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1.  Repair of a bowel-containing, scrotal hernia with incarceration contributed by femorofemoral bypass graft 
Journal of Surgical Case Reports  2017;2017(1):rjw228.
The rising use of endovascular techniques utilizing femoral artery access may increase the frequency with which surgeons face the challenge of hernia repair in reoperative groins—which may or may not include a vascular graft. We present a case where a vascular graft contributed to an acute presentation and complicated dissection, and review the literature. A 67-year-old man who had undergone prior endovascular aneurysm repair via open bilateral femoral artery access and concomitant prosthetic femorofemoral bypass, presented with an incarcerated, scrotal inguinal hernia. The graft with its associated fibrosis contributed to the incarceration by compressing the inguinal ring. Repair was undertaken via an open, anterior approach with tension-free, Lichtenstein herniorraphy after releasing graft-associated fibrosis. Repair of groin hernias in this complex setting requires careful surgical planning, preparation for potential vascular reconstruction and meticulous technique to avoid bowel injury in the face of a vascular conduit and mesh.
doi:10.1093/jscr/rjw228
PMCID: PMC5220119  PMID: 28069880
2.  Use of closed suction drain after primary total knee arthroplasty – an overrated practice 
SICOT-J  null;2:39.
Purpose: The age-old practice of closed suction drain following orthopedic procedures has been challenged since past few decades. Our aim was to assess the effectiveness of closed suction drain after total knee arthroplasty.
Materials and methods: One hundred twenty patients (135 knees) with primary Total Knee Arthroplasty were divided into a study group (no drain) and a control group (drain used). Inclusion criteria were grade 3 and grade 4 osteoarthritis of the knee. Revision cases and rheumatoid arthritis were excluded. Parameters assessed were pain, pre and post-op Hb, dressing change, early infection, ecchymosis and duration of stay. Results were calculated using Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee scoring systems at two weeks, six months and one year.
Results: Mean age was 72.03 ± 6.68 in study group and 71.38 ± 7.02 in control group. Pre and post op Hb was 12.1678 ± 1.3220 (study group), 12.1803 ± 1.2717 (control group) and 9.8373 ± 1.5703 (study group), 9.7918 ± 1.4163 (control group). There was one case of early infection in both groups which was controlled by oral antibiotics. Change of dressing and ecchymosis were more in the study group. Duration of hospital stay was more in the control group p < 0.0006 (statistically significant).
Conclusion: There is no added advantage of closed suction drain over no drain usage and this practice can safely be brought to a halt.
doi:10.1051/sicotj/2016034
PMCID: PMC5115035  PMID: 27855775
Drainage; Arthroplasty; Replacement knee; Length of stay
3.  Functional and computed tomography correlation of femoral and tibial tunnels in single-bundle anterior cruciate ligament reconstruction: Use of accessory anteromedial portal 
Indian Journal of Orthopaedics  2016;50(6):655-660.
Background:
An accessory anteromedial portal (AAMP) has been shown to be effective in placing an anatomically ideal femoral tunnel. It is well known that this is due to the independent femoral drilling which is possible with the AAMP. However very little is known regarding the significance of this reconstruction technique in influencing the functional outcomes of anatomic anterior cruciate ligament reconstruction (ACLR). This study documents the influence of tibial and femoral tunnel positions on functional outcomes of anatomic ACLR using the AAMP.
Materials and Methods:
41 patients who underwent anatomic ACLR between 2011 and 2013 were included in this prospective cohort study. The primary outcome involved the documentation of femoral and tibial tunnel positions with volume rendering imaging using a three-dimensional computed tomography (3D-CT) done at the end of 1 year. The tunnel position evaluations from the CT images were performed by an independent observer specializing in radiodiagnosis. Functional outcome measures included preoperative and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores (subjective) documented by an independent investigator who was not involved with the surgical procedure, at the end of 1 year.
Results:
The minimum followup was 1 year. All patients achieved good clinical and functional outcomes postoperatively with no reported complications. Tunnel position evaluations with 3D-CT revealed the average tibial tunnel distance to be 15.5 mm (standard deviation [SD] =2.52) from the anterior border of the tibial plateau and the average femoral tunnel distance to be 14.33 mm (SD = 2.6) from the inferior margin of the medial surface of lateral femoral condyle and 13.72 mm (SD = 2.8) from the posterior margin of the medial surface of lateral femoral condyle. The average tunnel diameters were found to be 7.9 mm (SD = 0.72) for the tibial tunnels and 8.6 mm (SD = 1.07) for the femoral tunnels. Statistically significant correlation between the tibial tunnel distance and the IKDC scores with anterior placement of tibial tunnel were found; however, no such statistical relationship were found between the femoral tunnel positions and the functional outcome measures.
Conclusion:
AAMP gives an ideal approach to drill the femoral tunnel independently. However, the influence of this tunnel placement on long term functional outcomes of ACLR needs to be assessed on larger cohort of patients.
doi:10.4103/0019-5413.193490
PMCID: PMC5122262  PMID: 27904222
Accessory anteromedial portal; anterior cruciate ligament reconstruction; International Knee Documentation Committee score; three-dimensional computed tomography; tunnel position; Anterior cruciatate ligament reconstruction; CAT scan; knee joint; arthroscopy
4.  Using an Artificial Neural Bypass to Restore Cortical Control of Rhythmic Movements in a Human with Quadriplegia 
Scientific Reports  2016;6:33807.
Neuroprosthetic technology has been used to restore cortical control of discrete (non-rhythmic) hand movements in a paralyzed person. However, cortical control of rhythmic movements which originate in the brain but are coordinated by Central Pattern Generator (CPG) neural networks in the spinal cord has not been demonstrated previously. Here we show a demonstration of an artificial neural bypass technology that decodes cortical activity and emulates spinal cord CPG function allowing volitional rhythmic hand movement. The technology uses a combination of signals recorded from the brain, machine-learning algorithms to decode the signals, a numerical model of CPG network, and a neuromuscular electrical stimulation system to evoke rhythmic movements. Using the neural bypass, a quadriplegic participant was able to initiate, sustain, and switch between rhythmic and discrete finger movements, using his thoughts alone. These results have implications in advancing neuroprosthetic technology to restore complex movements in people living with paralysis.
doi:10.1038/srep33807
PMCID: PMC5034342  PMID: 27658585
5.  Proceedings of the 13th annual conference of INEBRIA 
Watson, Rod | Morris, James | Isitt, John | Barrio, Pablo | Ortega, Lluisa | Gual, Antoni | Conner, Kenneth | Stecker, Tracy | Maisto, Stephen | Paroz, Sophie | Graap, Caroline | Grazioli, Véronique S | Daeppen, Jean-Bernard | Collins, Susan E | Bertholet, Nicolas | McNeely, Jennifer | Kushnir, Vlad | Cunningham, John A. | Crombie, Iain K | Cunningham, Kathryn B | Irvine, Linda | Williams, Brian | Sniehotta, Falko F | Norrie, John | Melson, Ambrose | Jones, Claire | Briggs, Andrew | Rice, Peter | Achison, Marcus | McKenzie, Andrew | Dimova, Elena | Slane, Peter W | Grazioli, Véronique S. | Collins, Susan E. | Paroz, Sophie | Graap, Caroline | Daeppen, Jean-Bernard | Baggio, Stéphanie | Dupuis, Marc | Studer, Joseph | Gmel, Gerhard | Magill, Molly | Grazioli, Véronique S. | Tait, Robert J. | Teoh, Lucinda | Kelty, Erin | Geelhoed, Elizabeth | Mountain, David | Hulse, Gary K. | Renko, Elina | Mitchell, Shannon G. | Lounsbury, David | Li, Zhi | Schwartz, Robert P. | Gryczynski, Jan | Kirk, Arethusa S. | Oros, Marla | Hosler, Colleen | Dusek, Kristi | Brown, Barry S. | Finnell, Deborah S. | Holloway, Aisha | Wu, Li-Tzy | Subramaniam, Geetha | Sharma, Gaurav | Wallhed Finn, Sara | Andreasson, Sven | Dvorak, Robert D. | Kramer, Matthew P. | Stevenson, Brittany L. | Sargent, Emily M. | Kilwein, Tess M. | Harris, Sion K. | Sherritt, Lon | Copelas, Sarah | Knight, John R. | Mdege, Noreen D | McCambridge, Jim | Bischof, Gallus | Bischof, Anja | Freyer-Adam, Jennis | Rumpf, Hans-Juergen | Fitzgerald, Niamh | Schölin, Lisa | Toner, Paul | Böhnke, Jan R. | Veach, Laura J. | Currin, Olivia | Dongre, Leigh Z. | Miller, Preston R. | White, Elizabeth | Williams, Emily C. | Lapham, Gwen T. | Bobb, Jennifer J. | Rubinsky, Anna D. | Catz, Sheryl L. | Shortreed, Susan | Bensley, Kara M. | Bradley, Katharine A. | Milward, Joanna | Deluca, Paolo | Khadjesari, Zarnie | Watson, Rod | Fincham-Campbell, Stephanie | Drummond, Colin | Angus, Kathryn | Bauld, Linda | Baumann, Sophie | Haberecht, Katja | Schnuerer, Inga | Meyer, Christian | Rumpf, Hans-Jürgen | John, Ulrich | Gaertner, Beate | Barrault-Couchouron, Marion | Béracochéa, Marion | Allafort, Vincent | Barthélémy, Valérie | Bonnefoi, Hervé | Bussières, Emmanuel | Garguil, Véronique | Auriacombe, Marc | Saint-Jacques, Marianne | Dorval, Michel | M’Bailara, Katia | Segura-Garcia, Lidia | Ibañez-Martinez, Nuria | Mendive-Arbeloa, Juan Manuel | Anoro-Perminger, Manel | Diaz-Gallego, Pako | Piñar-Mateos, Mª Angeles | Colom-Farran, Joan | Deligianni, Marianthi | Yersin, Bertrand | Adam, Angeline | Weisner, Constance | Chi, Felicia | Lu, Wendy | Sterling, Stacy | Kraemer, Kevin L. | McGinnis, Kathleen A. | Fiellin, David A. | Skanderson, Melissa | Gordon, Adam J. | Robbins, Jonathan | Zickmund, Susan | Korthuis, P. Todd | Edelman, E. Jennifer | Hansen, Nathan B. | Cutter, Christopher J. | Dziura, James | Fiellin, Lynn E. | O’Connor, Patrick G. | Maisto, Stephen A. | Bedimo, Roger | Gilbert, Cynthia | Marconi, Vincent C. | Rimland, David | Rodriguez-Barradas, Maria | Simberkoff, Michael | Justice, Amy C. | Bryant, Kendall J. | Berman, Anne H | Shorter, Gillian W | Bray, Jeremy W | Barbosa, Carolina | Johansson, Magnus | Hester, Reid | Campbell, William | Souza Formigoni, Maria Lucia O. | Andrade, André Luzi Monezi | Sartes, Laisa Marcorela Andreoli | Sundström, Christopher | Eék, Niels | Kraepelien, Martin | Kaldo, Viktor | Fahlke, Claudia | Hernandez, Lynn | Becker, Sara J. | Jones, Richard N. | Graves, Hannah R. | Spirito, Anthony | Diestelkamp, Silke | Wartberg, Lutz | Arnaud, Nicolas | Thomasius, Rainer | Gaume, Jacques | Grazioli, Véronique | Fortini, Cristiana | Malan, Zelra | Mash, Bob | Everett-Murphy, Katherine | Grazioli, Véronique S. | Studer, Joseph | Mohler-Kuo, M. | Bertholet, Nicolas | Gmel, Gerhard | Doi, Lawrence | Cheyne, Helen | Jepson, Ruth | Luna, Vanesa | Echeverria, Leticia | Morales, Silvia | Barroso, Teresa | Abreu, Ângela | Aguiar, Cosma | Stewart, Duncan | Abreu, Angela | Brites, Riany M. | Jomar, Rafael | Marinho, Gerson | Parreira, Pedro | Seale, J. Paul | Johnson, J. Aaron | Henry, Dena | Chalmers, Sharon | Payne, Freida | Tuck, Linda | Morris, Akula | Gonçalves, Cátia | Besser, Bettina | Casajuana, Cristina | López-Pelayo, Hugo | Balcells, María Mercedes | Teixidó, Lídia | Miquel, Laia | Colom, Joan | Hepner, Kimberly A. | Hoggatt, Katherine. J. | Bogart, Andy | Paddock, Susan. M. | Hardoon, Sarah L | Petersen, Irene | Hamilton, Fiona L | Nazareth, Irwin | White, Ian R. | Marston, Louise | Wallace, Paul | Godfrey, Christine | Murray, Elizabeth | Sovinová, Hana | Csémy, Ladislav
doi:10.1186/s13722-016-0062-9
PMCID: PMC5032602  PMID: 27654147
6.  Complete Genome of the Starch-Degrading Myxobacteria Sandaracinus amylolyticus DSM 53668T 
Genome Biology and Evolution  2016;8(8):2520-2529.
Myxobacteria are members of δ-proteobacteria and are typified by large genomes, well-coordinated social behavior, gliding motility, and starvation-induced fruiting body formation. Here, we report the 10.33 Mb whole genome of a starch-degrading myxobacterium Sandaracinus amylolyticus DSM 53668T that encodes 8,962 proteins, 56 tRNA, and two rRNA operons. Phylogenetic analysis, in silico DNA-DNA hybridization and average nucleotide identity reveal its divergence from other myxobacterial species and support its taxonomic characterization into a separate family Sandaracinaceae, within the suborder Sorangiineae. Sequence similarity searches using the Carbohydrate-active enzymes (CAZyme) database help identify the enzyme repertoire of S. amylolyticus involved in starch, agar, chitin, and cellulose degradation. We identified 16 α-amylases and two γ-amylases in the S. amylolyticus genome that likely play a role in starch degradation. While many of the amylases are seen conserved in other δ-proteobacteria, we notice several novel amylases acquired via horizontal transfer from members belonging to phylum Deinococcus-Thermus, Acidobacteria, and Cyanobacteria. No agar degrading enzyme(s) were identified in the S. amylolyticus genome. Interestingly, several putative β-glucosidases and endoglucanases proteins involved in cellulose degradation were identified. However, the absence of cellobiohydrolases/exoglucanases corroborates with the lack of cellulose degradation by this bacteria.
doi:10.1093/gbe/evw151
PMCID: PMC5010890  PMID: 27358428
CAZyme; amylase; agarase; cellulase; methylome; phylogeny
7.  Perivascular Adipose Adiponectin Correlates with Symptom Status of Patients Undergoing Carotid Endarterectomy 
Background and Purpose
Recent symptoms stand as a major determinant of stroke risk in carotid stenosis patients, likely reflective of atherosclerotic plaque destabilization. In view of emerging links between vascular and adipose biology, we hypothesized that human perivascular adipose characteristics associate with carotid disease symptom status.
Methods
Clinical history, carotid plaques, blood, and subcutaneous and perivascular adipose tissues were prospectively collected from patients undergoing carotid endarterectomy (CEA). Nine adipose associated biologic mediators were assayed and compared in patients with symptomatic (n=15) versus asymptomatic (n=19) disease. Bonferroni correction was performed for multiple testing (α/9=0.006).
Results
Symptomatic patients had 1.9-fold higher perivascular adiponectin levels (p=0.005). Other circulating, subcutaneous, and perivascular biomarkers, as well as microscopic plaque characteristics, did not differ between symptomatic and asymptomatic patients.
Conclusions
Symptomatic and asymptomatic CEA patients display a tissue-specific difference in perivascular adipose adiponectin. This difference, which was not seen in plasma or subcutaneous compartments, supports a potential local paracrine relationship to vascular disease processes which may relate to stroke mechanisms.
doi:10.1161/STROKEAHA.114.008468
PMCID: PMC4442051  PMID: 25967575
Carotid artery stenosis; Perivascular adipose tissue; Adipokine; Atherosclerosis
8.  Assessment of variation in depth of brachial plexus using ultrasound for supraclavicular brachial plexus block in patients undergoing elective upper limb surgery 
Indian Journal of Anaesthesia  2016;60(6):393-397.
Background and Aims:
Supraclavicular approach to the brachial plexus may be associated with complications such as pneumothorax, inadvertent vascular puncture, inter-scalene block and neurovascular injuries. The present study was conceived to find out the variation in depth of brachial plexus to suggest the minimum length of needle required to effectively perform the block, thus preventing possible complications.
Methods:
After approval from our Institutional Ethical Committee, informed and written consent was obtained from each of the ninety American Society of Anesthesiologists Physical Status I and II patients recruited, of either sex in the age group of 20–50 years. Supraclavicular fossa was scanned using a high-frequency linear probe, and the distances (shortest distance [SD] from skin to the most superficial neural element and longest distance [LD] from skin to the most deep neural element) were measured using on-screen callipers on optimal frozen image. Pearson correlation was used to find out the relation between these two distances and demographic parameters.
Results:
Mean SD was 0.60 ± 0.262 cm, and mean LD was found to be 1.34 ± 0.385 cm. We observed significant correlation between these two distances with weight and body mass index (BMI).
Conclusion:
Significant correlation was observed between SD and LD with weight and BMI. We suggest that a needle with a shaft length of 3 cm will be sufficient to reach the sheath of the brachial plexus during performance of the block.
doi:10.4103/0019-5049.183385
PMCID: PMC4910478  PMID: 27330200
Brachial plexus; depth; supraclavicular block; ultrasound
9.  Full genome sequencing of the bluetongue virus-1 isolate MKD20/08/Ind from goat in India 
Brazilian Journal of Microbiology  2016;47(3):527-528.
This communication reports full genome sequencing of the bluetongue virus-1 (BTV-1) isolate MKD20/08/Ind from goat in northern India. The total BTV-1 genome size was found to be 19,190 bp. A comparison study between the Indian isolate and other global isolates revealed that it belongs to the ‘Eastern’ BTV topotype. The full genome sequence of BTV-1 will provide vital information on its geographical origin and it will also be proved useful for comparing the Indian isolate with global isolates from other host species.
doi:10.1016/j.bjm.2016.04.022
PMCID: PMC4927677  PMID: 27266632
Bluetongue virus-1; Goat; Eastern BTV topotype; Next-generation sequencing
10.  Agricultural wastes as a resource of raw materials for developing low-dielectric glass-ceramics 
Scientific Reports  2016;6:24617.
Agricultural waste ashes are used as resource materials to synthesize new glass and glass-ceramics. The as-prepared materials are characterized using various techniques for their structural and dielectric properties to check their suitability in microelectronic applications. Sugarcane leaves ash exhibits higher content of alkali metal oxides than rice husk ash, which reduces the melting point of the components due to eutectic reactions. The addition of sugarcane leaves ash in rice husk ash promotes the glass formation. Additionally, it prevents the cristobalite phase formation. These materials are inherently porous, which is responsible for low dielectric permittivity i.e. 9 to 40. The presence of less ordered augite phase enhances the dielectric permittivity as compared to cristobalite and tridymite phases. The present glass-ceramics exhibit lower losses than similar materials synthesized using conventional minerals. The dielectric permittivity is independent to a wide range of temperature and frequency. The glass-ceramics developed with adequately devitrified phases can be used in microelectronic devices and other dielectric applications.
doi:10.1038/srep24617
PMCID: PMC4834533  PMID: 27087123
11.  Halitosis: Current concepts on etiology, diagnosis and management 
European Journal of Dentistry  2016;10(2):292-300.
Halitosis or oral malodor is an offensive odor originating from the oral cavity, leading to anxiety and psychosocial embarrassment. A patient with halitosis is most likely to contact primary care practitioner for the diagnosis and management. With proper diagnosis, identification of the etiology and timely referrals certain steps are taken to create a successful individualized therapeutic approach for each patient seeking assistance. It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required. This article succinctly focuses on the development of a systematic flow of events to come to the best management of the halitosis from the primary care practitioner's point of view.
doi:10.4103/1305-7456.178294
PMCID: PMC4813452  PMID: 27095913
Diagnosis; etiology; halitosis; management
12.  A rare presentation of lipoma on mandibular mucogingival junction 
Lipoma is the most common tumor of mesenchymal tissues of body, but its occurrence in oral cavity is infrequent. Buccal mucosa is the most common intraoral site of lipoma followed by tongue, floor of the mouth, and buccal vestibule. The involvement of mucogingival junction is rare. We present a unique case report of oral lipoma occurring on mandibular mucogingival junction with review of literature which has emphasis on differential diagnosis.
doi:10.4103/0972-124X.170827
PMCID: PMC4847469  PMID: 27143835
Diagnosis; differential; lipoma; mucogingival junction
13.  Complete Genome Sequence and Comparative Genomics of a Novel Myxobacterium Myxococcus hansupus 
PLoS ONE  2016;11(2):e0148593.
Myxobacteria, a group of Gram-negative aerobes, belong to the class δ-proteobacteria and order Myxococcales. Unlike anaerobic δ-proteobacteria, they exhibit several unusual physiogenomic properties like gliding motility, desiccation-resistant myxospores and large genomes with high coding density. Here we report a 9.5 Mbp complete genome of Myxococcus hansupus that encodes 7,753 proteins. Phylogenomic and genome-genome distance based analysis suggest that Myxococcus hansupus is a novel member of the genus Myxococcus. Comparative genome analysis with other members of the genus Myxococcus was performed to explore their genome diversity. The variation in number of unique proteins observed across different species is suggestive of diversity at the genus level while the overrepresentation of several Pfam families indicates the extent and mode of genome expansion as compared to non-Myxococcales δ-proteobacteria.
doi:10.1371/journal.pone.0148593
PMCID: PMC4765838  PMID: 26900859
14.  An Erupted Dilated Odontoma: A Rare Presentation 
Case Reports in Dentistry  2016;2016:9750947.
A dilated odontoma is an extremely rare developmental anomaly represented as a dilatation of the crown and root as a consequence of a deep, enamel-lined invagination and is considered a severe variant of dens invaginatus. An oval shape of the tooth lacking morphological characteristics of a crown or root implies that the invagination happened in the initial stages of morphodifferentiation. Spontaneous eruption of an odontoma is a rare occurrence and the occurrence of a dilated odontoma in a supernumerary tooth is even rarer with only a few case reports documented in the English literature. We present an extremely rare case of erupted dilated odontoma occurring in the supernumerary tooth in anterior maxillary region in an 18-year-old male, which, to the best of our knowledge, is the first ever case reported in English literature.
doi:10.1155/2016/9750947
PMCID: PMC4771879  PMID: 26989523
15.  Competitive SWIFT cluster templates enhance detection of aging changes 
Cytometry  2015;89(1):59-70.
Abstract
Clustering‐based algorithms for automated analysis of flow cytometry datasets have achieved more efficient and objective analysis than manual processing. Clustering organizes flow cytometry data into subpopulations with substantially homogenous characteristics but does not directly address the important problem of identifying the salient differences in subpopulations between subjects and groups. Here, we address this problem by augmenting SWIFT—a mixture model based clustering algorithm reported previously. First, we show that SWIFT clustering using a “template” mixture model, in which all subpopulations are represented, identifies small differences in cell numbers per subpopulation between samples. Second, we demonstrate that resolution of inter‐sample differences is increased by “competition” wherein a joint model is formed by combining the mixture model templates obtained from different groups. In the joint model, clusters from individual groups compete for the assignment of cells, sharpening differences between samples, particularly differences representing subpopulation shifts that are masked under clustering with a single template model. The benefit of competition was demonstrated first with a semisynthetic dataset obtained by deliberately shifting a known subpopulation within an actual flow cytometry sample. Single templates correctly identified changes in the number of cells in the subpopulation, but only the competition method detected small changes in median fluorescence. In further validation studies, competition identified a larger number of significantly altered subpopulations between young and elderly subjects. This enrichment was specific, because competition between templates from consensus male and female samples did not improve the detection of age‐related differences. Several changes between the young and elderly identified by SWIFT template competition were consistent with known alterations in the elderly, and additional altered subpopulations were also identified. Alternative algorithms detected far fewer significantly altered clusters. Thus SWIFT template competition is a powerful approach to sharpen comparisons between selected groups in flow cytometry datasets. © 2015 The Authors. Published Wiley Periodicals Inc.
doi:10.1002/cyto.a.22740
PMCID: PMC4737406  PMID: 26441030
flow cytometry; template; immunophenotyping; competitive clustering; EM algorithm; sample comparison; automated analysis; SWIFT
16.  Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications 
Purpose
Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures.
Methods
This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating. This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing.
Results
Full weight bearing was allowed in mean time period of 4.95 months (3–12 months). A major local complication of a wound which required revision surgery was seen in one case. Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound, 1 case of superficial infection, 1 case of sensory disturbance over the anterolateral foot, 1 case of muscle hernia and 2 cases of delayed union. Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5–8 cm).
Conclusion
The minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization. Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique.
doi:10.1016/j.cjtee.2015.07.010
PMCID: PMC4897832  PMID: 27033272
Tibial fractures; Bone plates; Minimally invasive surgical procedures
17.  Essential Oil Yield Pattern and Antibacterial and Insecticidal Activities of Trachyspermum ammi and Myristica fragrans 
Scientifica  2016;2016:1428194.
Two Indian spices, Trachyspermum ammi and Myristica fragrans, were studied for their essential oil (EO) yielding pattern, insecticidal activity, antibacterial activity, and composition. The essential oils (EOs) of T. ammi (1.94 ± 30 mL/100 gm) and M. fragrans (5.93 ± 90 mL/100 gm) were extracted using hydrodistillation method. In Gas Chromatography analysis, the beta-pinene, alpha-pinene, alpha-p-menth-1-en-4-ol, Limonene, and elemicin were found as major constituents of T. ammi essential oil whereas M. fragrans essential oil mostly contains Gamma-Terpinolene, p-Cymene, Thymol, and beta-pinene. The insecticidal activities of EO were demonstrated using LC50 values against Plodia interpunctella and EO of T. ammi was found comparatively more effective than EO of M. fragrans. Further, individual EO and combination of essential oil were examined for antibacterial activity against three Gram (−) bacterial strains (E. coli-MTCC 443, P. vulgaris-MTCC 1771, and K. pneumoniae-MTCC number 7028) and three Gram (+) bacterial strains (S. aureus-MTCC 3381, B. subtilis-MTCC 10619, and B. megaterium-MTCC 2412) by well agar diffusion method. The essential oil in combination (CEO) exhibited higher antibacterial activity as compared with individual essential oils.
doi:10.1155/2016/1428194
PMCID: PMC4844891  PMID: 27190677
18.  Nicotine Replacement Therapy in Dental Settings: An Exploratory Survey in Bangalore City, India 
Addiction & Health  2016;8(1):25-32.
Background
Smoking and other forms of tobacco use remain the most significant worldwide public health problem. The dental practice is being identified as potential location for smoking cessation activity. Nicotine replacement therapy (NRT) promotes the chances of tobacco cessation, however, evidence related to prescription of the NRT in dental settings is lacking. This study aimed to assess and compare the attitudes, practices, beliefs, and barriers in prescribing NRT for tobacco cessation among dental interns and post-graduates (PGs).
Methods
For a cross-sectional survey among 232 participants from 10 dental colleges in Bangalore, India, a 21-item questionnaire was developed: 11-item based on attitudes and practices toward tobacco cessation and 10-items regarding scope and challenges in prescribing NRT. The data were analyzed using descriptive statistics, chi-square test, and test of proportions.
Findings
Majority of participants reported ongoing tobacco cessation activity in their college. Statistically significant difference was found between interns and PGs for items related to tobacco cessation practice (assisting, providing follow-up visit). Regarding NRT, significant differences were seen for items related to practice (assisting, assessing motivation for NRT), belief (not an appropriate activity for dentist, a valuable resource, increase in quit attempts) and barriers (bitter taste, cost, and fear of addiction) (P < 0.050). The majority of the PGs suggested cessation center followed by health care workers and pharmacists for the provision of subsidized nicotine gums.
Conclusion
Favorable practices and beliefs are seen regarding the prescription of NRT among interns and PGs although differences exist. Time, cost, and taste emerged as major barriers.
PMCID: PMC4836760  PMID: 27274790
Nicotine replacement therapy; Tobacco; Dental practice; Barriers
19.  Biologic Foundation Restoration: A Natural Post And Core For Management 
Complicated crown fractures are a common outcome of dental trauma. Various treatment options are available for consideration. The preferred choice of treatment though, is determined by multiple factors associated with the nature of trauma itself. This case report highlights the management of a cervical crown fracture by modifying the clinical technique of an existing concept of the “Biologic Post and Core” and integrating it with current advances in adhesive technology, with an intention for preservation and reinforcement of residual tooth structure. The clinical success observed during subsequent patient recall has given reason for optimism in considering the employed method as a possible alternative to address this area of prosthetic concern.
doi:10.1007/s13191-013-0332-0
PMCID: PMC4501993  PMID: 26199529
Coronal fracture; Biologic foundation restoration; Natural tooth post and core
20.  Brief Intervention for Drug Users Presenting in Emergency Departments (NIDA CTN Protocol 0047: SMART-ED) 
JAMA internal medicine  2014;174(11):1736-1745.
IMPORTANCE
Medical treatment settings such as Emergency Departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization.
OBJECTIVE
To contrast the effects of a brief intervention with telephone boosters (BI-B) to those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients.
DESIGN
Between October 2010 and February 2012, 1285 patients were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers.
SETTING
EDs of six academic hospitals in the U.S.
PARTICIPANTS
Participants were adult ED patients scoring ≥ 3 on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and currently using drugs.
INTERVENTIONS
Following screening, MSO participants received only an informational pamphlet. SAR participants received assessment plus referral to addiction treatment if indicated. BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 “booster” sessions by telephone during the month following the ED visit.
MAIN OUTCOMES AND MEASURES
Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples.
RESULTS
Follow-up rates were 88%, 86%, and 81% at 3, 6, and 12 months, respectively. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265/280, 95%) than did participants in the MSO group (253/287, 88%) or the BI-B group (244/275, 89%). Hair analysis differences between groups at other time points were not significant.
CONCLUSIONS AND RELEVANCE
In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED.
doi:10.1001/jamainternmed.2014.4052
PMCID: PMC4238921  PMID: 25179753
21.  Achieving Cannabis Cessation - Evaluating N-acetylcysteine Treatment (ACCENT): Design and implementation of a multi-site, randomized controlled study in the National Institute on Drug Abuse Clinical Trials Network 
Contemporary clinical trials  2014;39(2):211-223.
Despite recent advances in behavioral interventions for cannabis use disorders, effect sizes remain modest, and few individuals achieve long-term abstinence. One strategy to enhance outcomes is the addition of pharmacotherapy to complement behavioral treatment, but to date no efficacious medications targeting cannabis use disorders in adults through large, randomized controlled trials have been identified. The National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) is currently conducting a study to test the efficacy of N-acetylcysteine (NAC) versus placebo (PBO), added to contingency management, for cannabis cessation in adults (ages 18–50). This study was designed to replicate positive findings from a study in cannabis-dependent adolescents that found greater odds of abstinence with NAC compared to PBO. This paper describes the design and implementation of an ongoing 12-week, intent-to-treat, double-blind, randomized, placebo-controlled study with one follow-up visit four weeks post-treatment. Approximately 300 treatment-seeking cannabis-dependent adults will be randomized to NAC or PBO across six study sites in the United States. The primary objective of this 12-week study is to evaluate the efficacy of twice-daily orally-administered NAC (1200 mg) versus matched PBO, added to contingency management, on cannabis abstinence. NAC is among the first medications to demonstrate increased odds of abstinence in a randomized controlled study among cannabis users in any age group. The current study will assess the cannabis cessation efficacy of NAC combined with a behavioral intervention in adults, providing a novel and timely contribution to the evidence base for the treatment of cannabis use disorders.
doi:10.1016/j.cct.2014.08.011
PMCID: PMC4252394  PMID: 25179587
N-acetylcysteine; cannabis; marijuana; pharmacotherapy; randomized trials; clinical study design
22.  Fecal Fistula Communicating with a Femur Shaft Fracture Secondary to a Malpositioned Suprapubic Catheter: A Case Report 
Patient: Male, 18
Final Diagnosis: Fecal fistula communicating with fracture shaft femur secondary to malpositioned SPC
Symptoms: —
Medication: —
Clinical Procedure: Advertisement and rail fixator application
Specialty: Orthopedics and Trauamtology
Objective:
Diagnostic/therapeutic accidents
Background:
Suprapubic catheter (SPC) insertion is a common urological procedure. Though considered a simple and safe procedure, complications are bound to occur if proper precautions are not taken during the procedure. The reported complications include gross hematuria, post-obstruction diuresis, insertion site skin-related complications, and intra-abdominal visceral injuries. Iatrogenic bowel injuries have been reported to occur as a complication in around 2.5% of cases.
Case Report:
We report a very rare case of a bowel injury due to improper insertion of a SPC leading to fecal matter tracking along the muscle planes to reach the fracture site of the femur shaft and formation of an external fecal fistula along the lateral aspect of thigh, which according to us is the first reported case in the literature.
Conclusions:
This case report shows the devastating complication of a technically simple procedure done in an improper manner and successful management of a rare case of femur fracture with communicating fecal fistula. The purpose of this case report is to highlight the importance of taking proper precautions before the procedure.
doi:10.12659/AJCR.894516
PMCID: PMC4601354  PMID: 26439133
Cystostomy; Fistula; Urinary Catheters
23.  Cross-sectional Serosurvey of Crimean-Congo Hemorrhagic Fever Virus IgG in Livestock, India, 2013–2014 
Emerging Infectious Diseases  2015;21(10):1837-1839.
We conducted a cross-sectional serosurvey of Crimean-Congo hemorrhagic fever (CCHF) among livestock in 22 states and 1 union territory of India. A total of 5,636 samples from bovines, sheep, and goats were screened for CCHF virus IgG. IgG was detected in 354 samples, indicating that this virus is widespread in this country.
doi:10.3201/eid2110.141961
PMCID: PMC4593432  PMID: 26402332
Crimean-Congo hemorrhagic fever; ticks; viruses; IgG; antibodies; livestock; serosurvey; Gujarat State; India; zoonoses; vector-borne infections; sheep; goats; cattle; bovines; bovids
24.  Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions 
BMC Pregnancy and Childbirth  2015;15(Suppl 2):S2.
Background
Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth.
Methods
The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care.
Results
Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships.
Conclusions
Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery.
doi:10.1186/1471-2393-15-S2-S2
PMCID: PMC4577867  PMID: 26390886
25.  Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions 
BMC Pregnancy and Childbirth  2015;15(Suppl 2):S1.
Background
The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick.
Methods
The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns.
Results
The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems.
Conclusions
Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions.
doi:10.1186/1471-2393-15-S2-S1
PMCID: PMC4578819  PMID: 26390820
Quality of care; pregnancy; childbirth; health systems; bottlenecks; maternal; newborn; stillbirths

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