeutic drugs for acute promyelocytic leukemia. Its anti-cancer activities against various human neoplastic diseases have been extensively studied. However, the clinical use of ATO for solid tumors is limited, and these limitations are because of severe systemic toxicity, low bioavailability, and quick renal elimination before it reaches the target site. Although without much success, several efforts have been made to boost ATO bioavailability toward solid tumors without raising its dose. It has been found that nanomedicines have various advantages for drug delivery, including increased bioavailability, effectiveness, dose-response, targeting capabilities, and safety as compared to traditional drugs. Therefore, nanotechnology to deliver ATO to solid tumors is the main topic of this review, which outlines the previous and present medical applications of ATO. We also summarised ATO anti-cancer mechanisms, limitations, and outcomes of combinatorial treatment with chemo agents. As a result, we strongly recommend conducting pre-clinical and clinical studies of ATO, especially nano-system-based ones that might lead to a novel combination therapy for cancer treatment with high efficacy, bioavailability, and low toxicity for cancer patients.

Combinatorial effect of thymoquinone with chemo agents for tumor therapy.

BACKGROUND: Most chemotherapeutics used in cancer therapies exhibit considerable side effects to the patients. Thus, developing new chemo agents to treat cancer patients with minimal toxic and side effects is urgently needed. Recently, the combination of different chemotherapeutics has become a promising strategy to treat malignancies. Thymoquinone (TQ) is a primary bioactive compound derived from the folk medicinal plant Nigella sativa, which has been found an antitumor, chemopreventive and chemopotentiating agent against human neoplastic diseases. PURPOSE: We briefly summarize the current research of the biomolecular mechanisms of TQ and evaluate the existing literature on TQ adjuvant therapies against various cancers. METHOD: The data in this review were gathered by several search engines including, Google Scholar, PubMed and ScienceDirect. We highlighted and classified the outcomes of both in vitro and in vivo experiments of TQ adjuvant therapies against human cancers and their chemopreventive activities on vital organs. RESULTS: Several studies have shown that TQ synergistically potentiated the antitumor activity of numerous chemo agents against human neoplastic disease, including lung, breast, liver, colorectal, skin, prostate, stomach, bone and blood cancers. TQ also acted as a chemopreventive agent and reduced the toxicity of many chemo agents to vital organs, such as the heart, liver, kidneys and lungs. CONCLUSION: In summary, we highly recommend an advanced evaluation of TQ adjuvant therapies at the level of preclinical and clinical trials, which could lead to a novel combinatorial therapy for cancer treatment with low or tolerable adverse effects on patients.

Treatment Of Vertical Fracture Of Distal Radius Using Interfragmentary Screws Through Direct Lateral Approach To Distal Radius.

BACKGROUND: Distal radius fractures are very common injuries. Majority of these fractures are transverse or oblique in nature. Isolated vertical fractures of the distal radius in the sagittal plane are rare injuries. The management of these vertical fractures is therefore different from the usual transverse or oblique fractures of the distal radius. We report on a 53-year-old right-handed gentleman who fell from his bicycle and sustained a vertical fracture of the distal radius. His distal radius fracture was fixed surgically using two interfragmentary screws. A direct lateral approach of the distal radius was used to expose the distal radius. The rationale for using direct lateral approach and interfragmentary screws for this type of fracture is discussed.

Transcriptome analysis of signaling pathways targeted by Ellagic acid in hepatocellular carcinoma cells.

BACKGROUND: Ellagic acid (EA) possesses prominent inhibitory activities against various cancers, including hepatocellular carcinoma (HCC). Our recent study demonstrated EA's activities in reducing HCC cell proliferation and tumor formation. However, the mechanisms of EA to exert its anticancer activities and its primary targets in cancer cells have not been systematically explored. METHODS: Cell proliferation assay and flow cytometric analysis were used to examine the effects of EA treatment on viability and apoptosis, respectively, of HepG2 cells. RNA-seq studies and associated pathway analyses by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were employed to determine EA's primary targets. Differentially expressed genes (DEG) in EA-treated HepG2 cells were verified by RT-qPCR and Western blot. Integrative analyses of the RNA-seq dataset with a TCGA dataset derived from HCC patients were conducted to verify EA-targeted genes and signaling pathways. Interaction network analysis of the DEGs, shRNA-mediated knockdown, cell viability assay, and colony formation assay were used to validate EA's primary targets. RESULTS: EA reduced cell viability, caused DNA damage, and induced cell cycle arrest at G1 phase of HepG2 cells. We identified 5765 DEGs encoding proteins with over 2.0-fold changes in EA-treated HepG2 cells by DESeq2. These DEGs showed significant enrichment in the pathways regulating DNA replication and cell cycle progression. As primary targets, p21 was significantly upregulated, while MCM2-7 were uniformly downregulated in response to EA treatment. Consistently, p21 knockdown desensitized liver cells to EA in cell viability and colony formation assays. CONCLUSION: EA induced G1 phase arrest and promoted apoptosis of HCC cells through activating the p21 gene and downregulating the MCM2-7 genes, respectively. GENERAL SIGNIFICANCE: The discoveries in this study provide helpful insights into developing novel strategies in the therapeutic treatment of HCC patients.

Thymoquinone Selectively Induces Hepatocellular Carcinoma Cell Apoptosis in Synergism With Clinical Therapeutics and Dependence of p53 Status.

Thymoquinone (TQ) is a natural compound extracted from the black seeds of Nigella sativa Linn. belonging to the Ranunculaceae family. TQ exhibits anti-inflammatory and antineoplastic activities against various cancers. Many therapeutics in hepatocellular carcinoma (HCC) treatments, such as doxorubicin (DOX) and cisplatin (DDP), exhibit considerable side effects on patients. We investigated cytotoxic effects of TQ, alone or in combination with DDP and DOX to HCC cells. TQ exhibited selective killing to HCC HepG2 and SMMC-7721 cells, but relatively low toxicity to normal liver HL-7702 cells. Importantly, when used with DOX or DDP, TQ showed synergistic inhibition of HCC cells, but not HL-7702 cells. We also discovered that Hep3B cells with a p53 null status were more sensitive to TQ than HepG2 and SMMC-7721 cells harboring wild type p53. Consistently, shRNA-mediated p53 silencing in HepG2 cells dramatically enhanced TQ-induced apoptosis, measured by caspase 3 and PARP cleavage. Furthermore, TQ-stimulated increase of reactive oxygen species (ROS) in p53-depleted cells was more pronounced than that in cells with intact p53. In summary, we discovered that TQ synergistically improves the anti-cancer activity of DOX and DDP, and loss of p53 sensitizes HCC cells to TQ-induced apoptosis.

Evaluation of the Swat River, Northern Pakistan, water quality using multivariate statistical techniques and water quality index (WQI) model.

This study evaluates the characteristics of water along the Swat River, Northern Pakistan. For this purpose, water samples (n = 30) were collected and analyzed for physicochemical parameters including heavy metals (HM). The mean concentrations of physicochemical parameters and HM were within the drinking water guideline values set by the World Health Organization (WHO 2011) except 34%, 60%, and 56% of copper (Cu), nickel (Ni), and lead (Pb), respectively. Pollution sources were identified by various multivariate statistical techniques including correlation analysis (CA) and principal component analysis (PCA) indicating different origins both naturally and anthropogenically. Results of the water quality index (WQI) ranged from 13.58 to 209 with an average value of 77 suggesting poor water quality for drinking and domestic purposes. The poor water quality was mainly related to high sodium (alkalinity) and salinity hazards showing > 27% and 20% water samples have poor alkalinity and salinity hazards, respectively. Hazard quotient (HQ) and hazard index (HI) were used to determine the health risk of HM in the study area. For water-related health risk, HQingestion, HQdermal, and HI values were > 1, indicating noncarcinogenic health risk (NCR) posed by these HM to the exposed population.

The surgical management for isolated scaphotrapeziotrapezoid (STT) osteoarthritis : a systematic review of the literature.

We performed a systematic review to find out the safety and efficacy of various procedures for isolated scaphotrapeziotrapezoid osteoarthritis. Eleven articles were included. The most common procedure was arthroplasty with pyrocarbon implant (28%), followed by resection of distal pole of scaphoid with proximal trapezium and trapezoid resection (18%). The other procedures included trapeziectomy with ligament reconstruction and tendon interposition (LRTI) (14%), arthroscopic resection of distal scaphoid (11%), trapezium and trapezoid resection with LRTI (10%) and arthrodesis (10%). Complications were noted in 18 (15%) patients. The most common complication (7.5%) was asymptomatic dorsal intercalated segmental instability (DISI) followed by dislocation of the pyrocarbon implant (3%). Fusion resulted in decreased range of motion and grip strength. The distal scaphoid resection was related to high rate of DISI. Although the pyrocarbon implant has a higher dislocation rate which requires revision surgery, this complication is avoidable with good surgical technique. Arthroplasty with pyrocarbon implant may be the first choice in younger patients.

Human health risks by potentially toxic metals in drinking water along the Hattar Industrial Estate, Pakistan.

This study aimed to investigate the contamination of drinking water sources with potentially toxic metals (PTMs) together with some hydrochemical characteristics in the highly populated industrial zone of Pakistan. For this purpose, drinking (n = 40) and surface (n = 20) water samples were collected and analyzed for PTM using graphite furnace atomic absorption spectrophotometer (GFAAS, PerkinElmer-700, USA). The metals, including cadmium (Cd), chromium (Cr), nickel (Ni), lead (Pb), and zinc (Zn), showed significantly (p = 0.05) higher concentrations than their respective limits set by the World Health Organization (WHO 2011) in drinking water. The chronic daily intake (CDI) and human hazard quotient (HQ) were also evaluated. The highest daily intake through drinking water consumption was found for Ni (4.3 µg/kg/day), while lowest for Cd (0.25 µg/kg/day). The highest hazard quotient values were found for Cd (0.33) and Ni (0.29) that could be attributed to industrial wastewater discharge. Higher CDI and HQ values of Ni and Cd may cause chronic human health problems. According to the Chadha Piper diagram, the hydrochemical facies distribution indicated that water trend in the study area followed an order such as follows: Ca-Mg-Cl < Na-Cl < Ca-HCO3 < Na-HCO3. Statistical analysis using one-way ANOVA, correlation analysis, and principal component analysis (PCA) revealed that the elevated levels of PTM were attributed to industrial wastewater discharge. This study provides baseline information for policy makers and the effective management of water in populated industrialized zone.

Outcome of surgery in neck of femur fracture patients with poor pre-fracture mobility.

BACKGROUND: Hip fractures are common with a UK incidence of over 70,000 cases and total healthcare costs of over £2 billion per year. Mortality rates of 10% at 30 days and up to 30% at 1-year have been reported. We wanted to assess the outcome of hip fracture surgery in patients with reduced pre-fracture mobility as this has not been exclusively studied previously. METHODS: We retrospectively reviewed 168 hip fracture patients with reduced pre-fracture mobility (wheelchair bound, bed bound, walking with 2 aids or a frame) who underwent hip fracture surgery at our institution between 2008 and 2013 using case notes, discharge letters, outpatient clinic letters and laboratory test results. Measured outcomes included 30-day renal, cardiac and respiratory morbidity as well as 30-day and 1-year mortality. RESULTS: Our study comprised 27% males and 73% females with a mean age of 82 years. The 30-day chest infection, acute renal failure and acute coronary syndrome rates were 26%, 7.7% and 4% respectively. In those patients who were either wheelchair or bed bound, 30-day and 1-year mortality rates were 11.8% and 52% respectively whereas in those who could mobilise with the help of 2 aids or frame, 30-day and 1-year mortality rates were 4.34% and 39.70% respectively. CONCLUSION: Our study highlighted increased 30-day and 1-year morbidity and mortality rates following hip fracture surgery with notable high rates of respiratory and renal complications in patients with reduced pre-fracture mobility. We would recommend pre- and postoperative optimisation with orthogeriatric review, chest physiotherapy and intravenous fluid hydration to reduce complication rates and improve morbidity and mortality.

Mapping human health risk from exposure to potential toxic metal contamination in groundwater of Lower Dir, Pakistan: Application of multivariate and geographical information system.

The study aimed to assess the physicochemical parameters (pH, electrical conductivity (EC), total dissolve solid (TDS), oxidation reduction potential (ORP), Temperature) and potential toxic metals (PTMs), including Ni, Mn, Cr, Cu, Cd, Pb, Co, Fe and Zn in the groundwater of Lower Dir, Pakistan. Furthermore, the pollution sources and spatial distribution pattern of PTMs were also investigated via principal component analysis (PCA) and geographic information system (GIS) application to understand the changing behaviors of PTMs in groundwater. The average concentrations of physicochemical parameters such as pH, EC, TDS, ORP and Temperature were 7.1, 418 µS/cm, 251 mg/L, 193 mV and 25.7 ○C, while the concentrations of PTMs; Ni, Mn, Cr, Cu, Cd, Pb, Co, Fe and Zn were 0.25, 0.34, 0.09, 0.29, 0.10, 0.08, 0.10, 0.83 and 0.25  mg/L, respectively. Among the selected metals, Mn, Cr, Cd, Pb, Co and Fe were exceeded the WHO guidelines and their percentage contribution were 43%, 57%, 45%, 70%, 70% and 62%, respectively. The increasing order of PTMs were; Pb > Co > Fe > Cr > Cd > Mn > Cu > Ni > Zn in the study area. PCA represented three significant factors, which explained 76% variability in the groundwater. Whereas, clustering analysis (CA) grouped groundwater into three distinct clusters less polluted (C1), moderate polluted (C2) and highly polluted (C3). Human health risk assessment was carried out to check the suitability of groundwater for drinking and domestic uses. The HQ and HRIs values of Cd were >1, suggested that the groundwater sources are unfit for drinking and domestic purposes and may be caused potential health risk after long term ingestion.

Pollution and energy reduction strategy in soft drink industries.

The present study was conducted on soft drink industry with the objective to reduce wastewater pollution through end-of-pipe treatment and controlling energy loss through steam pipeline insulation approach. For this purpose, the main operation and manufacturing steps were examined. Wastewater was analyzed for 10 physicochemical parameters. Among these parameters, total dissolved solids (TDS), total suspended solids (TSS) and chemical oxygen demand (COD) were above their permissible level of Pakistan national environmental quality standards (Pak NEQS). For wastewater treatment, sedimentation, flocculation, coagulation and adsorption were tested. The active study reduces the pollution load up to 48%. After treatment, all the parameters were below the Pak NEQS level. To reduce the energy loss and economic benefits, the steam pipeline system was galvanized using glass wool, sheet and paper. Through galvanizing, 91.4% of energy was recovered and reduced an extra cost of 91.5%. The net saving of energy and cost are 312 GJ and114098 Rs/year, respectively. The study recommends end off pipe treatment and insulation of bare pipeline system for soft drink industries.

Fluoride prevalence in groundwater around a fluorite mining area in the flood plain of the River Swat, Pakistan.

This study investigated the fluoride (F-) concentrations and physicochemical parameters of the groundwater in a fluorite mining area of the flood plain region of the River Swat, with particular emphasis on the fate and distribution of F- and the hydrogeochemistry. To better understand the groundwater hydrochemical profile and F- enrichment, groundwater samples (n=53) were collected from shallow (24-40m), mid-depth (48-65m) and deep (85-120m) aquifers, and then analysed using an ion-selective electrode. The lowest F- concentration (0.7mg/L) was recorded in the deep-aquifer groundwater, while the highest (6.4mg/L) was recorded in shallow groundwater. Most groundwater samples (62.2%) exceeded the guideline (1.5mg/L) set by the World Health Organization (WHO); while for individual sources, 73% of shallow-groundwater samples (F- concentration up to 6.4mg/L), 42% of mid-depth-groundwater samples, and 17% of deep-groundwater samples had F- concentrations that exceeded this permissible limit. Assessment of the overall quality of the groundwater revealed influences of the weathering of granite and gneisses rocks, along with silicate minerals and ion exchange processes. Hydrogeochemical analysis of the groundwater showed that Na+ is the dominant cation and HCO3- the major anion. The anionic and cationic concentrations across the entire study area increased in the following order: HCO3>SO4>Cl>NO3>F>PO4 and Na>Ca>Mg>K, respectively. Relatively higher F- toxicity levels were associated with the NaHCO3 water type, and the chemical facies were found to change from the CaHCO3 to (NaHCO3) type in calcium-poor aquifers. Thermodynamic considerations of saturation indices indicated that fluorite minerals play a vital role in the prevalence of fluorosis, while under-saturation revealed that - besides fluorite minerals - other F- minerals that are also present in the region further increase the F- concentrations in the groundwater. Finally, a health risk assessment via Dean's classification method identified that the groundwater with relatively higher F- concentrations is unfit for drinking purposes.

Treatment of Shoulder Dislocation with Greater Tuberosity and Glenoid Fractures.

Large glenoid fractures are relatively uncommon with shoulder dislocation. Simultaneous glenoid and greater tuberosity fractures with anterior shoulder dislocation are very rare. We report on a 48-year right-handed male who sustained a fall during skiing. He had anterior shoulder dislocation combined with large glenoid fracture and greater tuberosity fracture. He was treated surgically with fixation of the glenoid and greater tuberosity fractures, using two different approaches. The deltopectoral approach with coracoid osteotomy and subscapularis split was used for glenoid fixation. McKenzie's approach was used for greater tuberosity fixation.

Delta Reverse Polarity Shoulder Replacement: Single Surgeon Experience with a Minimum 2-Year Follow-up.

BACKGROUND: The delta reverse shoulder replacement system was developed for the treatment of rotator cuff arthropathy so that the deltoid can substitute for the deficient rotator cuff. To evaluate the results of delta reverse shoulder replacement for functional improvement and complications in a consecutive series by a single surgeon over a period of six years with a minimum follow-up of 2 years. METHODS: The data were collected retrospectively from electronic theatre records. Over a period of 6 years (2006-2012), 46 cases that fulfilled the inclusion criteria were identified. There were 34 females and 12 males. The average age of patients was 76.2 years (range, 58 to 87 years). A single surgeon performed all procedures using the anterosuperior approach. The mean follow-up time was 49 months (range, 24 to 91 months). All cases had preoperative and postoperative Constant scores. We collected the data on indications, hospital stay, and change in the Constant score, complications, and reoperation rates. RESULTS: The main indication for surgery was rotator cuff arthropathy (52.2%), followed by massive rotator cuff tear (28.3%), osteoarthritis (8.7%), fractures (6.5%), and rheumatoid arthritis (4.3%). Also, 65.2% of the cases were referred by general practitioners, 26% of the cases were referred by other consultants, and 8.8% of the cases were already under the care of a shoulder surgeon. The average preoperative Constant score was 23.5 (range, 8 to 59). The average Constant score at the final follow-up was 56 (range, 22 to 83). On average, there was an improvement of 33 points in the Constant score. The improvement in the Constant score was significant (p < 0.001). We observed complications in four patients (8.6%). Three of four patients (6.5%) needed reoperation. The first complication was pulmonary embolism in the early postoperative period. The other complications included dissociation of the glenosphere from the metaglene, deltoid detachment, and stitch abscess. CONCLUSIONS: This is a single-surgeon, single-approach series of 46 cases with a minimum follow-up of 2 years. At this stage, the results are encouraging with no cases of loosening, dislocation, or nerve injury.

Cytomorphology Versus Conventional Microbiological Tests in the Diagnosis of Tuberculous Lymphadenitis.

OBJECTIVE: To determine the accuracy of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of tuberculous lymphadenitis. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Department of Pathology, Khalifa Gul Nawaz Teaching Hospital (KGNTH), Bannu, from September 2012 to March 2013. METHODOLOGY: FNAC of enlarged lymph nodes was performed in the Department of Pathology, KGNTH, Bannu. Smears of the aspirates were examined under light microscope after staining with Haematoxylin and Eosin (H & E) stains. In cases of chronic lymphadenitis, the smears were stained with Ziehl-Neelsen (ZN) stain for Acid Fast Bacilli (AFB). If no AFB was visualized, the aspirate was subjected to culture on Lowenstein Jensen (LJ) medium for yield of AFB. The results were analyzed by Microsoft Excel software. RESULTS: Chronic granulomatous lymphadenitis was found in 110 (46.81%) out of 235 cases. AFB were seen in aspirates of 43/110 (39.09%) cases by direct microscopy. Among the remaining 67 aspirates subjected to LJ medium, only 07 (10.45%) yielded growth of AFB. Smears of 4/15 (3.6%), 13/47 (11.7%) and 33/48 (29.7%) cases with haemorrhagic, inflammatory and caseous background respectively, were confirmed by conventional microbiologic tests. Out of 125 nongranulomatous lymphadenitis cases only 05 were confirmed to be due to tuberculosis by direct microscopy while culture was not positive in any case. Thus accuracy of FNAC was 72.34%. CONCLUSION: FNAC has a good accuracy in diagnosing tuberculous lymphadenopathy.