Sabir Ali

Correlation of shock index and modified shock index with the outcome of adult trauma patients: A prospective study of 9860 patients

Background: Triage at emergency department is performed to identify those patients who are relatively more serious and require immediate attention and treatment. Despite current methods of triage, trauma continues to be a leading cause of morbidity and mortality. Aims: This study was to evaluate the predictive value of shock index (SI) and modified shock index (MSI) for hospital mortality among adult trauma patients. Materials and Methods: In this prospective longitudinal study, all adult patients who sustained trauma enrolled as per as inclusion/exclusion criteria. After the collection of data, SI and MSI were calculated accordingly. All parameters were again recorded hourly and calculations were done at six-hour intervals. Further, to achieve a value that can be analyzed, we determined threshold value for vital signs, which set the threshold values as heart rate at 120 beats per minute, systolic blood pressure at less than 90, and SI at cut-off 0.5-0.9 and MSI at less than 0.7 to more than 1.3. Results: We analyzed 9860 adult trauma patients. Multivariate regression analysis demonstrated that heart rate more than 120 beats per minute, systolic blood pressure less than 90 mmHg, and diastolic blood pressure (DBP) less than 60 mmHg correlate with hospital stay and mortality rate. MSI <0.7 and >1.3 had higher odds of mortality as compared to other predictors. Conclusions: MSI is an important marker for predicting the mortality rate and is significantly better than heart rate, systolic blood pressure, DBP and SI alone. Therefore, modified SI should be used in the triage of serious patients, including trauma patients in the emergency room.

MicroRNAs and Their Role in Bone Remodeling and Pathogenesis

MicroRNAs, a class of post-transcriptional gene expression regulators that bind to complementary sequences in the 3’ UTR or 5’ UTR of mRNAs have recently been detected in human body fluids including peripheral blood plasma as extracellular nuclease resistant entities. It is now clear that the biogenesis and functions of microRNAs are related to the molecular mechanisms of various clinical diseases and they can potentially regulate every aspect of cellular activity. This review will highlight our current understanding of microRNA biogenesis and their mechanisms of action. It will also summarize recent works on the role of microRNAs in bone remodeling including angiogenesis, osteoblast and osteoclast differentiation and in various bone related pathologies. An in-depth understanding of the roles of these regulatory mRNAs in the skeleton will be critical for the development of new therapeutics aimed on bone remodeling including fracture repair and bone-related diseases.

Study of Cysteine-Rich Protein 61 Genetic Polymorphism in Predisposition to Fracture Nonunion: A Case Control.

Background. Many factors are responsible for this impaired healing, especially in long bones, but a possible genetic predisposition for the development of this complication remains unknown till now. In the present study, we aim to examine the CYR61 gene polymorphism in fracture nonunion patients and the correlation with clinical findings. Materials and Methods. We performed SNP analysis of the CYR61 gene in 250 fracture nonunion patients and 250 healthy subjects were genotyped in this hospital-based case control study, and 56 cases were further evaluated for mRNA expression of CYR61 by real-time quantitative reverse-transcription PCR. Results. CYR61 gene TT, TG, and GG genotype frequencies of total fracture nonunion cases were 41.6%, 49.2%, and 9.20% and 54.4%, 39.2%, and 6.40% in healthy controls. Heterozygous TG genotype was found statistically significant in fracture nonunion cases compared with that in controls, whereas homozygous mutant GG genotype was not found significant. Moreover, we found that TG + GG genotypes were significantly different in serum expression of CYR61 mRNA when compared with cases (TT genotypes). Conclusions. Our result signifies that genotype of CYR61 affects the mRNA expression and acts as a risk factor that could synergistically increase the susceptibility of a patient to develop fracture nonunion.

Evaluation of injury severity score of missed injuries in pediatric trauma patients at institutional adult level II trauma center: Do we need a revised National Trauma policy for pediatric trauma?

Aims: The aim of the following study is to establish the incidence contributing factors and impact of the missed injuries in pediatric trauma patients at adult trauma center on the prognosis and overall outcome of these children. Settings and Design: Longitudinal prospective cohort study involving 603 patients in over 06 months. Materials and Methods: The relevant data (as defined) of all included patients were recorded. These patients were then followed to document the total length of hospital stay and the injury list defined at the discharge or on the 7 th day of admission; whichever came first. The injury severity score (ISS) at admission was compared with final ISS (multivariate regression analysis). Results: Total 115 (19.1%) missed injuries (adult + pediatric both) were discovered, out of which 71 (61.7%) were pediatric trauma missed injuries. The pediatric trauma missed injuries were 32.2% of all pediatric trauma patients and 11.8% of all trauma patients. Main contributing factors were incomplete assessment (52.5%) and patients′ arrival time. None of the missed injuries led to any mortality, morbidity or increased length of hospitalization. Final ISS did not correlate with missed injury. Conclusions: Missed injuries are a significant problem in trauma patients especially the pediatric trauma patients. Though the majority of children with trauma were treated efficiently in the anaplastic thyroid carcinoma, but there is a need for improvement in patient assessment and monitoring, that is, extended tertiary survey; with special exposure to the attending residents at casualty about pediatric trauma and its pathophysiology.

Identification of the cysteine-rich 61 (CYR61) gene variations in osteosarcoma patients.

BACKGROUND/AIM Osteosarcoma requires an angiogenesis process. CYR61 is one of the extracellular signaling molecules that promote angiogenesis, tumor growth, and the malignancy of osteosarcoma. In the present study, we investigate the CYR61 gene variations in osteosarcoma and their correlations with clinicopathological findings. MATERIALS AND METHODS We performed variation analysis of the CYR61 gene in 58 patients with osteosarcoma. With an aim to ascertain the variety of variations in exons 2, 3, 4, and 5 of the CYR61 gene in osteosarcoma, we did a PCR-SSCP followed by DNA sequencing. RESULTS In osteosarcoma the CYR61 gene variations found were 18.96% (11/58) in exon 2, 3.44% (2/58) in exon 3, 8.62% (5/58) in exon 4, and 15.51% (9/58) in exon 5. In our variation analysis, we detected one missense variation in exon 2 (Arg47Trp), one silent variation in exon 3 (Lys152Lys), one missense variation in exon 4 (Phe213Leu), and two missense variations in exon 5 (Gly315Arg and Asp339Asn). The overall CYR61 variation frequency in exons 2, 3, 4, and 5 was determined to be 46.55% (27/58). CONCLUSION Our study specifies the role of CYR61 gene variation in osteosarcoma. The result signifies that CYR61 might be used as a prognostic/diagnostic marker in osteosarcoma patients.

Effectiveness and safety of polygeline in patients with hypovolemia due to trauma

Background: This retrospective study examined the effectiveness and safety of polygeline in adult patients with hypovolemia due to traumatic injury. Materials and Methods: Polygeline was administered after evaluating the amount of blood loss and estimating hematological and biochemical parameters. Changes in vital signs, serum electrolytes, arterial pH, and serum lactate were evaluated. The safety was evaluated by recording the adverse events if any. Results: Sixty patients with the mean age 37.5 ± 11.26 years were included in the study. All patients had blood loss < 20%. The mean total polygeline administered was 1025.0 ± 464.18 ml. Blood transfusion was required in 3.33% of patients. Diastolic, systolic, and mean arterial blood pressure and pulse rate significantly increased after 1 h of polygeline administration (P < 0.0001). There was a trend toward increase in urine output (P = 0.0715) after 1 h. The improvement in vital parameters was consistent at 6, 14, and 18 h after administration of polygeline. Arterial pH significantly increased from 7.2 ± 0.12 to 7.3 ± 0.11 after 1 h of administration (P < 0.0001) and was consistent till 24 h (P = 0.035). Blood lactate decreased after 1 h (P < 0.0001). Changes in laboratory parameters were not clinically significant. After mean duration hospital stay of 10.5 ± 4.63 days all patients were discharged without any clinically significant abnormality or adverse event. Conclusion: Polygeline improved hemodynamic stability in patients with hypovolemia due to traumatic injury. The improvement was seen within 1 h (golden hour) of polygeline administration and maintained consistently. Polygeline can be safely administered to patients with traumatic injury to improve hemodynamic parameters and achieve stability.

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.

Analysis of Hypertension as a Risk Factor for Osteoarthritis Knee

The basic objective of the recent analysis was to study hypertension as a risk factor for osteoarthritis (OA) knee. In this study, totally 155 patients of OA knee, of age more than 40 years, were enrolled for the study. The study was carried out in the Department of Orthopedic Surgery, King George’s Medical University (KGMU), Lucknow, Uttar Pradesh, India. According to the diagnostic criteria of the American College of Rheumatology, the cases were taken into consideration. A brief history about the disease was taken, and complete examinations were done. For the clinical severity, visual analog scale (VAS) and Lequesne index were done and for radiological severity assessment, Kellgren–Lawrence (KL) grading and X-ray bilateral knee were done to observe the radiological changes. Moreover, the blood pressure was measured consecutively in both arms for three times via auscultatory method following the American Heart Association guidelines, and the average was calculated and recorded. If the recorded average is greater than 140/90 mm Hg, then the subject is labeled as “hypertensive.” In this study, we found a significant association between the severity of the OA knee and hypertension. The study is not only for our knowledge enrichment about the association of OA and hypertension, but also to fill the gaps with related information; it will reshape our knowledge toward the management of heart disease, hypertension, and OA. Also, we can determine the new possible risk factors for these diseases.

Does serum albumin level affect the healing outcomes of simple diaphyseal tibial fractures

Aims: To quantify the serum albumin level and its correlation with fracture healing progression and outcomes in adult patients. Settings and Design: A prospective cohort study at an institutional trauma center. Materials and Methods: A total of 50 adult patients with simple, fresh traumatic diaphyseal fractures of both bones of the leg managed conservatively were included in the study. Serum albumin was measured initially and at the 6 th week postfracture. The clinico-radiological follow-up was done to analyze the fracture healing progression and their final outcomes, which were correlated with the quantified serum albumin level of the patients. Statistical Analysis Used: Student t-test, Mann-Whitney U-test and Pearson correlation coefficient. Results: As per the last clinico-radiological follow-up at the 24 th week, patients were grouped into two groups: Group I (normal union n = 38) and Group II (impaired healing n = 12). The mean serum albumin levels were significantly higher in Group I when compared to Group II. The association between the serum albumin level at baseline and at the 6 th week was moderate. The best cut-off measure of serum albumin level was 3.45 g/dL, both at baseline and at the 6 th week after fracture to predict the healing outcome. The correlation of serum albumin levels with fracture healing outcomes was statistically significant. Conclusion: Serum albumin is moderately associated with the baseline and 6 th -week values and showed a positive correlation with the bony healing progression and may provide an early predictor of the healing outcomes of simple diaphyseal tibial fractures.

Role of alpha-crystallin, early-secreted antigenic target 6-kDa protein and culture filtrate protein 10 as novel diagnostic markers in osteoarticular tuberculosis

Summary Osteoarticular tuberculosis constitutes about 3% of all tuberculosis cases. Early and accurate diagnosis of tuberculosis is a challenging problem especially in the case of osteoarticular tuberculosis owing to the lower number of bacilli. However, an accurate and timely diagnosis of the disease results in an improved efficacy of the given treatment. Besides the limitations of conventional methods, nowadays molecular diagnostic techniques have emerged as a major breakthrough for the early diagnosis of tuberculosis with high sensitivity and specificity. Alpha-crystallin is a dominantly expressed protein responsible for the long viability of the pathogen during the latent phase under certain stress conditions such as hypoxia and nitric oxide stress. Two other proteins—early secreted antigenic target-6 and culture filtrate protein-10—show high expression in the active infective phase of Mycobacterium tuberculosis. In this article, we focus on the different proteins expressed dominantly in latent/active tuberculosis, and which may be further used as prognostic biomarkers for diagnosing tuberculosis, both in latent and active phases.