Safety and Efficacy of Trans-Perineal Urethroplasty for Management of Post-Traumatic Urethral Strictures in Pediatric Age-Group.

INTRODUCTION: Trans-perineal urethroplasty is the preferred treatment for distraction urethral injuries in adults. However, management of such injuries in children is challenging because of functional implications in a growing child. In the present study, we aim to evaluate the safety and efficacy of perineal urethroplasty for distraction urethral injuries in children. METHODS: The medical records of prepubertal pediatric patients (age <14 years) with traumatic urethral distraction injuries managed by perineal urethroplasty were retrospectively reviewed and analyzed with respect to demographics, stricture characteristics, management, complications, follow-up, and outcome. RESULTS: A total of 14 patients were included in the study. Ten had membranous, and 4 had bulbar urethral strictures. All membranous strictures were secondary to pelvic trauma; bulbar strictures were secondary to blunt perineal trauma; 7 patients had associated pelvic fractures. Anastomotic urethroplasty was used in 10 patients (71.4%) and buccal mucosal graft urethroplasty was done in 4 patients (38.6%). The mean follow-up duration was 56 months (range 24-76). Surgery was primarily successful in 85.7%. Failed repair in 2 patients was successfully managed with augmented anastomotic urethroplasty. Post-operatively, the mean maximal urinary flow rate was 26.4 mL/s. No significant complications occurred. All boys are continent. There was no chordee or urethral diverticula, during follow-up. CONCLUSION: In pediatric patients, bulbar and membranous strictures can be treated successfully with urethroplasty using the perineal approach. Longer follow-up is needed to confirm that these good results are maintained as these patients cross into adulthood, especially as these repairs were done before puberty.

Post parotidectomy facial nerve palsy: A retrospective analysis.

BACKGROUND &OBJECTIVES: Transient paralysis of facial nerve is seen to vary from 15 % to 66 % in post-parotid surgery. The objective of this study was to find out the complications in post-parotidectomy with regards to facial nerve dysfunction since it is a vital structure encountered in parotid surgeries. METHODS: This was a retrospective study through non probability convenient sampling technique carried from September 2010 to January 2019 in the Department of Otorhinolaryngology, Dow University of Health Sciences, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. Clinical data were recorded from 75 patients and out of them 70 patients had undergone surgery with parotid gland tumours and were reported on the morphology, age, sex, surgical procedure and complications, particularly facial nerve dysfunctions. In most cases ante-grade technique was performed to identify the facial nerve, whereas retrograde technique was used in recurring tumours, and in difficult cases. The stimulator of the nerve has not been used. The nature or severity of Facial nerve dysfunction was assessed in terms of either it is, permanent or temporary, total or incomplete in respect to its branches. RESULTS: Among total 75 patients; the mean age was 38.75 ± 9.26 years with male to female ratio of 1:1. Majority of the patients were diagnosed as pleomorphic adenoma, i.e. 78.6% after which 12% were diagnosed as mucoepidermoid carcinoma. 88.6% of patients had superficial parotidectomy and 11.4% of patients had total parotidectomy. About 75% of patients had no complications. 5(7.1%) patients had complete facial nerve palsy. Damage to the mandibular, buccal and temporozygomatic branch was observed in 10(14%), 2(3%) and 1(1.4%) patients respectively. CONCLUSION: The most prevalent benign parotid tumour in this study was pleomorphic adenoma. After performing parotid surgery, it was predicted that the rate of complications related to the facial nerve injury was reduced as compared to the previous studies.

Assessment of Impact of Various Root Canal Irrigants on the Adherence of the Gelatinase-producing and the Gelatinase-deficient E. faecalis Strains to Dentin.

AIM: Present study was planned to assess the impact of various root canal irrigants on the adhesion of different Enterococcus faecalis (E. faecalis) strains to the dentinal surface. MATERIALS AND METHODS: A total of 80 freshly extracted first and second molars were used in the present study. Preparation of dentin discs was done followed by a random division into four study groups and one control group. Four study groups included; 2.5 % sodium hypochlorite (NaOCl), 2 % chlorhexidine (CHX), 2.5 % NaOCl + saline + 2 percent CHX and 2.5 % NaOCl + 17 % ethylene diamine tetra-acetate (EDTA) + 2.5 % NaOCl group respectively. In the control group (E), sterilized dentin discs were incubated with sterile TSB solution. Division of all the groups into two subgroups were done depending upon the type of strain of E. faecalis used. Incubation of all the specimens was done followed by assessment with XTT assay and measurement of Optical density (OD). All the results were compiled and analyzed by Statistical Package for the Social Sciences (SPSS) software. RESULTS: Among the groups containing gelatinase producing strains; maximum score was exhibited by 2.5 percent sodium hypochlorite solution followed by 2.5 % NaOCl + 17 % Ethylene Diamine tetra-acetate (EDTA) + 2.5 % NaOCl group (group D). On comparing the OD values among various study groups incubated with Gelatinase producing strain, significant results were obtained. Gelatinase-producing E. faecalis showed a significantly higher amount of adherence to dentin, in comparison to the gelatinase-deficient E. faecalis strains. CONCLUSION: Lesser quantity of bacteria is recovered from specimens in whom CHX was added to the irrigation protocol. CLINICAL SIGNIFICANCE: Production of gelatinase by E. faecalis might lead to an increase in adhesiveness of E. faecalis to the dentin.

Design, synthesis, and evaluation of new α-aminonitrile-based benzimidazole biomolecules as potent antimicrobial and antitubercular agents.

The study explores the one-pot synthesis of novel α-aminonitriles by reacting 4-[(1H-benzimidazol-2-yl)methoxy]benzaldehyde, substituted anilines and sodium cyanide using a catalytic amount of copper dipyridine dichloride (CuPy2 Cl2 ) and employing the Strecker reaction under mild conditions. All the synthesized compounds were screened for antimicrobial and antitubercular activity. The promising lead compounds 4d and 4e were identified, with MIC values ranging between 3.9 and 7.8 µg/mL against different bacterial strains. Compounds 4c-e and 4g also showed good antifungal activities against the tested fungal strain. Among those tested, compound 4e exhibited excellent antitubercular activity (MIC 0.05 µg/mL) with a low level of cytotoxicity, suggesting that compound 4e is a promising lead for subsequent investigations in search for new antitubercular agents.

Relationship of the inter-condylar width with mandibular inter-canine width.

BACKGROUND: Aesthetic tooth selection and physiological tooth arrangement are the objectives of the complete denture fabrications. The objective of this study was to determine the relationship of the intercondylar width with mandibular inter-canine width. METHODS: This cross-sectional comparative study was conducted in Department of Prosthodontics, Lahore Medical and Dental College, Lahore from January to June 2011. A total of 250 dentate subjects were selected according to the inclusion criteria. Maxillary and mandibular arch impressions were taken. The distance between the cusp tips of mandibular canines was measured by using vernier calliper. The intercondylar width was measured using arbitrary face bow. The width between the two condylar rods was measured with vernier calliper in millimetres. Every width was measured three times by the same operator to ensure the accuracy. Data recorded on the Performa for statistical analysis. RESULT: Pearson correlation coefficients (r) for the inter condylar width and mandibular inter-canine are showing positive correlation and significant (r = 0.24, p = 0.005). CONCLUSIONS: Inter-condylar width provides significant measurements for the selection of anterior teeth in edentulous patients.

Synthesis and in-vivo evaluation of carbonyl-amide linkage based new benzimidazole derivatives.

In search of pharmacologically active potent compounds, a series of carbonyl-amide linkage based new benzimidazole derivatives were synthesized from acid, aldehydes and isocyanide at ambient temperature via Passerini reaction. All the compounds synthesized were screened for their potential anti-inflammatory, antidiabetic and anticonvulsant properties. The results revealed that compounds 2i and 2j were found to be the most potent anti-inflammatory agents, while compounds 2a, 2c, 2e, 2f, 2i and 2j showed increased antidiabetic activity than the reference drugs and 2a, 2g, 2h, 2i and 2j were found to be the main structural requirement for maintaining anticonvulsant activity.

Laryngeal Embryonal Rhabdomyosarcoma: A rare adult neoplasm.

The embryonal subtype of rhabdomyosarcoma is the most frequent, commonly seen in children. However, it is uncommon to discover this subtype in adults, especially in the larynx. We presented a rare case of a 63 years old man who presented with worsening hoarseness, dysphagia for solids, and dyspnea and was later diagnosed with embryonal rhabdomyosarcoma of the larynx.

Assessment of genetic diversity and volatile content of commercially grown banana (Musa spp.) cultivars.

Banana is an important fruit crop in the tropics and subtropics; however, limited information on biomarkers and signature volatiles is available for selecting commercial cultivars. Clonal fidelity is a major contributor to banana yield and aroma; however, there are no useful biomarkers available to validate clonal fidelity. In this study, we performed the molecular profiling of 20 banana cultivars consisting of diploid (AA or AB) and triploid (AAA or AAB or ABB) genomic groups. We screened 200 molecular markers, of which 34 markers (11 RAPD, 11 ISSR, and 12 SSR) yielded unequivocally scorable biomarker profiles. About 75, 69, and 24 allelic loci per marker were detected for RAPD, ISSR, and SSR markers, respectively. The statistical analysis of molecular variance (AMOVA) exhibited a high genetic difference of 77% with a significant FST value of 0.23 (p < 0.001). Interestingly, the UBC-858 and SSR CNMPF-13 markers were unique to Grand Nain and Ardhapuri cultivars, respectively, which could be used for clonal fidelity analysis. Furthermore, the analysis of banana fruit volatilome using headspace solid-phase microextraction-gas chromatography-tandem mass spectrometry (HS-SPME-GCMS) revealed a total of fifty-four volatile compounds in nine banana cultivars with 56% of the total volatile compounds belonging to the ester group as the significant contributor of aroma. The study assumes significance with informative biomarkers and signature volatiles which could be helpful in breeding and for the authentic identification of commercial banana cultivars.

Skin lesions in hospitalized cases of dengue Fever.

OBJECTIVE: To determine the frequency and types of skin lesions in cases of dengue fever in patients admitted in three hospitals of Karachi. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Three tertiary care hospitals of Karachi, from November 2006 to February 2007. METHODOLOGY: One hundred patients of dengue fever with positive anti-dengue Immunoglobulin M (IgM) serology were included in the study. The admitted patients in PNS Shifa Hospital, Jinnah Postgraduate Medical Centre (JPMC) and Civil Hospital, Karachi were selected for the study. Presenting features were noted. The patients were physically examined for the presence of skin and mucosal lesions and findings were recorded. Total and Differential Leukocyte Count (TLC and DLC), platelet count and Liver Function Tests (LFTs) were done in all the patients. RESULTS: All the patients had low leukocyte and low platelet counts. The common presenting symptoms were high-grade fever with or without rigors, headache, body aches, backache, vomiting, sore throat with cough and generalized weakness (seen in 86% patients). The uncommon presenting features were diarrhea, abdominal pain, bleeding from gums and nosebleeds (seen in 14% patients). Sixty-eight (68%) patients had skin lesions. The most common skin presentation was generalized macular blanchable erythema involving trunk and limbs, seen in 44 (65%) cases. Discrete petechial lesions were seen on various body areas in 24 (35%) cases. Palmer erythema was seen in 20 (30%) patients. Generalized itching was seen in 16 (23%) cases. Isolated itching of palms and soles was seen in 20 (30%) cases. Twenty-eight (28%) patients had deranged LFTs. Out of those, 4 patients had raised serum bilirubin level whereas rest of the 24 had raised ALT. CONCLUSION: Dengue fever commonly presents with specific skin lesions. The skin lesions can be a clue to the diagnosis in difficult cases.

Continuation of oral nutritional supplementation supports continued growth in nutritionally at-risk children with picky eating behaviour: A post-intervention, observational follow-up study.

Objectives To evaluate the 120-day post-intervention growth trajectory of picky-eating children aged 2 to 6 years who previously completed a 90-day, randomized, controlled trial of oral nutritional supplementation (ONS) plus dietary counselling (DC) (SDC, n = 98) compared with DC alone (n = 105). Methods A total of 203 children were included. Children were free to consume ONS during follow-up. Information on ONS consumption was collected. Weight-for-age percentile (WAP) and height-for-age percentile (HAP) were measured at Day 90 (beginning) and Day 210 (end point). Results Despite continued weight gain, there was a significant decline in WAP in both groups during the post-intervention period. However, children who took ONS voluntarily had a smaller loss in WAP compared with those who did not. Children in the SDC group showed no difference in a decline in HAP between those who took ONS during follow-up and those who did not. However, children in the DC group showed a marginally larger decline in HAP in those who did not take ONS during the follow-up compared with those who did. Conclusions Continued parental self-administration of ONS to their children slows down the loss of growth percentiles, supporting continued weight gain in picky-eating children at nutritional risk.

Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: a randomized, controlled trial.

Objectives To evaluate the effect of oral nutritional supplementation (ONS) plus dietary counselling (DC) (intervention) versus DC alone (control) on growth and upper respiratory tract infection (URTI) in nutritionally at-risk, picky eating children in India. Methods We performed a 90-day, prospective, randomized, controlled trial. A total of 255 children aged 24-72 months with a weight-for-age z-score ≥-2 and <-1, picky eating behaviour, and acute URTI were randomized to the control (n = 128) or intervention group (n = 127). The outcomes included the change in weight-for-age z-score from days 1 to 90 and the URTI incidence. Results The mean age was 44.0 ± 14.3 months. The intervention group showed a significantly greater increase in mean weight-for-age and body mass index-for-age z-scores compared with the control group from day 10 onwards. Higher energy intake in the intervention group was observed at all follow-up visits, except for day 10. The incidence of URTI in the control group was 2.01 times higher than that in the intervention group, controlling for confounding factors. Conclusions ONS plus DC is effective for improving weight and reducing the incidence of URTI in nutritionally at-risk, picky eating children with an acute URTI episode.

Dyeing and characterization of regenerated cellulose nanofibers with vat dyes.

Recent advancement in dyeing of nanofibers has been accelerated to improve their aesthetic properties, however, achieving good color fastness remains a challenge. Therefore, we attempt to improve the color fastness properties nanofibers. Vat dyes are known for better color fastness and their application on nanofibers has not been investigated to date. Herein, we report dyeing of regenerated cellulose nanofibers (RCNF) that were produced from precursor of cellulose acetate (CA) followed by deacetylation process. The resultant RCNF was dyed with two different vat dyes and the color attributes were examined under spectrophotometer which showed outstanding color build-up. Morphological of CA before and after deacetylation and before and after vat dyeing was investigated under TEM, FE-SEM and SEM respectively. The vat dyed RCNF were further characterized by FTIR and WAXD. Excellent color fastness results demonstrate that vat dyed RCNF can potentially be considered for advanced apparel applications.

Nitric oxide, a mediator of inflammation, suppresses tumorigenesis.

Inflammation influences the development of cancer. The nitric oxide synthase (NOS2) is induced by inflammatory cytokines, e.g., tumor necrosis factor alpha and interleukin 1beta, and produces nitric oxide (NO*), a critical mediator of the inflammatory response. Because p53 governs NO* production by transcriptionally transrepressing NOS2, we used a genetic strategy to determine whether NO* and p53 cooperatively regulate tumorigenesis. Lymphomas developed more rapidly in p53-/-NOS2-/- or p53-/-NOS2+/- mice than in p53-/-NOS2+/+ mice that were cross-bred into a >95% C57BL6 background and maintained in a pathogen-free condition. Likewise, sarcomas and lymphomas developed faster in p53+/-NOS2-/- or p53+/-NOS2+/- than in p53+/-NOS2+/+ mice. When compared with the double knockout mice, p53-/-NOS2+/+ mice showed a higher apoptotic index and a decreased proliferation index with an increased expression of death receptor ligands, CD95-L and tumor necrosis factor-related apoptosis-inducing ligand, and the cell cycle checkpoint protein, p21(waf1), in the spleen and thymus before tumor development. Furthermore, mice deficient in both p53 and NOS2 produced a high level of anti-inflammatory interleukin 10 when compared with p53-deficient mice. These studies provide genetic and mechanistic evidence that NO* can suppress tumorigenesis.

Human health risk assessment, congener specific analysis and spatial distribution pattern of organochlorine pesticides (OCPs) through rice crop from selected districts of Punjab Province, Pakistan.

To evaluate the screening level risk assessment of OCPs in rice (Oryza sativa L.) straw (n=20) and rice grains (n=20), samples were collected from different districts of Punjab Province, Pakistan. ∑OCPs' levels (ng g(-1)) in rice straw and grains ranged from 3.63 to 39.40, 2.72 to 49.89, respectively. DDTs were found predominant over the other detected OCP isomers followed by HCH and heptachlor. Results of one way ANOVA reflected no significant difference for OCPs' levels among sampling sites, except heptachlor for rice grains. ∑OCPs' concentration in rice straw samples was exceeding the minimal residual levels (MRLs) (Australian and Japanese). Results of dietary intake and risk assessment suggested that rice straw is not safe for animals to consume as fodder. Human health was suggested to have some carcinogenic risks by consumption of rice grains, however, no considerable hazardous risk (non-carcinogenic) to human health was found.

Strangulated small bowel obstruction secondary to a transmesosigmoid hernia.

Internal hernias are an infrequent cause of small bowel obstruction with transmesosigmoid herniation being very rare, especially in patients with no history of abdominal surgery or trauma. Early surgical intervention is important in acute presentation to reduce the high morbidity and mortality rates associated with this disease.

Gallium-68 DOTA-TATE Positron Emission Tomography/Computed Tomography: Scintigraphic Changes of Adrenal Glands Following Management of Ectopic Cushing's Syndrome by Steroidogenesis Inhibitors.

In the era of emerging functional imaging techniques, an understanding of the effects of hormonal therapies on the scintigraphic appearance of endocrine organs is desirable to minimize the erroneous scan interpretation. The mechanisms by which changes in the scintigraphic appearance of endocrine organs occur however sometimes remain ambiguous. This case demonstrates the gallium-68 (Ga-68) DOTA-TATE positron emission tomography/computed tomography (CT) appearance of adrenal glands following management with steroidogenesis inhibitors. The potential mechanisms underlying this change are discussed. A 17-year-old boy with adrenocorticotropic hormone (ACTH) dependent Cushing's syndrome secondary to ectopic ACTH secretion underwent pre- and post-metyrapone and dexamethasone treatment Ga-68 DOTA-TATE scans 4 months apart. Pretreatment, both adrenals demonstrated normal symmetrical prominent Ga-68 DOTA-TATE uptake and normal CT appearance. The posttherapy scan revealed marked symmetrical suppression of Ga-68 DOTA-TATE uptake, but with bilateral adrenal hypertrophy on CT.

Metyrapone: a management option for ectopic ACTH syndrome in small cell lung cancer treated with intravenous etoposide.

Small cell lung cancer (SCLC) with ectopic adrenocorticotropic hormone (ACTH) syndrome and resultant hypercortisolism carries a poor prognosis with a short median survival and high incidence of infective complications. The combination of etoposide with either carboplatin or cisplatin is the current standard chemotherapy used for the management of SCLC. Etoposide is metabolised by cytochrome P450 3A4. Ketoconazole is an imidazole derivative possessing antifungal properties and also causes inhibition of adrenal corticosteroid and androgen production. There is an additional increased risk of toxicity due to a potential interaction between etoposide and ketoconazole, which is a strong inhibitor of cytochrome P450 3A4, and theoretically can lead to greater myelosuppression. Metyrapone can be a safe alternative in such settings.