[Errata] Estudo piloto sobre diâmetro do canal lombar e distância percorrida em pacientes com estenose espinhal lombar: um modelo de predição multivariado / [Erratum] Pilot study on lumbar canal diameter and walking distance in patients with lumbar spinal stenosis: a multivariate prediction model

INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.

INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.

Reporting adverse events of ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) among the vaccinated healthcare professionals: A cross-sectional survey

Background & objectives: The safety of the ChAdOx1 nCoV-19 vaccine is a cause of concern for many who have been vaccinated. The people have multiple concerns and fear regarding the adverse events of the vaccine. Thus, this study was undertaken to establish the safety profile of ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) among the healthcare professionals. Methods: This was a descriptive cross-sectional survey. After taking clearance from the institutional ethics committee 1500 healthcare professionals, who had their vaccination in the past two weeks were selected. They were provided with an online survey proforma regarding adverse events following immunization (AEFIs) of COVID-19 vaccine developed using google forms with an informed consent form affixed to it. Results: A total of 1036 individuals participated in the study. The mean and median (inter quartile range) age of the participants was 37.7 ±11.25 and 35 (29-46) yr, respectively. Of these, 52.1 per cent were female, 29.3 per cent were doctors, 33.4 per cent were nurses and 9.5 per cent were paramedical staff. Forty six per cent participants experienced one or more minor AEFIs such as pain, tenderness, redness, etc. at the injection site. Fatigue (31.75%), generalized feeling of unwell (28.57%), muscle pain (23.16%) and fever (21.71%) were the most commonly reported systemic AEFIs followed by headache (20.07%), dizziness (10.03%) and joint pains (15.25%). Most of them experienced these AEFIs within 24 h of the first dose of administration. About 42 per cent of the participants took oral antipyretics/analgesics for managing the AEFIs. Interpretation & conclusions: ChAdOx1 nCoV-19 Corona Virus Vaccine was found to be associated with mild local and systemic AEFIs that were more common after the first dose as compared to the second dose. There adverse events could be dealt with oral over-the-counter medications, with no requirement of hospitalization

Estudo piloto sobre diâmetro do canal lombar e distância percorrida em pacientes com estenose espinhal lombar: um modelo de predição multivariado / Pilot study on lumbar canal diameter and walking distance in patients with lumbar spinal stenosis: a multivariate prediction model

INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.

INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.

Congenital Pseudarthrosis of Tibia- Treated Using Ilizarov Technique.

The diagnosis of congenital pseudarthrosis of the tibia (CPT) in pediatric age group is difficult (1), particularly if the patient had repeated trauma and was mismanaged.[2,3] The etiology of congenital pseudarthrosis is unknown. Mostly patient presents with neurofibromatosis.[4] Most of cases have defect on anterolateral angulation. Most effective treatment option for CPT is surgery. Surgical methods like Ilizarov technique, intramedullary fixation, and grafting [5] with combination of two or three types surgeries. However, Ilizarov ring fixation is the most effective treatment option. Every surgery should include correction of deformity, bone remodeling, limb lengthening, and complete removal of the lesion. Many patients developed deformity and degenerative arthritis of knee and ankle joints. Unfortunately, operation can’t differ according to the nature of disease history and pathology.[1] As such cases should undergo Ilizarov ring fixation. Most common complication was refracture. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed.

Functional Outcome of Treatment of Fracture Shaft Femur in Children Using Titanium Elastic Nails System.

Fractures of the femur are the most incapacitating fractures. For children aged 6-16 years, there is no clear consensus as to the preferred treatment. The conventional treatment of traction and casting is no longer preferred. We report our experience in titanium elastic nailing for treatment of paediatric femoral diaphyseal fractures. We wanted to study the functional outcome following the use of flexible titanium nails for femoral shaft fractures in children and evaluate the duration of union in the above-mentioned fractures. We also wanted to study the complications of fracture shaft femoral after intramedullary nailing.METHODSThirty patients in the age group of 6-16 years with displaced diaphyseal femoral fractures were stabilized with titanium elastic nails. Patients were followed up clinically and radiologically for a minimum period of 6 months to 1 year. The final results were evaluated using Flynn’s criteria. Technical difficulties and complications associated with the procedure were also analysed.RESULTSOverall results were excellent in 28 cases and satisfactory in 02 cases. No patient had poor result. The average hospital stay was 6.47 days. All the fractures healed in 70 days (10 weeks) of times with an average time of union of 60 days (7.5 weeks). The most common complication encountered was soft tissue irritation at the nail entry site seen in 2 cases. Clinically, shortening was noticed in 3 cases, while no patient had lengthening. Malalignment was seen in only 6 cases. There was no iatrogenic bone injury, delayed injury and non-union, bending or breaking of implant, refracture and avascular necrosis of femoral head. There was no evidence of physeal injury on follow up.CONCLUSIONSTitanium elastic nails are a relatively easy to use, minimally invasive, physeal-protective implant system with high rate of good and excellent outcomes in children aged 6-16 years. Technical pitfalls can be eliminated by adhering to the basic principles.

Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture   and   rapid   inclusion   of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups.

Lumbosacral Transitional Vertebrae- An Osteological Study In Dry Human Sacra Of North Indian Origin With Its Clinical And Forensic Implications

Context: Lumbosacral transitional vertebrae (LSTV) are congenital anomalies that occur due to defect in normalsegmentation of the lumbosacral spine during development. This may be either in the form of assimilation offifth lumbar vertebra with the sacrum (sacralisation), or transition of the first piece of sacral vertebra into thelumbar configuration (lumbarisation).Aims and Objectives: Although presence of LSTV is common in general population but knowledge about its exactclinical implications is still lacking. The primary aim of the present study was to determine the rate of incidenceof transitional vertebra and their sex difference (if present) in dried human sacra. Secondary aim was to studythese transitional vertebra in detail and correlate these findings clinically.Materials and Methods: A total of fifty unbroken adult sacra were examined (male to female ratio of 3:2). Thepresence or absence of a lumbar transitional vertebra was noted and classified as incomplete or complete. Thesacral indices (SI) of all sacra were measured and values compared between typical and atypical sacra with LSTVas well as between male and female sacra.Results: Out of fifty sacra, six sacra (12%) showed presence of LSTV. Among them, four (8%) showed sacralisationof the fifth lumbar vertebra and two (4%) showed lumbarisation of first sacral vertebra. Among the four sacrashowing sacralisation, two showed incomplete fusion and two showed complete fusion of fifth lumber vertebrawith sacrum. LSTV was found to be more common in male than female. Sacralisation was seen only in male sacrawhile lumbarisation only in female sacra. The difference in the mean SI of typical sacra (97.76±4.08) and sacrawith LSTV (83.69±2.38 and 98.11±1.52 for sacralised and lumbarised sacra respectively) was found to bestatistically significant (p<0.05) and that between the male (94.55±5.70) and female (100.14±3.42) sacra wasfound to be highly significant (p<0.01).Conclusion: Presence of LSTV has many clinical and forensic implications and its knowledge is important fororthopaedic surgeons, neurosurgeons, forensic experts and also to radiologists.

Ameliorative effect of daidzein: A caveolin-1 inhibitor in vascular endothelium dysfunction induced by ovariectomy.

Estrogen deficiency was produced in female Sprague-Dawley rats by surgical removal of both the ovaries and these animals were used 4 weeks later. Endothelium-dependent and endothelium-independent relaxations due to acetylcholine and sodium nitroprusside were observed respectively, in isolated rat thoracic aortic ring preparation. Extent of lipid peroxidation was measured by estimating serum TBARS. Integrity of vascular endothelium was assessed using hematoxylin and eosin staining. Generation of nitric oxide was measured indirectly, by estimating serum and urinary nitrite/nitrate concentration. Ovariectomy produced significant vascular endothelial dysfunction, measured in terms of reduced acetylcholine-induced endothelium-dependent vasorelaxation, serum and urinary nitrite/nitrate concentration and impairment of integrity of vascular endothelium. Administration of daidzein (0.2 mgkg-1day-1, sc 0.4 mgkg-1day-1, sc and 0.8 mgkg-1day-1, sc) and Atorvastatin (30 mgkg-1day-1, po Positive Control) for one week markedly improved vascular endothelial dysfunction due to increase in nitric oxide bioavailability perhaps by inhibiting caveolin-1 and activation of PI3K-AKT pathway.

Multiple Enchondromatosis: Ollier's Disease.

Multiple enchondromatosis (Ollier's disease) is a rare disease characterized by widespread enchondromas with a unilateral predominance, especially in fingers in early childhood. In general, the short tubular bones of the hand are involved, with progressive lesions resulting in cosmetic problems and functional deformities. Herein, we, describe two cases of Ollier's disease diagnosed on X-ray of hands followed by MRI. There was no evidence of cortical disruption or periosteal reaction associated in either case. The bone lesions revealed cartilaginous matrix. MRI using conventional T1W and T2W sequences and STIR showed expansile lesions within the metacarpals and phalanges of both hands with cartilaginous matrix.

A Comparative Study of Management of Thoracolumbar Spine Injuries with Neurological Deficit by Steffee Plating and Conservative Method.

In a prospective study conducted in the Postgraduate Department of Orthopaedics Govt. Medical College, Jammu, over a period of 2 years. Forty cases, both male and female in the age group of 20 to 50 years with thoracolumbar spinal injury between D11 and L2 vertebra with neurological deficit were included . Out of these forty cases, 20 cases were managed by posterior decompression and stabilization with Steffee plating and 20 cases of similar injuries were managed conservatively and comparison of the two groups was made. The results were analyzed according to neurological improvement as per Frankel's grading, the complications and the duration of hospital stay in both the groups. In operative group; 50% of the patients showed some degree of recovery with 30% of the patients showed full recovery. The mean postoperative correction of kyphosis was 12.5% and the average hospital stay was 23.7days. 15% of the patients in operated group developed complications. In the conservative group; 30% of the total patients showed neurological recovery with 20 % patients showed significant recovery (Grade D). There were various complications in 65% patients and the average hospital stay was recorded as 40.5 days. General complications were more in conservative group. In view of increased incidence of neurological recovery, decreased incidence of complications, decrease in hospital stay and ease of nursing care in case of operated group, we recommend posterior spinal fixation with Steffee plate system in patients with unstable dorsolumbar spinal fractures especially with incomplete neurological deficit to be adopted in oprative practise.

Role of glucagon-like peptide-1 in vascular endothelial dysfunction.

The present study has been undertaken to investigate the effect of exendin-4 (a glucagon-like peptide-1 agonist) in diabetes mellitus (DM) and hyperhomocysteinemia (HHcy)-induced vascular endothelial dysfunction (VED). Streptozotocin (55 mg kg−1, iv, once) and methionine (1.7% w/w, po, 4 weeks) were administered to rats to produce DM (serum glucose >200 mg dl−1) and HHcy (serum homocysteine >10 μM) respectively. VED was assessed using isolated aortic ring preparation, microscopy of thoracic aorta, and serum nitrite/nitrate concentration. Serum TBARS concentration was estimated to assess oxidative stress. Atorvastatin has been employed as standard agent. Exendin-4 (1 μg kg−1, ip) and atorvastatin (30 mg kg−1, po) treatments significantly attenuated increase in serum glucose and homocysteine but their concentrations remained markedly higher than sham control value. Exendin-4 and atorvastatin treatments markedly prevented DM and HHcy-induced (i) attenuation of acetylcholine-induced endothelium-dependent relaxation, (ii) impairment of vascular endothelial lining, (iii) decrease in serum nitrite/nitrate concentration, and (iv) increase in serum TBARS. However, this ameliorative effect of exendin-4 has been prevented by L-NAME (25 mg kg-1, ip), an inhibitor of NOS. It may be concluded that exendin-4 may activate eNOS due to activation of GLP-1 and consequently reduce oxidative stress to improve vascular endothelial dysfunction.

Effect of chlorophyll and aqueous extracts of Bacopa monniera and Valeriana wallichii on ischaemia and reperfusion-induced cerebral injury in mice.

Bilateral carotid artery occlusion followed by reperfusion produced significant cerebral infarction and impaired short-term memory, motor co-ordination and lateral push response. Individual pretreatments with chlorophyll and aqueous extracts of B. monniera and V. wallichii markedly attenuated ischaemia-reperfusion induced cerebral injury in terms of decreased infarct size, increase in short-term memory, motor in coordination and lateral push response. The results suggest that chlorophyll and aqueous extracts of B. monniera and V. wallichii prevent ischaemia-reperfusion induced cerebral injury with comparable potency.

Involvement of p38 Mapkinase in attenuation of antinociceptive effect of morphine in diabetic mice.

Experimental diabetes induced by streptozotocin (200 mg/kg, ip) markedly decreased the antinociceptive effect of morphine and significantly increased the urinary nitrite concentration. Administration of FR-167653 (a selective p38MAPKinase inhibitor) in a dose of 4 mg/kg improved the antinociceptive effect of morphine and attenuated the increase in urinary nitrite concentration in diabetic mice. It may be concluded that diabetes-induced decrease in antinociceptive effect of morphine may be due to induction of p38 MAPKinase activity.

Remote ischaemic preconditioning and prevention of cerebral injury.

Bilateral carotid artery occlusion of 10 min followed by reperfusion for 24 hr was employed in present study to produce ischaemia and reperfusion induced cerebral injury in mice. Cerebral infarct size was measured using triphenyltetrazolium chloride staining. Short-term memory was evaluated using elevated plus maze. Inclined beam walking test was employed to assess motor incoordination. Bilateral carotid artery occlusion followed by reperfusion produced cerebral infarction and impaired short-term memory, motor co-ordination and lateral push response. A preceding episode of mesenteric artery occlusion for 15 min and reperfusion of 15 min (remote mesenteric ischaemic preconditioning) prevented markedly ischaemia-reperfusion-induced cerebral injury measured in terms of infarct size, loss of short-term memory, motor coordination and lateral push response. Glibenclamide (5 mg/kg, iv) a KATP channel blocker and caffeine (7 mg/kg, iv) an adenosine receptor blocker attenuated the neuroprotective effect of remote mesenteric ischaemic preconditioning. It may be concluded that neuroprotective effect of remote mesenteric ischaemic preconditioning may be due to activation of adenosine receptors and consequent activation of KATP channels in mice.

Effect of bacosides, alcoholic extract of Bacopa monniera Linn. (brahmi), on experimental amnesia in mice.

To investigate the effect of bacosides (alcoholic extract of brahmi) on scopolamine (3 mg kg(-1), ip), sodium nitrite (75 mg kg(-1), ip) and BN52021 (15 mg kg(-1), ip) induced experimental amnesia in mice, using Morris water maze test, all the agents were administered 30 min before the acquisition trials on each day and repeated for 4 consecutive days, and on 5th day during the retrieval trials. Bacosides on anterograde administration (before training) in mice, significantly decreased the escape latency time (ELT) during the acquisition trials for 4 consecutive days and increased the time spent (TS) in target quadrant during the retrieval trials on 5th day, and on retrograde administration (after training) bacosides were found not to affect TS significantly. Bacosides also significantly decreased the ELT and increased the TS in mice treated anterogradely with scopolamine and sodium nitrite. Bacosides did not exhibit any significant effect on TS of mice treated retrogradely with sodium nitrite. On the other hand, bacosides significantly increased the TS of mice treated retrogradely with BN52021. On the basis of the present results it can be concluded that bacosides facilitate anterograde memory and attenuate anterograde experimental amnesia induced by scopolamine and sodium nitrite possibly by improving acetylcholine level and hypoxic conditions, respectively. Beside this bacosides also reversed BN52021 induced retrograde amnesia, probably due to increase in platelet activating factor (PAF) synthesis by enhancing cerebral glutamate level.