Alterations in shear stress, mechanical deformation, extracellular matrix (ECM) composition and exposure to inflammatory conditions are known to cause endothelial to mesenchymal transformation (EndMT). This change in endothelial phenotype has only recently been linked to adult pathologies such as cancer progression, organ fibrosis, and calcific aortic valve disease; and its function in adult physiology, especially in response to tissue mechanics, has not been rigorously investigated. EndMT is a response to mechanical and biochemical signals that results in the remodeling of underlying tissues. In diseased aortic valves, glycosaminoglycans (GAGs) are present in the collagen-rich valve fibrosa, and are deposited near calcified nodules. In this study, in vitro models of early and late-stage valve disease were developed by incorporating the GAGs chondroitin sulfate (CS), hyaluronic acid, and dermatan sulfate into 3D collagen hydrogels with or without exposure to TGF-β1 to simulate EndMT in response to microenvironmental changes. High levels of CS induced the highest rate of EndMT and led to the most collagen I and GAG production by mesenchymally transformed cells, which indicates a cell phenotype most likely to promote fibrotic disease. Mesenchymal transformation due to altered ECM was found to depend on cell-ECM bond strength and extracellular signal-regulated protein kinases 1/2 signaling. Determining the environmental conditions that induce and promote EndMT, and the subsequent behavior of mesenchymally transformed cells, will advance understanding on the role of endothelial cells in tissue regeneration or disease progression. © 2017 Wiley Periodicals Inc. J Biomed Mater Res Part A: 105A: 2729-2741, 2017.
Introduction: Skin diseases are eighth most common reasons for outpatient in Nepal, and fourth cause of disability globally. Skin diseases varies with the reason, season and socioeconomic status. As the socioeconomic conditions are changing, so are the disease patterns. We planned to report the current trend of skin diseases in Kathmandu and compare with similar studies in past. Materials and methods: Outpatient department records of Civil Service Hospital from the year 2075 Bikram Sambat were reviewed after ethical clearance from institution review committee and were analyzed after tabulation. Results: Total number of cases were 9886 (4.51% of total hospital attendance). In total 8097 cases were new, males were 4218 (52.1%) and females 3879 (47.9%). Most common diagnosis was eczemas (18.47%), followed by dermatophytosis (15.29%). Eczemas, chronic urticaria, psoriasis and lichen planus were more common in the adult population of more than 30 years. While infections and acne were more common in young adults, 15-30 years, in both the sexes. Tinea was common during summer and so was scabies in males, while in females, melasma peaked in summer and chronic urticaria during spring and winter. Conclusion: The pattern of skin diseases is changing with the time. Diseases of possible allergic and immunologic etiology are increasing and diseases with infective etiology are still a huge burden on society.
Background: Steroid-modified tinea, also known as tinea incognito, is an infection by the dermatophytes, where the clinical morphology is modified due to corticosteroids, either systemic or topical. Rampant use of topical corticosteroids has led to increasing recurrence in tinea infections. Methods: All consenting cases of tinea presenting to outpatient department of dermatology department of Civil Service Hospital from March to August 2020 for a total of 6 months were included in this study. Tinea infection involving only the palms, soles, nails or scalp were excluded.Results: A total of 200 patients were included in this study. Among these, 175 patients (87.5%) were using topical corticosteroids. A significant association was noted between dermatophyte infection of more than one month and topical corticosteroids use (p<0.05). This study revealed that males were using super-potent topical corticosteroids more as compared to females (p<0.05). Moreover, no association was noted between the level of education attained and the use of topical corticosteroids (p=0.91). Only 25 (12%) patients were either using correct or no topical medications during the time of consultation with the dermatologist. Among the patients using topical corticosteroids, 155 (88.6%) patients were using them on recommendation of the local pharmacist and only 2 (1.2%) patients were prescribed by a physician. Conclusions: In short, use of topical steroids was rampant among patients with tinea whilst 77.5% patients procured steroid topicals over-the-counter. Hence, a tougher law and strict regulatory guidelines deemed necessary to curb the unauthorized and rampant sale of these medicines.Keywords: Dermatophytes; over-the-counter; steroid misuse; self-medications; tinea; topical corticosteroid
Background: Successful treatment of both bone fractures depends on the restoration of normal alignment and full recovery of range of motion that can be achieved by either closed reduction and casting or surgical intervention. Number of surgical treatment modalities have been mentioned for unstable pediatric both bone fractures that includes Kirschner wire fixation, plating, external fixation and elastic intramedullary nailing Methods: This was descriptive cross-sectional study performed from January 2016 to December 2019. A total of 85 diaphyseal pediatric forearm fractures were treated surgically with TENs during this period. Functional outcomes and complications were analysed 6 months after surgery. Results: The mean age of patients in our study was 10.67±1.88. There were 50 (64.1%) male and 28 (35.9%) female. Incidence of fracture is higher in left side 47 (60.2%) in comparison to right side 31 (39.8%). Thirteen (16.7%) fractures were in proximal third, 50 (64.1%) in middle third and 15 (19.2%) in distal third of both bone forearm.There were excellent outcomes in 91%, good outcomes in 6.4% and fair results in only 2.6% of patients.Seven different types of complications were noted including skin irritation 8 (10.2%), cortex perforation in 2 (2.5%) and iatrogenic fracture in 1 (1.3%) case. Conclusions: Titanium elastic nailing is excellent treatment option for displaced unstable pediatric both bone fractures especially in elderly children. This is technically easy, minimally invasive procedure where bone healing is relatively fast, implant removal is easy with excellent cosmesis of skin without long ugly scar in forearm.
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