Analyzing the impact of pesticides on the indus river: contamination levels in water, sediment, fish, and associated human health risks.

Pesticides are frequently used to protect crop yields and manage malaria vectors; however, their inadvertent transport into aquatic habitats poses a significant concern. Various anthropogenic activities influence the Indus River in Pakistan. This study aimed to assess the presence of eight pesticide residues at three different sites (Kalabagh, Kundian, and Chashma) in water, sediment, and the fish species (Labeo rohita) during both dry and wet seasons to measure the intensity of this pressure. Pesticide analysis was carried out using gas chromatography equipped with an electron capture detector. The results revealed the highest concentrations of pesticides during both dry and wet seasons at all sites, measuring 0.83 and 0.62 µg/l (water), 12.37 and 9.20 µg/g/dw (sediment), and 14.27 and 11.29 µg/g/ww (L. rohita), respectively. Overall, pesticide concentrations were higher in the dry season than in the wet season across all study sites. Based on detection frequency and concentration in both seasons at all sites, dominant pesticides included cypermethrin and carbofuran (in water), as well as endosulfan and cypermethrin (in sediment and fish tissue). Levels of endosulfan and cypermethrin exceeded standard limits. Moreover, principal component analysis (PCA) indicated no correlation among pesticides in fish tissue, sediment, and water. However, pesticides exhibited different behavior in different seasons. Furthermore, endosulfan and triazophos impose great human health risk, as indicated by the THQ value (> 1). The overall HI value was greater for site 1 in the dry season (8.378). The study concluded that the presence of agricultural pesticides in the Indus River poses a risk to aquatic life and has the potential to disrupt the entire food chain. This highlights the importance of sustainable practices for the study area and Pakistan overall agricultural and environmental sustainability. It is further recommended to strengthen regulations for reduced pesticide use and promote eco-friendly pest management.

Implications of Heavy Metal Accumulation in Fish Feed, Water, Sediment, and Different Fish Species in a Polyculture System.

Heavy metal bioaccumulation in organisms is primarily a result of dietary uptake. The current study examines the concentrations of heavy metals (Pb, Cd, Cr, and Cu) in fish feed, water, sediment, and three fish species (Catla catla, Labeo rohita, and Cyprinus carpio) from different feeding zones in a polyculture pond system. Furthermore, associated human health risks were also evaluated. The fish samples (n = 25 for each species) were collected from 10 different fish ponds in the Kohat district, Pakistan. Heavy metals were determined using an atomic absorption spectrometer. Results revealed higher concentrations of heavy metals in sediment, followed by water. However, the concentration of heavy metals in fish feed was lower than the standard limits. In the case of fish, the bottom feeder (C. carpio) notably exhibited higher (P < 0.05) levels of heavy metals than the column feeder (L. rohita) and surface feeder (C. catla) fish. Moreover, in the liver of all fish species, the bioaccumulation of heavy metals was higher, followed by the gills. Principal component analysis (PCA) demonstrated a strong correlation of heavy metals in C. carpio gills, flesh, feed, and pond water, while the heavy metals in the liver correlated with the detected metals in sediment. The human health risk analysis shows that bottom feeder fish had higher estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) values (> 1). Consequently, the exposed population may experience adverse health effects. The findings of this study suggest that the bottom feeder (C. carpio) bioaccumulates a higher concentration of heavy metals than column (L. rohita) and surface feeder (C. catla) in the polyculture system.

Sublethal Concentrations of Cadmium and Lead: Effects on Hemato-Biochemical Parameters and Tissue Accumulation in Wallagu attu.

The exposure of fish to heavy metals can significantly impact physiological processes and potentially lead to adverse health effects. This study assesses the effects of exposure to Cd and Pb sublethal concentrations in water on Wallagu attu. A total of 48 fish with an average body weight of 145.5 ± 26 g were distributed among three groups (control, Cd-treated, and Pb-treated) within 60 L fiberglass tanks. They were exposed to 30% sublethal concentrations of Cd and Pb for durations of 1, 15, and 30 days. Following this exposure, an assessment was conducted on metal bioaccumulation and hemato-biochemical responses. Results revealed a significantly (P < 0.05) higher concentration of heavy metals in the fish tissues of metals exposed groups than in the control. The concentration of Cd and Pb increases in fish tissues (kidney > gills > intestine) with exposure time. In most cases, the Pb-exposed group exhibited significantly (P < 0.05) higher concentrations of Pb in different tissues than the Cd-treated group. With extended exposure time, the activities of CAT and SOD show a significant decrease in both Cd and Pb-treated groups. However, the reduction in activities was more pronounced in the Cd-exposed group. On 15 and 30 days, the levels of red blood cells (RBC), hemoglobin (HB), hematocrit (HCT), and total protein (TP) decrease in groups exposed to Cd and Pb. The cortisol and glucose levels exhibit a more noticeable (P < 0.05) increase with prolonged exposure to Cd and Pb than the control group. On day 30, the survival rate decreased more in the Pb-exposed group. The findings of this study indicate that exposure to sublethal doses of Cd and Pb induces stress in Wallagu attu, resulting in rapid changes in specific hemato-biochemical parameters.

An Update Summary on the Learning Sciences Within an Ophthalmic Context.

Clinical reasoning, specifically diagnostic decision-making, has been a subject of fragmented literature since the 1970s, marked by diverse theories and conflicting perspectives. This article reviews the latest evidence in medical education, drawing from scientific literature, to offer ophthalmologists insights into optimal strategies for personal learning and the education of others. It explores the historical development of clinical reasoning theories, emphasising the challenges in understanding how doctors formulate diagnoses. The importance of clinical reasoning is underscored by its role in making accurate diagnoses and preventing diagnostic errors. The article delves into the dual process theory, distinguishing between type 1 and type 2 thinking and their implications for clinical decision-making. Cognitive load theory is introduced as a crucial aspect, highlighting the limited capacity of working memory and its impact on the diagnostic process. The zone of proximal development (ZPD) is explored as a framework for optimal learning environments, emphasising the importance of scaffolding and deliberate practice in skill development. The article discusses semantic competence, mental representation, and the interplay of different memory stores-semantic, episodic, and procedural-in enhancing diagnostic proficiency. Self-regulated learning (SRL) is introduced as a student-centric approach, emphasising goal setting, metacognition, and continuous improvement. Practical advice is provided for minimising cognitive errors in clinical reasoning, applying dual process theory, and considering cognitive load theory in teaching. The relevance of deliberate practice in ophthalmology, especially in a rapidly evolving field, is emphasised for continuous learning and staying updated with advancements. The article concludes by highlighting the importance of clinical supervisors in recognising and supporting trainees' self-regulated learning and understanding the principles of various teaching and learning theories. Ultimately, a profound comprehension of the science behind clinical reasoning is deemed fundamental for ophthalmologists to deliver high-quality, evidence-based care and foster critical thinking skills in the dynamic landscape of ophthalmology.

Human Health Risk Assessment due to the Incidence of Heavy Metals in Different Commercial Feeds Used for the Culturing of Biofloc Fish (Nile tilapia: Oreochromis niloticus).

Fish meat is a major and rich source of white protein; its quality is determined by the fish feed. However, the low-quality feed may contribute to a source of contamination if it does not fulfill the standard protocol. Biofloc is considered one of the most efficient, successful aquacultures, but this system is still under investigation for its efficiency and safety. Thus, current study focused on the heavy metal contamination in biofloc fish fed on different commercial feeds and human health risk analysis. Samples of extensively used three feeds (Supreme™, Hitech™, and MH-Aqua™), tanks water, and biofloc fish (gills, liver muscle) were collected for heavy metals (Cu, Cd, Pb, and Cr) analysis using atomic absorption spectrometry. An experiment was designed by dividing the fish into three groups: group 1 (Supreme™), group 2 (Hitech™), and group 3 (MH-Aqua™). A bioaccumulation factor and human health risk assessment have been calculated to measure fish and human health. Results revealed that most of the heavy metal concentration was higher (P < 0.05) in MH-Aqua™ feed compared to others. Similarly, heavy metal concentration was higher (P < 0.05) in the water of group 3, where fish was cultured on MH-Aqua™ feed. However, in the fish gills, liver, and muscle, the heavy metal concentration was significantly greater in group 3 fed on MH-Aqua™ feed, followed by group 1. Heavy metals in all feeds were positively correlated to the heavy metal concentration of the fish muscles. The bioaccumulation factor for Cu and Pb was higher in the fish liver, Cd and Cr in the case of fish gills, and least in the fish muscle. EDI and THQ values vary in all the groups, while the HI value was found lower than 1 in group 1 and group 2 but higher in group 3 fed on MH-Aqua™ feed. Strict checks and balances in formulating a diet will be helpful to progressively lower the amount of dangerous heavy metals.

Deciphering key genes involved in cisplatin resistance in kidney renal clear cell carcinoma through a combined in silico and in vitro approach.

The low survival rate of Kidney renal clear cell carcinoma (KIRC) patients is largely attributed to cisplatin resistance. Rather than focusing solely on individual proteins, exploring protein-protein interactions could offer greater insight into drug resistance. To this end, a series of in silico and in vitro experiments were conducted to identify hub genes in the intricate network of cisplatin resistance-related genes in KIRC chemotherapy. The genes involved in cisplatin resistance across KIRC were retrieved from the National Center for Biotechnology Information (NCBI) database using search terms as "Kidney renal clear cell carcinoma" and "Cisplatin resistance". The genes retrieved were analyzed for hub gene identification using the STRING database and Cytoscape tool. Expression and promoter methylation profiling of the hub genes was done using UALCAN, GEPIA, OncoDB, and HPA databases. Mutational, survival, functional enrichment, immune cell infiltration, and drug prediction analyses of the hub genes were performed using the cBioPortal, GEPIA, GSEA, TIMER, and DrugBank databases. Lastly, expression and methylation levels of the hub genes were validated on two cisplatin-resistant RCC cell lines (786-O and A-498) and a normal renal tubular epithelial cell line (HK-2) using two high throughput techniques, including targeted bisulfite sequencing (bisulfite-seq) and RT-qPCR. A total of 124 genes were identified as being associated with cisplatin resistance in KIRC. Out of these genes, MCL1, IGF1R, CCND1, and PTEN were identified as hub genes and were found to have significant (p < 0.05) variations in their mRNA and protein expressions and effects on the overall survival (OS) of the KIRC patients. Moreover, an aberrant promoter methylation pattern was found to be associated with the dysregulation of the hub genes. In addition to this, hub genes were also linked with different cisplatin resistance-causing pathways. Thus, hub genes can be targeted with Alvocidib, Estradiol, Tretinoin, Capsaicin, Dronabinol, Metribolone, Calcitriol, Acetaminophen, Acitretin, Cyclosporine, Azacitidine, Genistein, and Resveratrol drugs. As the pathogenesis of KIRC is complex, targeting hub genes and associated pathways involved in cisplatin resistance could bring a milestone change in the drug discovery and management of drug resistance, which might uplift overall survival among KIRC patients.

A new hybrid algorithm for intelligent detection of sudden decline syndrome of date palm disease.

Date palm is an important domestic cash crop in most countries. Sudden Decline Syndrome (SDS) causes a huge loss to the crop both in quality and quantity. The literature reports the significance of early detection of disease towards preventive measures to improve the quality of the crop. The number of prevailing detection methods limits to consideration of a certain aspect of disease identification. This study proposes a new hybrid fuzzy fast multi-Otsu K-Means (FFMKO) algorithm integrating the date palm image enhancement, robust thresholding, and optimal clustering for significant disease identification. The algorithm adopts a multi-operator image resizing cost function based on image energy and the dominant color descriptor, the adaptive Fuzzy noise filter, and Otsu image thresholding combined with K-Means clustering enhancements. Besides, we validate the process with histogram equalization and threshold transformation towards enhanced color feature extraction of date palm images. The algorithm authenticates findings on a local dataset of 3293 date palm images and, on a benchmarked data set as well. It achieves an accuracy of 94.175% for successful detection of SDS that outperforms the existing similar algorithms. The impactful findings of this study assure the fast and authentic detection of the disease at an earlier stage to uplift the quality and quantity of the date palm and boost the agriculture-based economy.

Optical coherence tomography angiography: a review of the current literature.

This narrative review presents a comprehensive examination of optical coherence tomography angiography (OCTA), a non-invasive retinal vascular imaging technology, as reported in the existing literature. Building on the coherence tomography principles of standard OCT, OCTA further delineates the retinal vascular system, thus offering an advanced alternative to conventional dye-based imaging. OCTA provides high-resolution visualisation of both the superficial and deep capillary networks, an achievement previously unattainable. However, image quality may be compromised by factors such as motion artefacts or media opacities, potentially limiting the utility of OCTA in certain patient cohorts. Despite these limitations, OCTA has various potential clinical applications in managing retinal and choroidal vascular diseases. Still, given its considerable cost implications relative to current modalities, further research is warranted to justify its broader application in clinical practice.

Post-operative Horner's Syndrome Following Total Thyroidectomy: A Case Report.

The oculosympathetic chain is a three-neuron pathway responsible for sympathetic innervation to the eye, which follows a complex anatomical course through the head and neck. Neck surgery may cause injury to this pathway, causing loss of sympathetic innervation producing the eponymous Horner's syndrome (ipsilateral ptosis, miosis and anhidrosis), but this is rare in the reported literature. We present the case of a 23-year-old female who underwent total thyroidectomy for a right-sided, metastatic papillary thyroid carcinoma. Following surgery, in the immediate postoperative period, she was noted to have unilateral ptosis and miosis. This patient was assessed by an ophthalmologist due to persistent unilateral ocular symptoms following thyroidectomy. She was subsequently diagnosed with right-sided Horner's syndrome. The diagnosis was confirmed following the observed reversal of her ocular symptoms using apraclonidine 1% minims. The management of Horner's syndrome following thyroidectomy is conservative if no evidence of compressive hematoma or seroma is identified as in this case. The patient was followed up at six weeks following thyroidectomy and a partial improvement in ptosis was noted. The patient also reported blurred vision secondary to increased refractive error due to reduced pupillary function in her right eye. Prognosticating recovery from Horner's syndrome following thyroidectomy is challenging due to limited evidence. Horner's syndrome as a possible complication of thyroidectomy should be counselled to patients pre-operatively. A residual deficit from Horner's syndrome may cause functional impairment in addition to the poor cosmetic outcome.

The number of androgen receptor CAG repeats and mortality in men.

INTRODUCTION: The androgen receptor (AR) mediates peripheral effects of testosterone. Evidence suggests that the number of CAG repeats in exon-1 of the AR gene negatively correlates with AR transcriptional activity. The aim of this analysis was to determine the association between CAG repeat number and mortality in men. METHODS: Men aged 40-79 years were recruited from primary care for participation in the UK arm of the European Male Aging Study between 2003 and 2005. Cox proportional hazards modelling was used to determine the association between CAG repeat number/mortality. Results were expressed as hazard ratios(HR)/95% confidence intervals (CI). RESULTS: 312 men were followed up. The mean baseline age was 59.5 years. At follow up, 85/312(27%) men had died. CAG repeat length ranged from 14 to 39, with the highest proportion of CAG repeat number at 21 repeats(16.4%). In a multivariable model, using men with CAG repeat numbers of 22-23 as the reference, men with a lower number of CAG repeats(<22) showed a trend for a higher mortality in the follow-up period (HR 1.46 (0.75, 2.81)) as did men with higher number of repeats (>23) (1.37 (0.65, 2.91)). CONCLUSION: Our data suggest that CAG repeat number may partially influence the risk of mortality in men. Further larger studies are required to quantify the effect.

Deep Learning in Healthcare System for Quality of Service.

Deep learning (DL) and machine learning (ML) have a pivotal role in logistic supply chain management and smart manufacturing with proven records. The ability to handle large complex data with minimal human intervention made DL and ML a success in the healthcare systems. In the present healthcare system, the implementation of ML and DL is extensive to achieve a higher quality of service and quality of health to patients, doctors, and healthcare professionals. ML and DL were found to be effective in disease diagnosis, acute disease detection, image analysis, drug discovery, drug delivery, and smart health monitoring. This work presents a state-of-the-art review on the recent advancements in ML and DL and their implementation in the healthcare systems for achieving multi-objective goals. A total of 10 papers have been thoroughly reviewed that presented novel works of ML and DL integration in the healthcare system for achieving various targets. This will help to create reference data that can be useful for future implementation of ML and DL in other sectors of healthcare system.

Critical Retrospection of Performance of Emerging Mobile Technologies in Health Data Management.

The recent advancement in mobile technologies has led to opening a new paradigm in the field of medical healthcare systems. The development of WBAN sensors, wearable devices, and 5G/6G wireless technology has made real-time monitoring and telecare of the patient feasible. The complex framework to secure sensitive data of the patient and healthcare professionals is critical. The fast computation of health data generated is crucial for disease prediction and trauma-related services; the security of data and financial transactions is also a major concern. Various models, algorithms, and frameworks have been developed to tame critical issues related to healthcare services. The efficiency of these frameworks and models depends on energy and time consumption. Thus, the review of recent emerging technologies in respect of energy and time consumption is required. This paper reviews the developments in recent mobile technologies, their application, and the comparative analysis of their performance parameters to explicitly understand the utility, capacity, and limitations. This will help to understand the shortcomings of the recent technologies for the development of better frameworks with higher performance capabilities as well as higher quality of services.

Force Platform-Based Intervention Program for Individuals Suffering with Neurodegenerative Diseases like Parkinson.

The term "neurodegenerative disease" refers to a set of illnesses that primarily affect brain's neurons. Substantia nigra (a midbrain dopaminergic nucleus) with lack of hormone called dopamine causes Parkinson's disease (PD), a neurological disorder. PD leads to tremor, stiffness, impaired posture and balance, and loss of automatic movements. Patient with Parkinson's often develops a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement. Gait analysis is often used to diagnose neurodegenerative illnesses and determine their stage. In this study, we attempt to investigate postural balance, and of gait signals for Parkinson's patients, also, we incorporate interim rehabilitation technique. We included 25 PD patients who had 2.5 to 3 IV score of Hoehn and Yahr scale. A ten-minute walk test has been performed to observe primary and secondary results of dual task interference on gait velocities, and gait time motion vector for right and left legs was observed. Two experimental ground conditions include three conditions of trunk alignment, that is, erect on a regular basis (RE), trunk dorsiflexion 30° (TF1), and trunk dorsiflexion 50° (TF2) were analysed. We identified the walking speed of PD patients was decreased, and trunk dorsiflexion variables influence the gait pattern of Parkinson's disease patients, where higher 95% CI for TF1 condition was reported. The regular erect trunk showed swing time reduction (0.7%) in PD, so the higher unified PD rating scale (UPDRS) values have significant difference in swing phase time in Parkinson's patients. The average Hoehn and Yahr scale (H&Y scale) was 4.3 ± 2.5 reported in the study participants. In a 10-week follow-up evaluation, the stance duration was shown to be substantial, as was the slower speed gait in the baseline condition. Excessive flexion was discovered in our investigation at the lower limb joints, particularly the knee and ankle. Patients with Parkinson's disease had similar maximum dorsiflexion and minimum plantarflexion values in stance. The trunk fraction conditions were found significant in patients after rehabilitation training. The best response to rehabilitation treatment was seen when the trunk was rotated. When steps and posture distribution analysis performed, we found that the trunk flexure 1 (p < 0.05), and trunk flexure 2 (p < 0.01) were shown significant values. When GRF threshold characteristics are employed, mean accuracy improves by 52%. Regardless of gait posture, the step regular trunk flexure had significantly higher posture than the corresponding level steps, with a considerable rise in the 50 in trunk dorsiflexion 2 gait relative to the step "L." This study shows that there was some significant improvement observed in the gait parameters among patients with PD's which shows positive impact of the intervention. Furthermore, rehabilitation programmes can aid and improve poor gait features in patients with Parkinson's disease, especially those who are in the early stages of the condition. This gait and balance research provides a rationale for intervention treatments, and their use in clinical practise enhances evidence of therapeutic efficacy. However, prolonged follow-up is needed to determine whether the advantages will remain all across disease's course, and future studies may recommend a specific rehabilitation technique based on gait analysis results.

Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series.

INTRODUCTION: Some levothyroxine unresponsive individuals with hypothyroidism are prescribed a natural desiccated thyroid (NDT) preparation such as Armour Thyroid® or ERFA Thyroid® . These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms. METHODS: The ThyPRO39 (thyroid symptomatology) and EQ-5D-5L-related QoL/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later. RESULTS: There were 28 women and 3 men. The dose range of NDT was 60-180 mg daily. Age range was 26-77 years with length of time since diagnosis with hypothyroidism ranging from 2 to 40 years. One person discontinued the NDT because of lack of response; two because of cardiac symptoms. EQ-5D-5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241-0.542), t = 6.82, P < .001. EQ-VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95% CI 25.2-50.2), t = -4.9, P < .001. ThyPRO scores showed consistent fall across all domains with the composite QoL-impact Score improving from 68.3 (95% CI 60.9-75.7) to 25.2 (95% CI 18.7-31.7), a difference of 43.1 (95% CI 33-53.2) (t = 5.6, P < .001). CONCLUSION: Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism treated with NDT, suggesting the need for further evaluation of NDT in this context.

The Nexus Between Human Resource Management Practices and Service Recovery Performance in Takaful Insurance Industry in Pakistan: The Mediating Role of Employee Commitment.

Service recovery performance (SRP) is very important for the takaful insurance industry for maintaining and attracting new clients, which in turn serves as a competitive advantage for the survival and continued future of the businesses. If the insurance sector could not maintain SRP, then the competitive advantage of the organizations could be decayed. Therefore, under the theoretical foundation of equity theory and resource-based theory, this research has investigated the link between human resources management practices (HRMP) (such as human capital, training, job description, teamwork, empowerment, and rewards) and SRP directly and indirectly through the employee commitment. By using a convenient sampling technique data was collected from the employees working in the Takaful industry in Pakistan to empirically test the proposed hypotheses and validate the findings. Using cross research design and quantitative research approach. The Structural Equation Modeling (SEM) had presented the positive relationship between HRM practices and SRP. On the other hand, employee commitment had also mediated this relationship. As employee commitment is significantly mediated among most of the HRMP, this aspect is therefore considered to be a big contribution of the study in the context of Pakistan. Based on these findings, the current study has several important implications the practitioners and readers.

Breaking the deadlock of calcified coronary artery lesions: A contemporary review.

Percutaneous coronary intervention (PCI) of severely calcified lesions is known to result in lower procedural success rates, higher complication rates, and worse long-term clinical outcomes compared to noncalcified lesions. Adequate lesion preparation through calcium modification is crucial in ensuring procedural success and reducing adverse cardiovascular outcomes. There are numerous calcium modification devices currently available whose usefulness depends on the nature of the calcific disease and its anatomical distribution. It can be challenging for the interventionists to decide which device is best suited for their patient. There is also emerging evidence for intravascular imaging in guiding selection of calcium modification devices using parameters such as calcium distribution and depth that directly impact on procedural success and clinical outcomes. In this review we aim to discuss the pathophysiology of coronary calcification, evaluate strategies and technologies of calcium modification and propose an A-M-A-S-A algorithm in managing calcified coronary lesions.

Medial versus Posterior Triceps Splitting Approach in Open Reduction Internal Fixation of Displaced Supracondylar Fracture of Humerus.

BACKGROUND: The purpose of this study is to compare the clinical and radiological outcome of medial versus posterior triceps splitting approach in open reduction internal fixation of displaced supracondylar fracture of humerus in children. METHODS: A retrospective review of total 70 children with medial approach (n=30) and posterior triceps splitting approach (n=40) children was made. Time to radiological union, postoperative Bauman's angle and Lateral humerocapitellar angle was compared for radiological outcome. Cosmetic and functional outcome was assessed and compared using Flynn's criteria. RESULTS: Radiological parameters like time to union, postoperative Bauman's angle and Lateral humerocapitellar angle were similar and non-significant between medial and posterior triceps splitting approach. Flynn's cosmetic outcome was similar between these approach (p=0.198). Loss of ROM was significant in posterior triceps splitting approach (p=0.00). Flynn's functional outcome was better with medial approach as compared to posterior triceps splitting approach with statistical significance (p=0.00). CONCLUSIONS: Medial approach has better functional outcome compared to posterior triceps splitting approach in open reduction internal fixation of displaced supracondylar fracture of humerus in children.

Variability in the ocular phenotype in mucopolysaccharidosis.

PURPOSE: Mucopolysaccharidoses (MPSs) are a heterogeneous group of lysosomal storage disorders. Ocular complications (such as corneal clouding, retinopathy and optic neuropathy) are common. Notably, there is a paucity of data on the effect of genotype and systemic treatments (enzyme replacement therapy or haematopoietic stem cell transplantation) on the ocular phenotype in MPS. We prospectively studied the ocular features of patients with MPSI (Hurler/Hurler-Scheie/Scheie), MPSIV (Morquio) and MPSVI (Maroteaux-Lamy), to evaluate the effect of different therapeutic interventions and to correlate the findings with genetic and biomarker data. METHODS: Prospective observational cohort study. Study participants underwent detailed ocular examination including visual acuity; assessment of corneal clouding (Iris camera Corneal Opacification Measure score and Pentacam densitometry) and retinal and optic nerve imaging (optical coherence tomography and wide-field fundus imaging). Data on genotype, biomarkers and delivered therapies (type and length of treatment) were also collected for each patient where available. RESULTS: Overall, 21 patients with MPSI, 4 patients with MPSIV and 3 patients with MPSVI were recruited. Corneal clouding scores were higher in MPSI compared with MPSIV and MPSVI. Retinopathy was evident in patients with MPSI only. Association was observed between corneal clouding and biomarkers in MPSI, MPSIV and MPSVI. However, no clear association was seen between genotype or treatment type and ocular phenotype. CONCLUSIONS: The ocular phenotype in MPS is variable, with corneal clouding occurring in MPSI, MPSIV and MPSVI, and retinopathy in MPSI only. There was an association between corneal clouding and efficacy of systemic treatment as measured by biomarkers.

Multiplex amplification refractory mutation system PCR (ARMS-PCR) provides convenient method for differentiation of canine parvovirus vaccine and field strains.

Vaccination with canine parvovirus-2 (CPV-2) modified live attenuated vaccine remains an effective control strategy for preventing parvovirus induced enteritis in dogs. Virus shedding is a common phenomenon few days after vaccination, possessing a diagnostic dilemma for accurate differentiation of CPV-2 vaccine and wild type field strains. Though several molecular approaches are available for differentiation, the present study focuses on a simple, rapid, cost-effective differentiating infected from vaccinated animals strategy employing ARMS-PCR for differentiation of CPV-2 vaccine and wild type field strains. The ARMS-PCR was initially validated using positive controls of recombinant plasmids, further used for screening six commercial CPV-2 vaccines and 24 archived CPV-2 positive field samples as well as to check fecal shedding of vaccine virus for 10 days post-vaccination in three vaccinated dogs. Sequencing of randomly selected CPV-2 commercial vaccine strains and archived field samples confirmed authenticity of the developed ARMS-PCR assay.