AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair

@#Introduction: The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods: This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray’s test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results: The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion: AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.

A Review On Pyrazoline Derivatives As Antimicrobial Agent

At present, there is a lot of research about the pyrazoline heterocyclic compound, its ring structure is being changed and new derivatives are being made, many of which have antimicrobial activity over the derivatives. Pyrazoline is the five-member heterocyclic ring which have two N atoms in nearby position and contains two endocyclic double bonds. Noteworthy consideration has been concentrated on pyrazolines and pyrazoline derivative due to their important pharmacological action. Some replaced pyrazolines have been stated near retain particular important pharmacological actions as antimicrobial, antifungal, antineoplastic, antidepressant, insecticidal, anticonvulsant, anti-inflammatory, antibacterial and antitumor properties.

Re-exposure animal bite management among incident animal bite cases in a secondary care Hospital in Delhi, India

Complete postexposure prophylaxis with 4 doses of anti-rabies vaccine (ARV) in a previously vaccinated (nonna飗e) individual results in administration of two extra ARV doses resulting in wastages of precious resources comprising vaccine logistics, human resources, physician, and patient time. This cross-sectional study conducted in a secondary care hospital in Delhi among 175 incident animal bite cases observed 39 (22.3%) had an animal-bite history within the previous 5 years. A total of 19 (10.8%) cases reported a history of complete ARV vaccination during a previous animal-bite exposure. However, in the absence of supportive patient medical documentation, all the animal bite cases without exception were prescribed a full course of ARV irrespective of their previous exposure status. Rabies immunoglobulins (anti rabies serum) were also re-administered in 13 (81.2%) cases. National guidelines for rabies prophylaxis should, therefore, consider the inclusion of an explicit decision-making algorithmic mechanism when the health-care provider is confronted with this situation carrying the potential for hidden vaccine wastage.

Early detection of multi-drug resistance and common mutations in Mycobacterium tuberculosis isolates from Delhi using GenoType MTBDRplus assay.

Purpose: There is scarcity of prevalence data of multi-drug–resistant tuberculosis (MDR-TB) data and common mutations responsible in North India. This study aimed to detect MDR-TB among MDR-TB suspects from Delhi and mutation patterns using GenoType MTBDRplus assay. Materials and Methods: All MDR suspects in fi ve districts of New Delhi were referred to the laboratory from 1st October 2011 to 31st December 2012 as per criterion defi ned by Programmatic Management of Drug Resistant Tuberculosis (PMDT). GenoType MTBDRplus assay was performed on 2182 samples or cultures and mutations in the rpoB gene for rifampicin (RIF) and katG and inhA genes for isoniazid (INH) were analyzed. Results: A total of 366 (16.8%) MDR-TB cases were diagnosed. MDR rate was found to be 32%, 16.6% and 10.2% during criterion A, B and C respectively. The most common mutation detected for RIF was S531L (59.0%) and for INH was S315T1 (88.3%). Mutations S531L and S315T1 occurred signifi cantly higher in MDR strains as compared to RIF mono-resistant and INH mono-resistant strains, respectively. Average laboratory turn-around time (TAT) for dispatch of result to districts for test conducted on samples was 4.4 days. Conclusion: GenoType MTBDRplus is a useful assay for rapid detection of MDR-TB. The common mutations for RIF and INH were similar to those seen in other regions. However, mutations determining MDR strains and mono-resistant strains differed signifi cantly for both RIF and INH.

Sickle Children Vs Normal Children: A Transcranial and Extracranial Doppler Study.

A prospective hospital based study was carried out to evaluate the role of transcranial Doppler in sickle cell anemia for period of 2 yrs (July 2009- August 2011). A total of 100 children, 50 normal individuals in control group and 50 diagnosed sickle cell disease patients in sickle group were evaluated in the age group .Children were from Newborn to15 years of age, of which 62% were males and 38% were females. Common Carotid Artery (CCA), External Carotid Artery (ECA), Internal Carotid Artery (ICA), Vertebral Artery,Middle Carotid Artery (MCA), Anterior Carotid Artery (ACA), Posterior Carotid Artery (PCA) was evaluated by Transcranial and Extracranial Doppler on both sides in sickle cell patient. The mean velocities in all the vessels were higher in sickle group patient as compared to normal group patients. Evaluation of Extracranial carotid vessels has not been done in previous published studies. Our study can act as benchmark in extracranial Doppler studies of sickle cell patients. We have not followed the patients of sickle cell disease till stroke, but we can say with certainty that increased values of velocity >200 cm/sec is an absolute indication for blood transfusion to prevent stroke, which was observed in 10% of sickle cell patient in our study where velocities reduced by 20-25 cm/sec after blood transfusion.

A Rare Case of Prolapsed Omphalomesenteric duct with ruptured Umbilical Hernia.

Strangulated ileal intussusceptions into the Meckel’s diverticulum (which is caused by an incomplete obliteration of omphalomesentric duct) and coming out through ruptured umbilical hernia is an extremely rare presentation. A 3- months- old male child presented with low grade fever, refusal to feed and episodes of discomfort often alternating with long period of sleepiness and lethargy. On abdominal examination loops of intestine were seen at the site of ruptured umbilical hernia. The abdomen was opened under general anaesthesia by transverse incision. Proximal ileal intussusception into the Meckel’s diverticulum, which was gangrenous, was noted. A resection with end to end ileo-ileal anastomosis was undertaken. The prolapsed bowel was replaced back and double breasting of umbilical defect was done with vicryl 2-0. The patient was completely asymptomatic and healthy.

Presumptive identification of Mycobacterium tuberculosis complex based on cord formation in BACTEC MGIT 960 medium.

We considered samples received for culture of mycobacteria using BACTEC MGIT 960 system over a period of 1 year. Tubes flagged positive by MGIT were evaluated for presence of serpentine cording. The cord formation was compared with isolates identified as Mycobacterium tuberculosis complex (MTC) based on p-nitrobenzoic acid (PNB) test. Cords were found in 591 isolates of which 584 (98.8%) were confirmed as MTC. The sensitivity and specificity of cord formation were found to be 99.7% and 89.9%, respectively.

Human pneumocystosis.

Pneumocystis is an atypical fungus causing pneumonia in immuno-compromised individuals. Though previously termed as Pneumocystis carinii, the recent taxonomy has considered human derived Pneumocystis to be a different species Pneumocystis jiroveci. The organism is the most common cause of opportunistic infections among patients with acquired immunodeficiency syndrome (AIDS) in developed countries. Incidence of Pneumocystis pneumonia or pneumocystosis in developing countries including India continues to be low. Microscopy of appropriate clinical samples has been the mainstay of diagnosis of pneumocystosis. Amplification techniques are now being evaluated for detection of P. jiroveci. This review attempts to give a recent update on P. jiroveci with special focus on epidemiology, taxonomy, current diagnostic modalities and recommended immuno-prophylaxis.

Analysis of serological evidence of different hepatitis viruses in acute viral hepatitis in prisoners in relation to risk factors.

BACKGROUND & OBJECTIVES: The present study describes an outbreak of acute viral hepatitis in an institutional population (inmates of a prison) with an aim to delineate the etiological agents of this outbreak and to analyse the clinical, biochemical and serological evidence of different hepatitis viruses in relation to risk factors. METHODS: Fifty patients of acute viral hepatitis identified during the outbreak were evaluated on the basis of history, clinical examination, risk factor distribution, biochemical profile and serological markers for hepatitis A-E infection. Adequate epidemiological data were collected from prison administration including housing of prisoners, food and water supply. RESULTS: Of the 50 patients, 35 (70%) had serological evidence of HEV infection. Evidence of HBV infection was found in 17 patients (34%), HAV infection in 2 (4%) and HCV in 8 (16%) patients. While 16 patients (32%) had evidence of multiple viral infections, none of the viral markers could be detected in 8 patients (16%). One or more risk factor(s) could be identified in more than half of the subjects (26/50; 52%). There were 11 patients who gave history of more than one risk factor while 24 (48%) patients had none of the risk factors. INTERPRETATION & CONCLUSIONS: HEV was found to be the major cause of the outbreak and contamination of drinking water supply could be the possible source of infection. This outbreak was seroepidemiologically similar to other outbreaks of hepatitis occurring in the country with HEV being the most common cause. However, there was evidence of multiple viral infections, particularly HBV and HCV in the high-risk predisposed prison population.

Recurrent femoral pseudoaneurysm following intravenous opioid abuse: a case report.

Long term intravenous drug abuse is associated with recurrent femoral pseudoaneurysm in a 36-year-old man. The clinical features alongwith a suitable discussion is described in this case report.

Risk factors for duodenal ulcer in north India.

OBJECTIVES: The present study was designed to evalutate the association of various risk factors such as smoking, alcohol, NSAIDs, inadequate dietary intake of fibres and consumption of spicy foods with chronic duodenal ulcer using a case-control design and to establish the association of Helicobacter pylori and duodenal ulcer using different diagnostic techniques in Indian subjects. MATERIALS: A total of 16 consecutive patients with endoscopically proven duodenal ulcer (DU) constituted the test group while 160 subjects with non-ulcer dyspepsia (NUD) were recruited as controls. METHODS: All subjects were interviewed based on a standard questionnaire and underwent an upper gastrointestinal endsocopy wherein multiple biopsies were taken for rapid urease test (RUT), histology and culture for detection of H. pylori. The serum samples of all the subjects were tested for the presence of antibodies against H. pylori using ELISA. RESULTS: There were significantly greater number of smokers (80%) and alcoholics (58%) in the male population of DU group as compared to the controls (49% smokers & 15% alcoholics). Similar trend was seen in relation to history of chronic exposure to NSAIDs (29% in DU & 11% in NUD) and inadequate intake of fibre in diet (66% and 39% respectively). The overall prevalence of H. pylori was 82.5% in DU and 50.6% in NUD [p < 0.001]. CONCLUSIONS: In North Indian subjects, alcohol consumption, smoking, inadequate intake of fibre in diet and use of NSAIDs are the risk factors associated with doudenal ulcer disease. Further, infection with H. pylori is strongly associated with DU in the North Indian population.

Intracellular signalling: phosphatidylinositol lipid metabolism in cancer cells.

Evidence for heightened capacity for signal transduction in rat hepatoma as well as in human breast and ovarian carcinoma cells as reflected by coordinate increases in PI kinase and PIP kinase in the PI phosphorylation sequence leading to the production of second messengers IP3 and DAG is shown. The linkage of signal transduction enzymes with malignant growth is also seen as MDA-MB- 435 human breast carcinoma or ovarian OVCAR-5 cells express their proliferative capacity in tissue culture in the log phase. In both cases, quercetin inhibit cell proliferation with a decline in PI kinase activity and IP3 levels preceding the growth inhibition seen with quercetin. The elevated steady state activities of PI and PIP kinase indicate a metabolic up-regulation in signal transduction capacity of cancer cells which is down-regulated by quercetin. Since the gain in function manifested in the over-expressed capacity for signal transduction confers selective growth advantage to cancer cells, increased activities of PI and PIP kinases may be considered as sensitive targets for cancer chemotherapy. The potential of quercetin as an interceptor of intracellular signal transduction mechanisms needs to be explored.

Bleomycin, cisplatinum and ifosfamide infusion chemotherapy in advanced/recurrent cancer of cervix.

Twenty one patients age ranging from 26-70 years, with biopsy proven recurrent/advanced carcinoma of the cervix were treated with bleomycin, cisplatinum and ifosfamide infusion therapy. 88% patients reported subjective improvement. The objective response rate was 66.6% (Complete 38% and partial 28.5%). Side effects were mainly nausea, vomiting, and alopecia. Treatment related fever was common. Hematuria and reversible encephalopathy with ifosfamide were seen in three and two patients respectively. These results indicate that BIP infusion chemotherapy is an active and safe combination for treatment of advanced/recurrent cervical cancer.

Primary Hodgkin's disease of small intestine: a report of two cases.

Two patients with primary Hodgkin's disease of the small intestine are reported because of rarity of this condition. Both patients presented with primary intestinal symptoms and were diagnosed after surgical resection. The modalities of treatment and favorable long term survival are presented.

Correlation between antibodies to mannophosphoinositides & detection of antigen in circulating immune complexes in patients with pulmonary tuberculosis.

Enzyme linked immunosorbent assays were used to detect the concentration of mannophosphoinositides in circulating immune complexes (CICs) and antibodies to these antigens in the sera of patients with pulmonary tuberculosis. Serum samples from 235 tuberculosis patients at various levels of disease progression were analysed. Multiple regression analysis showed a direct correlation between antigen levels in CICs and serum antibodies to mannophosphoinositides.