Patella dislocation: an online systematic video analysis of the mechanism of injury

Background@#The mechanism of injury (MoI) for a patellar dislocation has not been fully established. The aim of this study was to use systematic video analysis to determine the MoI of a patella dislocation. @*Methods@#A systematic search was conducted of three video sharing websites and three popular search engines to identify videos demonstrating a patellar dislocation. Videos were reviewed by three surgeons trained in systematic video analysis, who commented on the position of the lower limb and the situation in which the injury occurred.The results were reviewed to build a consensus of the MoI for each video. Statistical analysis was conducted for interobserver agreement (p < 0.05). @*Results@#Initial search yielded 603 videos with 13 meeting the inclusion criteria. The injuries were sustained performing a sporting activity (n = 9) or whilst dancing (n = 4). The injury was predominantly sustained during a non-contact situation (n = 10). The most common mechanism was an unbalanced individual with a flexed hip sustaining a valgus force to their flexed knee with the tibia externally rotated. @*Conclusions@#This study provides some insight into the MoI for a patellar dislocation and the findings may assist in developing injury prevention programmes and rehabilitation protocols as well as guiding future research.

Properties of Coronavirus and SARS-CoV-2

@#Zoonotic coronaviruses were discovered in the 1960s. Since then pathogenic human coronaviruses were identified beginning with the discovery of SARS-CoV in 2002. With the recent detection of SARS-CoV-2, there are now seven human coronaviruses. Those that cause mild diseases are the 229E, OC43, NL63 and HKU1, and the pathogenic species are SARS-CoV, MERS-CoV and SARS-CoV-2 Coronaviruses (order Nidovirales, family Coronaviridae, and subfamily Orthocoronavirinae) are spherical (125nm diameter), and enveloped with club-shaped spikes on the surface giving the appearance of a solar corona. Within the helically symmetrical nucleocapsid is the large positive sense, single stranded RNA. Of the four coronavirus genera (a,b,g,d), human coronaviruses (HCoVs) are classified under a-CoV (HCoV-229E and NL63) and b-CoV (MERS-CoV, SARS-CoV, HCoVOC43 and HCoV-HKU1). SARS-CoV-2 is a b-CoV and shows fairly close relatedness with two bat-derived CoV-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21. Even so, its genome is similar to that of the typical CoVs. SARS-CoV and MERS-CoV originated in bats, and it appears to be so for SARS-CoV-2 as well. The possibility of an intermediate host facilitating the emergence of the virus in humans has already been shown with civet cats acting as intermediate hosts for SARS-CoVs, and dromedary camels for MERS-CoV. Human-to-human transmission is primarily achieved through close contact of respiratory droplets, direct contact with the infected individuals, or by contact with contaminated objects and surfaces. The coronaviral genome contains four major structural proteins: the spike (S), membrane (M), envelope (E) and the nucleocapsid (N) protein, all of which are encoded within the 3’ end of the genome. The S protein mediates attachment of the virus to the host cell surface receptors resulting in fusion and subsequent viral entry. The M protein is the most abundant protein and defines the shape of the viral envelope. The E protein is the smallest of the major structural proteins and participates in viral assembly and budding. The N protein is the only one that binds to the RNA genome and is also involved in viral assembly and budding. Replication of coronaviruses begin with attachment and entry. Attachment of the virus to the host cell is initiated by interactions between the S protein and its specific receptor. Following receptor binding, the virus enters host cell cytosol via cleavage of S protein by a protease enzyme, followed by fusion of the viral and cellular membranes. The next step is the translation of the replicase gene from the virion genomic RNA and then translation and assembly of the viral replicase complexes. Following replication and subgenomic RNA synthesis, encapsidation occurs resulting in the formation of the mature virus. Following assembly, virions are transported to the cell surface in vesicles and released by exocytosis.

Diabetes mellitus does not increase the risk of knee stiffness after total knee arthroplasty: a meta-analysis of 7 studies including 246 053 cases

PURPOSE@#The association of diabetes mellitus with knee stiffness after total knee arthroplasty is still being debated. The aim of this study was to assess through meta-analysis the impact of diabetes mellitus on the prevalence of postoperative knee stiffness after total knee arthroplasty.@*METHODS@#We conducted a literature search for terms regarding postoperative knee stiffness and diabetes mellitus on Embase, CINAHL, and PubMed NCBI.@*RESULTS@#Of 1142 articles, seven were suitable for analysis. Meta-analysis showed that diabetes mellitus does not confer an increased risk of primary or revision total knee arthroplasty-induced postoperative knee stiffness when compared to nondiabetic patients (primary total knee arthroplasty, estimated odds ratio [OR] 1.474 and 95% confidence interval [CI] 0.97–2.23; primary and revision total knee arthroplasty, OR 1.340 and 95% CI 0.97–1.83).@*CONCLUSION@#There is no strong evidence that diabetes mellitus increases the risk of knee stiffness after total knee arthroplasty. The decision to proceed with total knee arthroplasty, discussion as part of the consent process, and subsequent rehabilitation should not differ between patients with and without diabetes mellitus with regards to risk of stiffness.LEVEL OF EVIDENCE: Level III (meta-analysis)

Diagnosing Diabetic Neuropathy: Something Old, Something New

There are potentially many ways of assessing diabetic peripheral neuropathy (DPN). However, they do not fulfill U.S. Food and Drug Administration (FDA) requirements in relation to their capacity to assess therapeutic benefit in clinical trials of DPN. Over the past several decades symptoms and signs, quantitative sensory and electrodiagnostic testing have been strongly endorsed, but have consistently failed as surrogate end points in clinical trials. Therefore, there is an unmet need for reliable biomarkers to capture the onset and progression and to facilitate drug discovery in DPN. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging modality for in vivo evaluation of sensory C-fibers. An increasing body of evidence from multiple centers worldwide suggests that CCM fulfills the FDA criteria as a surrogate endpoint of DPN.

Risk factors associated with abdominal obesity in suburban adolescents from a Malaysian district

INTRODUCTION@#We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolescents.@*METHODS@#This cross-sectional study included adolescents aged 15-17 years from five randomly selected secondary schools in the Hulu Langat district of Selangor state, Malaysia. Waist circumference (WC) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Information on sociodemographic data, dietary habits, physical activity levels and duration of sleep was obtained via interviewer-administered questionnaires. Participants' habitual food intake was determined using a 73-item Food Frequency Questionnaire.@*RESULTS@#Among 832 participants, 56.0% were girls; 48.4% were Malay, 40.5% Chinese, 10.2% Indian and 0.8% of other ethnic groups. Median age and WC were 16 (interquartile range [IQR] 15-16) years and 67.9 (IQR 63.0-74.6) cm, respectively. Overall prevalence of AO (> 90th percentile on the WC chart) was 11.3%. A higher proportion (22.4%) of Indian adolescents were found to have AO compared with Malay and Chinese adolescents. Logistic regression analysis showed that female gender (adjusted odds ratio [OR] 7.064, 95% confidence interval [CI] 2.087-23.913; p = 0.002), Indian ethnicity (adjusted OR 10.164, 95% CI 2.182-47.346; p = 0.003), irregular meals (adjusted OR 3.193, 95% CI 1.043-9.774; p = 0.042) and increasing body mass index (BMI) (adjusted OR 2.867, 95% CI 2.216-3.710; p < 0.001) were significantly associated with AO.@*CONCLUSION@#AO was common among Malaysian adolescents. Female gender, Indian ethnicity, irregular meals and increasing BMI were significant risk factors.

Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa [MENA] region: Much work needs to be done

The prevalence of diabetic peripheral neuropathy and painful diabetic peripheral neuropathy in the Middle East shows huge variability. This reflects the differing diagnostic techniques employed to diagnose neuropathy, but also the heterogeneity of the populations studied and the selection of populations from primary and secondary care. The treatment of diabetic neuropathy per se is inadequate as reflected by the poor control of risk factors such as glucose control, blood pressure and lipids in this region, which translates into the high rates of foot ulceration and amputation. In relation to symptomatic treatment, recommendations based on trials conducted in the West are without question, endorsed for the treatment of populations in the Middle East. Surely the demographics and patient responses both in terms of efficacy and side effects differ and therefore warrant local clinical trials. There is an over reliance on the prescription of B vitamins with the claim that they induce nerve repair. Whilst there is evidence for the relief of neuropathic symptoms with both vitamin B and D, again clinical trials are required in this region to establish their role in the treatment of diabetic neuropathy and painful diabetic neuropathy

Pancreatic islet cell transplantation as a treatment for brittle type 1 diabetes: a case report and review of the literature

Hypoglycaemia is the most common life-threatening acute complication in patients with type 1 diabetes mellitus [T1DM]. Approximately 30% of patients with T1DM will suffer from one episode per year of severe hypoglycaemia in which third-party assistance is required, and is associated with significant morbidity and mortality. Islet cell transplantation was approved by the National Commissioning Group [UK] for reducing the frequency of lifethreatening hypoglycaemic attacks in patients with impaired hypoglycaemia awareness. To date, five patients have undergone this procedure in Manchester, UK, since its approval in 2010. We present the case of a 56-year-old man with T1DM for 30 years on approximately 50 units of insulin per day with a glycated haemoglobin [HbA1c] of 9% [75 mmol/mol]. He scored 7 on the Gold Score and 6 on the Modified Clarke Scale for hypoglycaemia, making him eligible to undergo islet cell transplantation. He received two islet transplants, one in 2010 and the second in 2011. The patient did not achieve complete insulin independence post-transplant but reduced his daily insulin to approximately 17 U. However, the episodes of severe hypoglycaemia were reduced from approximately 50/year to 0.25/year, and he now has excellent glycaemic control with an HbA1c of 6.8% [51 mmol/mol]. The long-term microvascular complications, especially neuropathy, assessed by the novel technique of corneal confocal microscopy have not shown progression. He developed side effects from the immunosuppressive therapy, which included mouth ulcers, hypertension and moderate deterioration of renal function

Level of awareness of lung cancer risk factors, signs, symptoms and safe practices among college teachers of different states in India: do awareness programmes have an impact on adoption of safe practices?

Introduction: Lung cancer is the one of the most common cause of cancer mortality among men in India where incidence rates are increasing although they are largely preventable diseases. In India, late presentation is generally responsible for high mortality and morbidity rates and early detection is one of the best ways to control it. The purpose of this study is to measure the level of awareness on lung cancer among women represented by a sample of college teachers in India and the impact of awareness programs in changing or adopting safer practices and the prevention and early detection of the disease

Material and methods: The assessment was conducted during a Pink Chain Campaign on cancer awareness in 2011 in various women colleges in India. Pre-test related to lung cancer was followed by awareness programs. Post-test using the same questionnaire was conducted at the end of interactive session, at 1 year and 6 months

Results: A total of 156 out of 182 teachers participated in the study [overall response rate was 85.7%]. Mean age of the study population was 42.4 years [range- 28-59 yrs]. There was a significant increase in level of knowledge regarding lung cancer at 6 months and this was sustained at 1 year. Magazines and newspapers were the primary source for information regarding risk factors, signs and symptoms of lung cancer in more than 60% of teachers whereas more than 30% teachers were educated by doctors. At post-awareness after 1 year and 6 months, there was a significant change in alcohol and smoking habits. The main reasons for not undergoing screening tests are: ignorance [50%], lethargic attitude [44.8%] and lack of time [34.6%]

Conclusion: Knowledge about lung cancer was very low among teachers. Overall awareness of risk factors, signs and symptoms, and screening modalities of lung cancer have improved after 1 year along with practices related to smoking and alcohol consumption. There was a significant improvement in people undergoing regular check-up's. Improved means of communication, access to information and effective warnings about cigarette smoking are necessary to increase public awareness. To ensure the adoption of safe practices in the lifestyle of people who smoke and consume alcohol, awareness programmes such as the pink chain campaign should be conducted regularly, frequently and more widely in various areas of India

Giant fecaloma causing small bowel obstruction: case report and review of the literature

Fecaloma is a mass of hardened feces being impacted mostly in rectum and sigmoid. The most common sites of the fecaloma is the sigmoid colon and the rectum. There are several causes of fecaloma and have been described in association with Hirschsprung's disease, psychiatric patients, Chagas disease, both inflammatory and neoplastic, and in patients suffering with chronic constipation. Up to now several cases of giant fecaloma has been reported in the literature most of them presenting with megacolon or urinary retention. We herein report a case of giant fecaloma leading to bowel obstruction who was successfully treated by surgery. A 30-yrar-old man presented with sign and symptoms of acute bowel obstruction. He underwent exploratory laparotomy and enterotomy. He was found to have a giant fecaloma causing bowel obstruction in the jejunum. He was discharged after the operation with good condition. Jejunal fecaloma is extremely rare condition

Relationship between resilience and quality of life in diabetics

To determine the relationship between resilience and quality of life of diabetes patients controlling the effect of personal level [i.e., gender, age, and income] and disease-specific [i.e., duration of disease, and current glucose level] demographics. Analytical study. Outpatient Departments of various hospitals in Islamabad and Rawalpindi, from October to November 2012. Patients diagnosed with diabetes taking treatment in an outdoor patients' facility were included. Patients with a major diabetes complications causing or coexistent with a physical disability, medical condition or psychiatric comorbidity were excluded. Informed consent was taken from patients before administration of questionnaires. The patients were asked to respond to a demographic sheet, State-Trait resilience inventory, and WHO-Quality of Life BREF. Statistical testing was conducting using bivariate correlation, Mann-Whitney U-test, and multiple linear regression analysis for moderation testing. There were 242 patients including [n=108, 44% females; and n=134, 56% males] aged 17 - 85 years with mean of 44.56 +/- 16.56 years. Trait resilience predicted all aspects of quality of life of diabetic patients [b range = 0.30 to 0.42, p < .01] and explained 17% variance in physical functioning, 29% in psychological functioning, 17% in environmental functioning, 30% in social dimension, and 29% in overall quality of life. Duration of diabetes moderated effect of state resilience on all aspects of quality of life [b interaction range = 0.20 to 0.26, p < .05] and explained an additional 4% variance in physical functioning, 5% in psychological functioning, 3% in environmental functioning, 5% in social dimension, and 4% in overall quality of life of diabetics. Trait resilience has unconditional positive effect on all aspect of quality of life. Long standing diabetics may benefit from intervention addressing state resilience

Type 2 diabetes mellitus; effectiveness of paid for screening emotional problems of patients affecting adherence and blood glucose level

The study is aimed to assess emotional problem of patients with Type- 2 diabetes by translating and validating PAID. Associations between PAID and blood glucose levels, and differences in prevalence of emotional problems across treatment modalities and BMI. Data was collected from various outpatients of Rawalpindi and Islamabad. The sample of study comprised of 300 patients with diabetes both male = 135 [45%] and female n=165 [55%]. Formal approval was taken from authorities at respective hospitals and after taking informed consent patients were interviewed. Data collection was completed during Feb to April, 2013. Patients were asked to fill in demographic sheet along with Translated PAID scale. Latest blood glucose levels were collected from their medical records whereas BMI was calculated by measuring patients' weight and height. Results showed that emotional problems as assessed by PAID are positively correlated with blood glucose levels [r=.12 to r=.19, p<.05]. Additionally, patients with IV modality of treatment [i.e., taking insulin shots] suffered significantly high [MD=4.88, p=.01] from emotional problems and patients with normal BMI and Obese Class-II have are at higher risk of emotional problem. Finally, patients rated serious concerns on diabetes-related issues like lifelong maintenance, future complications, depression and anxiety, and satisfaction with physician. PAID is a very effective instrument in identifying emotional problems of diabetes patients related to adherence and compliance to their treatment regime and hence it shall be used by physicians and health professional in routine practice

The Effect Of Oral Health Education Seminar On The Oral Health Knowledge, Practice And Perception Of Role Of The Preschool Teachers

Background: In Malaysia, preschool teachers have longbeen utilised as oral health educators. However their levelof oral health knowledge and effectiveness of the trainingthey received are seldom investigated. This study aims toevaluate the of oral health education seminar (OHE) heldfor public preschool teachers (KEMAS) in terms of theimprovement of their knowledge, practices and attitudesMethods: This was a one arm interventional study (beforeand after survey following OHE seminar intervention). AllKEMAS preschool teachers (n=107) in Hulu Terengganuwere invited to attend OHE seminar which consisted of1 hour lecture and 40 minutes OHE demonstration. Pretestquestionnaire was collected before the seminar startedand post-test questionnaire was collected two weeks later.A self-administered questionnaire used in this study wasadapted from “preschool teachers’ knowledge, practicesand attitudes towards oral health”, National Oral HealthSurvey of Preschool Children, 2005. Data were analysedusing descriptive and McNemar test, SPSS version 15.0.Results: Of 107 subjects, only 61 teachers respondedyielding to 57% response rate. All subjects were femalewith mean age of 46 years (SD: 6.03). Overall, therewas an improvement of teachers’ oral health knowledge,practices and attitudes after the seminar. Severalitems seem to have be improved significantly after theseminar, for example knowledge item on factors causingperiodontal disease (p=0.03). In terms of practice, allteachers reported they brushed teeth at least twice dailyusing fluoridated toothpaste and use of dental floss wasincreased significantly after the seminar (p<0.001).Majority of teachers have positive perceptions on theirroles in oral health education. Conclusion: Oral healtheducation seminar appeared to be effective at influencingcertain aspects of teachers’ oral health knowledge,practices and attitudes.

Knowledge and behavior of primary school teachers towards attention deficit hyperactivity disorder

School teachers in Bahrain have never received any educational programs about attention deficit hyperactivity disorder [ADHD] except for a workshop which was conducted for primary school social supervisors in 2005. To evaluate the knowledge of primary school teachers of ADHD, attitude and behavior towards ADHD students. Cross-Sectional study. Primary Schools in Bahrain. One hundred fifty-eight randomly selected governmental primary school teachers completed the questionnaire about knowledge and attitude towards ADHD. Eighty-four [53.2%] of the teachers were knowledgeable about ADHD. Their main sources of knowledge about ADHD were newspapers and magazines. Teachers' Knowledge of ADHD was found to be less than optimal

Incidence of alveoloplasty and its indications - protocol to reduce the incidence

Alveoloplasty is one of the common pre prosthetic surgical procedure carried out in dental surgical practice setups. The aim of pre-prosthetic surgery is to improve the quality of oral supporting structures, which can provide better retention and stability to dental prosthesis. It also prevents any further hard or soft tissue loss. Alveoloplasty procedure is used for recontouring of bony irregularities at time of extractions or after initial healing. Simplest form includes squeezing of socket walls at time of extraction, which reduces the incidence of secondary alveoloplasty at later stages when patient requires denture rehabilitation. It may involve more complex procedures such as maxillary tuberosity reduction, removal of excessive undercuts, and bony exostosis like mandibular and palatal tori. It also reduces the chances of post-operative discomfort and complications. Mucosa covering the alveolar arches after alveoloplasty should be of uniform thickness and density so that occlusal load is distributed equally throughout the dental arches, making it more comfortable for patients to wear prosthesis. This study includes data consisting of number of patients requiring secondary alveoloplasty at Oral and Maxillofacial Surgery department of Islamic International Dental Hospital in last 3 years [2009, 2010 and 2011]. It also includes the symptoms with which patients present and suggestions / protocols to reduce the incidence of this second surgical procedure. We have implemented these protocols in this department, to reduce the need of secondary alveoloplasty because this procedure causes extra financial and surgical burden on patients. It also delays the rehabilitation of oral health. Second arm of this study is being planned after implementation of these protocols to evaluate their outcome

Solid pseudopapillary neoplasm of the pancreas: a case report with review of the diagnostic dilemmas and tumor behavior

Solid pseudopapillary neoplasm of the pancreas is a rare tumor of the pancreas often detected initially on imaging. Of uncertain histogenesis, it has a low-grade malignant potential with excellent post-surgical curative rates and rare metastasis. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. Pathological and/or cytological evaluation remains the gold standard in reaching a definitive diagnosis. On morphology alone, other primary pancreatic tumors and metastatic tumors pose a diagnostic challenge. Recent advances in immunohistochemical characterization have made the histopathologic diagnosis more specific and, in turn, shed light on the likely histogenesis of this rare tumor. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed intraoperatively on imprint cytology guiding definitive surgery. The diagnostic dilemmas are reviewed.

Investigation on the prevalence of leukaemia at a tertiary care hospital, Lahore

Cancer in all forms is causing about 12% deaths throughout the world. After recent advances and improvement in treatment and prevention in cardiovascular diseases, tumour is an important cause of morbidity and mortality[1]. The incidence of leukaemia across the world is i per 100,000 annually. It contributes to 25% of childhood cancers[2]. The study was designed to investigate the Prevalence ofLeukemia subtypes at Lahore General Hospital/The Graduate Medical Institute, Lahore and was carried out in the Bone Marrow Clinic. The study was cross - sectional prospective. The period of the study was two year from 01 June, 2010 to 30 June, 2012. Complete blood counts, bone marrow aspiration and trephine biopsies were performed according to standard methods. In a total of 45 cases of leukaemia, acute leukemia was more prevalent than chronic leukaemia. The ratio of acute and chronic leukaemias was 4:1. Male to female ratio was 1.3: 1. Most of the patients [42%] were below the age of 15 years. ALL [49%] was more common than AML [31%]. Among chronic leukaemias, CML [16%] was more common than CLL [2%] and CMML [2%]. The study of acute leukaemia subtypes revealed that ALL - L[2] was more common [77%] than L[1] [24%]. In AML subtypes, M[3] [57%] was most prevalent while M[2] [14%] and M[4] [14%] and M[1] [7%] and M[6] [7%] were less prevalent of leukaemia subtypes. Acute leukaemias were more prevalent than chronic leukaemias. Leukaemias of all types were slightly more prevalent in male patients. ALL was more common than AML and was found to be a childhood malignancy. In leukaemia subtypes, ALL - L[2] and AML-M[3] were most common and in chronic leukaemias CML was most common

Ulcerative colitis: a challenge to surgeons

Ulcerative colitis is a chronic disease that specifically affects the mucosa of the rectum and colon. Although the etiology of this recurring inflammatory disorder remains essentially unknown, there have been significant advances in identifying the likely genetic and environmental factors that contribute to its pathogenesis. The clinical course of the disease typically manifests with remissions and exacerbations characterized by rectal bleeding and diarrhea. Since ulcerative colitis most commonly affects patients in their youth or early middle age, the disease can have serious long term local and systemic consequences. There is no specific medical therapy that is curative. Although medical therapy can ameliorate the inflammatory process and control most symptomatic flares, it provides no definitive treatment for the disease. Proctocolectomy or total removal of the colon and rectum provides the only complete cure; however, innovative surgical alternatives have eliminated the need for a permanent ileostomy. The aim of this review is to provide a detailed account of the surgical management of ulcerative colitis

Ovarian hernia a rarity

Ovarian hernias are extremely rare. The prevalence of ovaries and fallopian tubes in operable inguinal hernias is only about 2.9%. We report here an unusual case of an ovary in a hernia sac in an adult female. She presented with symptoms and signs of an incarcerated left inguinal hernia. The left ovary contained a haemorrhagic cyst and, along with the left fallopian tube and broad ligament, these were found in the sac. She underwent a left ovarian cystectomy and the inguinal hernia was repaired with mesh

Amyand's hernia study of four cases and literature review

The presence of the appendix in an inguinal hernial sac is described as Amyand's hernia. It is a rare entity which presents mostly at the exploration of the inguinal canal. The appendix may be apparently normal or have all the features of acute appendicitis with its possible complications. We report four cases of Amyand's hernia which were treated at Sultan Qaboos University Hospital, Oman. All patients underwent appendectomy. In three cases, the inguinal hernia were repaired with Vipro mesh while, in the remaining case, a darning repair was done with Prolene sutures