We present a case of a 53-year-old woman who developed multifocal insufficiency fractures associated with adefovir dipivoxil (ADV) induced osteomalacia, including recurring metatarsal insufficiency fractures and a subtrochanteric femoral insufficiency fracture requiring surgical fixation. She had received low-dose ADV treatment for 59 months for chronic hepatitis B viral infection at the time of presentation with subtrochanteric fracture. Imaging evidence of multifocal insufficiency fractures and metabolic disease on background of hypophosphatemia is attributed to hypophosphatemic osteomalacia from adefovir-induced renal proximal tubular dysfunction. Radiologists and clinicians should be aware of the possibility of insufficiency fractures in patients receiving ADV therapy to avoid delayed diagnosis and progression of high-risk proximal femoral fractures.
Osteomalacia

Humans ; Hypnotics and Sedatives ; Propofol ; Singapore

Any hypothalamic disturbance manifesting clinically is considered a major red flag for multiple sclerosis, whereas MRI lesions involving deep grey matter structures are considered an intermediate red flag. However, hypothalamic lesions manifesting clinically with hypersomnia have been described in some patients of multiple sclerosis. We report a case where the first and presenting feature of multiple sclerosis was acute onset hypersomnia with bilateral hypothalamic lesions. On review of recent literature, we also question whether clinical or radiological hypothalamic involvement is really so unusual that it should be considered a red flag for multiple sclerosis

PURPOSE: To find the association of trial without catheter (TWOC) outcome for first spontaneous acute urinary retention (AUR) in benign prostatic obstruction with age, prior lower urinary tract symptoms (LUTS), retention volume at catheterization (RV), and size of prostate. METHODS: Our prospective observational analytical (interventional) study enrolled 77 cases of spontaneous AUR over 24 months. After clinical evaluation, digital rectal examination, and transabdominal ultrasonography, all patients were catheterized per urethra and their RV was recorded. TWOC was administered after 2 or 3 doses of 0.4 mg tamsulosin-oral absorption control system and after 48-72 hours had passed. A successful endpoint was defined as a maximum flow-rate, >5 mL/sec; voided volume, >100 mL; postvoid residue, <200 mL; and voiding within 6 hours of catheter removal. Data obtained from 58 patients were analyzed after excluding the cases lost to follow-up and secondary exclusion. Age, RV, duration of LUTS, and prostate volume on examination and ultrasonography (PUSG) were recorded and statistically analyzed. Prostate-specific antigen levels were obtained on follow-up and cases of cancer, as seen on transrectal ultrasound-guided biopsy, were secondarily excluded. RESULTS: The patients had a mean age of 65.89+/-8.67 years. Prior LUTS was seen in 35 patients (2.07+/-2.91 months). The mean PUSG and RV were 46.81+/-20.58 mL and 854.8+/-36.26 mL, respectively. Thirty patients underwent a successful TWOC; a mean age of 63.13+/-8.58 years (mean+/-standard deviation; unpaired t-test; P=0.0053) and a PUSG of < or =45 mL (Pearson chi-square test; P=0.0427) were significantly associated with a successful outcome. CONCLUSIONS: There is a significant association between TWOC outcome, age (P=0.0053), and PUSG (P=0.0427).
Absorption ; Biopsy ; Catheterization ; Catheters ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Lost to Follow-Up ; Lower Urinary Tract Symptoms ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Retention (Psychology) ; Sulfonamides ; Urethra ; Urinary Retention ; Urination Disorders

OBJECTIVE: The present study aimed to investigate whether graded doses of Bacopa Monniera (BM) extract could produce antidepressant-like effects in chronic unpredictable stress (CUS) induced depression in rats and its possible mechanism(s). METHODS: Rats were subjected to an experimental setting of CUS. The effect of BM extract treatment in CUS-induced depression was examined using behavioral tests including the sucrose consumption, open field test and shuttle box escape test. The mechanism underlying the antidepressant-like action of BM extract was examined by measuring brain-derived neurotrophic factor (BDNF) protein and mRNA expression in brain tissues of CUS-exposed rats. RESULTS: Exposure to CUS for 4 weeks caused depression-like behavior in rats, as indicated by significant decreases in sucrose consumption, locomotor activity and escape latency. In addition, it was found that BDNF protein and mRNA levels in the hippocampus and frontal cortex were lower in CUS-treated rats, as compared to controls. Daily administration of the graded doses of BM extract during the 4-week period of CUS significantly suppressed behavioral changes and attenuated the CUS-induced decrease in BDNF protein and mRNA levels in the hippocampus and frontal cortex. CONCLUSION: The results suggest that BM extract alleviates depression induced by CUS. Present study also confirms that 80-120 mg/kg doses of BM extract have significantly higher antidepressant-like activity.
Animals ; Bacopa* ; Brain ; Brain-Derived Neurotrophic Factor* ; Depression* ; Hippocampus ; Models, Animal* ; Motor Activity ; Rats ; RNA, Messenger* ; Sucrose ; United Nations

Posterior urethral valves (PUV) are now commonly suspected on antenatal ultrasound, but can present with a broad spectrum of severity postnatally. Rarely, the diagnosis is missed until adolescence or adulthood when the patient usually presents with lower urinary tract symptoms. We describe an even rarer case of PUV in a late adolescent who first presented with preserved renal function and urinary incontinence. We review the literature on presentation, natural history and outcomes of both early and late presenting PUV cases.
Adolescent ; Humans ; Lower Urinary Tract Symptoms ; Natural History ; Urethra ; Urinary Incontinence

INTRODUCTIONRecent periodicals direct that reactive carbonyl compounds are formed due to existing oxidative stress in type 2 diabetes mellitus, which further nonenzymatically react with proteins and lipids to form irreversible advanced glycation end products (AGE) and advanced lipoxidation end products (ALE). In type 2 diabetes mellitus, insulin resistance plays a pivotal role in hyperglycaemia. In this study, we tried to fi nd the relation between insulin resistance and carbonyl stress.

MATERIALS AND METHODSForty-seven patients of type 2 diabetes mellitus (age 51 ± 5.06 years) were selected and fasting plasma glucose, serum insulin, total carbonyl compounds, HbA1c, thiobarbituric acid reacting substances (TBARS) and Trolox equivalent antioxidant capacity (TEAC) were estimated using standard protocols. Homeostatic model assessement of insulin resistance (HOMA-IR) was evaluated from fasting plasma glucose and serum insulin levels.

RESULTSWe found highly significant correlations of carbonyl compounds with HOMA-IR, fasting plasma glucose and glycated haemoglobin (HbA1c). Correlations of lipid peroxidation end product, TBARS were not so significant.

CONCLUSIONFindings from this study indicate that the level of carbonyl compounds can be a biomarker of insulin resistance in type 2 diabetes mellitus.

Blood Glucose ; metabolism ; Diabetes Mellitus, Type 2 ; metabolism ; physiopathology ; Female ; Glycation End Products, Advanced ; blood ; metabolism ; Homeostasis ; physiology ; Humans ; Hyperglycemia ; metabolism ; Insulin Resistance ; physiology ; Male ; Middle Aged ; Oxidative Stress ; physiology

PURPOSE: Unsatisfactory results of hemiarthroplasty in Neer's 3- and 4-part proximal humerus fractures in elderly, have led to the shift towards reverse shoulder arthroplasty (RSA). The objective of our study was to repair the tuberosities that are generally overlooked during RSA and observe its impact on the functional outcome and shoulder scores. METHODS: We include elderly patients with acutely displaced or dislocated 3- or 4-part proximal humerus fractures from July 2013 to November 2019 who were treated with RSA along with tuberosity repair by non-absorbable sutures and bone grafting harvested from the humeral head. Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded. According to the tuberosity healing on radiographs of the shoulder at 9th postoperative month, the patients were divided into 2 groups, as the group with successful tuberosity repair and the other with failed tuberosity repair. Statistical analysis of the functional outcome and shoulder scores between the 2 groups were done by independent t-test for normally distributed parameters and Mann-Whitney test for the parameters, where data was not normally distributed. RESULTS: Of 41 patients, tuberosity healing was achieved in 28 (68.3%) and failed in 13 (31.7%) cases. Lysis of the tuberosity occurred in 5 patients, tuberosity displacement in 2, and nonunion in 2. Mean age was 70.4 years (range 65 - 79 years) and mean follow-up was 58.7 months (range 18 - 93 months). There were no major complications. Group with successful tuberosity repair showed improvement in mean active range of movements, like anterior elevation (165.1° ± 4.9° vs. 144.6° ± 9.4°, p < 0.000), lateral elevation (158.9° ± 7.2° vs. 138.4° ± 9.6°, p < 0.000), external rotation (30.5° ± 6.9° vs. 35.0° ± 6.3°, p = 0.367), internal rotation (33.7° ± 7.5° vs. 32.6° ± 6.9°, p = 0.671) and in mean shoulder scores including Constant score (70.7 ± 4.1 vs. 55.5 ± 5.7, p < 0.000), American shoulder and elbow surgeons score (90.3 ± 2.4 vs. 69.0 ± 5.7, p < 0.000), disability of arm shoulder and hand score (22.1 ± 2.3 vs. 37.6 ± 2.6, p < 0.000). CONCLUSION Successful repair and tuberosity healing around the RSA prosthesis is associated with statistically significant improvement in postoperative range of motion, strength and shoulder scores. Standardized repair technique and interposition of cancellous bone grafts, harvested from the humeral head can improve the rate of tuberosity healing.
Humans ; Aged ; Child, Preschool ; Child ; Arthroplasty, Replacement, Shoulder/methods* ; Arm/surgery* ; Retrospective Studies ; Shoulder Fractures/surgery* ; Humerus/surgery* ; Humeral Head/surgery* ; Humeral Fractures/surgery* ; Treatment Outcome ; Range of Motion, Articular

Anesthesia/adverse effects* ; Anesthesiology ; Humans ; Neuromuscular Monitoring

AIMTo investigate the effect of arsenic on spermatogenesis.

METHODSMature (4 months old) Wistar rats were intraperitoneally administered sodium arsenite at doses of 4, 5 or 6 mg.kg(-1).day(-1) for 26 days. Different varieties of germ cells at stage VII seminiferous epithelium cycle, namely, type A spermatogonia (ASg), preleptotene spermatocytes (pLSc), midpachytene spermatocytes (mPSc) and step 7 spermatids (7Sd) were quantitatively evaluated, along with radioimmunoassay of plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and assessment of the epididymal sperm count.

RESULTSIn the 5 and 6 mg/kg groups, there were significant dose-dependent decreases in the accessory sex organ weights, epididymal sperm count and plasma concentrations of LH, FSH and testosterone with massive degeneration of all the germ cells at stage VII. The changes were insignificant in the 4 mg/kg group.

CONCLUSIONArsenite has a suppressive influence on spermatogenesis and gonadotrophin and testosterone release in rats.

Animals ; Arsenites ; analysis ; pharmacology ; Body Weight ; Enzyme Inhibitors ; analysis ; pharmacology ; Follicle Stimulating Hormone ; blood ; Luteinizing Hormone ; blood ; Male ; Organ Size ; Rats ; Rats, Wistar ; Sodium Compounds ; analysis ; pharmacology ; Sperm Count ; Spermatogenesis ; drug effects ; Testis ; chemistry ; cytology ; drug effects ; Testosterone ; blood