Subhas C. Gupta

Trace element toxicity relationships to crop production and livestock and human health: implications for management

Abstract In nature, trace element toxicities occur in all living organisms. The consequences of these toxicities have been described in crops, livestock and humans. In some instances, the toxicities are a direct consequence of the organisms position in the food chain and their environment, while in others, they are based upon genetic abnormalities resulting in physiological impairment.Nutrient toxicities in crops are more frequent for manganese (Mn) and boron (B) than for other nutrients. Manganese toxicity is found on acid soils in many parts of the world. Boron toxicities occur in irrigated regions where the well or irrigation waters are exceptionally high in B. Most other nutrient toxicities occur when large amounts of nutrients in question have been added in waste, e.g., sewage sludge. Crops grown near mines and smelters are prone to nutrient toxicities. Generally, the symptoms of toxicity in crops occur as burning, chlorosis and yellowing of leaves. Toxicities can result in decreased yield and/or im...

Skin Substitutes and Alternatives: A Review

PURPOSE To provide the specialist in skin and wound care with a review of skin replacement alternatives and their most common uses. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in wound care and related disorders. OBJECTIVES After reading this article and taking this test, the reader should be able to: Describe characteristics of skin and skin substitutes for grafting. Identify indications for and uses of common grafting procedures and products.

Negative pressure wound therapy with instillation: a pilot study describing a new method for treating infected wounds

This data review reports the results of 15 patients who were treated with Vacuum‐Assisted Closure® (VAC) negative pressure therapy system in addition to the timed, intermittent delivery of an instilled topical solution for management of their complex, infected wounds. Prospective data for 15 patients treated with negative pressure wound therapy (NPWT)‐instillation was recorded and analysed. Primary endpoints were compared to a retrospective control group of 15 patients treated with our institution‘s standard moist wound‐care therapy. Culture‐specific systemic antibiotics were prescribed as per specific patient need in both groups. All data were checked for normality of distribution and equality of variance and appropriate parametric and non parametric analyses were conducted. Compared with the standard moist wound‐care therapy control group, patients in the NPWT‐instillation group required fewer days of treatment (36·5 ± 13·1 versus 9·9 ± 4·3 days, P < 0·001), cleared of clinical infection earlier (25·9 ± 6·6 versus 6·0 ± 1·5 days, P < 0·001), had wounds close earlier (29·6 ± 6·5 versus 13·2 ± 6·8 days, P < 0·001) and had fewer in‐hospital stay days (39·2 ± 12·1 versus 14·7 ± 9·2 days, P < 0·001). In this pilot study, NPWT instillation showed a significant decrease in the mean time to bioburden reduction, wound closure and hospital discharge compared with traditional wet‐to‐moist wound care. Outcomes from this study analysis suggest that the use of NPWT instillation may reduce cost and decrease inpatient care requirements for these complex, infected wounds.

Artificial dermis as an alternative for coverage of complex scalp defects following excision of malignant tumors

Background: Artificial dermis has been used successfully for coverage of full-thickness wounds with a well-vascularized surgical bed. However, the use of artificial dermis in the reconstruction of partial- and full-thickness scalp defects has not been well documented. Methods: Seven patients (six men and one woman; mean age, 70 ± 14 years) with partial-thickness (three patients) and full-thickness (four patients) soft-tissue defects of the scalp (mean defect area, 97 ± 58 cm2) following resection of recurrent malignant tumors and/or previous failed reconstructions underwent staged scalp reconstruction with a bilaminate skin substitute (Integra). After adequate débridement of scalp wounds, including burring the outer table of the calvaria down to bleeding bone for full-thickness defects, Integra was scored and applied unexpanded. A split-thickness skin graft (0.011 ± 0.0 inch in thickness) was placed on the operative site at postoperative day 36 ± 15 after removal of the silicone layer of the artificial dermis. Two patients required repeated applications of artificial dermis to compensate for contour deficits before skin grafting. Results: Clinically, all reconstructed areas showed well-vascularized neodermis before skin grafting. There was a 100 percent take of the skin grafts, with no infections or other complications noted. All reconstructive procedures were performed in less than 3 hours of combined operative time, with the last stage performed on an outpatient basis. Conclusions: Artificial dermis can be used successfully for reconstruction of complex scalp defects following oncologic resection, offering minimal donor-site morbidity, expedient operative time, and when needed, temporary quality closure until final pathologic results are known. Integra skin may offer another option for definitive management of extensive full-thickness scalp defects.

Selenium in soils and crops, its deficiencies in livestock and humans: implications for management.

Abstract Selenium (Se) content in soils varies greatly depending upon the parent rock, weathering and texture. In general, total soil Se of 0.1 to 0.6 mg kg‐1 is considered deficient. Selenium deficiency regions in New Zealand, Denmark and the Atlantic Region of Canada contain 0.1 to 0.6 mg Se kg‐1 in the soil. Soil acidity is an important factor resulting in decreased Se availability to crops. Selenium concentration in plants can range from 0.005 mg kg‐1 in deficient crops to about 5500 mg kg‐1 in Se accumulators on seleniferous soils. Among crops, brassicas and legumes, particularly soybeans, contain higher Se than other crops. Selenium is an essential mineral for livestock as well as for humans, but its essentiality for the growth of Se accumulators or non‐accumulators has so far not been demonstrated. Feed crops containing more than 0.1 mg Se kg‐1 will protect livestock from Se deficiency disorders. Inadequate Se in animal rations can cause White Muscle Disease in calves, sheep and goat; Exudative Diathesis in poultry and Mulberry Heart Disease in pigs. Selenium deficiency can be prevented by Se injections to females at late gestation and/or to the young stock shortly after birth. In humans, lack of Se has been linked to several kinds of cancer, heart disease and other chronic and life threatening conditions. Oral Se therapy has been reported to produce significant decreases in lung, prostate and colorectal cancer in a recently published study. It has also been shown to help prevent cardiomyopathy in young children in China. Pills containing Se alone or in combination with vitamins and/or minerals, are available in several countries as a human supplement. Eating Se enriched foods and animal products and/or Se pills may protect humans from pathology associated with Se deficiency. Selenium fertilization of crops is now permitted in New Zealand, Finland and to a limited extent in China and Canada.

Guidelines for managing pressure ulcers with negative pressure wound therapy.

Pressure ulcers are a serious health issue, leading to clinical, financial, and emotional challenges. Numerous treatment modalities are available to promote wound healing, yet clinicians may be unsure how to incorporate these treatment options into an overall plan of care for the patient with a pressure ulcer. A consensus panel of experienced wound care clinicians convened in July 2004 to review the mechanisms of action and research basis for one such treatment modality: negative pressure wound therapy. After answering key questions about this modality, they developed an algorithm to assist the clinician in making decisions about using negative pressure wound therapy appropriately in patients with Stage III and Stage IV pressure ulcers.

A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series.

Over the last decade Vacuum Assisted Closure® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult‐to‐treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy and V.A.C. Instill® with either GranuFoam™ or GranuFoam Silver™ Dressings. The panel reviewed infected wound treatment methods within the context of evidence‐based medicine coupled with experiential insight using V.A.C.® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state‐of‐practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.

Sources and Deficiency Diseases of Mineral Nutrients in Human Health and Nutrition： A Review

Mineral nutrients are fundamentally metals and other inorganic compounds. The life cycle of these mineral nutrients begins in soil, their primary source. Soil provides minerals to plants and through the plants the minerals go to animals and humans; animal products are also the source of mineral nutrients for humans. Plant foods contain almost all of the mineral nutrients established as essential for human nutrition. They provide much of our skeletal structure, e.g., bones and teeth. They are critical to countless body processes by serving as essential co-factors for a number of enzymes. Humans can not utilize most foods without critical minerals and enzymes responsible for digestion and absorption. Though mineral nutrients are essential nutrients, the body requires them in small, precise amounts. We require them in the form found in crops and they can be classified into three different categories: major, secondary, and micro or trace minerals. This classification is based upon their requirement rather than on their relative importance. Major minerals such as potassium (K) and phosphorus (P) are required in amounts of up to 10 g d−1. The daily requirement of secondary and micro minerals ranges from 400 to 1 500 mg d−1 and 45 μg d−1 to 11 mg d−1, respectively. To protect humans from mineral nutrient deficiencies, the key is to consume a variety of foods in modest quantities, such as different whole grains, low fat dairy, and different meats, vegetables and fruits. For insurance purposes, a supplement containing various mineral nutrients can be taken daily.

Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis

Our aim was to review the efficacy of the wound vacuum-assisted closure (VAC) system in the treatment of deep infection after extensive instrumentation and fusion for spinal deformity in children and adolescents. A total of 14 patients with early deep spinal infection were treated using this technique. Of these, 12 had neuromuscular or syndromic problems. Clinical and laboratory data were reviewed. The mean follow-up was 44 months (24 to 72). All wounds healed. Two patients required plastic surgery to speed up the process. In no patient was the hardware removed and there was no loss of correction or recurrent infection. We believe that the wound VAC system is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for the retention of the instrumentation and the maintenance of spinal correction. It is reliable and easy to use.

QUALITY OF ANIMAL AND HUMAN LIFE AS AFFECTED BY SELENIUM MANAGEMENT OF SOILS AND CROPS

Nutrient management of soils and crops affects the quality of crops with respect to their selenium (Se) and other mineral composition. A number of world regions are deficient in Se to meet the needs of animals and humans. In general, soils containing less than 0.6 mg Se kg−1 and crops containing less than 0.1 mg kg−1 are considered deficient for animals and humans. Areas receiving sulfur fertilization contain low Se because sulfur interferes with Se uptake by plants. Principal Se responsive diseases in animals can be divided in to four groups: Musculoskeletal (white muscle disease and neonatal weakness), reproductive (retained placentae and abortions), gastrointestinal (diarrhea and ill thrift), and immunologic (immune system deficits). Human pathology reflects these animal disease states. Specific immune, reproductive, neurologic, and cardiac disorders are found in humans deficient in Se. Additionally, certain cancers and chronic diseases appear to be related to Se in the human diet. A higher Se status in humans has proven beneficial in specific disease states such as pediatric cardiomyopathy and viral hepatitis. Selenium fertilization of soil, Se application as a foliar spray or seed treatment with Se at 10 g Se ha−1 applied as selenate results in crops sufficiently enriched with Se, for one year, to protect against Se deficiency. Selcote® ultra (CropCare Holdings Ltd., Richmond, New Zealand) at 10 g Se ha−1 provides a longer residual effect with adequate Se levels in most crops for up to two years. Although there are other methods of overcoming Se deficiency but crop enrichment and consumption of crop products containing Se in organic form is more bio available.