Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

@#Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

Predictors of Functional Outcome in Unstable Ankle Fractures Treated Surgically – A Prospective Cohort Study

@#Introduction: Unstable ankle injuries require anatomical reduction and stabilisation for optimal outcome. In spite of adequate care, a few patients have poor outcome. In this study, we assessed the risk factors that predict the clinical outcomes in surgically treated unstable ankle fractures. Material and methods: This prospective cohort study was conducted on 68 patients who underwent surgical management for an unstable ankle injury. Demographic details, fracture type and associated medical comorbidities were recorded. Pre-operative radiographic assessment was done for all patients. At the end of one year follow-up, clinical (American Orthopaedic foot and ankle societyAOFAS and Olerud-Molander ankle - OMAS) scores and radiological parameters were assessed and analysed. Results: Fracture dislocation (0.008), diabetes mellitus (0.017), level of alchohol consumption (0.008) and preoperative talocrural angle (TCA) > 100° (0.03) were significant predictors of poor outcomes as per AOFAS. Fracture dislocation (0.029), diabetes mellitus (0.004), preoperative TCA > 100° (0.009), female gender (0.001), age more than 60 years (0.002) and open injuries (0.034) had significantly poor outcome as per OMAS. Other parameters (smoking, hypertension, classification, syndesmotic injury, medial clear space and tibiofibular overlap) did not affect the outcome significantly. Conclusion: Our study showed that poor outcome predictors in unstable ankle fractures are age >60 years, female gender, diabetes mellitus, alcohol consumption, fracture dislocation, open fractures and pre-op TCA >100°.

Alveolar rhabdomyosarcoma in children with histomorphological review.

Rhabdomyosarcomas (RMS) are aggressive malignant neoplasm of mesenchymal origin, related to skeletal muscle lineage. These are the most common soft tissue tumors in children. The diagnosis is made by microscopic analysis and ancillary techniques like immunohistochemistry, electron microscopy, cytogenetics and molecular biology. We encountered a case of a 03 years old child who presented with a tender, reddish, soft swelling over cheek for three weeks. The FNAC was reported as a small round cell tumor, Probably Primitive Neuroectodermal Tumor (PNET). The biopsy of tumor revealed a small round cell tumor with an alveolar pattern. Tumor giant cells were absent and mitotic figures were infrequent. Hence, differentials of alveolar rhabdomyosarcoma and PNET were rendered. Immunohistochemistry (IHC) demonstrated desmin positivity. Thus, a final diagnosis of alveolar rhabdomyosarcoma was offered.

Faculty Perception and Attitude on Problem Based Learning (PBL) in Medical College from Central India.

Background: PBL is an innovative teaching learning method that enhances intrinsic motivation, promotes self learning, encourages clinical reasoning, and develops longlasting memory. It is an established leading educational innovative method in medical sciences throughout the world. In India, it is used by only few institutions. The reason may be the lack of awareness or negative perception on PBL. Aims: To study the response of medical faculty on PBL. Material and Methods: The study was conducted at the Index Medical College Hospital and Research Centre, Indore, India. The introductory sensitizing lecture cum discussion was organized on PBL. Pre-Test, Post-Test and feedback data from the faculty was encoded in numerical variables and analyzed by the SPSS. Results: Fifty eight faculty participated, 82.14% were entry and junior level, 80.34% didn’t attend any course on medical education, 94.6% have not attended any kind of formal training on PBL, 78.5% desired to acquire special training and 83.9% were in the favor of PBL. There was significant improvement in the knowledge of faculty on PBL as evidenced by post test and feedback data (Unpaired t test P value equals to 0.0009). Conclusion: The faculty’s attitude was receptive on implementation of the PBL but majority of them required special training which can be conducted by the medical education department of the institute with the collaboration and support of other institutions that run the PBL in their curriculum. It should be integral part of the PBL implementation programme at institute.

Prevalence and spectrum of hemoglobinopathies in tertiary care centre in a rural area of Madhya Pradesh.

Background: Haemoglobinopathies like thalassaemia and sickle cell anaemia etc are increasing due to unawareness of rural population. This study indicates type of haemoglobinopathies amongst the patients of a rural based tertiary care hospital in one year and nine months. Methods: Five hundred ten patients were studied during last one year and nine month for all suspected cases of haemolytic anaemia based on Complete Blood Count, Red cell indices and Peripheral blood smear examination. Sickling test, test for Hb F and haemoglobin electrophoresis with quantification of bands are done in all these cases Results: Out of all 510 cases of anaemia 461 cases (90.39%) were confirmed to nonhaemolytic anaemia whereas 49 cases (9.60%) had shown abnormal haemoglobin bands on electrophoresis. Out of these 49 cases 29 (59.18%) were Males and 20 (40.81%) were females. Most common Haemoglobinopathy observed was Sickle cell  Thalassaemia 23 (4.50%) followed by  Thalassaemia Trait 9 (1.76%), Sickle Cell trait 7 (1.37%).  Thalassaemia Major 5 (0.98%) & Sickle Cell Disease 5 (0.98%) have equal prevalence. The onset of disease was most prominent in Neonatal to pediatric age group including early adolescent (0-18 years) followed by reproductive age group (19- 45 years). Few cases of old age (46+ years) were detected. Conclusion: Study provides data on the spectrum & pattern of Haemoglobinopathies in a rural tertiary care centre. Screening of all anemic patients should be done for Haemoglobinopathy and proper Genetic counseling must be given to all cases to prevent incidence of cases in future generation.

Diagnostic accuracy of FNAC in diagnosis for causes of lymphadenopathy: a hospital based analysis.

Introduction: The lymphadenopathy consist wide range of etiology from inflammatory process to a malignant condition and it is most common clinical presentation in outpatient department. Fine needle aspiration cytology is a simple, safe, reliable, rapid and inexpensive method of diagnosis in lymph nodes. Aims and objectives: To find out diagnostic accuracy of FNAC in lymphadenopathy and common pattern of lymphadenopathy in our institute. Methods: This prospective study was carried out in the department of Pathology of Index Medical College Hospital and research Centre, Indore, India from June 2011 to May 2013. The patients with palpable lymph nodes were included in this study. The slides were stained with Papanicolaou and May Grunewald Geimsa stain. Special stain like Ziel Neelson, Alcian blue was done whenever is required. A detailed analytic study was performed for correlation of Cyto-histopathological diagnosis. Results: The result shows male to female ratio of 1.0:0.8. The age of the patients ranges from 2 to 79 year with mean age of 32 years. The study shows reactive hyperplasia 149 (33.38%), tubercular lymphadenitis 177 (39.77%), granulomatous lymphadenitis 32(7.1%), lymphoma 25 (5.5%), metastatic carcinoma 40 (8.9%) and others 22 (4.9%). We found cyto-histpathological concordant in 161 (95.8%) cases and discordant in 7 (4.2%) cases. Conclusion: The sensitivity of FNAC in lymphoma and metastatic tumors is 81.48% and 97.5% with test accuracy of 96.5% and 99.4% respectively. Hence FNAC should be used as preliminary screening investigation in all forms of lymphadenopathy and interpretation should be done in conjunction with clinical picture of the patients.

Study of HIV-1 subtypes in serodiscordant couples attending an integrated counselling and testing centre in Mumbai using heteroduplex mobility analysis and DNA sequencing.

Aims: To determine the prevalent subtypes of HIV-1 in serodiscordant couples. Setting: Integrated Counselling and Testing Centre (ICTC), Department of Microbiology. Study Design: Prospective pilot study. Participants: Thirty HIV-1 serodiscordant couples. Inclusion Criteria: a) Documentation of HIV-1 infection in one partner and seronegative status in the other, current history of continued unprotected sexual activity within the partnership, demonstration that they have been in a partnership for at least 1 year and are not currently on highly active antiretroviral therapy HAART; b) willingness of both partners to provide written informed consent including consent to continued couple counselling for 3 months. Materials and Methods: HIV-1 subtyping was carried out by heteroduplex mobility analysis (HMA) by amplifying env region; and DNA sequencing by amplifying gag region. Results: HIV-1 env gene was amplified successfully in 10/30 samples; gag gene, in 25/30 samples; and both env and gag gene were amplified successfully in 5/30 samples. HIV-1 subtype C was detected from 21 samples; subtype B, from 7; and subtype A, from 2. Sample from 1 positive partner was detected as subtype C by env HMA and subtype B by gag sequencing. Conclusion: HIV-1 subtype C was found to be the predominant subtype of HIV-1 in serodiscordant couples attending our ICTC, followed by HIV-1 subtype B and HIV-1 subtype A, respectively. DNA sequencing was found to be the most reliable method for determining the subtypes of HIV-1.

Multiple non-odontogenic cysts--a case report.

Nonodontogenic cysts have been identified at various locations in oral cavity. These occur primarily in relation to fusion of maxillary process either with its counterpart or different portions of nasal part of frontonasal process. Usually solitary, these primarily affect maxilla alone; can rarely be seen in ramus of mandible. We present a case of multiple non-odontogenic cysts involving both maxilla and mandible.

Hypertrophic spinal pachymeningitis presenting as compressive myelopathy: a case report.

Hypertrophic pachymeningitis (HP) is a rare chronic inflammatory process that causes thickening of the dura leading to compressive myelopathy. HP has diverse etiologies like infections, chronic inflammatory processes, collagen vascular diseases and malignancy. We report one such case of HP who presented with compressive myelopathy, underwent decompressive surgery and died due to complications of surgery with the original disease process.

Parathyroid adenoma with ectopic intrathymic parathyroid--a case report.

We report here a 14 year female who complained of a swelling in left flank, multiple fractures of the left humerus and tibia and a solitary nodule on the left side of the neck. Relevant investigations suggested a parathyroid adenoma. Surgical exploration of the neck was done. The adenoma was excised along with a suprasternal swelling. Histopathological examination confirmed the parathyroid adenoma of the mixed chief and oxyphil type. An incidental finding of an intrathymic parathyroid was also made. This article highlights the significance of detecting ectopic glands in abnormal locations. If undetected, these ectopic rests are subject to neoplastic change. They mimic a variety of neoplasms in these ectopic sites. Immunohistochemistry may aid in resolving this dilemma. They are also subject to functional activity and hence necessitate removal by the surgeon at the first sitting, having detected these abnormally located parathyroid tissues.

Spectrum of renal lesions in HIV patients.

BACKGROUND: A variety of renal lesions have been reported in HIV positive patients from western world however there is paucity of Indian data. METHODS: Over a four year period, all hospitalised HIV positive patients were screened for renal involvement. Screening was done with urinalysis. Those with abnormality in urine examination underwent further assessment with clinical, biochemical, immunological profile and renal biopsy. Renal histology was studied by light and electron microscopy. RESULTS: Twenty-five (17.6%) of the 142 patients screened, had proteinuria/abnormal urinary sediment however none of the patient had proteinuria in nephrotic range. Fourteen of these 25 patients were asymptomatic while others had AIDS. Renal biopsy was studied by light microscopy in all and by electron microscopy in 11 cases. On histology mesangioproliferative GN was encountered in eight, focal segmental glomerulosclerosis in four and collapsing GN in one patient. In two cases cryptococcal infiltration and in one lymphomatous deposits were seen in glomerulus and interstitium. In one patient interstitium showed granulomas and in other three mononuclear cell infiltration. Histology was normal in 8 (32%) patients. On EM visceral cell hyperplasia and vacuolisation was seen in all, two had collapse of glomerular basement membrane and in three cases tubuloreticular structures were seen. There was no co-relation of renal histology with duration or severity of the disease (p > 0.05). No deterioration of renal function was seen over a short follow up period of 4.2 months (1-20 months). CONCLUSION: This study highlights that HIV patients exhibiting abnormal urinary sediment usually have underlying renal lesion and at times unexpected opportunistic infections may be present.

Emerging bacterial drug resistance in hospital practice.

The growing multiple drug resistance among bacteria in hospital practice is posing a serious threat to the successful antimicrobial therapy. Our data on the bacterial drug resistance at a tertiary care centre during 1995-1996 has been alarming with an incidence of 73 to 99% resistance to the common antibiotics like ampicillin, chloramphenicol, cotrimoxazole and first generation cephalosporins among the gram negative isolates. The resistance to gentamicin and ciprofloxacin ranged from 53 to 79%. Resistance to amikacin, netilmicin and the third generation cephalosporins ranged from 30 to 73%. The frightening observation was the emergence of resistant isolates which were sensitive only to two drugs, sensitive only to one drug and resistant to all the available antibiotics (2.64, 17.6 and 11.5% respectively) during 1994 to 1996. Resistance among the gram positive bacteria was much less but the increase in methicillin resistant Staphylococci (52-65%) was a serious matter. The data were an eye opener and the infection control measures could bring marginal improvement in the situation in 1996. It is vehemently appealed that the national antibiotic policies be formed and be stringently implemented before we are thrown back to the pre-antibiotic era.

Antibiogram study over bacterial isolates from cases of bacteraemias.

During January, 1994 to December, 1994, 703 of the 1778 blood specimen were positive for blood culture and 59.9% of the isolates were of staphylococci. Thirty two percent of the staphylococci were methicillin resistant. Netilmycin showed the lowest in vitro resistance among Gram positive cocci & Klebsiella species. Netilmycin, amikacin, ciprafloxacin and the third generation cephalosporins in general showed greater in vitro sensitivity among gram negative bacilli. The netilmycin had the lowest incidence of drug resistance based on the pooled data over the blood culture.