Otitis Media with Effusion (OME) in Urban Pediatric Population in a Tertiary Care Centre: A Clinical Study

Abstract

Otitis media with effusion (OME) is a common condition affecting children. It is one of the most common causes for reduced hearing in pediatric age group leading to various learning disabilities including delayed speech development. The aim of this study was to find out various epidemiological characteristics and risk factors for developing OME and various treatment modalities depending on the clinical features and their outcomes in urban pediatric population. A prospective comparative study was done in 100 children taken 50 as cases and 50 as controls for a period of 2 years. The risk factors, common presenting features and the examination and investigational findings (tympanometry) of the study condition were compared among the cases and controls. Among the 50 cases, 28 children were treated medically and 22 underwent surgical treatment in the form of Myringotomy and Grommet insertion. The patients were followed up-to 6 months in both groups.

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Wide Awake Open Reduction of Irreducible Metacarpal Phalangeal Joint Dislocations

No abstract available

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MULTINODULAR AND VACUOLATING NEURONAL TUMOURS IN EPILEPSY: DYSPLASIA OR NEOPLASIA?

Abstract

Multinodular and vacuolating neuronal tumour (MVNT) is a new pattern of neuronal tumour included in the recently revised WHO 2016 classification of tumours of the CNS. There are fifteen reports in the literature to date. They are typically associated with late onset epilepsy and a neoplastic versus malformative biology has been questioned. We present a series of ten cases and compare their pathological and genetic features to better characterised epilepsy associated malformations including focal cortical dysplasia type II (FCDII) and low-grade epilepsy associated tumours (LEAT). Clinical and neuroradiology data were reviewed and a broad immunohistochemistry panel was applied to explore neuronal and glial differentiation, interneuronal populations, mTOR pathway activation and neurodegenerative changes. Next generation sequencing was performed for targeted multi-gene analysis to identify mutations common to epilepsy lesions including FCDII and LEAT. All of the surgical cases in this series presented with seizures, and were located in the temporal lobe. There was a lack of any progressive changes on serial pre-operative MRI and a mean age at surgery of 45 years. The vacuolated cells of the lesion expressed mature neuronal markers (neurofilament/SMI32, MAP2, synaptophysin). Prominent labelling of the lesional cells for developmentally regulated proteins (OTX1, TBR1, SOX2, MAP1b, CD34, GFAPδ) and oligodendroglial lineage markers (OLIG2, SMI94) was observed. No mutations were detected in the mTOR pathway genes, BRAF, FGFR1 or MYB. Clinical, pathological and genetic data could indicate that MVNT aligns more with a malformative lesion than a true neoplasm with origin from a progenitor neuro-glial cell type showing aberrant maturation. This article is protected by copyright. All rights reserved.

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HIPPOCAMPAL SCLEROSIS, HIPPOCAMPAL NEURON LOSS PATTERNS AND TDP-43 IN THE AGED POPULATION

Abstract

Hippocampal neuron loss is a common neuropathological feature in old age with various underlying aetiologies. Hippocampal sclerosis of aging (HS-Aging) is neuropathologically characterized by severe CA1 neuronal loss and frequent presence of transactive response DNA-binding protein of 43kDa (TDP-43) aggregations. Its aetiology is unclear and currently no standardized approaches to measure HS-Aging exist. We developed a semi-quantitative protocol, which captures various hippocampal neuron loss patterns, and compared their occurrence in the context of HS-Aging, TDP-43, vascular and tau pathology in 672 brains (TDP-43 staining n=642/672, 96%) donated for the population-based Cambridge City over-75s Cohort and the Cognitive Function and Ageing Study. HS-Aging was first evaluated independently from the protocol using the most common criteria defined in literature, and then described in detail through examination of neuron loss patterns and associated pathologies. 34 (5%) cases were identified, with a maximum of five pyramidal neurons in each of over half CA1 fields-of-view (x200 magnification), no vascular damage, no neuron loss in CA2-CA4, but consistent TDP-43 neuronal solid inclusions and neurites. We also report focal CA1 neuron loss with vascular pathology to affect predominantly CA1 bordering CA2 (Fisher's exact, p=0.009), whereas neuron loss in the subicular end of CA1 was associated with TDP-43 inclusions (Fisher's exact, p<0.001) and high Braak stage (Fisher's exact, p=0.001). Hippocampal neuron loss in CA4-CA2 was not associated with TDP-43.

We conclude that hippocampal neuron loss patterns are associated with different aetiologies within CA1, and propose that these patterns can be used to form objective criteria for HS-Aging diagnosis. Finally, based on our results we hypothesize that neuron loss leading to HS-Aging starts from the subicular end of CA1 when it is associated with TDP-43 pathology, and that this neurodegenerative process is likely to be significantly more common than "end-stage" HS-Aging only. This article is protected by copyright. All rights reserved.

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3D-printed tracheoesophageal puncture and prosthesis placement simulator

Publication date: Available online 18 August 2017
Source:American Journal of Otolaryngology
Author(s): Samuel R. Barber, Elliott D. Kozin, Matthew R. Naunheim, Rosh Sethi, Aaron K. Remenschneider, Daniel G. Deschler
ObjectivesA tracheoesophageal prosthesis (TEP) allows for speech after total laryngectomy. However, TEP placement is technically challenging, requiring a coordinated series of steps. Surgical simulators improve technical skills and reduce operative time. We hypothesize that a reusable 3-dimensional (3D)-printed TEP simulator will facilitate comprehension and rehearsal prior to actual procedures.MethodsThe simulator was designed using Fusion360 (Autodesk, San Rafael, CA). Components were 3D-printed in-house using an Ultimaker 2+ (Ultimaker, Netherlands). Squid simulated the common tracheoesophageal wall. A Blom-Singer TEP (InHealth Technologies, Carpinteria, CA) replicated placement. Subjects watched an instructional video and completed pre- and post-simulation surveys.ResultsThe simulator comprised 3D-printed parts: the esophageal lumen and superficial stoma. Squid was placed between components. Ten trainees participated. Significant differences existed between junior and senior residents with surveys regarding anatomy knowledge(p<0.05), technical details(p<0.01), and equipment setup(p<0.01). Subjects agreed that simulation felt accurate, and rehearsal raised confidence in future procedures.ConclusionsA 3D-printed TEP simulator is feasible for surgical training. Simulation involving multiple steps may accelerate technical skills and improve education.



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Marble industry effluents cause an increased bioaccumulation of heavy metals in Mahaseer ( Tor putitora ) in Barandu River, district Buner, Pakistan

Abstract

The present study was conducted to evaluate the impact of marble industry effluents on the accumulation of heavy metals in selected tissues of mahaseer (Tor putitora) in Barandu River. Fish samples were collected from three selected sites (upstream (US), effluents/industrial (IS), and downstream (DS) sites) on monthly basis for 8 months. Heavy metal concentrations were determined in fish tissues using Atomic Absorption Spectrophotometer. Liver accumulated the highest level of metal concentrations while the lowest concentrations were found in muscles in T. putitora. Among metals, Fe was reported in the highest amount whereas the lowest was Cd in all the fish organs. In all the months, the metal concentrations were significantly higher (P < 0.05) at IS than the other two selected sites and also very often the metal concentrations at DS were found significantly higher (P < 0.05) compared to the US. The obtained results revealed that discharging industrial effluents caused an increased accumulation of heavy metals in fish tissues at IS compared to US and DS. Furthermore, in many cases, the concentrations at DS were also found significantly higher (P < 0.05) compared to US. It is further confirmed by skewness z-score which was found to be higher than 1.96 suggesting the hazardous effects of marble industries on the collective health of the river. It is therefore recommended that all these industries either should be moved away from the bank of River Barandu or must be bound to properly treat their effluents prior to discharge into the river in order to protect the biota of River Barandu from the pollution caused by these marble industries.

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Expression and characterization of the zebrafish orthologue of the human FOLR1 gene during embryogenesis

Publication date: Available online 18 August 2017
Source:Gene Expression Patterns
Author(s): RoJenia N. Jones, Stephanie A. Erhard, Mark R. Malham, Ayaz Y. Gen, Kyle Sullivan, Kenneth W. Olsen, Rodney M. Dale
It has been well established that many types of rapidly dividing normal and diseased cells require an increased amount of folate for DNA replication and repair as well as cellular metabolism. Thus one of folate's cognate receptors, Folate Receptor 1 (FOLR1) is usually up-regulated in rapidly dividing cells, including many types of cancerous tumors. Because zebrafish have become a model organism for understanding conserved vertebrate cellular pathways and human disease, there has been an increased need to identify and elucidate orthologous zebrafish genes that are central to known human maladies. The cells of all early animal embryos go through a phase of rapid division (cleavage) where particular cell cycle checkpoints are skipped until a specification event occurs directing these embryonic stem cells to their fated germ layer cell type. Interestingly, this rapid cell division that ignores cell cycle checkpoints is also observed in many cancers. Developing blastula and tumor cells both require folr1 expression to obtain folate. In this report we have identified the expression pattern of the zebrafish gene zgc:165502, located on chromosome 15. Using computational and comparative methods and molecular biology techniques such as reverse transcription polymerase chain reaction (RT-PCR) and whole mount in situ hybridization (WISH) during embryogenesis, we demonstrate that zgc:165502 is the zebrafish orthologue of the human FOLR1 gene. Understanding when and where FOLR1 orthologues are expressed in different biomedical model organisms such as the zebrafish will help researchers design better experiments to study the endogenous FOLR1 activity.



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