Systematic review of topical interventions for the management of odour in patients with chronic or malignant fungating wounds.

Chronic wounds adversely affect the quality of life of individuals and odour is a well-recognised associated factor. Odour can affect sleep, well-being, social interactions, diet and potentially wound healing. This systematic review aims to examine the effectiveness of topical interventions in the management of odour associated with chronic and malignant fungating wounds. A systematic review guided by PRISMA recommendations of randomised controlled trials where odour intensity/odour is the primary outcome was undertaken. Inclusion criteria were adults (18 years and over) with chronic venous, arterial, diabetic or pressure ulcers or with malignant fungating wounds where odour has been managed through topical application of pharmacological/non-pharmacological agents. Searches were conducted in CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, and Web of Science. Eligibility screening, risk of bias assessment and data extraction was completed by authors working independently. Searches retrieved 171 titles and abstracts (157 post de-duplication). Thirteen studies were retained for full text review of which five (n = 137 individuals) examining the following treatments remained: metronidazole (n = 4), silver (n = 1). Meta-analysis was not possible but individual studies suggest improved outcomes (i.e., reduced odour) using metronidazole. Treatment options to manage wound odour are limited and hampered by lack of clinical trials, small sample sizes, and absence of standardised outcomes and consistent measurement. Whereas metronidazole and silver may have a role in controlling wound odour, robust and well-designed interventions with rigorous procedures and standardised odour outcomes are necessary to evaluate their contribution.

Intracluster correlation estimates from a World Health Organisation STEPwise approach to surveillance (STEPS) survey for cardiovascular risk factors in Vellore, Tamil Nadu, India.

OBJECTIVES: Most World Health Organisation (WHO) STEPS surveys use cluster sampling to assess the prevalence of risk factors for non-communicable diseases (NCDs) for which design effects need to be estimated using intracluster correlation (ICCs) coefficients, for sample size calculation. Although there are many reports of risk factor surveys reported from developing countries, there are very few reports of ICCs for risk factors for NCDs, which can inform planning the appropriate sample size needed for such surveys. This study reports the ICCs for NCD risk factors, obtained from a WHO STEPS survey conducted in Vellore district, in the state of Tamil Nadu, South India. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study was carried out in 48 urban clusters (wards) and nine rural clusters (villages) between 2011 and 2012, using the WHO STEPS methodology for assessing behavioural, anthropometric, physical and biochemical risk factors. The ICC estimates for various risk factors were obtained using loneway and xtmelogit commands using STATA to study clustering of risk factors. RESULTS: The number of respondents was 6196 adults aged 30-64 years. The median ICC of cardiovascular risk factors in the urban area was 0.046, while it was 0.064 in the rural area. Clustering was higher for behavioural risk factors such as physical activity (ICC: 0.179 rural, 0.049 urban) and fruit and vegetable intake (ICC: 0.105 rural, 0.091 urban) as compared with physical risk factors (ICCs for hypertension: 0.044 rural, 0.006 urban; body mass index: 0.046 rural, 0.041 urban) and biochemical outcomes such as fasting plasma glucose (ICC: 0.017 rural, 0.027 urban). CONCLUSIONS: This study provides estimates of ICCs for cardiovascular risk factors from Vellore, South India, as such data have not been reported from WHO STEPS surveys in India or neighbouring countries. Such estimates of ICCs if reported from various WHO STEPS being carried out across the country can contribute to better planning of epidemiological surveys. Clustering of behavioural risk factors at village/ward level as seen in this study points to the need for community-based interventions for health promotion, as spatial clustering influences behaviour, which in turn affects chronic disease outcomes.

Host Th1/Th2 immune response to Taenia solium cyst antigens in relation to cyst burden of neurocysticercosis.

Neurocysticercosis (NCC), Taenia solium larval infection of the brain, is an important cause of acquired seizures in endemic countries, which relate to number, location and degenerating cysts in the brain. Multicyst infections are common in endemic countries although single-cyst infection prevails in India. Single-cyst infections in an endemic country suggest a role for host immunity limiting the infection. This study examined ex vivo CD4(+) T cells and in vitro Th1 and Th2 cytokine responses to T. solium cyst antigens of peripheral blood mononuclear cells of healthy subjects from endemic and nonendemic regions and of single- and multicyst-infected patients for association with cyst burden of NCC. T. solium cyst antigens elicited a Th1 cytokine response in healthy subjects of T. solium-endemic and T. solium-non-endemic regions and those with single-cyst infections and a Th2 cytokine response from subjects with multicyst neurocysticercosis. Multicyst neurocysticercosis subjects also exhibited low levels of effector memory CD4(+) T cells. Th1 cytokine response of T. solium exposure and low infectious loads may aid in limiting cyst number. Th2 cytokines and low effector T cells may enable multiple-cyst infections to establish and persist.

Peri-operative Morbidity Associated with Bilateral Hip Arthroplasty for Inflammatory Arthritis: Results from a Consecutive Series of 168 Hips.

AIM: This study aims to assess the risks and peri-operative morbidity associated with a single-stage sequential bilateral hip arthroplasty (SBHA) when performed in patients with arthritis secondary to inflammatory arthropathy. METHODS: Data of patients who underwent SBHA between 2012 and 2018 for inflammatory arthritis were extracted from a database, for peri-operative complications and functional improvement. SBHA for other causes was excluded. RESULTS: Data of 84 consecutive patients with a mean age of 34.5 years were analyzed. The mean follow-up was 2.4 years. 66% had ankylosing spondylitis, while 14% had rheumatoid arthritis. 50% of the patients had bilateral fusion of the hips, and 34% had flexion deformity > 30°.None of the patients had peri-operative cardiac or pulmonary complications. 2.4% had per-operative hypotension (MAP < 50 mmHg) and 1.2% had desaturation (SpO2 < 90%). The mean drop in hematocrit was 9.3%. While 31% did not require blood transfusion, 35% required more than 1 unit of blood. Patients with pre-operative PCV of > 36% had a significantly lower risk of being transfused > 1 unit of blood (p = 0.02). ICU admission was 6%-mostly for post-operative monitoring. While one patient had a local hematoma that needed a wash-out, there were no infections, dislocations, or mortality in these patients. The modified Harris hip score improved from a mean of 26.5-85. The mean hip flexion improved post-operatively from 32° to 92°. CONCLUSIONS: SBHA for inflammatory arthritis can be performed with minimum complications in a multidisciplinary setting. Pre-operatively, PCV of > 36 is advised to reduce transfusion rates.

Subtrochanteric femoral shortening for hip centre restoration in complex total hip arthroplasty with functional outcome.

AIMS: Complex total hip arthroplasty (THA) with subtrochanteric shortening osteotomy is necessary in conditions other than developmental dysplasia of the hip (DDH) and septic arthritis sequelae with significant proximal femur migration. Our aim was to evaluate the hip centre restoration with THAs in these hips. METHODS: In all, 27 THAs in 25 patients requiring THA with femoral shortening between 2012 and 2019 were assessed. Bilateral shortening was required in two patients. Subtrochanteric shortening was required in 14 out of 27 hips (51.9%) with aetiology other than DDH or septic arthritis. Vertical centre of rotation (VCOR), horizontal centre of rotation, offset, and functional outcome was calculated. The mean followup was 24.4 months (5 to 92 months). RESULTS: The mean VCOR was 17.43 mm (9.5 to 27 mm) and horizontal centre of rotation (HCOR) was 24.79 mm (17.2 to 37.6 mm). Dislocation at three months following acetabulum reconstruction required femoral shortening for offset correction and hip centre restoration in one hip. Mean horizontal offset was 39.72 (32.7 to 48.2 mm) compared to 42.89 (26.7 to 50.6 mm) on the normal side. Mean Harris Hip Score (HHS) of 22.64 (14 to 35) improved to 79.43 (68 to 92). Mean pre-operative shortening was 3.95 cm (2 to 8 cm). Residual limb length discrepancy was 1.5 cm (0 to 2 cm). Sciatic neuropraxia in two patients recovered by six months, and femoral neuropraxia in one hip recovered by 12 months. Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 13.92 (9 to 19). Mean 12-item short form survey (SF-12) physical scores of 50.6 and mental of 60.12 were obtained. CONCLUSION: THA with subtrochanteric shortening is valuable in complex hips with high dislocation. The restoration of the hip centre of rotation and offset is important in these hips. LEVEL OF EVIDENCE IV: Femoral shortening useful in conditions other than DDH and septic sequelae.Restoration of hip centre combined with offset to be planned and ensured.

Benign tumors and tumor-like lesions of the calcaneum: a study of 12 cases.

UNLABELLED: Benign tumors of the calcaneum are rare. Cystic lesions such as simple bone cysts and aneurysmal bone cysts are commonly seen. AIMS AND OBJECTIVES: To evaluate tumors of the calcaneum, which were seen over a 12-year period. MATERIALS AND METHODS: We analyzed noninfectious, noninflammatory, benign lesions of the calcaneum seen in the Orthopedic Out Patient Department from 1991 to 2003. Twelve such tumors were encountered. There were 11 males and one female and their ages varied from 18 to 53 years with a median of 31. Data was collected from the histopathology reports, radiographs, and inpatient and outpatient records. One of the coauthors reviewed the histopathologic findings of all the tumors. RESULTS: Twelve benign lesions were seen in 12 patients. In our series, cysts predominated, with three aneurysmal bone cysts and five simple bone cysts. The other benign tumors were: one fibrous dysplasia, one vascular hamartoma, one osteoblastoma, and one chondromyxoid fibroma. The bone cysts were treated by curettage, with or without bone grafting, except for one large aneurysmal bone cyst, which was treated by excision of the calcaneum. The postoperative function in this patient was good, with modified footwear. CONCLUSION: The calcaneum is an uncommon site for most bone tumors, and in our series, bone cysts were the most common benign lesions. Curettage and bone grafting or the use of bone substitutes can be effectively used in the treatment of symptomatic bone cysts of the calcaneum.

Mitochondrial ATP synthase inhibition and nitric oxide are involved in muscle weakness that occurs in acute exposure of rats to monocrotophos.

Organophosphate poisoning in the context of self-harm is a common medical emergency in Asia. Prolonged muscle weakness is an important but poorly understood cause of morbidity and mortality of the poisoning. This study examined mitochondrial function and its modulation by nitric oxide in muscle weakness of rats exposed to an acute, oral (0.8LD(50)) dose of monocrotophos. Muscle mitochondrial ATP synthase activity was inhibited in the rat in acute exposure to monocrotophos while respiration per se was not affected. This was accompanied by decreased mitochondrial uptake of calcium and increased levels of nitric oxide. Reactive cysteine groups of ATP synthase subunits were reduced in number, which may contribute to decreased enzyme activity. The decrease in ATP synthase activity and reactive cysteine groups of ATP synthase subunits was prevented by treatment of animals with the nitric oxide synthase inhibitor, L-N(G) Nitroarginine methyl ester, at 12 mg/kg body weight for 9 days in drinking water, prior to monocrotophos exposure. This indicated a role for nitric oxide in the process. The alterations in mitochondrial calcium uptake may influence cytosolic calcium levels and contribute to muscle weakness of acute organophosphate exposure.

Is it safe to do a single-stage implant exit and primary hip replacement? clinical and microbiological profiling.

Background: A single-stage implant revision for failed fixation of proximal femoral fractures is performed only when there is no evidence of infection. Else, a two-staged revision is preferred - where the definitive revision surgery is done a few months after the implant exit. This study aims to audit the safety and incidence of culture positivity in single-stage revisions. Materials and Methods: Forty one of 284 patients that presented over the last 12 years for implant exchange of the hip, had a single stage revision surgery for failed fixation of a fracture of the hip, as there was no obvious evidence of infection at the time of implant exit. Results: Micro-organisms were grown in 51% of the 41 hips. 76% were gram positive, of which 63% were Coagulase negative staphylococci (CoNS). 50% of CoNS and 75% of S. aureus were resistant to oxacillin, but susceptible to Vancomycin. Of the gram negative organisms, 2 (Enterobacter sp) were resistant to carbapenam, while others were susceptible. Preoperative ESR and CRP, individually, had low specificity - 50% for ESR >30mm at 1 hour and 62% for CRP>10. The combined use of ESR > 30mm and CRP>10 increased the specificity to 90%. 12% of the patients had immediate postoperative complications that required a wash out in theatre. The long term clinical follow up of these patients is limited. Conclusion: This study suggests that implant exit and simultaneous arthroplasty for failed fracture fixation should be done with caution due to the high possibility of infection. It may be prudent to opt for a 2 stage revision.

Seroprevalence of Taenia solium antibodies in Vellore district, south India.

Although Taenia solium neurocysticercosis is the cause of almost one-third of epilepsy in Vellore district, south India, the level of exposure to T. solium in the district is not known. This study determined the seroprevalence of cysticercus antibodies in seizure-free, study subjects aged 2-60 years from urban and rural areas of Vellore district. Cysticercus antibodies, as determined by immunoblots, were noted in 15.9% of 1063 people and were significantly higher in the rural population (17.7%) compared with the urban population (6.0%). Twenty-four percent of the rural population and 12% of the urban population ate pork. One-third of all households in the district had one or more members seropositive for cysticercus antibodies. The high index of exposure to T. solium in south India calls for improved animal husbandry and sanitation.

Cleavage specificity of chloroplast and nuclear tRNA 3'-processing nucleases.

tRNAs in eukaryotic nuclei and organelles are synthesized as precursors lacking the 3'-terminal CCA sequence and possessing 5' (leader) and 3' (trailer) extensions. Nucleolytic cleavage of the 3' trailer and addition of CCA are therefore required for formation of functional tRNA 3' termini. Many chloroplast tRNA genes encode a C at position 74 which is not removed during processing but which can be incorporated as the first base of the CCAOH terminus. Sequences downstream of nucleotide 74, however, are always removed. Synthetic yeast pre-tRNA(Phe) substrates containing the complete CCA74-76 sequence were processed with crude or partially purified chloroplast enzyme fractions. The 3'-extended substrates (tRNA-CCA-trailer) were cleaved exclusively between nucleotides 74 and 75 to give tRNA-COH, whereas a 3'-mature transcript (tRNA-CCAOH) was not cleaved at all. A 5'-, 3'-extended chloroplast tRNA-CAG-trailer was also processed entirely to tRNA-COH. Furthermore, a 5'-mature, 3'-extended yeast pre-tRNA(Phe) derivative, tRNA-ACA-trailer, in which C74 was replaced by A, was cleaved precisely after A74. In contrast, we found that a partially purified enzyme fraction (a nuclear/cytoplasmic activity) from wheat embryo cleaved the 3'-extended yeast tRNA(Phe) precursors between nucleotides 73 and 74 to give tRNA(OH). This specificity is consistent with that of all previously characterized nuclear enzyme preparations. We conclude that (i) chloroplast tRNA 3'-processing endonuclease cleaves after nucleotide 74 regardless of the nature of the surrounding sequences; (ii) this specificity differs from that of the plant nuclear/cytoplasmic processing nuclease, which cleaves after base 73; and (iii) since 3'-mature tRNA is not a substrate for either activity, these 3' nucleases must require substrates possessing a 3'-terminal extension that extends past nucleotide 76. This substrate specificity may prevent mature tRNA from counterproductive cleavage by the 3' processing system.

Chronic rupture of the extensor apparatus of the knee joint.

Chronic ruptures of the extensor mechanism of the knee are uncommon injuries, and previously reported literature assumes the presence of an intact patella for repair. We present a case of chronic rupture following patellectomy done twelve years previously. The defect in the extensor apparatus was extensive (18cm), and this was bridged using a large fascia lata graft from the opposite thigh, with reasonably successful results.

Single-step labeling of DNA using restriction endonucleases and T4 polynucleotide kinase.

DNA restriction fragments can be end-labeled in a combined digestion and labeling reaction with restriction endonuclease plus T4 polynucleotide kinase, omitting a dephosphorylation step. Both pBR322 and phage lambda DNA digests are efficiently labeled in one step, one tube and one incubation.

ELISA using mycobacterial antigens as a diagnostic aid for tuberculous meningitis.

An enzyme-linked immunosorbent assay (ELISA) was studied as a possible laboratory test to aid in the diagnosis of tuberculous meningitis (TBM) in an Indian population. The assay detected mycobacterial antibodies in the cerebrospinal fluid (CSF) of TBM patients. Three antigens, PPD, BCG and M. tuberculosis were tested for use in the assay and of these, M. tuberculosis was found to be the most suited. A sensitivity of 72% and specificity of 92% with M. tuberculosis as antigen was obtained for the ELISA under discussion. The system therefore does hold promise as a diagnostic laboratory test for TBM.

Molecular forms of adenosine deaminase do not aid the diagnosis of tuberculosis.

To investigate the diagnostic utility of adenosine deaminase as a test for tuberculosis, molecular forms of the enzyme indicative of cell-mediated immunity were studied in tuberculosis pleural effusion, peritonitis and meningitis. Twenty-six pleural, 21 peritoneal, and 24 cerebrospinal tuberculous and non-tuberculous fluids were examined for adenosine deaminase and the large and small forms of the enzyme were differentiated on immunoblots. Adenosine deaminase levels ranged from zero to 81 units/L, zero to 31 units/L and zero to 31 units/L in the pleural, peritoneal and cerebrospinal fluids, respectively. The large form of adenosine deaminase (280 kDa) was detected in one of 14 proved tuberculous cases, a peritoneal fluid. The small form of the enzyme (35-39 kDa) was seen in both tuberculous and non-tuberculous conditions in 6 pleural, 7 peritoneal and 8 cerebrospinal fluids. Molecular forms of adenosine deaminase did not appear to help in the diagnosis of tuberculosis in this patient population and may not be suited for analysis in fluids with low enzyme activity.

Taenia solium metacestode glycoproteins as diagnostic antigens for solitary cysticercus granuloma in Indian patients.

Taenia solium metacestode glycoproteins specific for lentil lectin were evaluated as diagnostic antigens for solitary cysticercus granulomas in Indian patients, using both an ELISA and immunoblotting. In 250 patients suspected to have neurocysticercosis and subjected to a computerized tomography scan or magnetic resonance imaging, the proteins were diagnostic by the ELISA in 86 patients (80%) and by immunoblots in 67 (62%) of 107 patients with solitary cysticerus granuloma. Among 100 non-cysticercosis patients, the ELISA and immunoblot were negative in 94% and 97% respectively. No cross-reactions were observed with sera from patients with central nervous system tuberculosis. Proteins of

Muscle injury in organophosphorous poisoning and its role in the development of intermediate syndrome.

Muscle injury and its role in the development of Type II paralysis was studied in 25 patients with acute organophosphate poisoning. All patients were assessed for severity of poisoning at admission and through the course of poisoning for the development and duration of intermediate syndrome (IS) (Type II paralysis). Blood levels of acetylcholinesterase, creatine kinase, creatine kinase MM, LDH and LDH5 were estimated through the course of the poisoning. Of the 25 patients, 22 were severely poisoned and 3 had mild to moderate poisoning. Severely poisoned patients had a significantly greater rate of developing intermediate syndrome (17/22) (P = 0.026). Type I paralysis and fasciculations occurred in 76 and 70.5% of patients who developed intermediate syndrome, in comparison to 38 and 50%, respectively, of those who did not develop intermediate syndrome. Weakness developed in the same groups of muscles in both Types I and II paralysis but was of longer duration in patients who developed Type II paralysis. Acetylcholinesterase was inhibited > 90% throughout the course of poisoning with greater inhibition in patients with longer duration intermediate syndrome. Muscle injury was seen in all patients beginning at admission, peaking over the first 5 days and then declining over the next 5 days. Temporal profiles of blood muscle isoenzymes showed significantly greater muscle injury in those patients with greater severity of poisoning at admission, those who developed intermediate syndrome and in patients with longer duration intermediate syndrome. The findings of this study suggest that Types I and II paralysis in organophosphate poisoning are not separate syndromes but a clinical continuum determined by the severity of poisoning. The magnitude of organophosphate exposure and of muscle injury during the cholinergic crises appears to determine the occurrence and severity of intermediate syndrome.

Poor diagnostic value of adenosine deaminase in pleural, peritoneal & cerebrospinal fluids in tuberculosis.

Adenosine deaminase (ADA) was estimated in 84 pleural, 140 peritoneal and 136 cerebrospinal fluids to study its diagnostic usefulness as a routine test for tuberculosis. The sensitivity, specificity, positive and negative predictive values for diagnosing tuberculosis in pleural fluids (ADA > 30 U/l) was 67, 92, 78 and 87 per cent respectively, in peritoneal fluids (ADA > 15 U/1) it was 89, 81, 25 and 99 per cent respectively and in cerebrospinal fluids (ADA > 10 U/l) it was 50, 90 21 and 97 per cent respectively. The differences in mean ADA levels between tuberculous (28.0 and 19.5 U/1) and non-tuberculous (9.7 and 4.8 U/1) peritoneal and cerebrospinal fluids although statistically significant (P < 0.001), were of no practical clinical value. A wide scatter in ADA values was seen in both tuberculous and non-tuberculous fluids. ADA estimation in plasma, lymphocytes and cell fractions of fluids was also not diagnostically useful nor did it throw light on the source of elevated ADA in fluids.

Oxidative damage in intermediate syndrome of acute organophosphorous poisoning.

BACKGROUND & OBJECTIVES: The main cause of morbidity due to organophosphate poisoning is intermediate syndrome (Type II paralysis) that can occur 48-72 h after poisoning. Mechanisms that underlie the intermediate syndrome are not known. This study investigates the role of oxidative damage to muscles as a possible mechanism underlying the development of the intermediate syndrome. METHODS: Nineteen patients with acute organophosphate poisoning were evaluated from admission to discharge from intensive care for the severity of poisoning and the development and duration of the intermediate syndrome. Blood cholinesterases and parameters of oxidative stress were studied daily and their temporal profiles analysed according to the severity of poisoning and the development and duration of the intermediate syndrome. RESULTS: Fifteen patients had severe poisoning and 16 developed intermediate syndrome. There was a positive association between the severity of poisoning and the occurrence of intermediate syndrome. There was no association between the organophosphate ingested and the development of intermediate syndrome. Erythrocyte membrane acetylcholinesterase and serum butyrylcholinesterase levels at admission and over the course of poisoning were significantly (P < 0.001) reduced in patients compared to controls. There were significantly (P < 0.05) higher levels of lipid peroxidation, conjugated dienes and protein thiols in erythrocyte membranes of patients who developed the intermediate syndrome compared to healthy controls, in patients who developed intermediate syndrome compared to those who did not and in patients with long compared to short duration intermediate syndrome. INTERPRETATION & CONCLUSION: In acute organophosphate poisoning, severe and prolonged acetylcholinesterase inhibition is associated with oxidative stress, detected in erythrocyte membranes, that occurs early in the course of poisoning and may contribute to the development and severity of intermediate syndrome.

Neuroparalysis and oxime efficacy in organophosphate poisoning: a study of butyrylcholinesterase.

The temporal profile of butyrylcholinesterase (BuChE) and in vitro pralidoxime-reactivated BuChE was studied in a cohort of 25 organophosphate-poisoned patients to examine their relationship to the development of intermediate syndrome and to understand reasons for lack of efficacy of oxime treatment. The clinical severity of poisoning (assessed by the Namba Scale) correlated significantly with the severity of intermediate syndrome. BuChE activity increased significantly over time and showed significant relationship to muscle power. The temporal profile of the enzyme was correlated to the clinical severity of poisoning. Reactivation potentials of BuChE (the difference between oxime-reactivated and -unreactivated enzyme activity) declined significantly with time after organophosphate ingestion. The reactivation potential of the enzyme at admission decreased significantly with increasing severity of poisoning and was lower in patients who developed intermediate syndrome. Patients who received oxime prior to hospitalization had a higher rate of intermediate syndrome and lower levels of BuChE at admission than those who had not. The study suggests that (i) BuChE reflects the clinical course of poisoning, confirming earlier studies; (ii) intermediate syndrome may be associated with a persistent inhibition of BuChE; and (iii) the lack of oxime efficacy in our patients maybe due to their severity of poisoning and the timing of oxime treatment.

Monoclonal antibody which recognizes a common antigenic determinant on intermediate filament proteins, actin, and myosin.

A monoclonal antibody is described which reacts with the intermediate filament proteins vimentin, desmin, keratins, actin, and myosin. This is the first report of an epitope common to intermediate filament proteins and myosin. X1, the wide-spectrum monoclonal antibody in question, was isolated in the course of screening monoclonal antibodies to chicken thymocytes. Cross-reactivities were investigated by immunofluorescence on various types of cultured cells and sectioned tissues, ELISA with a panel of purified antigens, immunoprecipitation, immunodot tests, and immunoblotting.