Clinical and functional outcome of total knee arthroplasty in osteoarthritic patients at a tertiary care center in Kerala: a prospective study

Background:Osteoarthritis affects the knee joint more frequently than any other joint. Osteoarthritis is a chronic joint disease that affects the older age group, women more frequently, and is associated in 90% of cases with a varus deformity of the knee. The following study was conducted to evaluate the functional outcome of total knee arthroplasty in osteoarthritis using the knee society score.Methods:The study was conductedin patients treated for osteoarthritis of the knee joint at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala during the period from December 2019 to March 2022. Thirty patients diagnosed with osteoarthritis of the knee joint were taken into the study, all were undergone total knee arthroplasty. Patients were followed up at 4 weeks, 12 weeks, and 24 weeks.Results:The sample consisted of thirty osteoarthritic patients with 8 males and 22 were females. The patients' ages ranged from45-75 years. Among these 30 patients, 14 involved the right side, and 16 involved the left knee joint. The mean pre-operative knee clinical score was 36.93 which was improved to post-operative 84.70 following total knee arthroplasty. The mean pre-operative knee functional score was 16.83 which was improved to post-operative 71.17 following total knee arthroplasty.The outcome was rated as per knee society score. We got excellent results in 25 cases (83%), good in 3(10%), and fair in 2 patients (7%) according to knee clinical score whereas 8 excellent (27%), 16 good (53%), 5 fair (17%) and 1 poor(3%) results were found according to knee functional score.Conclusions:Total knee arthroplasty shows drastic improvement in the functional ability of the patient and the ability of the patient to get back to a pre-disease state, which is mainly because of pain-free joint movements, reflected by the improvement in the post-operative knee clinical score and knee functional score.

Utility of Neutrophil to Lymphocyte Ratio as a Predictor of Complications in Patients with Liver Cirrhosis.

Neutrophil to Lymphocyte Ratio (NLR) has been considered an inexpensive biomarker to reflect inflammation in patients with cirrhosis. Raised NLR has been associated with poor clinical outcome and mortality in these patients. We conducted this study to correlate the association of Neutrophil to Lymphocyte Ratio with complications of cirrhosis and assess the short-term outcome during hospital admission. MethodsWe conducted a prospective observational study in 120 patients with cirrhosis from January 2017 to June 2018. All patients were diagnosed based on clinical history, examination and ultrasound. Complications were diagnosed by clinical and laboratory evaluation. Total white blood cell count, lymphocyte count, and neutrophil count were recorded, and neutrophil to lymphocyte ratio was calculated. Statistical analysis by means of test of association and binary logistic regression analysis was carried out. ResultsOut of the 120 patients enrolled in our study, majority were male (90%), and in the age group 51 - 60 years (38.3%). Majority (39.2%) of the patients had portal hypertension with oesophageal variceal bleeding as complication. Mean NLR for the patients was 5.824. A total of 91% patients with NLR>12 were admitted with decompensated liver disease and 66.7% of those patients presented with more than 2 complications that is hepatic encephalopathy and spontaneous bacterial peritonitis. 41.7% patients with NLR >12 had mortality as the outcome. Chi square test of association of NLR with complications (p=0.003) and mortality (p=0.03) were significant. However, NLR could not predict complications in our study population. ConclusionsRaised Neutrophil to Lymphocyte Ratio is associated with complication and mortality in patients with cirrhosis. However, it could not effectively predict the complications in patients with cirrhosis.

An Osteological Study Of Arcuate Foramen In Atlas And Its Clinical Significance

Background: Atlas, first cervical vertebra bears sulcus over posterior arch for third part of vertebral artery.Sometimes an osseous bridge converts the sulcus into a foramen called as Arcuate foramen. It is commonlycalled as Kimmerle’s anomaly, also known as Ponticulus Posticus. It is the product of the complete or incompleteossification of the posterior atlanto-occipital membrane over the vertebral artery groove resulting in the formationof a foramen (Arcuate foramen) containing the vertebral artery and the posterior branch of the C-1 spinal nerve.This variation has been associated with vertebro-basilar insufficiency symptoms, various types of headaches,and acute hearing loss. The knowledge of this variant prevents complications during lateral mass screw fixation,posterior laminectomy and endovascular surgery.Aims: The aim of the present study was to analyze the percentage of incidence of arcuate foramen and to identifyits clinical significance.Materials and Methods: Hundred dried human atlas bones were used to study the presence of arcuate foramen inthe department of Anatomy at ESIC Medical College and PGIMSR, Rajajinagar, Bangalore.Results: We came across the presence of arcuate foramen in two out of hundred bones. In both the atlas bones,osseous bridge extending from posterior aspect of superior articular facet to the posterior arch of atlas on theleft side, forming arcuate foramen, posterior to foramen transversarium was observed.Conclusion: Arcuate foramen commonly called as Kimmerle’s anomaly where in a groove for vertebral artery isconverted into a foramen by ossification of the ligament. Awareness of osseous bridging is essential in performingcranio-cervical junction surgeries. It also serves as an anthropological data and also identifying the impact ofcomplete arcuate foramen on the signs and symptoms of vertebra-basilar insufficiency.

In vitro cytotoxicity and antimicrobial activity of Talaromyces flavus SP5 inhabited in the marine sediment of Southern Coast of India / 中国天然药物

Marine sediment samples were collected from the coastal areas of Southern India, particularly in Kanyakumari District. Twenty-eight different fungal strains were isolated. The screening of fungi from marine sediment was done to isolate a potent fungus that can produce bioactive compounds for biomedical applications. Only three strains viz Trichoderma gamsii SP4, Talaromyces flavus SP5 and Aspergillus oryzae SP6 were screened for further studies. The intracellular bioactive compounds were extracted using solvent extraction method. The crude extracts were tested for its anti-microbial and anti-cancer properties and analytically characterized using Gas Chromatography Mass Spectrometry (GC-MS). All the three extracts were active, but the extract from T. flavus SP5 was found to be more active against various human pathogens, viz., Pseudomonas aeruginosa ATCC 27853 (17.8 ± 0.1), Escherichia coli ATCC 52922 (18.3 ± 0.3), and Candida tropicalis ATCC 750 (17.7 ± 0.4). It also exhibited cytotoxic activity against HEp2 carcinoma cell line with the LC value of 25.7 μg·L. The GC-MS data revealed the presence of effective bioactive compounds. These results revealed that the extract from isolated fungus T. flavus SP5 acted as a potent antimicrobial, antifungal, and anticancer agent, providing basic information on the potency of marine fungi towards biomedical applications; further investigation may lead to the development of novel anticancer drugs.

Prediction of age at menopause in women of suburban areas in Chennai using a model of FSH over age - a pilot study

The human ovary is characterized by early senescence and the end stage of ovarian activity is termed menopause. The age at which menopause occur is between 45 and 55 years world wide. The objective of this pilot study is to determine the age at menopause by using a model of FSH over age in women of sub urban region around Chennai, India. The subjects include 500 patients of age between 30 and 36 yrs with BMI ranging from 24-28. After recording their general profile and history, blood samples were obtained by venipuncture and hormone FSH was estimated on the day 3 of the menstrual cycle. Based on functional dependence of FSH in the form of exponential relation with age, a model was proposed. Using least square approximation the beta values were calculated. With the help of beta values and using the cut off value of 40 IU/ml for FSH, this predicted model determined the age of menopause as 44.6 yrs in women of sub urban region around Chennai. The age of menopause is different in various region worlds wide. According to this pilot study the suburban women of Chennai, attain menopause at an age of 44.6 years. Further exploration should be done to alleviate the role of diet, life style and ethnic variation on menopausal age and the impact of chronic disease like osteoporosis during the period of menopause

Hepatoprotective and cytoprotective properties of Hyptis suaveolens against oxidative stress-induced damage by CCl(4) and H(2)O(2)

OBJECTIVE@#To investigate capacity of Hyptis suaveolens (H. suaveolens) methanol extract as an antioxidant to protect against carbon tetrachloride (CCl(4))-induced oxidative stress, hepatotoxicity in Albino Wistar rats and cytoprotective effect of hydrogen peroxide (H(2)O(2)) induced cell death in HepG(2) cell line.@*METHODS@#Two different doses of methanol extract of H. suaveolens were evaluated for the hepatoprotective activity against carbon tetrachloride (CCl(4)) induced hepatotoxicity in rats. Animals in Group I: served as control, group II: H. suaveolens (100 mL/kg b.w), group III: H. suaveolens (50 mL/kg b.w) + CCl(4) (1 mg/kg), group IV: H. suaveolens (100 mL/kg b.w) + CCl(4) (1 mL/kg) and group V: CCl(4) (1 mL/kg). Histopathologic changes of liver were also evaluated. Cytotoxicity was also determined by 3, (4,5-dimethylthiazol-2-yl)2,5-diphenyl-tetrazolium bromide (MTT) assay.@*RESULTS@#Oral sigle dose treatment of CCl(4) produced a marked elevation in the serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and Lactate dehydrogenase (LDH). Histopathological analysis of the liver of CCl(4)-induced rats revealed marked liver cell necrosis with inflammatory collections that were conformed to increase in the levels of SOD, GSH, GST, GR and LPO. Treatment with H(2)O(2) significantly induced death of HepG(2) cell. Pretreatment with H. suaveolens methanol extract inhibited or attenuated H(2)O(2) induced cytotoxicity.@*CONCLUSIONS@#This study shows that H. suaveolens methanol extract can be proposed to protect the liver against CCl(4)-induced oxidative damage in rats and protect the cells against H(2)O(2)-induced oxidative damage in HepG(2) cells. The hepatoprotective and cytoprotective effects might be correlated with its antioxidant and free radical scavenger effects.

Comparative study on production, purification of penicillin by Penicillium chrysogenum isolated from soil and citrus samples

<p><b>OBJECTIVE</b>To explore various unexplored locations where Penicillium spp. would be available and study the production of penicillin from the isolated Penicillium spp. in different media with altered carbohydrate source.</p><p><b>METHODS</b>The collected soil samples were screened for the isolation of Penicillium chrysogenum (P. chrysogenum) by soil dilution plate. The isolated Penicillium species were further grown in different production media with changes in the carbohydrate source. The extracted penicillin from various isolates was analyzed by HPLC for the efficacy of the product. Further the products were screened with various bacterial species including methicillin resistant Staphylococcus aureus (MRSA). And the work was extended to find the possible action on MRSA, along with characterization using other pathogens.</p><p><b>RESULTS</b>From the various soil and citrus samples used for analysis, only the soil sample from Government General Hospital of Bangalore, India, and Sanjay Gandhi Hospital, Bangalore, India, showed some potential growth of the desired fungi P. chrysogenum. Different production media showed varied range of growth of Penicillium. Optimum production of penicillin was obtained in maltose which proved maximum zone of inhibition during assay. Characterization of penicillin on pathogens, like wild Escherichia coli strain, Klebsiella spp., and MRSA, gave quite interesting results such as no activity on the later strain as it is resistant. HPLC data provided the analytical and confirmation details of the penicillin produced. Accordingly, the penicillin produced from the soil sample of Government General Hospital had the high milli absorbance unit of 441.5 mAu compared with that of the penicillin produced from Sanjay Gandhi Hospital sample, 85.52 mAu. Therefore, there was a considerable change in quantity of the penicillin produced from both the samples.</p><p><b>CONCLUSIONS</b>The Penicillium spp. could be possibly rich in hospital contaminants and its environments. This research focuses on various unexplored sources of medical ailments, and also shows that the growth of penicillin is high in maltose rich media that could possibly enhance the growth.</p>

Simultaneous determination of multi drug components theophylline, etofylline, guaiphenesine and ambroxol hydrochloride by validated RP-HPLC method in liquid dosage form

The RP-HPLC [reverse phase high performance liquid chromatography] method was developed and validated for simultaneous determination of Multi drug components i.e., Theophylline, Etofylline, Guaiphenesine and Ambroxol Hydrochloride in a liquid dosage form. Chromatographic separation of the four drugs was performed on a Hypersil Phenyl BDS [25cmX4.6mm, 5um]. The mobile phase constituted of triethylamine pH 3.0 buffer: methanol [85:15] v/v was delivered at the flow rate 1.5 mL/min. Detection was performed at 235 nm. The peak purity of Theophylline, Etofylline, Guaiphenesine and Ambroxol Hydrochloride were 0.99970, 0.99979, 0.99986 and 0.99949 respectively. Calibration curves were linear with correlation coefficient between 0.99995 to 0.99997 over a concentration range of 5 to 37 micro g/mL for Theophylline, 19 to 140 micro g/mL for Etofylline, 20 to 149 micro g/mL for Guaiphenesine and 6 to 45 micro g/mL for Ambroxol hydrochloride. The relative standard deviation [RSD] was found < 2.0%. The percentage recovery was found between th e range of 98.6% and 100.5% at three different levels. Robustness and ruggedness were performed and result found within the RSD of 2%. All the parameters of validation were found in the acceptance range of ICH guideline

The response of Rhizobium meliloti to L-methionine DL-sulphoximine.

A strain of Rhizobium meliloti has been shown to be capable of growth in the presence of methionine sulphoximine concentrations at least two orders of magnitude higher than that required for the complete inhibition of glutamine synthetase activity. Neither the specific growth rate, nor the nutritional requirements of the organism were affected by methionine sulphoximine in the medium. Rhizobium meliloti appeared to assimilate ammonia via the glutamate dehydrogenase pathway during growth in the presence of methionine sulphoximine. This suggests that Rhizobium meliloti may have some regulatory mechanism controlling ammonia assimilation that is not present in other enterobacteria possessing similar enzymatic machinery.