Rn Srivastava

Immunoregulation of bone remodelling.

Remodeling, a continuous physiological process maintains the strength of the bones, which maintains a delicate balance between bone formation and resorption process. This review gives an insight to the complex interaction and correlation between the bone remodeling and the corresponding changes in host immunological environment and also summarises the most recent developments occuring in the understanding of this complex field. T cells, both directly and indirectly increase the expression of receptor activator of nuclear factor kB ligand (RANKL); a vital step in the activation of osteoclasts, thus positively regulates the osteoclastogenesis. Though various cytokines, chemikines, transcription factors and co-stimulatory molecules are shared by both skeletal and immune systems, but researches are being conducted to establish and analyse their role and / or control on this complex but vital process. The understanding of this part of research may open new horizons in the management of inflammatory and autoimmune diseases, resulting into bone loss and that of osteoporosis also.

Diagnostic and prognostic role of MRI in spinal trauma, its comparison and correlation with clinical profile and neurological outcome, according to ASIA impairment scale.

Aims and objectives: To evaluate the role of magnetic resonance imaging (MRI) as a non-invasive diagnostic tool in patients with acute and chronic spinal trauma and to compare and correlate the MRI findings with those of patients’ clinical profile and neurological outcome according to ASIA impairment scale to assess prognostic and clinical value of MRI. Materials and Methods: Sixty two patients of spinal trauma formed the study group in a prospective fashion. The patients undergoing MR imaging and magnetic resonance images were analyzed and correlated with findings on neurological examination according to American Spinal Injury Association (ASIA) impairment scale (AIS) at the time of MRI examination and subsequently at sub-acute interval to assess neurological outcome. Statistical Analysis: Sample profile was described in terms of 95% confidence limit and proportion. To describe strength of association between extent of spinal cord injury and outcome, odds ratio, bivariate and multi variant analysis, was used. Pearsons chi square (χ) 2 statistics was applied to test the association between two categorical variables. Data were analyzed using statistical software package, STATA 9.2 and the difference was considered to be significant if ‘P’ value was <0.05. Observation and Results: The cord edema without hemorrhage was the most common MR finding (41.5%). The others were sizable focus of hemorrhage within the cord (33%), epidural hematoma (5.0%), and normal cord (26%). Majority of MR findings correlated well with clinical profile of the patient according to ASIA impairment scale. This study demonstrated that patients with presence of sizable focus of haemorrhage had larger cord edema and more severe grade of initial ASIA impairment scale( AIS) with poor recovery at follow up (P=0.032).Improvement in upper extremity was more than lower extremity. Severe cord compression was also associated with poor neurological outcome; however it was not statistically significant (P=0.149). Conclusions: With this study the authors concluded that various MRI findings in acute spinal cord injury correlated well with the initial clinical findings and on follow-up according to ASIA impairment scale. MRI is useful for initial diagnosis of acute spinal cord injury and its prognostication for predicting neurological recovery.

Ligamentotaxis for complex calcaneal fractures using Joshi's external stabilization system

Background: Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshis external stabilization system (JESS) for its efficacy. Materials and Methods: Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition) fractures of the calcaneum, who were treated by external fixator (JESS) based on the principle of ligamentotaxis. The gradual distraction was done to bring the articular margins together to maintain both alpha and beta angles to near normal range. Thirteen (28.9%) patients underwent additional corticocancellous bone grafting with elevation of posterior facet. All patients were evaluated for their functional outcomes by American Orthopedic Foot and Ankle society (AOFAS) Score for the ankle and hind foot. Mean duration of follow-up was 20.5 months. Results: Forty-two (93.4%) of our patients did well with the ligamentotaxis. On evaluating final outcomes by AOFAS, approximately 71% of cases showed good results. Eleven patients (24.4%) complained of persistent heel pain in the long-term follow-up. Out of these, eight (17.8%) patients were those who had severe comminution with almost total loss of calcaneal height. The origin of heel pain was not the subtalar joint in all of these patients. On long-term follow-up none of these patients suffered from such severe pain so as to compel them to change the nature of their activity. Conclusion: We conclude that ligamentotaxis by JESS provides a viable and user-friendly alternative method of management of these complex calcaneal fractures.

Phosphorylated neurofilament heavy: A potential blood biomarker to evaluate the severity of acute spinal cord injuries in adults

Aims: The aim of this study is to analyze the serial estimation of phosphorylated neurofilament heavy (pNF-H) in blood plasma that would act as a potential biomarker for early prediction of the neurological severity of acute spinal cord injuries (SCI) in adults. Settings and Design: Pilot study/observational study. Subjects and Methods: A total of 40 patients (28 cases and 12 controls) of spine injury were included in this study. In the enrolled cases, plasma level of pNF-H was evaluated in blood samples and neurological evaluation was performed by the American Spinal Injury Association Injury Scale at specified period. Serial plasma neurofilament heavy values were then correlated with the neurological status of these patients during follow-up visits and were analyzed statistically. Statistical Analysis Used: Statistical analysis was performed using GraphPad InStat software (version 3.05 for Windows, San Diego, CA, USA). The correlation analysis between the clinical progression and pNF-H expression was done using Spearmans correlation. Results: The mean baseline level of pNF-H in cases was 6.40 ± 2.49 ng/ml, whereas in controls it was 0.54 ± 0.27 ng/ml. On analyzing the association between the two by Mann–Whitney U–test, the difference in levels was found to be statistically significant. The association between the neurological progression and pNF-H expression was determined using correlation analysis (Spearmans correlation). At 95% confidence interval, the correlation coefficient was found to be 0.64, and the correlation was statistically significant. Conclusions: Plasma pNF-H levels were elevated in accordance with the severity of SCI. Therefore, pNF-H may be considered as a potential biomarker to determine early the severity of SCI in adult patients.

Association of Intronic Single Nucleotide Polymorphism (SNP) of CALM 1 gene with Osteoarthritis of the Knee in Indian Population: A Case-control Study

ABSTRACT: H1N1 influenza is an emerging threat that is life threatening to pregnant women in the third trimester. Pregnant women are a high-risk group for morbidity and mortality from influenza (H1N1). During the current pandemic of H1N1 influenza, few cases of H1N1 have been reported in pregnancy. We report a case of H1N1 influenza in a 23-year old female with 28 weeks of gestation, who developed acute respiratory distress syndrome, required mechanical ventilation and eventually recovered. KEYWORDS : H1N1; Acute Respiratory Distress Syndrome; Pregnancy; Influenza Internet Journal of Medical Update 2012 January;7(1):73-76