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Fulltext Perspectives Review of Management in Renal Injury: A Single Centre Experience

Kavin Raj P, Kaillash Kumar, YT Cheong

IIUM Medical Journal Malaysia, 2019;18(101):4-0.
MyJurnal

Renal injury occurs in 1%–5% of all trauma cases. The objective of this retrospective study is to register a clinical audit on renal injury management of a single center.Materials and Methods: All renal–related trauma cases presented to Penang Hospital between August 2015 and July 2017 were included in this audit. These injuries were classified using American Association for the Surgery of Trauma (AAST) renal injury scale.Results: A total of 145 cases of renal trauma were audited; of which 40 cases of Grade I injury, 30 cases of Grade II, 45 cases of Grade III and 30 cases constituting Grade IV and V injury. Broadly, these patients were managed via two main approaches; 138 (95.27%) via conservative approach and 7 (4.83%) via surgical intervention. Among those who underwent surgical intervention, 3 had emergency nephrectomy performed while the other 4 had ureteric stenting.Conclusion: Literature review had shown up to 95% of renal injuries can be successfully managed conservatively, especiallyin cases of blunt trauma. The clinical audit of our center demonstrates that the perspective of renal injury management is in par with internationally acclaimed general consensus; hence affirms the feasibility of conservative management in a vast number of cases, with a prudential role for surgical intervention in severe injuries.
Evaluation of Effectiveness of Two Different Endodontic Retreatment Systems in Removal of Gutta-percha: An in vitro Study

Raj PKT, Mudrakola DP, Baby D, Govindankutty RK, Davis D, Sasikumar TP, et al.

J Contemp Dent Pract, 2018 Jun 01;19(6):726-731.
PMID: 29959303

AIM: To determine the effectiveness of two different endodontic retreatment systems for the removal of laterally compacted gutta-percha (GP).
MATERIALS AND METHODS: Sixty-three freshly extracted human maxillary central incisors were used for the study. The teeth were instrumented with K-flex files and obturated using lateral condensation technique with GP and AH Plus sealer. The teeth were divided into three retreatment groups, each group consisting of 21 teeth. Group I: D-RaCe desobturation files (D-RaCe); group II: ProTaper Universal retreatment files (PTUR); group III: Hedstrom files (H-file). After removal of GP, the teeth were split longitudinally and divided into three equal parts: Cervical, middle, and apical third. The middle and apical thirds of all root halves were examined using scanning electron microscope (SEM). The total surface area covered by the residual debris was evaluated using Motic Image plus 2.0 software. Statistical analysis was done by one-way analysis of variance (ANOVA) test with a p-value <0.05 used to determine significance and Tukey's multiple post hoc tests used for comparison between the groups, and 't' test was done for comparison between the thirds within the same group.
RESULTS: The PTUR retreatment files showed overall better performance compared with D-RaCe files and H-files. The PTUR files performed better at middle third compared with others. The PTUR files and D-RaCe files performed equally at apical third better than H-files.
CONCLUSION: ProTaper retreatment files are better compared with D-RaCe files and H-files for the retreatment of the previously endodontically treated teeth.
CLINICAL SIGNIFICANCE: Highest efficacy for the removal of GP was shown by ProTaper Universal System followed by D-RaCe and H-file.
Fulltext Synthesis and evaluation of selected 1,3,4-oxadiazole derivatives for in vitro cytotoxicity and in vivo anti-tumor activity

Tiwari A, Gopalan Kutty N, Kumar N, Chaudhary A, Vasanth Raj P, Shenoy R, et al.

Cytotechnology, 2016 Dec;68(6):2553-2565.
PMID: 27282155 DOI: 10.1007/s10616-016-9979-9

The oxadiazole moiety is known for its anticancer activity through its antiangiogenic and mitostatic potential. Taking this as a cue, the present study was designed to investigate the anti-cancer potential of selected oxadiazole derivatives. Twelve 1,3,4-oxadiazole derivatives (AMK OX-1 to AMK OX-12) were synthesized and were tested for IC50values through brine shrimp lethality assay and MTT assay on HeLa and A549 cell lines. Four compounds, AMK OX-8, 9, 11 and 12 showed potential cytotoxicity activity with low IC50value. These compounds produced considerable cytotoxic effect on Hep-2 and A549 cancer cell lines. However, they were found to be comparatively safer to normal cell lines, viz., V-79 cell lines than to the tested cancer cell lines, such as HeLa, A 549, and Hep2 cell lines. The mechanism of cytotoxicity was evaluated through nuclear staining and DNA ladder assay. Although DNA ladder assay showed DNA fragmentation (apoptotic phenomenon) in Hep-2 cells treated with only AMK OX-12, the staining procedures using acridine orange, ethidium bromide and propidium iodide showed apoptotic bodies in cells treated with AMK OX-8, 9 and 12 also. In JCI staining on isolated mitochondria of Hep2 cells, AMK OX-8, 9-11 and 12 displayed increasing fluorescence intensity with time which confirmed involvement of mitochondrial pathway and intrinsic pathway of apoptosis. All four compounds were found to be safe in acute oral toxicity study in Swiss albino mice. These derivatives were effective in reducing tumor size and weight in the in vivo DLA-induced solid tumor model. They were found to be significantly effective in reducing tumor volume and tumor weight.
Influence of Asian Ethnicities on Short- and Mid-term Outcomes Following Laparoscopic Sleeve Gastrectomy

Koh ZJ, Tai BC, Kow L, Toouli J, Lakdawala M, Delko T, et al.

Obes Surg, 2019 06;29(6):1781-1788.
PMID: 30767187 DOI: 10.1007/s11695-019-03716-8

PURPOSE: Prevalence of obesity in Asia has been on the increasing trend, with corresponding increase in utilisation of bariatric surgery. The objective of this study was to examine differences in weight loss outcomes following bariatric surgery between Asian ethnicities.
MATERIALS AND METHODS: A retrospective database review was conducted of patients undergoing primary laparoscopic sleeve gastrectomy between 2009 and 2013 in 14 centres from Singapore, Malaysia, Taiwan, Hong Kong, Japan, Korea, India, Australia, Switzerland, and the USA. All patients with available follow-up data at 12 months and 36 months post-surgery were included in this study. Outcome measures used were percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Differences in outcomes between ethnicities were analysed after adjusting for age, gender, baseline body mass index (BMI), and presence of diabetes.
RESULTS: The study population (n = 2150) consisted of 1122 Chinese, 187 Malays, 309 Indians, 67 Japanese, 259 Koreans, and 206 Caucasians. 67.1% were female and 32.9% were male. Mean age was 37.1 ± 11.2 years. Mean pre-operative BMI was 40.7 ± 8.1 kg/m2. With the Caucasian population as reference, Japanese had the best %TWL (3.90, 95% CI 1.16-6.63, p p
Fulltext Amino acid signatures of HLA Class-I and II molecules are strongly associated with SLE susceptibility and autoantibody production in Eastern Asians

Molineros JE, Looger LL, Kim K, Okada Y, Terao C, Sun C, et al.

PLoS Genet, 2019 04;15(4):e1008092.
PMID: 31022184 DOI: 10.1371/journal.pgen.1008092

Human leukocyte antigen (HLA) is a key genetic factor conferring risk of systemic lupus erythematosus (SLE), but precise independent localization of HLA effects is extremely challenging. As a result, the contribution of specific HLA alleles and amino-acid residues to the overall risk of SLE and to risk of specific autoantibodies are far from completely understood. Here, we dissected (a) overall SLE association signals across HLA, (b) HLA-peptide interaction, and (c) residue-autoantibody association. Classical alleles, SNPs, and amino-acid residues of eight HLA genes were imputed across 4,915 SLE cases and 13,513 controls from Eastern Asia. We performed association followed by conditional analysis across HLA, assessing both overall SLE risk and risk of autoantibody production. DR15 alleles HLA-DRB1*15:01 (P = 1.4x10-27, odds ratio (OR) = 1.57) and HLA-DQB1*06:02 (P = 7.4x10-23, OR = 1.55) formed the most significant haplotype (OR = 2.33). Conditioned protein-residue signals were stronger than allele signals and mapped predominantly to HLA-DRB1 residue 13 (P = 2.2x10-75) and its proxy position 11 (P = 1.1x10-67), followed by HLA-DRB1-37 (P = 4.5x10-24). After conditioning on HLA-DRB1, novel associations at HLA-A-70 (P = 1.4x10-8), HLA-DPB1-35 (P = 9.0x10-16), HLA-DQB1-37 (P = 2.7x10-14), and HLA-B-9 (P = 6.5x10-15) emerged. Together, these seven residues increased the proportion of explained heritability due to HLA to 2.6%. Risk residues for both overall disease and hallmark autoantibodies (i.e., nRNP: DRB1-11, P = 2.0x10-14; DRB1-13, P = 2.9x10-13; DRB1-30, P = 3.9x10-14) localized to the peptide-binding groove of HLA-DRB1. Enrichment for specific amino-acid characteristics in the peptide-binding groove correlated with overall SLE risk and with autoantibody presence. Risk residues were in primarily negatively charged side-chains, in contrast with rheumatoid arthritis. We identified novel SLE signals in HLA Class I loci (HLA-A, HLA-B), and localized primary Class II signals to five residues in HLA-DRB1, HLA-DPB1, and HLA-DQB1. These findings provide insights about the mechanisms by which the risk residues interact with each other to produce autoantibodies and are involved in SLE pathophysiology.