The Effect of Kryptonite Bone Cement combined with a Standard Kirschner Wire on Tibial Bone Fracture in Rats

Objective This study aims to observe whether Kryptonite Bone Cement combined with a standard Kirschner wire, instead of autogenous bone grafts, increases bone healing and mechanical strength in rats with tibia fractures. Methods The study included sixteen rats, which were divided into two groups as a control group (n=8) and an experimental group (n=8). After segmental fractures were made in both groups, intramedullary fixation of tibia procedures were conducted with the use of a Kirschner wire. No additional procedures were performed inthe control group, but Kryptonite Bone Cement was applied in the experimental group. The rats were evaluated clinically, radiologically and histologically4 times; immediately after the operation, and atthe 1st, 3rd, and 6thweeks following surgery. Results One rat from the experimental and one from the control group had both wound dehiscence and wound site infection. No recovery was observed in any rats either in the control or experimental group immediately after surgery. During week 1, callus formation was identified in 5 rats in the experimental group (p=0.0072), and during week 3, fracture lines disappeared in 4 rats in the experimental group (p=0.064); the differences between control and experimental groups were statistically significant. During week 6, no statistical significance was observed in radiological assessments for the control group and experimental group (p=0.71). The rate of non-union was higher in the control group (37.50%) than in the experimental one, while the rate of complete fusion was higher in the experimental group (87.50%) than that in the control group. Conclusion Osteoconductivity and ergonomic qualities of Kryptonite Bone Cement prove helpful in bone repair. Future studies to be conducted in a prospective and randomized manner will be effective on demonstrating the effectiveness of Kryptonite Bone Cement.

Evaluation of P40 and Napsin A in the Differential Diagnosis of Non Small Cell Bronchogenic Carcinoma on Small Lung Biopsies

BACKGROUND :- Lung cancer is the leading cause of cancer-related mortality over word wide, Although the pathological diagnosis of lung carcinoma is limited as only small specimen available for diagnosis.the availability of targeted therapies has created a need for precise subtyping of non-small cell lung carcinoma . Several recent studies have demonstrated that the use of Immunohistochemical markers can be helpful in differentiating lung squamous cell carcinoma (LSCC) from lung adenocarcinoma (LAC) not on surgically resected material but also on small biopsy samples and cytology. AIM (1) To classify the non small cell lung carcinoma into major categories like squamous cell carcinoma (LSCC) and adenocarcinoma (LAC) and other categories by applying immunohistochemicalmarker like p40 (truncated p63) and Napsin A (2) To analyse the sensitivity and specificity of p40 and Napsin A in light of histomorphology and/or other relevant immunohistochemical markers available, using appropriate statistical tests. Material and methods:- This study was a one and half year (18 months) prospective study from Jan 2017 to June 2018, conducted in department of pathology on patients attending the outpatient and inpatient department of TB and respiratory disease, a total of 210 bronchoscopic guided biopsies / transthoracic (CT/MRI /guided) small tissue biopsies from the patients suspected of lung malignancy were incorporated in the study. 20 corresponding resection specimens (wedge resection and lobectomy) were also included in the study for correlation of morphology and immunohistochemical findings on small biopsies. RESULTS:-In our study IHC for both p40 and napsin –A aided in subtyping of 71.9% cases of non small cell lung carcinoma and this diagnostic accuracy was found to be statistically significant with p-value < 0.05.,on statistical analysis we found that napsin-A had a sensitivity of 90% and specificity of 80%. Also, positive predictive value and negative predictive value were seen to be 88.0% and 81.8% respectively.

Prevalence of Overweight and Obesity among Secondary Schools Adolescents in Onitsha, Anambra State Nigeria

Background: The prevalence of obesity is increasing worldwide, both in developed and developing countries. In Nigeria, obesity is emerging as an important public health problem. Childhood and adolescent obesity results in adult obesity with the resultant morbidities. Objectives: This study determines the prevalence of overweight and obesity in apparently healthy secondary school adolescents. Methods: This study was a cross-sectional study of secondary school adolescents aged 10-19 years randomly selected from two public schools and three private schools. The weights and heights of the study subjects were measured using standard equipment. BMI was computed using the standard formula weight (kg) / height2 (m). Using the WHO; 2007 age and sex-specific BMI percentile cut-offs, the subjects were classified as underweight (3rd to <15th percentile), normal (15th to <85th percentile), overweight (85th to <97th percentile) or obese ≥97th percentile. Results: Data were initially collected from 1250 participants, but 52 were excluded from improperly completed questionnaires. Thus, 1198 students were ultimately included in the study, giving a response rate of 95.8%. These included 621 females (51.8%) and 577 males (48.2%) aged 10-19 years, giving an F: M ratio of approximately 1: 0.9. The mean age of the students was 15.07 ±1.96 years overall, 15.13 ± 2.08 years for males and 15.03 ± 1.83 years for females. There was no statistically significant difference between males and females in the distribution of age groups (p=0.12). The mean BMI was 21.51±3.57kg/m2 for females and 20.22±3.16kg/m2 for males. The BMI was significantly higher in females in all age groups (p<0.001) except for those aged 10-<12 years (p=0.13). The prevalence rates of overweight and obesity were 14.4% and 5.1%, respectively. The prevalence rates of overweight and obesity were significantly higher in females than males (17.7% vs 10.7%, 5.6% vs 4.5% respectively (p<0.001) and most prevalent among the early adolescence (10<12yrs; p= 0.04). Conclusion: Prevalence of overweight and obesity is high among secondary school adolescents in Onitsha, Anambra state. There is a need for regular monitoring of weight and height as an early measure to prevent and control overweight and obesity.

Veno-Arterial Extracorporeal Membrane Oxygenation in Adults with Septic Shock

Survivors and non-survivors were compared for 20 adults supported with veno-arterial extracorporeal membrane oxygenation (VA ECMO) for refractory septic shock from 2012-2018. The primary outcome was hospital survival. Secondary outcomes were ECMO associated complications and survival to decannulation. Median age was 53.5 (IQR 42.0-61.3). At ≤ 24 hours prior to cannulation, median SOFA score was 17.5 (IQR 15 - 19) and 17 patients (85%) had new cardiac dysfunction. Median left ventricular ejection fraction (LVEF) was 20% (IQR 10-38). Thirteen patients had a mixed (cardiogenic and distributive) or cardiogenic shock profile (65%), 7 had a distributive shock profile (35%), and 17 (85%) survived to decannulation. Fourteen (70%) survived to hospital discharge and median cerebral performance category score was 1 (IQR 1-2). No differences were found in age, comorbid conditions, time from shock onset to cannulation, peak flow rate on ECMO, ECMO complications, shock profile, LVEF, or vasoactive-inotrope score (VIS). More patients in the distributive shock profile experienced limb ischemia complications (n=3, 42.9%) compared to the cardiogenic and mixed shock profiles (n=1, 7.7%). Survivors to hospital discharge had a lower SOFA score. VA ECMO support may be a beneficial therapy for refractory septic shock and could be considered in select adult patients.

Brain, Spinal Cord and Labyrinthine Concussion in Sports

In this paper, we discuss the 3 types of concussion that occur in sports; brain concussion, spinal concussion (spinal cord neurapraxia), and labyrinthine (inner ear) concussion. Brain concussion data was collected from professional ice hockey players (Tohoku Free Blades, Japan) during 9 consecutive seasons. Spinal cord concussion and Labyrinthine concussion data was collected from athletes who sustained the injury in various sports including ice hockey. Material and methods The average incidence of brain concussion in professional ice hockey players was 2.0 per season. All 13 cases of spinal cord concussion were cervical cord concussion. Seven cases showed evidence of spinal cord compression; six cases had no radiological abnormality observed. All cases of labyrinthine concussion were sustained through a traumatic blow to the lateral aspect of the head. Results In any sports injury, all three of these concussions can co-exist and requires the team doctor to be at the site in order to fully assess the injury.

Clinical consequences of Hypotension in patient with organophosphate poisoning

Objective: Aim of study is to describe the clinical consequences of hypotension in patient with organophosphate poisoning. Method: In the retrospective cohort study, we analyzed data of 66 patients with organophosphate poisoning who were treated at Bir Hospital, Nams Kathmandu. Data from those with hypotension and normal blood pressure were compared to identify significant clinical consequences. Results: All together 66 patients were enrolled in this study out of which 44(66.7%) were female and 22(33.3%) were male. After analyzing data, we found 18.2% of case with severe poisoning (ACHE < 700 U/L). Among all, 41(62%) were found to have normal blood pressure and 25(37.9%) were found to have low blood pressure. Among those with hypotension, around 56% were found to have prolonged QTc interval, p < 0.003 and there was statistically significant association between QTc prolongation and vasopressor requirement, X2(1) = 22.98, P < 0.001. Patients requiring higher dose to reach atropinization had statistically significant hypotension, P < 0.001. Those with low blood pressure were found to require more days of hospital admission, P < 0.001. Patients with hypotension were found to have severe poisoning both on the basis of POP Score severity grading, 16(64%) P <0.002 and ACHE Severity scale, 7(28%) P < 0.05. In comparison with normal blood pressure group, low blood pressure group had significantly more chance of developing complications like septic shock (2), aspiration pneumonia (5), ARDS (1) and bed sore, P = 0.002. Vasopressor requirement was significantly more among those with low blood pressure, P < 0.001. Most of hypotensive patients were needing ICU care, found to have higher WBC count P = 0.002 and lower GCS Score at admission P < 0.001. There was positive correlation between hypotension and POP Score at admission P < 0.001. Conclusion: Hypotension is a common complication in patient with organophosphate poisoning and is associated with higher POP Score, lower ACHE level, lower GCS Score, increased vasopressor requirement, more hospital stays, increasing ICU admission, more chance of developing septic shock and aspiration pneumonia.

The Potential of Hydroxyapatite Toothpaste towards the Hypersensitive Tooth

Dental hypersensitivity is a communal problem that we may often encounter in the daily life of both men and women, especially in the elderly who can unconsciously affect every daily activity. Dentin hypersensitivity is defined as sharp pain caused by stimulation of exposed dentin and unprotected dentin by enamel which can be caused by attrition, abrasion, crown fracture, gingival recession, and orthodontic trauma. Aim: The aim of this study was to analyse the potential of hydroxyapatite toothpaste towards the hypersensitive tooth through literature review. Method: This study analyzed 35 journals from each database PubMed, Ebsco, Google Scholar, ResearchGate, Wiley Online Library, and other international journal websites with keywords hydroxyapatite, hypersensitive dentin, remineralization. Conclusion: Toothpaste containing hydroxyapatite was more effective than toothpaste without hydroxyapatite in inducing tooth remineralization process. The use of toothpaste containing hydroxyapatite in the long term and routine for 15 days is more effective in reducing dental hypersensitivity.

Evaluation of the Effect of Mesenchymal Stem Cells on Cisplatin Induced Toxicity in Neuroblastoma Tumor Model

Objective: High-dose cisplatin (CDDP) causes dose-limiting side effects in neuroblastoma (NB) treatment. Mesenchymal stem cells (MSC) are a current research area. The aim of this study is to assess the interaction of MSC with CDDP in nude mouse NB model. Methods: Athymic male nude mice (n=28) thatbhad basal auditory tests, with subcutaneous NB were randomized to control, CDDP, MSC and CDDP+MSC treatment groups. Seven days later, hearing tests were repeatedand the animals were sacrificed. Necrosis, apoptosis and viabilitywere assessed in tumors. MSC rate within the tumor was assessed with flow cytometry for triple CD34+ CD44+ and CD117- expression. Expression of the cochlear cell proteins of calretinin, math-1 and myosin2A were immunohistochemically assessed. Results: Tumor tissues were found to have statistically significantly higher levels of necrosis in CDDP and CDDP+MSC groups. MSC did not change the tumor dimensions in the CDDP group. MSC group had higher triple CD34+ CD44+ and CD117- expression within tumor tissue compared to the control and CDDP groups. In the inner ear, the expression of cochlear cell proteins calretinin, math-1 and myosin2A were identified to be highest in MSC group. 15-decibel loss at 12, 16, 20 and 32 kHz frequencies with CDDP was resolved with MSC administration. Conclusion: MSC prevented hearing loss caused by CDDP without disrupting the antitumor effect of CDDP. Systemic MSC may be assessed for clinical use to reduce the side effects of CDDP.

“Pleurotomy during CABG on the Clinical Outcome Following Left Internal Mammary Artery (LIMA) Harvesting”

Background: The internal mammary artery (IMA) is the graft of choice for coronary artery bypass grafting (CABG) due to superior patency and enhanced patient survival. Pleurotomy during coronary artery bypass grafting (CABG) may cause post-operative events, mostly pulmonary complications. Objective: To assess the impact of intact pleura during left internal mammary artery harvesting on clinical outcome. Materials and Methods: This Cross sectional observational study was carried out in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2019 to December 2019.101 patients who underwent Department of Cardiac Surgery, BSMMU were enrolled in this study and divided into two groups: group A (n = 48, 36 male and 12 female patients at a mean age of 56.5 ± 11.2 years) underwent routine CABG and pleurotomy and group B (n = 53, 45 male and 8 female patients at a mean age of 55.4 ± 10.3 years) had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. Results: The Incidence Of Postoperative Pericardial Effusion Was Similar Between The Groups, But The Incidence Of Postoperative Pulmonary Complications Such As Pleural Effusion (Except For Mild Pleural Effusion) On The Second (No: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.1% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) and fifth postoperative days (no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) was significantly lower in group B (p value < 0.001 and p value = 0.007, respectively). Also, the incidence of atelectasis (except for mild atelectasis) on the second (no: 2.1%, mild: 22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%, mild: 59.3%, moderate: 31.5%, and severe: 0 in group B) and fifth postoperative days (no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no: 39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B) was significantly higher in group A (p value < 0.001 and p value = 0.004, respectively). Postoperative partial oxygen pressure and O2 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A (p value = 0.017). Amount of bleeding (p value = 0.008) and duration of hospitalization (p value = 0.002) were significantly higher in group A than those in group B. Conclusion: Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion.

“Clinical Profile & Prognostic Factors In Patients with Sudden Sensorineural Hearing Loss”

Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency disease requiring immediate diagnosis and treatment. The incidence of ISSNHL in the Western countries’ population was estimated to 5–20 per 100,000 inhabitants. The etiology of ISSNHL remains unknown. Its pathogenesis is most often suggested to be due to a disturbed microcirculation and infection. Objective: To study the clinical profile & prognostic factors in patients with sudden sensorineural hearing loss. Material and Methods: A retrospective study was carried out from patients of sudden sensineural hearing loss (SSNHL) presenting to ENT Department ofNorthern Private Medical College, Rangpur, Bangladesh from January to June-2020. All patients were given intravenous steroids as treatment modality for 14 days and pure tone audiogram was done every 3 days during hospital admission. It was followed by oral steroids in tapering dose for further 14 days. After 1 month, audiogram was done again. After 1 month if hearing threshold was decreased by more than 50% of presenting one, then it was labeled as improved. Results:Total 51 patients (55ears) with age ranging from 6-70 years (average-38.5 years) were included. Three fourth were male. Presentation was 1-14days after onset of hearing loss (average- 3.7days) with pure tone audiogram (PTA) of 38-117dB (average 83.1dB). The flat audiogram (62.3%) was most common type. Smoking was present in 14 patients and tinnitus in 30 ears. Hemoglobin ranged from 7.3-18.7gm %( average- 15.3gm/dl). PTA post treatment was 8-73dB (average- 56dB). Average age of improved patient was 39.8years which was lower than non-improved patients (42.3years). In improved patients, average PTA at presentation was 77.9dB while it was 86.6dB in non-improved patients. Conclusion: Our study demonstrates that the age distribution and clinical characteristics of ISSNHL patients vary according to levels of hearing loss. Moreover, ISSNHL patients with vertigo tend to sufer from a more severe hearing loss. Further studies are needed to obtain better knowledge about the etiopathogenesis of SSNHL. SSNHL is more commonly seen in male patients with polycythaemia and is commonly presented in winter season and is frequently associated with tinnitus. Young age and lower audiogram threshold at presentation favor prognosis.