Lupine Publishers | Common Types of Neurogenetic Disorders, A Brief Review

 Lupine Publishers | Journal of Pediatrics and Neonatology

Mini Review

There are various genetic disorders which can involve the nervous system or confined to the nervous system alone. This is a brief review on some neurogenetic disorders. Gene mutations disorders are the most common types of neurogenetic disorders. Myotonic syndromes, muscular dystrophies and motor neuron disease are some examples of these disorders. Genetic imprinting in some disorders like Prader–Willi syndrome and Angelman’s syndrome can be seen. In both of these syndromes there is a disruption on a part of chromosome 15 which the autosomal genes differential expression depends on their parental origin (maternal genes disruption in Prader–Willi syndrome and father’s genes disruption in Angelman’s syndrome). Duplication of part of chromosome 17 which includes the peripheral myelin protein 22 gene coding, can cause some types of hereditary motor and sensory neuropathy. The patients with such disorder would develop sensory loss, distal weakness and wasting. Hereditary neuropathy with a liability to pressure palsies is an example of neurogenetic disorders with gene deletions. In this disorder there is a deletion on chromosome 17. This large deletion includes the peripheral myelin protein 22 gene coding. The affected patients can develop recurrent focal entrapment neuropathies. Mitochondrial disorders are other disorders which may result from mitochondria genome defects and nuclear-coded genes defects [1-2].
Disorders related to Trinucleotide repeat are other neurogenetic disorders. Expanded and abnormal triplet repeat in the genome can cause some disorders to appear. Friedreich’s ataxia and Huntington’s disease are two examples of Trinucleotide repeat disorders [3-4]. As the new genetic studying methods have been developed and is now under development, finding the genetic basis of some neurological disorders can be possible due to such developments and this causes to know the certain neurogenetic pathologies better.

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Lupine Publishers | Potentials of Unconventional Liming Materials in Reducing Soil Acidity

 Lupine Publishers | Journal of Food & Nutrition

Abstract

The shells of molluscs (oyster-Spondulusspinosus and snail - Achatina achatina), which are known to contain high amounts of calcium carbonate and which are abundant in the state were compared with commercial lime in the management of soils developed on acid sands in Akwa Ibom State. Results showed high neutralizing equivalent value of 65 and 75% for oyster and snail shells, respectively compared to 76% for CaC0₃. Chemical composition of mollusc shells indicated high mean Ca contents of 461.0 ± 28.4 and 441.0 ± 56.6gkg^-1for oyster and snail shells while CaC0₃ contained 541.1 ± 41.7gkg Magnesium contents were higher in oyster (215.2 ± 5.1 gkg^-1) than in snail (182.4 ± 17.2gkg^-1) shells and CaC0₃ (91.2 ± 8.7gkg^-1). Iron content was 796mgkg^-1for oyster, 127mgkg^-1for snail and 292mgkg^-1for CaC0₃. The mollusc shells and CaC0₃, drastically reduced the exchange acidity and increased the soil pH, basic nutrients (Ca and Mg), effective cation exchange capacity and percent base saturation of the studied soil. Mollusc shells compared favorably with CaC0₃ and could serve as alternative liming materials for soil developed on acid sands in Akwa Ibom State.

Keywords: Mollusc shells; Liming equivalence; Acid sands; Chemical composition

Introduction

Soil acidity is a major problem in the production of arable crops in the humid tropical soils. Yields of many crops are highly reduced by soil acidity. Most of agricultural soils in Akwa Ibom State are derived from Coastal plain sands and Beach ridge sands and are generally referred to as ‘Acid sands’ [1], because they are strongly weathered, sandy and highly acidic. Most arable crops give poor yields and for the crops to do well the soils will have to be limed to remove the adverse effects of high acidity. The source of limestone close to Akwa Ibom State is M famosing in Cross River State and this limestone is used mainly for the manufacture of cement and a raw material in the iron and steel industry. The limestone in Ini Local Government Area of Akwa Ibom State has not been exploited so far for any purpose. There is therefore lack of limestone in the area for agricultural purposes. There is also the problem of lack of awareness of the farmers about the importance of lime in reducing soil acidity and thus bringing about high yields of arable crops in the high acidic soils of the area. The high cost and unavailability of commercial lime underscores the need to look for cheap and alternative sources of liming materials for management of soils developed on acid sands in Akwa Ibom State. It was also to create the awareness of the importance of liming to the farmers. The use of mollusc shells may provide the solutions since the shells are found to contain high percentage of calcium carbonate, which is the active compound in liming materials. Mollusc sea foods are. sources of animal protein to Akwa Ibom people and beyond, and for many coastal inhabitants. Their shells are commonly found thrown away in the market places and around homes. They include snail, slug, periwinkle, clam, oyster and other shells.
The objectives of this study were
(i) To determine calcium carbonate equivalence of oyster and snail shells.
(ii) Evaluate the chemical composition of snail and oyster shells as liming materials for soils developed on acid sands in Akwa Ibom State and
(iii) Examine the effects of these shells relative to commercial lime on selected soil chemical properties.

Materials and Methods

Study area

Soil samples were taken from the University of IJyo Teaching and Research Farm while mollusc shells were collected at their dumping site near Etuk Market, along Aka Road in Oyo Metropolis. Uyo is situated at latitude 4030’ and 5030’N and longitude 7075’ and 7093’E. The area experiences two distinct seasons: the wet and dry seasons. The wet or rainy season begins from April and lasts till October. It is characterized by heavy rainfall of about 2500- 4000mm per annum. The rainfall is bimodal with peaks in July and September and a relatively moisture stressed period in August, known as “August break”. The dry season starts from November till March. It is characterized by high temperature with a mean annual temperature of 28 °C. The highest temperatures are experienced between January through March, the period described by Enwezor et al. [2] as overhead passage of the sun. Relative humidity is between 75% and 95%. The soil in the area is formed on coastal plain sands parent materials and has been described as Typic Paleudult [3].

Soil analysis

Composite soil samples were taken at (0-30cm) depth. The samples were air dried and sieved (< 2mm). The samples were processed for chemical analysis. The soils were analyzed using the procedures described in Il TA [4]. Soil pH was determined in 1:2.5 soil to water ratio using the glass electrode pH metre and organic carbon was determined using wet oxidation method. Total Nitrogen (N) was determined by the Kjeldahl digestion method, available phosphorus (P) was extracted with Bray P-1 method and P in the extract measured by the blue colour method. Exchange acidity (EA) was extracted with IN KCI and estimated in the extract by titration. Exchangeable bases were extracted using INNH40Ac. Potassium (K) and Sodium (Na) were determined by flame photometer while calcium (Ca) and magnesium (Mg) were determined by EDTA (ethylene diamine tetraacetic acid) titration using NaOH. Effective cation exchange capacity (ECEC) was taken as the sum of the exchangeable bases and exchangeable acidity.

Percentage base saturation was computed using the formula:
%BS = x 100

Collection and preparation of mollusc shells

Mollusc shells (snail and oyster) were collected from the dumping site near Etuk Market in Uyo metropolis. Commercial lime (calcium carbonate) was bought and used as control sample. The shells were washed in warm water and rinsed thoroughly with distilled water. They were placed in clean watch glasses, oven-dried at 80 °C for 48 hours, and were separately crushed to powder in a hammer mill and sieved to obtain particles less than 2mm. The samples and commercial lime were analyzed for Ca, Mg, K, Na, P, and organic carbon. The iron (Fe), manganese (Mn), copper (Cu), zinc (Zn), boron (B), and molybdenum (MO) contents were also determined using the procedures recommended by the Association of Official Analytical Chemists [5]. One gram (lg) of each material was digested with a mixture of concentrated trioxonitrate (v), tetraoxochloroate (Vll) and hydrofluoric acids in the ratio of 1:1:1 in a fume cupboard at 130 °C, the digests were cooled and 20ml of distilled water added, filtered and made up to mark with distilled water. Na and K in the digest were measured using flame analyzer while Ca and Mg were determined by EDTA. Fe, Mn, Zn, Cu, B, and MO were measured with atomic absorption spectrophotometer (AAS) while P was determined by the molybdenum blue method.

Determination of liming equivalence of oyster and snail shells

Measured 0.5g of milled snail and oyster shells were placed in a 250ml flask, and 50ml of 0.5M HCI added, swirled gently and then boiled gently on a steam bath for 5 minutes. The flask was cooled, and 2-3 drops of phenolphthalein indicator added. The surplus acid was back titrated with 0.25M NaOH. The calcium carbonate equivalence was calculated as follows:

Effect of mollusc shells (snail and oyster) on pH and other chemical properties

The method adopted was described by Jacobs and Reed [6], The soil sample was oven-dried at 105 °C, ground into powder and sieved. One hundred grams (100 g) of sieved soil sample was placed in each beaker thus. (i) Soil (100 g), (ii) CaC03 only (1g), (iii) Snail only (1g), (iv) Oyster only (1g), (v) Snail (lg) + 100g of soil, (vi) Oyster (lg) + 100g of soil, (vii) CaC03 (lg) + 100 g of soil.
Twenty (20)ml of distilled water was added and stirred to mix. The mixture was allowed to stand for 1 hour with occasional stirring. The pH was measured using glass electrode pH metre. Similar experiment was set up thus:
a. snail (2g) + 100g soil
b. oyster (2g) + 100g soil
c. CaC03 (2g) + 100g soil
To assess the effect of liming materials on chemical properties of the soil and the experiment was left for 21 days with occasional stirring. The soil samples were taken and analyzed for exchangeable bases, exchange acidity, available P, organic carbon and total N. Effective cation exchange capacity (ECEC) and percent base saturation were obtained by calculation. Other parameters were Fe, Mn, Cu, Zn, B and MO, using atomic absorption spectrophotometer after digestion.

Statistical analysis

The study used mean and standard deviation (X ± SD).

Results and Discussion

Mineral composition of oyster and snail shells and calcium carbonate

Liming equivalence of oyster and snail shells

Liming equivalence, which is the measurement of the relative value of the liming material in oyster and snail shells, .is presented in Figure 1. The shells have high neutralizing equivalent values, 65% for oyster shell and 75% for snail shell compared to calcium carbonate with 76.00%. These values are similar to those obtained by Tisdale et al. [7], implying that oyster and snail shells are good liming materials. Mean macronutrient contents of mollusc shells and commercial lime (CaC0₃) are presented in Table 1. Ca content of oyster (461.0gkg^-1) and snail (441.0gkg^-1) shells were lower than that of CaC0₃ (541.1gkg^-1). Mg content of mollusc shells was higher in oyster (215.2gkg^-1) than snail (182.4gkg^-1) shells with commercial lime having the least (91.2gkg^-1). In a similar study, Inyang (2006) obtained 373gkg^-1 and 536gkg^-1 Ca and 27.1gkg^-1and 27.3gkg^-1and Mg for oyster and snail shells, respectively, while commercial lime used advantage in 508gkg^-1 and 208gkg^-1 Mg. The relatively high contents of Mg in the shells are of significance because when made available to plants it improves plant growth especially through the synthesis of chlorophyll. All the liming materials were low in K (2.0-2.5gkg^-1) while Na was moderate in oyster (3.7gkg^-1) and snail (2.4gkg^-1) shells but low in CaC0₃ (1.3gkg^-1). The low Na content in commercial lime can be attributed to beneficiation while the shells had not been purified and sodium may be present as silicates.

Figure 1: Liming equivalence of mollusc shells.

Table 1: Mean values of macronutrient content of mollusk shell and commercial lime.

N and P were low in the shells and CaC0₃ (Table 1). However, since liming materials are usually applied in large quantities, (in mega grams per hectare), the low concentration of N and P in the shells may translate into significant level of addition to soils. The ash content, an index of mineral content in biota, was very high and values were the same for the liming materials (98%). This result implies that mollusc shells would be good sources of mineral elements to plants if properly ground and applied to soils. Organic carbon contents of the shells under study and commercial lime were high with the highest value obtained in oyster shell (70.9gkg- 1), followed by CaC0₃ (54.5gkg^-1) and the least value was found in snail shell (36.4gkg^-1). These values translate to high organic matter contents of 93.96gkg^-1 for CaC0₃, 122.23gkg^-1 for oyster shell and 62.75gkg^-1 for snail shell, respectively. The carbon to nitrogen (C/N) ratio described as an indication of the type of organic matter present and in particular, the degree of humification [8], was very high (in favour of organic C) in mollusc shells and CaC0₃ studied. This confirms the fact that mollusc shells are poor sources of N. The micronutrient contents of mollusc shells and commercial lime are presented in Table 2. Fe concentration was highest for oyster shell (795.7mgkg^-l) and least in snail shell (127.1mgkg^-1) Mn was quite low with values of 0.517mgkg^-1 , 0.227mgkg^-1 and 0.192 mgkg^-1 for CaC0₃, snail and oyster shells, respectively. The value of Zn was also low while Cu, B and MO were found in trace amounts in both the shells and commercial lime. The critical levels of 1.0, 0.5, 0.2 and 0.13mgkg^-1 for Mn, Zn, Cu and B [9] and Oyinlola [10] show that the amount in these materials may not have any significant influence in the soil. However, since limes are usually applied in large quantities, the concentrations of these micronutrients may increase considerably, depending on the pH of the soil and quantity of liming materials supplied. Again, the very high concentration of Fe in the liming materials may not pose any threat to crops grown since the solubility of this element will decline with increase in the pH of the soil.

Table 2: Mean of micronutrient content of molusc shell and commercial lime.

Soil properties

Some chemical properties of the soil studied before and after liming are presented in Table 3. The soil was strongly acidic with low total N (0.24gkg^-1) and organic carbon content (9.70gkg-1). With a separating index of 25 between fertile and infertile soil [8], the C/N ratio of 40 obtained for this soil indicates that the soil is poor in N. Available P content of the soil was high and far above the (15-25mgkg^-1) determined as critical level for this zone [11]. Calcium level was moderate (3.60 cmolkg^-1) while K was lower than Na in the soil. Exchange acidity was high (3.6cmolkg^-1) and effective cation exchange capacity low (9.14cmolkg^-1) show that percent base saturation was high (60%) and within the >50% regarded as critical value for a fertile soil [8].

Effect of liming materials on soil chemical properties

Results of incubating the soils with liming materials for 21 days indicate that all the liming materials significantly raised the soil pH to between 7.58 and 7.72, representing or 61.8, 58.9 and 00.2% by commercial lime respectively, oyster and snail shells. As shown in Table 1, snail shell and calcium carbonate were moderately alkaline (pH 8.98 and 8.23) while was very ‘strongly alkaline (pH 11.36) Such that oyster and snail shells could be used as suitable alternative liming materials for acid soils. Inyang [12] and Akpabio [13] noted that mollusc shells were as effective as calcium carbonate in reducing soil acidity. Liming soil with oyster and, snail shells increased organic C content from 9.70gkg^-1 in the unlimed soil to 12.15 and 10.10gkg^-1, respectively but decreased to 9.55gkg-1 in CaC03 treated soil. The liming materials had no effect on total N content of the soil. Available P content in the soil after treatment with mollusc shells was 123.75mgkg^-1 for oyster and 115.12mgkg-1 for snail shells. Commercial lime had the least effect on the P value (95.^-1) of the three liming materials. These values are many times above the critical level of 15-25mgkg^-1 P for soils of this zone but lower than the amount of P before application of liming materials. Ibia et al. [14] and Effiong et al. [15] had observed increased availability of P when acid soils were limed, while a report by IlTA [16] indicated that available P decreased as the amount of various liming materials increased, in three Ultisols. The reduction of P content following liming might have resulted from phosphate fixation which is always a problem in alkaline soils due to the formation of complex insoluble calcium phosphates [17]. High pH value and available Ca content are also closely related to low availability of P especially at conditions of low Na content [18]. Liming acid soil with various liming materials increased exchangeable Ca and Mg, exchange acidity, ECEC and percent base saturation (Table 3). Exchangeable Ca increased appreciably from 3.60cmolkg^-1 in the unlimed soil to 34.80, 25.60 and 25.40 cmolkg^-1 in soil treated with lime, oyster and snail shells, respectively. Previous studies showed that exchangeable Ca increased with the quantity of lime applied [19,15]. Mg content also increased from 1.60 to 4.40, 3.40 and 4.60 cmol kg^-1 in soil treated with lime, snail, and oyster shells. The various liming materials had no significant effect on K and Na, because of the very low concentrations of these two nutrients in the liming materials and soil. Brady and Weil [17] noted that the availability of K in soil may decrease or increase due to liming. The reduction of soil acidity is one of the most commonly mentioned specific effects of lime. As indicated in Table 4, exchange acidity was reduced by 80, 76 and 69%, respectively by snail, lime and oyster shells. This reduction raised soil pH and increased ECEC and percent base saturation, remarkably in the soil. Effective cation exchange capacity (ECEC) increased from 9.14cmolkg^-1 in unlimed soil to 40.36, 31.79 and 30.00cmolkg^-1 in the soil treated with lime, oyster, and snail shells, respectively. The micronutrient content of the soil after liming are presented in Table 4. Fe was 24.48, 24.66 and 24.24mgkg^-1 in soils limed with lime, oyster, and snail shells, respectively. These values are many times lower than those found in the mollusc shells and commercial lime. The drastic reduction of Fe contents in the soil probably resulted from the alkaline nature of the soil following liming. This observation calls for proper calculation of the rate of liming to avoid over liming, which is probably responsible for the reduction in Fe content in the soil. Mn content was moderate at 1.98, 2.16 and 1.72mgkg^-1 in the soil limed with CaC03, oyster and snail shells, respectively, which are slightly higher than the critical limit of 1.0mgkg^-1 [8]; and also higher by 74, 91 and 87% than the values found in mollusc shells and CaC03. Soil Zn content was enhanced by liming though Cu, B and MO values were almost the same following liming with CaC03, oyster and snail.

Table 3: Selected chemical properties of the soil studied before and after liming.

Table 4: Values of micronutrient levels of the soil after liming with commercial and unconventional lime.

Conclusion

This study has revealed that mollusc shells (oyster and snail) have high neutralizing values, high contents of Ca and Mg, organic C and ash and Fe while micronutrients (Cu, B and MO) were low. Oyster and snail shells used as liming materials have drastically reduced exchange acidity and appreciably increased the soil pH, basic nutrients, ECEC and percent base saturation of the soil. Mollusc shells compared favorably with lime and so can be used in replacement for neutralizing acidity in soils developed on acid sands in Akwa Ibom State. Lime is unavailable and unaffordable at critical periods, whereas the mollusc shells are common place as wastes around homes and in market places.

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Lupine Publishers| The Failure Bauhinias Damper as a Possible Cause of Chronic Autointoxication and the Development of Psoriasis

 Lupine Publishers| Journal of Gastroenterology and Hepatology

Abstract

The goal is to assess the impact of biogenetic on the condition of patients with psoriasis

Materials and Methods: The study group included 415 patients aged 19 to 65 years (34% of men and 66% of women), in whom irrigoscopy revealed the injection of contrast into the ileum, i.e., the insolvency of the baugine flap (NBZ) was diagnosed, 74 of them suffered from psoriasis. For the detection of chronic intoxication were evaluated the data of clinical manifestations, indican urine, level of middle molecules, blood serum, lipid metabolism, microbial resistance, the hydrogen breath test.

Results: NBZ is a chronic endointoxication, which regresses in collaboration with the clinical manifestations of psoriasis after biogenetic.

Conclusion: Hypothesized that NBZ is one of the causes of psoriasis, and biogenetica – link in etiopathogenetic method of treatment.

Keywords: Insolvency bauhinias dampers; Chronic endo intoxication; Psoriasis; surgery

Introduction

Recognizing the harmfulness of dysfunction of such barrier structures as cardia, pylorus, sphincter of Oddi, heart valves, venous valves of the lower extremities, etc., modern medicine ignores the failure of the ileocecal locking system (Bauhinia valve) as a possible cause of the pathology of the digestive system and associated various extraintestinal diseases [1].
But it is worth paying attention to the opinion of I.I. Grekova [2] “Despite a number of works devoted to the proximal colon, the pathology of this department is still not sufficiently explained because in these works the role of the bauhinia valve was completely ignored.” Bauhinia valve (BZ) distinguishes between the functions of the small and large intestines, isolates the small intestine from the reflux of the colonic contents, which differs sharply in chemical composition, physical condition and bacterial spectrum [3-5]. According to LG Peretz [6], in 1 ml of intestinal contents there are up to 5000 microbes, and in 1 g of the contents of the large intestine there are about 30-40 billion [6]. With the failure of the Bauhinia Damper (NBZ), billions of colon microbes are thrown into the small one [4,6], colonization of the small intestine with allochthonous (alien) microorganisms occurs, excessive bacterial growth syndrome (SIBO) or enteric dysbacteriosis develops [7,8].
Absorbing the blood products of microorganisms (indole, phenol, cresol, skatole, pyrocatechin, carbolic acid, hydrogen sulfide, mercaptan, ethane, methane, etc.) causes autointoxication phenomena that cannot be sufficiently arrested, especially for liver diseases [7,9-11].
The development of putrefactive and fermentation processes in the small intestine - The consequence of the SIBO. The lymphoid tissue in the course of the gastrointestinal tract suffers because of a violation of the barrier function of the intestinal wall [4,12], resulting in a deficiency of immunoglobulins A and M. In 70% of patients with chronic enterocolitis there is a marked decrease in the body’s immunological reactivity the body becomes less protected before microbial aggression - in patients with chronic colitis [5].
Recognizing NBZ as one of the anatomical causes of SIBR, nevertheless, the authors do not have a therapeutic effect on it [13,14], although they assign SIBOs key pathogenetic mechanisms in many diseases of the digestive tract and associated extradigestive conditions [7,10].

The interrelation between the pathology of the gastrointestinal tract (GIT) and the development of dermatosis is a well-known fact. The small intestine is the organ of the digestive canal, the most responsible for the development of dermatosis. The relationship between the intensity of skin manifestations and the activity of ileocolitis Roberts et al. [15] with psoriasis was detected in 2/3 of patients with enterocolitis [15]. Sensitization to intestinal autoflora was revealed. So sharply positive were skin tests, primarily to Escherichia coli-up to 97% [16]. Allergic dermatosis, rosacea, seborrhea, food allergy, urticaria, neurodermatitis were found in 176 (22%) of 800 patients with diseases of the alimentary canal [17]. In the etipathogenesis of dermatosis, the following enterocolitic links are distinguished [18].
a. The most responsible for the development of dermatosis is the small intestine. The immune complexes formed in the intestine penetrate the blood and settle in various tissues, including the skin with the development of immediate and delayed hypersensitivity types.
b. There is a shortage of many substances as a result of malabsorption in the small intestine, in particular vitamins, whose participation in the pathogenesis of dermatosis is large.
c. The use of sorbents, hemosorption, plasmapheresis significantly improves the effect of therapy, which confirms the role of endogenous intoxication in the development of dermatoses.
The goal is to assess the effect of Bauhinoplasty on the condition of patients suffering from psoriasis.

Materials and Methods

The study group included 415 patients aged from 19 to 65 years old (34% of men and 66% of women), in whom a reflux of contrast into the ileum, i.e. diagnosed NBZ (Figure 1). In 111 patients, reflux of the radiopaque substance to the ileum was regarded by doctors as the norm. But all surveyed to the question: “Do you consider yourself ill?” answered in the affirmative. From the onset of the first signs of the disease, 15% of those examined passed from 1 year to 5 years, 32% have from 5 to 10 years, and 53% have more than 10 years. Of the 415 patients with NBZ, 74 suffered from psoriasis. Previously, they identified: chronic gastritis - in 62.5%, chronic cholecystitis - in 37%, chronic gastroduodenitis - in 12.5%, chronic colitis - in 12.5%, chronic pancreatitis - in 6%, duodenal ulcer - 6%. In 6% of patients with a history of appendectomy.

Research methods

Irrigoscopy: It is important to note that the refusal to hold a tight filling of the cecum at NBZ can lead to a false-negative conclusion. A repeated X-ray examination immediately after a bowel movement is of fundamental importance, since during a bowel movement a maximum pressure is created in the bowel, which at the NBZ will be accompanied by a pronounced reflux of the radiopaque substance into the ileum (Figures 1-3).

Figure 1: Before surgery on irrigography all patients is determined by the reflux of contrast material into the ileum.

Figure 2: Patient S, Irrigography with tight filling of the cecum was performed prior to defecation, regurgitation of contrast and the cecum into the ileum is not detected.

Figure 3: The same patient S. Irrigography performed after defecation, define a significant reflux of barium into the small intestine.

Chronic autointoxication was detected by such studies as urine indican (Obermeyer was tested for this purpose.), The level of the average serum molecules was measured according to N.I. Gabrielyana, lipid metabolism.
Microbial resistance was determined by the content of antibodies to peptidoglycan Staphylococcus aureus (method of Professor A.N. Mayansky). Peptidoglycan is the most common element of the cell wall of all bacteria, which makes it possible to indirectly judge the content of anti-peptidoglycan antibodies in general. The content of antibodies to peptidoglycan Staphylococcus aureus (strain 885, solubilized by ultrasound) was determined. Each sample was placed in 3 repetitions, calculating the average result. Negative controls were the wells in which the stage of treatment with the antigen (peptidoglycan) was omitted. Indicators of negative control from the results of the experiments were subtracted. A pool of 25 sera from healthy donors was used as a positive control. The results are statistically processed on the IBM / AT-286 computer using the following criteria: determination of averages, Fisher criterion, Wilcoxon-Whitney-Mann criterion.

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Lupine Publishers| Automated Chamber for Prickle Pear Cauterization

 Lupine Publishers| Journal of  Robotics & Mechanical Engineering

Abstract

Mexico is the world largest producer of cactus pear (Opuntia spp.) and is searching for new processes that allow to export them. The fruit is rich in nutrients but is highly perishable having ambient shelf life of 9 days. Cauterization and cryo-cauterization techniques have increased shelf life to 2 and 3 months without refrigeration. An automatic system was developed to flip the fruit towards the dry-ice wall inside a chamber. A horizontal actuator pushed the container to cauterize the fruit. The entire cauterizing process for each fruit lasted 23 seconds. By exchanging the dry-ice wall every 500 fruits, a 100% cauterizer efficiency was achieved.

Keywords: Automatic Chamber; Cauterization; Prickle Pear; embedded system

Introduction

Cactus pear (Opuntia spp.) is a fruit produced in arid and semi-arid regions around the world [1]. Mexico is the world’s largest producer of cactus pear (Opuntia spp.) with 79.4% of world production, and with 49,165 ha under cultivation [2]. Italy is now the world’s largest exporter of cactus pear to the European Union (EU), producing about 87 thousand tons annually in Sicily, which corresponds to 96% of the total Italian harvest [3]. Cactus pear is generally consumed fresh, but is highly perishable, showing high incidence of spots and rotting after 9 days. After 20 days at ambient conditions, almost 70% of the fruit was visibly damaged [4]. By cooling prickle pears to 10 °C, shelf life increased to 6 weeks [5]. Fresh cactus pear shelf life can be increased to 32 days in modified atmosphere packaging with less than 20 kPa CO2 [6]. A cauterizer cut and seal 120 pieces of fruit per hour [7]; cuts were made close to the cactus cladode at 150 °C during harvest, destroying thorns. After 2 months of storage, 78% of the pears were unspoiled. The application of uniform heat treatments has been effective in controlling postharvest diseases, but can damage the treated fruit tissue if not applied carefully. Excessive heating period may damage the fruit, while insufficient heating may leave non-sterilized surface segments [8]. Further developments of cauterizer machines by Hahn [9-12] applied heat to sliced pears. After applying a constant pressure of 100 kPa at 200 °C during 30 s to harvested cactus pears increased shelf life to 2 months, controlling effectively postharvest diseases [9]. However, heat application is expensive when many fruits are cauterized. A cryo-cauterization process used a pneumatic robotic gripper to press a cactus pear against a dry-ice wall within a thermally isolated chamber. Fruit cryocauterizing at 150kPa for 15s increased shelf life to 90 days, keeping 86% of marketable fruit [11].
Automation of agriculture tasks have improved pre-harvest, harvest and post-harvest stages. Machine vision sorting of fruits presents advantages of high accuracy, precision and processing speed [13]. Non-contact detection makes grading and sorting free of mankind diseases. Fruits and vegetables produced in farms are sorted according to quality and maturity levels and decisions taken of the market it can be sent on the basis of transportation delay [14]. Post-harvesting operations require quality detection [15] and skin defects [16]. A pepper robotic harvester system [17] avoiding stem and fruit damage would be highly successful. Although food processing methods extend the shelf life of fruit and vegetable products, fresh-cut produce may lead to flavor loss, discoloration, rapid softening, and increased rate of vitamin loss [18]. Emerging smart packaging reduce losses, maintain quality, add value and extend shelf-life of agricultural produce [19]. It alerts the consumer from contamination of pathogens, pesticide residues or food degradation in food packaging products [20]. Intelligent packaging with nano sensors senses and informs the condition of the product to provide information about quality during transport, distribution, and storage [21]. This technology may also be used to detect adverse reactions in consumers after taking food such as gluten, peanuts and tree nuts [22]. Automation for the application of these sensors is considered a future close innovation. In this paper, an automatic system used for prickle pear cryo cauterization within a very small chamber was developed. The chamber size obeys to the rapid melting of dry-ice caused by environmental conditions. A minimum number of operations is required and the system efficiency evaluated to cauterize 120 pears per hour.

Mechanism for Pear Cauterization

The top-surface sliced prickly pear is moved within a container into the cryo-cauterized chamber (Figure 1) by means of a conveyor belt. This band transports the fruits in a direction parallel to the dry-ice wall where cauterization takes place. A trapezoidal metal container resembles a porcelain coffee mug and holds the prickly pear (Figure 2) whose flat base stops at the bottom. The container base is 3mm thick (Figure 2) and has force sensor in between the base and the prickle pear. The system mechanism has to perform the following functions:

Figure 1: Prickle pear conveyor belt and cauterizer chamber.

Figure 2: Bottom actuator and initial rotation operation.

1. Detect when the prickle pear is present within the metal container.
2. Rotate it 9° counterclockwise.
3. Displace it against the dry ice wall.
4. Return it and deposit it to the original band.
During the first stage, a conveyor belt transports the prickle pear to the cauterizer chamber rising the door in the left side. At the same time, it opens another door to exit the previous cauterized pear. For the second function, the mechanism used an actuator (A1) to flip the metal container (Figure 2). The linear piston or actuator (mod. LA 14, LINAK, Denmark) is characterized by its compact size being ideal for this chamber having a limited amount of space available. The aluminum actuator is used in harsh and cold environments up to -40 °C. A metal ring with a sectional groove is located at the container base (Figure 2). The lower piston plunger enters the groove and as it moves upwards, it turns the container base (Figure 3); a tip rod flips the container as the piston rises. After 45 or 50 degrees of rotation, the actuator rod gets out of the groove and the container falls by gravity. A small compression spring stops the container reaching its end point over a pair of rails (Figure 3). The third operation requires of a second electric actuator (A2) that pushes the container together with the fruit until it reaches the dry-ice wall, where it will stay pressurizing the pear for 15 seconds. Fruit moves at most 5cm over two rails before it reaches the dry-ice wall. The electric actuator (mod. LA 25, LINAK, Denmark) presents a speed of 20mms-1, withstanding cold temperatures of -25 °C.

Figure 3: Ending prickle pear rotation.

The fourth operation returns the container with a 12 VDC round electromagnet mounted at the end of the piston rod. After activating the 30mm diameter electromagnet, the container remained fixed and forced to return. A micro switch (MS1) was activated at the runend, and the voltage supplied to the electromagnet was interrupted releasing the container that felt to initial band position. The voltage supplied to the horizontal actuator was also cut.

Electrical Automation

Once implemented the chamber with its mechanisms, the sensors for automation were obtained. The process begins when the conveyor belt is turned on, which will enter the cauterization chamber and an inductive presence sensor (SI1) will detect when it is in the desired position. This sensor will serve to turn off the band and at the same time it will feed the actuator (A1) so that its rod moves upward, initiating the rotation of the container. The rod or plunger will come out from the container base and an inductive sensor (SI2) provides a signal to limit its travel. The container flips unto a pair of rails and a capacitive sensor (SC3) detects its presence, and its signal activates the horizontal actuator (A2). Its plunger with the electromagnet at its end pushes the fruit container towards the dry-ice wall. The force sensor (SF) starts measuring when the prickle pear touches the wall. The contact is maintained for 15 seconds and at the same time a negative voltage is applied for 5 seconds to the vertical actuator so that it returns to its initial position. Force sensor resistors (FSR) provide a resistance that is inversely proportional to the applied force and can measure grabbing and pressing. Flex Force sensors enable non-intrusive static and dynamic force measurements presenting better force linearity, hysteresis and temperature sensitivity than other thinfilm force sensors [23-25]. Voltage processing was done through a Wheatstone bridge having the variable flex force sensor in one arm as in the data glove [25]. The output voltage is compared and the output provided to the embedded system. At the end of the cauterizer time, the electromagnet (EM) is activated and the polarity of the horizontal actuator is reversed until it touches a micro switch (MS1). When MS1 is actuated, the electromagnet and the horizontal piston are turned-off allowing the container to fall by gravity onto the conveyor belt. The band turns on and a new cycle starts taking out of the chamber the cauterized fruit and putting in the prickly pear to be treated. Figure 4 shows the cauterizer system timing chart for automation.

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Lupine Publishers | Sewerage and Climate

 Lupine Publishers | Journal of Oceanography and Petrochemical Sciences

Introduction

The earth and atmosphere for millions of years created the animal and plant worlds. Together with them, water quality also developed. In constant motion, water formed a continuous chain of transformation in the bodies of living things and leaves of plants. The harmonious interaction of water, atmosphere and biota has led to the existing balance - the circulation of water through the atmosphere, where the properties of water acquire their initial starting quality for new transformations. Man, in the process of industrialization, turned water into a working tool. He made the water perform unnatural functions for her. Pressure, transportation, spraying, storage, boiling, burning, poisoning of ever increasing volumes of water have led to a change in the quality of water in the atmosphere. Changes in the quality, volume and rate of evaporation across the planet lead to climate change. More details at: https://www.actascientific.com/ASMI/pdf/ASMI-SI-01-0009.pdf

The Main Sources of Artificial Fumes are

a) Reservoirs of artificial structures

b) Floods rivers overflow banks and create immense areas of evaporation.

c) Existing crop production with deep plowing.

d) Garbage and ore landfills. It is known that the area of the world landfill is equal to the area of Mexico.

e) Aviation, and all transport destroys significant amounts of moisture in the air with the destruction of structures.

f) All asphalt and concrete surfaces.

g) All types of water flow for cooling, washing and everything else.

h) Of particular note is water consumption in the utilities sector.

Each of the listed positions can be changed without any loss of comfort and convenience, if humanity understands the emergency of the current moment. Considering the last position, it can be noted that toilet matters alone can significantly affect the climate. Man went against nature by mixing pure drinking water with his feces in order to transport them to one place and then clean them. Everything that is flushed from the toilet falls into the sump. The middle and above it in the sediment represents a clear liquid. It can be used for repeated flushing from the toilet. To do this, it is necessary to disconnect the flow of water to it from the main water supply and bring the supply from the pump. Odor can be eliminated by taking the simplest technical measures for weathering. Many different odor elimination methods are known. But the simplest and most affordable is the automatic ventilation device of the toilet itself with the release of air into the ventilation pipes. The water purified in this way is fed back to the toilet with a special pump and flushes its contents. Thus, the small water circuit closes: toilet bowl - pipes - sludge - pipe cleaning - toilet bowl. Specialists calculated the water consumption in the household with these indicators:

https://yandex.ru/search/?text=cost%20water%20on%201 %20person%20in%20day&clid=2270455&banerid=6101003224 %3A4655801518424859060&win=346&lr=162:

(Figure 1) The water in the sump is replenished with other wastewater from related consumers. If you carefully look at the costs, you can see that it can be used for other purposes, for example, for external washing of a car, sidewalks, roads. Everything else can be spent on watering green spaces near the house. You can accumulate water in special tanks, from several houses, gradually treat it by smell and use it for washing roads, for a fire reserve. In addition, knowing how water is used in spaceships, it is not difficult to pick up a purification complex and use this water to wash everything else, except dishes and drink. In any case, one must be prepared for the fact that the flow of clean water will disappear. This is already happening in some places, for example, in South Africa, Australia. It will be necessary to create devices a little more complicated for the treatment of water near each house or area. The separated solid waste is periodically taken to enterprises for incineration and / or preparation of fertilizers. Thus, everything that comes into the house through the water supply system must be used 100% in place. Nothing should go into the sewers. The sewage centralization industry is disappearing. The vast territories occupied by devices and sewage enterprises with all states are being freed. But most importantly, settling tanks and reservoirs disappear - powerful sources of artificial evaporation that affect the water cycle between the atmosphere and the earth, create natural disasters and change the climate.

Figure 1: Wastewater from Related Consumers.

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Lupine Publishers | Carbon Nanotubes: Exploring Intrinsic Medicinal Activities and Biomedical Applications

 Lupine Publishers | Journal of Oncology

Introduction

Carbon Nano materials the king of nonmaterial’s have fascinating nanofamily including buckyballs or buckminsterfullerenes [1], multiwalled carbon nanotubes [2], the single-walled carbon naotubes(SWCNTs) [3], Carbon Nanohorns(CNHs), Carbon nanocones, Carbon nanofibers (CNFs), carbon nanothread, Buckypaper, carbon dots, nanodimons, nanoonions, nanorods, nanoribbons. Also called as powerful particles, CNTs (carbon nanotubes) has thus bloomed over the past decade [4,5]. Increasing evidence has shown that certain CNT properties such as nano-sized dimension, high surface energy, and large reactive surface area are directly correlated to their biological activities [6,7]. Great property of loading various biomolecules, diagnostic and therapeutic moieties resulting in diversified biomedical applications of CNTs (Figure 1).

Figure 1: Intrinsic Biomedical Applications of Carbon Nanotubes (CNT).

I. Diagonsis and Imaging: CNT act as biosensor or Nanorobots, which helps in diagnosis of disease, their progression level and their pathological condition in quick and better way. CNT biosensor are made up by conjugating different biochemicals with CNTs, like in glucuometer biosensor, glucose peroxidase is conjugated with CNTs that is use for the detection of blood sugar level in diabetic patients. Another example is SWCNTs-DNA biosensor that is use of detection of antigen –antibody comlex, which further helps in molecular diagnosis in pathology [7,8]. Complex of fluorescent agents and CNTs act as radio-opique agent that is use for the detection of cell and biological system in In-vivo organs [9].

II. Cancer Therapy: Carbon nantubes are effective against Pancreatic Cancer, Brain Cancer, Blood Cancer, Breast Cancer, Colon Cancer, Liver Cancer, Lymph Node, Metastasis, Prostate Cancer by using different anticancer drugs like Paclitaxel, Daunorubicin, Amphotericin B, Carboplatin, siRNA, Doxorubicin, Metal halides, Methotrexate etc. Apart from drug delivery route there are another two methods for cancer therapy using CNTs are immunotherapy and anti-tumor hyperthermia therapy [10].

III. Gene Therapy: CNTs and CNHs are used as vector in genetic engineering due to their cylindrical nature, which wrap the desired DNA and deliver it to target site to cure the genetic disorders by correcting misread or missense gene sequence [7].

IV. Infection/HIV Therapy: CNTs itself have antimicrobial activity by oxidising intracellular glutathione and resulted increase the oxidative stress on microbial cell that cause natural death of pathogen. CNTs also used in number of vaccinations to active immune response by triggering MHC-II, which further promote natural antibody production to stop the infection [11]. HIV( human immunodeficiency virus) that attack the immune response and decline the natural immunity, till date we cannot stop it completely but we can suppress or stop virus multiplication and control the disease .In this case conjugation of CNTs with siRNA that further deliver to T-Cell to stop virus proliferation [12].

V. Ocular Delivery: In case of ocular delivery there are number of challenges to deliver the drug to get adequate response with minimizing risk of infection. So therefore, SWCNTs-NH₃+ used as carrier to deliver antigen synthetic vaccination, safely and effectively by avoiding risk of necrosis and tissue degeneration [13].

VI. As Antioxidant: CNTs and CNHs are natural anti-oxidants. They are used in preserving drug molecules in formulation by inhibiting their oxidation. Furthermore, due to this property they are also used in anti-aging cosmetics products that oxidized the skin and stay it healthy and young [7].

VII. Neurodegenerative (ND)/Alzheimer Disease: Graphene sheets, and by extension CNTs, are excellent conductors of electricity, and thus are highly useful in the regeneration of neurons. Neurons can grow successfully on CNT beds, and modifying the surface with 4-hydroxyonoenal, known to be involved with neuron growth, can improve the neuron length and degree of branching over CNTs [11]. CNTs have many small additional sites that provide high surface area for external modification that’s why it is use as carrier to deliver the acetylcholine through blood brain barrier (BBB) and to treat Alzheimer Disease [14-16].

VIII. Tissue/Bone Regenreation: CNTs for the purpose of bone regeneration are being developed, which use negatively charged functional groups with calcium bonded to them. This can provide a scaffold to which hydroxyapatite, the most common inorganic component of bone, can attach. CNTs are very strong, stiff, and flexible which makes them an excellent alternative to the titanium or ceramic bone scaffolds [17,18].

IX. Carbon based nonmaterial by virtue of its therapeutic and diagnostic dual functions have emerged as theranostic nanomedicine. Carbon nanotubes intrinsic medicinal activities along with drug candidates may enhance the effectiveness of drug delivery. Unprecedented growth of patents and publication in last decade has forecasted the future of carbon based drug materials. A precise control for synthesis, purification and tools to increase solubility and further bio-functionality may lead to the development of carbon naotube based formulations. There is a need of clinical investigations for exploring the intrinsic medicinal activities of carbon nanotubes.

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Lupine Publishers | Models of Modernity

 Lupine Publishers | Open Access Journal of Anthropological and Archaeological Sciences 

Opinion

Modernity, as we know it, emanated from the twin revolutions of Europe: Industrial revolution and French revolution. The economic principles of industrialization and the political principles of French revolution have been built into the development processes of many nations. This is particularly true of post-colonial nations, wherein the principles of the above said modernity have been incorporated into many of their constitutions. These two, economic modernity of industrialization and political modernity of equality, liberty and fraternity have been related processes. Often in developing countries the first has been inadequate. That is to say the industrial modernity has never been realized fully in developing countries. The developing countries of Africa and Asia in particular, to this day, largely remain pre-industrial. And this has limiting consequences on their political modernity. The requisite economic basis, by way of industrial modernity has never come to materialize in order to make way to political modernity. The political modernity therefore is circumscribed by the many limitations not only of their variegated historical past but also by their inadequate industrial development since the decolonization.
Therefore, what one finds in many developing countries is a not an archetypical modernity of Europe, but different degrees of approximation to it. The political economy of these countries is still held back by the unresolved agrarian and rural question. The agrarian pre-modernity, with all the particularities and backwardness that it carries, colors the nature of the modernity in developing countries. Industrialization could not take place in developing countries owing to the policies they adopted since the decolonization, owing to dependent nature of their economies and owing to the unequal international political economy. Thus, these are mutually reinforcing factors that keep many of the developing countries politically pre-modern. Of all, the main point that we would like stress here, is the continuation of large populations in developing countries in agriculture which keeps them tied to backward productive forces and social relations of production. This keeps the entire nations beholden to an archaic pre-industrial past. The breakthrough that the European and other advanced nations have achieved from agriculture to industry, from rural to urban, from pre-modern to modern does not happen, or happens only in a very distorted manner in developing countries of Asia and Africa today. This is after nearly seven decades of decolonization.
And worse, owing to the globalization and the crises that we have seen since the 9/11 and wars on terror the question of realizing modernity has seen a reversal in many countries. There has been an emergence of cultural aversion to western modernity and going back to native principles. This has resulted in increasing emergence of backward looking nationalisms and rightwing governments. This apart, one should also keep in mind, very starkly indeed, that there is no de-contextualized modernity anywhere in the world. The modernity in the developing world can only have the birth marks of the particular society in which it is born. Therefore though the economic principles of industrial development and the political principles of liberty, equality and fraternity appear to be universal principles, their emergence or development in particular societies will only be imbued with particularities. This also means the imperfect realization of the principles. This is true in terms of economic, social and political institutional processes and their inter sectionalities. Thus, there cannot be one model of modernity any more. There are different models of modernity: Asian modernity, African modernity and so on. This may sound paradoxical, but is inevitable in an imperfect world.
The situation has come to such an impasse that in many parts of the developing world there are even questions of whether adopting the principles of (what was European) modernity at all relevant or meaningful. And there is slide backwards to rely in pre-modern world views and modes of life. This raises a pertinent question. Is modernity relevant today? This authors thinks yes, because, the principles of enlightenment embodied in modernity and the political principles of liberty, equality and fraternity have been historically been a step forward to mankind. It is immaterial today whether these principles are of European or some other origin, their value on human grounds is immeasurable. And, let us also be aware of the fact that many reversals that the developing countries are witnessing today from modernity have the effect of reinforcing the pre-modern, and primordial inequalities and oppressions. Far from emancipating the ones who are chained to history, they strengthen the bondages. Thus, this is more than a rhetorical question as to how many people will enjoy what kind of liberties, what kind of egalitarianism and what social and economic opportunities in terms of industrial modernity. To deny the importance of modernity is to deny the possibilities of development to a large number of people caught in pre-modern routines of agriculture, pre-modern social relations of inequality and oppression and pre-modern institutions of particularity and irrationality. Today it is important to reaffirm our faith in the principles of modernity, thereby, on the founding principles of the polities of the many developing nations of the world. This is in the face of the many reversals from development that the humanity is witnessing in this part of the world: Modernity and its characteristics being the most pre-eminent amongst them.

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Lupine Publishers | Proposed S.A.M.S Therapy to Tackle the Corona virus

 Lupine Publishers | Journal of Anesthesia & Pain Medicine

Opinion

S.A.M.S. is an acronym for Seun Ayoade’s Medical System [1], an alternative form of therapy based on the Germ Terrain Duality theory of disease. The Germ-Terrain duality theory of disease states that the etiology of certain diseases/diseased states is better explained as a complex interplay between germs and the inherent anatomical/physiological integrity of the body cells. It argues that the etiology of certain diseases is not fully explained merely by the presence of germs (Germ Theory) or by a mere loss of cellular integrity (Terrain Theory). As a result, the prevention and treatment of such diseases should focus not just on fighting germs but on maintaining/restoring the anatomical/physiological cellular integrity. The Germ-Terrain duality theory is a harmonization of the current Germ Theory (popularized by Louis Pasteur) and the hitherto discarded Terrain Theory (popularized by Pierre Bechamp) [2-3]. The corona virus outbreak has taken thousands of lives away [4] and is causing global panic. The corona virus menace seems to be validating the germ terrain duality theory of disease. For some reason, very few children are succumbing to the virus [5]. It seems the elderly are having the most fatalities. Like the previous SARS and MERS outbreaks, the very young seem to have some strange resistance. Since all people from new born babies to the very old are being exposed to the same corona virus but are having different infection, recovery and fatality rates it is obvious that whatever is causing this disparity is a function of the terrain. I hereby humbly wish to appeal to all those doctors and immunologists, pharma cologistsetcetera furiously working ona cure/treatment/vaccine for the corona virus to look not only at the virus but the terrain. One terrain parameter present in babies but absent in large amounts in adults is the foetal haemoglobin, otherwise called Haemoglobin F. Could the use of Haemoglobin F-such as is now being used to treat the sickle cell disease(e.g. via hydroxyurea)-help adults resist the corona virus? I do not have a medical degree, my degree is in physiology, but with my limited knowledge and in light of the fact that malaria and AIDS medicine is already being tried for treatment of the corona virus [6-11], it should be no big stretch to try Haemoglobin F. Best of luck and good health to all!.

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Lupine Publishers| Primary Cemented Hemiarthroplasty in Unstable Inter- Trochanteric Fracture of Femur in Elderly

 Lupine Publishers| Journal of Orthopedics and Sports Medicine

Abstract

Introduction: Unstable Intertrochanteric fractures are Complex fractures which become more difficult when it’s associated with age related osteoporosis. Internal fixation methods like Dynamic hip screws and proximal femoral nails have lot of complications which adds to the morbidity and mortality of the patient.

Material and Methods: 23 patients aged more than 60 years presenting with unstable Intertrochanteric Femur fracture were operated with primary cemented bipolar Hemiarthroplasty Along with Greater Trochanter and Lesser Trochanter reconstruction with Steel wires or non-absorbable sutures.

Result: The average Harris Hip Score (HHS) at final follow up was 85.24 with 9 excellent, 7 good, 3 fair and 2 poor results.

Conclusion: Hemiarthroplasty in unstable Intertrochanteric fractures is better than other methods of internal fixation in elderly patients as it has less complications and the major advantage of bipolar Hemiarthroplasty is early mobilization and less mechanical complications.

Keywords: Bipolar; Hemiarthroplasty; unstable Intertrochanteric fracture; osteoporosis

Introduction

Around 45% of all hip fractures are Intertrochanteric fractures (IT fractures) [1] and the incidences of hip fractures are still higher in elderly. With increase in life expectancy, there is an increase in population of elderly patients. Osteoporosis which is very common in elderly, is a major cause of fractures following trivial trauma. About 35-40% of Intertrochanteric fractures are unstable [2]. The treatment of stable IT fractures is osteosynthesis with good results but there has been a wide consensus regarding the best treatment modality for unstable Intertrochanteric fractures in elderly patients. The major problem with these fractures is difficulty in obtaining acceptable reduction, poor bone quality and high rates of morbidity and mortality due to various factors especially prolonged recumbency. The primary goal of treatment is stable fixation and early mobilization. The treatment of these fractures evolved from conservative treatment with the skeletal traction to operative procedures like fixed angle blade plates, sliding hip screws and intramedullary devices. [3] Hemiarthroplasty and Total Joint Replacement is mainly used for femoral neck fractures and as a salvage for failed pinning and other complication of primary surgical procedure [4]. osteosynthesis in unstable Intertrochanteric fractures with osteoporosis has failure rate between 4-16.5%. [5] When internal fixation is adopted, the range of general complications such as Deep Venous Thrombosis (DVT), Pulmonary embolism, Pneumonia, bed sores etc. ranges from 22- 50%. [6-7] The primary aim of this study is to analyze the role of primary cemented Hemiarthroplasty in unstable Intertrochanteric fracture of femur in elderly patients.

Material and Methods

The study was done prospectively on 23 patients aged more than 60 years presenting with unstable Intertrochanteric Femur fracture. One of the cases died on 8th month postoperatively and one case was lost to follow up after 4th month postoperatively. These 2 cases were excluded and only 21 cases were included in the study. The fractures were classified according to AO/OTA and Evan’s classification and the fractures with AO/OTA type 31-A2.2 and 31-A2.3 and Evan’s type 3 and 4 were included in the study. Only the patients who were independently mobile before sustaining injury were included in the study were included. Written informed consent was taken from all the patients. The patients who were unfit for surgical procedure or polytrauma patients, open or pathological fractures, old or malunited fractures were excluded from the study. The patients who had any significant rheumatological, neurological or psychiatric disorders were also excluded from the study.

Surgical Technique

Figure 1: Preoperative X-ray.

Primary cemented bipolar Hemiarthroplasty was done using posterolateral approach in lateral position. The joint capsule opened using inverted ‘T’ capsulotomy incision and then the fracture pattern assessed. The femoral head was then extracted by cutting the head of femur from neck, at sub capital region. Then the Greater Trochanter (GT) and Lesser Trochanter (LT) were temporarily reconstructed according to their comminution and displacement. Then excessive part of neck trimmed, and femoral canal prepared with reamers and broaches. Trial stem was then inserted taking care of appropriate version of prosthesis, by taking the long axis of leg and transcondylar axis of lower end of femur as reference. In severely comminuted fractures, especially in comminuted LT fractures, exact prosthesis height determination was difficult. So, both the knees were brought together, and height of prosthesis was marked. Second generation cementing technique and cement restrictor was used in all the cases. Appropriate prosthesis size selected, and the prosthesis stem was sunk till the previously marked point to avoid limb length discrepancy. Definitive reconstruction of GT and LT was then done using SS wires by Tension Band Wiring and/or encirclage technique. In cases of severe comminution Ethi bond sutures were used to keep Trochanter in place. There were a few cases where LT was severely comminuted, then it was left as it is within the soft tissue and the calcar was made using cement mantle. The sleeves of Gluteus Medius and vastus medialis anchored to GT using bone drills and wires. Short external rotators were also attached. The joint was then reduced; range of motion and stability was checked. Wound is then closed in layers over suction drain. Patients were allowed to sit on 1^st postoperative day onwards and standing with support was allowed on 2^nd postoperative day. Walking with support was allowed on 3^rd –4^th postoperative day and walking without support was encouraged and allowed as tolerated by patient. Follow up was done on 2^nd week, 4^th week, 3 months, 6 months, 1 year and 2 year. On each follow up clinic-radiological evaluation was done and Harris Hip Score (HHS) used for assessment. HHS less than 70 is graded as poor outcome, 70-79 as fair, 80-89 as good and 90-100 as excellent outcome. (Figures 1-3).

Result

Prospective study on 21 patients operated for unstable osteoporotic Intertrochanteric fractures with primary Hemiarthroplasty. The average age of the patients was 70 years and it included 14 male and 7 female patients. The duration of days since injury to presentation ranged between 1 to 13 days, average 4.33 days. The fracture pattern was of AO/OTA type A2.2 and A2.3 and Evan’s type 3 and 4. The average duration of surgery was 89.76 minutes and average intraoperative blood loss was 426.19ml. Postoperatively patient was made to bear weight on 1^st day to maximum on 8^th post-operative day (POD), average 3.52 days. Walking without support was started on 28^th to 62^nd day. There were 8 patients which were not able to walk without support. Five of them used stick to walk with limp, 2 used walkers and 1 patient refused to walk at all and was wheelchair bound and had poor result. Remaining 13 patients walked well without any support. The average hospital stay was 9.48 days with maximum of 25 days in a patient who developed bed sore on 13^th POD and was advised to stay in hospital for proper nursing care and dressing. There was 1 patient who developed superficial Surgical Site Infection (SSI) which was managed conservatively with antibiotics and dressing and one patient who developed deep SSI on 6^th week POD for which revision surgery had to be done with implant removal and re-implantation. There were 5 cases that had limb length discrepancies, 1 had limb lengthening and 4 had shortening which was managed with shoe raise but still continued to walk with limp and used walker/ stick. The average Harris Hip Score (HHS) at 3weeks was 74.29 and at final follow up average HHS was 85.24 with 9 excellent, 7 good, 3 fair and 2 poor results. All the patients were followed up for at least 1 year at maximum for 3 years 5 months; average follow up period was of 26.1 months.

Discussion

Management of Intertrochanteric fractures has always been a challenge. Every case is different, and no single surgical approach is applicable for all the patients. There are a number of surgeries proposed for Intertrochanteric fractures, either osteosynthesis by plates like Dynamic Hip Screws (DHS), intramedullary nails like Proximal Femoral Nail (PFN) etc. or replacement surgeries like Hemiarthroplasty or total hip replacement surgery. DHS and PFN are excellent implants which give very promising results, but all these also have high chances of morbidity due to mechanical failure and prolonged recumbence leading to conditions like pneumonia, bed sores, DVT etc. Since Intertrochanteric fractures are more common in elderly and these old patients are still more prone for such complication. Another challenge in elderly patients is Osteoporosis. Due to severe depletion of bone stock, the fixation is weak, poor screw hold, higher chances of cut outs and implant failure. Osteosynthesis with implants like DHS is easier and has better results with simple 2 parts Intertrochanteric fractures rather than comminuted unstable Intertrochanteric fractures. To avoid such complications in unstable Intertrochanteric fractures in elderly a good alternative is replacement of femoral head and neck with prosthesis, i.e. Hemiarthroplasty. In Intertrochanteric fractures doing Hemiarthroplasty is surgically more difficult as we have to repair Greater Trochanter (GT) and Lesser Trochanter (LT) also with steel wires or non-absorbable sutures but the surgery is very rewarding. In the above study we have done Hemiarthroplasty with Bipolar prosthesis with reconstruction of GT and LT with steel wires or non-absorbable sutures in 21 cases of unstable Intertrochanteric fractures in elderly patients. We had to make calcar with cement in a few cases where repair of LT was not possible.

The average age of the study patients was 70 years (ranging from 61-91 years). The patients presented after an average of 4.33 days after injury (ranging from 1-13 days). Postoperatively the patients were made to bear weight on average 3.52 days after surgery and walking with support allowed from 4^th, 5^th day onwards, with maximum delay of 28 days in one patient and another one patient refused to walk at all. Majority of the patients started walking after about 4 weeks, with exception of 8 cases which continued to use support for walking. Due to early mobilization of the patient there were very few complications and the hospital stay of the patients also drastically reduced. The average hospital stay was 9.48 days ranging from 7 days to maximum of 25 days in one patient. Study done by Thakur et al. [3] had an average age of study patients of 80.7 years and average duration of injury to surgery was 3 days. The patients were mobile with walker on average 2.6 days and average duration of hospital stay was 17.5 days. Another study done Ahmed Emory et al. [8] had average hospital stay period of study patients of 8.78 days and the mean time interval between injury and operation was 2.9 days. Out of 41 patients, 27 cases were able to ambulate independently using walker and 13 cases need assistance along with walker. Study done by Sachet et al. [9] has Harris Hip Score (HHS) at final follow up 84.8 +- 9.72 (58-97) with 10 excellent, 15 good, 7 fairs. 2 poor and 1 failed result. Choy et al. [10] in his study had mean HHS at last follow-up 80.6+- 9.3, with excellent in 8, good in 19, fair in 9 and poor in 4 out of total 40 cases, i.e. better than fair results in 67.5% cases. In our study final mean HHS was 85.24. out of total 21 cases, 9 had excellent results, 7 good, 3 fair and 2 poor results, i.e. 76.19% had better than fair results. In our study one patient had developed bed sore on 13^th post-operative day (POD), which healed with nursing care and dressing. This patient refused to walk and had poor results. There was one patient who developed superficial surgical site infection (SSI) which was managed conservatively with dressing and antibiotics and one patient developed deep SSI on 6^th week POD for which revision surgery was done with implant removal and reimplantation. This patient was a known diabetic with improper control of blood sugar. There were no cases of dislocation or loosening. Similar study done by Nikunkj et al. [1] on 28 patients of Intertrochanteric fractures had 1 patient with superficial SSI, 1 patient with deep SSI, 1 case of acetabular erosion, 4 patients of nonunion GT and 2 patients with GT cerclage wire breakage. There was 1 patient with periprosthetic fracture 6 months after surgery. Overall, he had mean HHS 84.8 +- 9.72 at final follow up. Another study done by KV Puttakemparaju et al. [11] on 20 cases had 1 case of deep SSI for which implant removal was done, 1 case of grade 1 bed sore which healed with dressings and antibiotics. There was no dislocation, rotational deformities or subsidence of stem. Gashi et al. [12] in his study compared outcome of primary cemented bipolar Hemiarthroplasty with DHS in elderly patients with unstable Intertrochanteric fracture and concluded that early mobilization was significantly better in Hemiarthroplasty than DHS. General and mechanical complications were more common in DHS group. At final follow up mortality rate didn’t differ in between the two groups but mean HHS was better in Hemiarthroplasty group. Comparative study done by Mohamad Emmi et al. [13] concluded that HHS (86+-9 vs. 75+-7.6), range of flexion (105+- 11o vs. 90 +- 17o), external rotation (35 +-7o vs. 20+- 7o) were significantly higher in bipolar group compared to DHS group (P<0.05). However, there were no significant differences in pain severity in both the groups. Yee Suk Kim et al. [14] in a comparative study found that elderly patients with AO type A2 Intertrochanteric fractures, patients treated with Hemiarthroplasty were able to perform early ambulation. However, no significant difference in operative time, amount of postoperative transfusion, clinical results, hospital stay, and radiological failure rate was observed between bipolar Hemiarthroplasty and compression hip screw fixation groups. Study done by Sameer Ajit Mansukhani et al. [15] on DHS, Cemented bipolar Hemiarthroplasty and PFN for treatment of unstable Intertrochanteric fractures found that mean intraoperative blood was significantly less with PFN as compared with other two, whereas there was no significant difference in mean hospital stay and intraoperative time of all the three groups. There were more early complications seen in DHS group as compared to PFN and Hemiarthroplasty. Late complications such as femoral head AVN and implant cut outs were higher in PFN group whereas chances of hip dislocation were higher in Hemiarthroplasty patients. Mortality at 12 months was highest after bipolar Hemiarthroplasty and least after DHS. Reoperation rates were highest for PFN as compared to other two groups. On functional assessment unaided walking was best with DHS whereas other parameters didn’t have any significant difference. He concluded that Treatment of unstable Intertrochanteric fracture of femur is a matter open to debate. Intertrochanteric fractures of elderly must be treated with considering the age of the patient, mental status, bone quality, and the type of fracture. It is certain that the main objective is to prevent the possible complications by early mobilization and to help the patient to return to their daily life. Kayali et al. [16] in their study found that cone Hemiarthroplasty can be an alternative treatment for unstable Intertrochanteric fractures in elderly patients so as to achieve earlier mobilization. The limitations of our study were that the sample size was small and there was no comparison of bipolar Hemiarthroplasty with osteosynthesis surgeries like DHS and PFN. The study period was not too long and so long-term complications like hip osteoarthritis, loosening, protrusion, stem failure etc. cannot be assessed.

Conclusion

Bipolar Hemiarthroplasty is a reasonably good alternative in unstable Intertrochanteric fractures in elderly patients who have severe osteoporosis. The major advantage of bipolar Hemiarthroplasty is early weight bearing and less short and midterm complications. Internal fixation is a preferred especially in young patients with stable Intertrochanteric fractures but have high complication rates in elderly with unstable fractures due to prolonged Recumbency and severe osteoporosis.

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Lupine Publishers| Excess Weight, Obesity, Diabetes and Coronavirus Disease

 Lupine Publishers| Journal of Diabetes and Obesity

Introduction

SARS-CoV-2 virus has created an unprecedented public health and global economic crisis. Despite the fact, that this virus was discovered half a century ago, earlier version of this RNA virus (SARS-CoV) was less virulent than the 2019 version of the virus (CoV-2), which turned out to be the most potent killer virus. According to the Johns Hopkins University (JHU) Coronavirus Resources Center (coronavirus.jhu.edu), globally there are 28 million Covid-19 infected individuals and 900,000 deaths. In the USA, we have over 6.4 million infected individuals and 192,000 confirmed covid-related deaths. The response from the public health perspective is important, to prevent further escalation of the SARS-CoV-2 epidemic. Having said that, it is important to note, that each country has responded differently. Vietnam, and Taiwan have done well in keeping the Covid-19 infection rate and death to a minimum. Public health experts worldwide, should study the response of Taiwan, in preventing the spread of this highly contagious disease, without massive tests and lockdowns. Currently the oldest (USA) and the youngest (India) democracies, are competing for the number one position, interns of highest number of infected individuals. India has over 4.5 million infected individuals and 76,000 deaths. According to the JHU report dated September 10, 2020, Mexico has the highest observed case-fatality ratio (CFR) of 10.7%, compared to the USA (3.0%), and India (1.7%). In earlier articles we have discussed the role of comorbidities such as hypertension, excess weight, obesity, diabetes (Type-2) and vascular diseases, on the severity of Covid-19 infection [1-6]. However, if one looks at this situation from a historic perspective, in the last four decades cardiometabolic disease such as hypertension, excess weight, obesity, diabetes (Type-2), and vascular diseases, have increased in prevalence and incidence to epidemic proportions worldwide [7-16]. Added to this global burden of metabolic diseases, a killer virus has taken advantage of the existence of these metabolic risks, which are known to promote, oxidative stress, inflammation, vascular and immune dysfunction.

China Medical Treatment Expert Group for Covid-19, reported in January of 2019, that on admission, 20-51% of patients reported as having at least one comorbidity, with diabetes (10-20%), hypertension (10-15%), and other cardiovascular diseases (7-40%) being the most common [17]. In this guest editorial, we will briefly discuss the role of metabolic diseases such as hypertension, obesity, and diabetes in the progression and severity of the coronavirus disease. According to news reports, the first group of people to get hit by the virus in Italy were the elderly. They also noted that Italy has the second oldest population in the world, after Japan. Irony of this comparison is, that Japan did not suffer such devastating effect from the SARS-CoV-2 as Italy and Spain. In China, of the 1590 patients hospitalized in the early days of Covid-19 pandemic, the mean age was 48.9 years. In the USA, rates were highest among persons aged 65 years (12.2%), 65-74 (17.2%), and population older than 85 (54.4%). Public health experts believed that younger population was less susceptible for the SARS-CoV-2 infection. As is with any prediction about the Covid-19, the story keeps changing as the timeline changes. Currently there are over 500,000 infected young students in the USA. Earlier reports from China, indicated hypertension and diabetes (Type-2) as the two major comorbidities. However, in the recent months, dozens of studies have reported that many of the sickest patients have been people with obesity [18]. Furthermore, studies have demonstrated that even people who are merely overweight, also are at higher risk for Covid-19. The study by Ogden et al reported, the prevalence of childhood and adolescent obesity, and noticed grater increases (2-fold) in non-Hispanic Black and Mexican American adolescents [19]. This is particularly concerning, because adolescents with severe obesity are at high risk for the development of serious comorbidities including hypertension, diabetes as well as Covid-19. In a recent editorial in JAMA, Rodgers and Gibbons discuss the role of obesity and hypertension as comorbidities of Covid-19. SARS-CoV-2 pandemic has brought out the susceptibility of minority communities of color, and has exposed the complex interplay of contributing factors, that are rooted in the social determinants of health, and racial inequities. A 6-fold increase in the rate of death for African Americans, living in the USA due to a ubiquitous virus should be deemed unconscionable, as reported in the recent issue of JAMA (April15, 2020). What is currently known about these differences in disease risk and fatality rates? In Chicago, more than 50% of COVID-19 cases and nearly 70% of COVID-19 deaths involve African American individuals, although they make up only 30% of the population. This trend can me tracked down in various US Cities. Poor living conditions, health care disparity, unhealthy nutrition, and high incidence of metabolic diseases, seem to contribute to the excess CFR in this ethnic group, as well as in other minority communities [20, 21].

Considering the contribution of comorbidities to the progression and severity of the coronavirus disease, one would expect that China and India, with the largest populations of diabetic subjects, should have the highest CFR (Deaths per 100,000 population) for Covid-19. On the other hand, Mexico (10.7%), Iran (5.8%), and Spain (5.4%) have lot more mortality than the USA (3.0%) and India (1.7%). Since the two major populations with highest number of diabetics have not shown comparatively high case fatality rate, it is worthwhile discussing the other two comorbidities (hypertension and obesity) as the chief contributors for the Covid-19 progression and severity. Trends in the prevalence of hypertension in the USA, according to the NHANCE survey of age standardized prevalence, decreased from 48.4% in 1999-2000 to 45.4% in 2015-2016. However, absolute burden of hypertension consistently increased, from 87.0 million in 1999-2000 to 108 million in 2015-2016 [22]. Hypertension appears to be more common in Mexico, than among Mexican Immigrants in the United States. As far as the obesity goes, the number of obese children and adolescents aged five to 19 years, has risen tenfold in the past four decades and if current trends continue, there will be more obese children and adolescents than those moderately or severely [23]. Among adolescents, obesity prevalence in the USA was 16.8% in 2007 and 18.5% in 2016. Age standardized obesity in adults increased from 33.7% in 2007 to 39.6% in 2015. Whereas, 62% of the participants in Mexico reported, at least, being overweight [24]. When considering obesity data based on the BMI, we should keep in mind that South Asians have a different body fat distribution, compared to the European and Western population. South Asians in general have central abdominal obesity.

Data from 6916 patient records that researchers from Kaiser Permanente reported, compared to normal body mass index (BMI) of 18-24 Kg/m2, the risk of death more than doubled for patients with a BMI of 40-44 Kg/m2 and nearly doubled again, for those with a BMI of 45kg/m2 or more [25] In an accompanying editorial, David A Kass, a Cardiologist at the Johns Hopkins University, wrote, “that these findings taken with prior research -should put to rest the contention that obesity is common in severe COVID-19, -because it is common in the population.” The pathophysiology of hypertension involves, complex interaction of multiple vascular effectors, including activation of the sympathetic nervous system, of the renin-angiotensin-aldosterone system, and of the inflammatory mediators. Oxidative stress and endothelial dysfunction are consistently observed in hypertensive subjects [26]. As we have discussed earlier, obesity has reached epidemic proportions worldwide. In the USA alone, the prevalence of obesity has increased 50% in the past three decades, with 70% of all adults being classified as either overweight or obese [27]. Beyond an impaired response to infections, people with obesity also suffer from chronic, low grade inflammation. Fat cells secrete inflammation triggering chemical messengers called cytokines, and more come from immune cells called macrophages, that clean up dead and dying fat cells. These in turn, impair vascular homeostasis and lead to endothelial dysfunction [28].

If we carefully analyze a series of clinical events, that develop post SARS-CoV-2 infection, we can begin to understand, why metabolic diseases serve as independent risk factors for the progression and severity of coronavirus disease. Initial route of entry is via nasal and oral mucosa, -the preferred receptor that facilitates the transmission seems to be the ubiquitous ACE2, which is found in multiple types of cells and tissue including vascular endothelium. Recent findings, that following the injury to the lung tissue, the virus gets entry into the endothelium, opens a whole new avenue for the progress of the disease and its severity. Endothelium is the largest organ of the body, covering a large surface area and reaching out to every tissue and organ. As such, the injury to the endothelium could introduce a cascade of events, leading to platelet activation, thrombin generation, and promotion of both thrombotic and thrombolytic events [3]. Furthermore, people with metabolic diseases such as, hypertension, excess weight, obesity, diabetes (Type-2), and vascular disease, already have a compromised endothelium and invasion of the SARS-CoV-2 virus leads to further injury to the vascular system, by the disruption of vascular integrity and endothelial cell death. These events lead to the exposure of the subendothelial basement membrane, and results in the activation of thrombotic and clotting cascade of events.

The question of why China and India with the largest populations of diabetics, have relatively low rates of Covid-related mortality, is quite puzzling. In China, -Covid-19 pandemic’s epicenter, Wuhan, and its province, Hubei, Chinese Center for Disease Control-network, formed 1300 epidemic investigation teams, in addition to the 40,000 doctors and nurses. They used very clever tracing tools with big data support. In the first week of January the novel coronavirus infection was detected, and on 23 January 2020, they locked down the city of 11 million people and soon the rest of the Hubei-a province of nearly 60 million. The WHO-China Joint Mission on Coronavirus Disease 2019 Task Force concluded, “In the face of unknown virus, China has rolled out perhaps the most ambitious, agile, and aggressive, disease containment effort in history.” The strategy that underpinned this containment effort was initially a national approach, that promoted universal temperature monitoring, masking, and hand washing [29]. As far as India is concerned, the general population thinks, that they have innate immunity, as they are exposed to a variety of Asian viruses. On the other hand, some scientists speculate that the SARS-CoV-2 in India is a milder version, compared to the European and US strains. According to a news report by Rajesh Nair in ‘The Hindu’ of September 11, 2020, “Diabetes seems to be the main cause of COVID-19 deaths in the Union Territories (UT) of India. A survey conducted by the Jawaharlal Institute of Postgraduate Medical Sciences and Research (JIPMER) showed 30% of the government servants in Puducherry (UT) were diabetic.

In the same report by Nair, Emergency Surgeon of New Medical Center, Dr T. Arjun Sundaram expresses his optimism by saying, “It is an obedient (SARS-CoV-2) virus, if treated early for even people with comorbidities. But people with comorbidities try to ignore early symptoms, as part of their existing medical conditions, - just as flu-like symptoms.” Comorbidities such as hypertension, excess weight, obesity, diabetes, and vascular diseases increase COVID-19 related hospitalization by 6-fold and deaths, by 12-fold. In a recent report from the USA, underlying conditions were reported in 71% of individuals admitted to hospital with COVID-19 and in 94% of the deaths [30]. In a study done at Westchester County, New York, among Covid-19 patients, who presented with a comorbid condition, more than 57% had high blood pressure, while 41.7% were obese and 33.8% had diabetes. This study also found 90% of coronavirus patients, who were put on ventilators died. A recent global estimate published in Lancet, estimated that one in five individuals worldwide are at risk for infection by SARS-CoV-2 virus. A recent report by Jain and associates from New Delhi, India, discusses differential mortality in COVID-19 patients from India and Western Countries [31]. The authors discuss the age of the population, genetics of the virus, mutation of the virus, immune variations of Indian subjects and the expression of the ACE2 receptor in the adipose tissue.

Authors claim that they have investigated and identified the possible reasons and hypotheses for this disparity in observed or reported Covid-19 related mortality. However, we feel strongly, that there may be other, as yet unknown causes, and only future history will reveal all the mysteries of coronavirus disease.

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