ABSTRACT
STUDY DESIGN: A retrospective computed tomography (CT)-based radiological analysis. PURPOSE: To obtain CT-based morphometric data for the S2 alar iliac (S2AI) screw in the Indian population presenting to School of Medical Sciences and Research, Greater Noida, we used the concept of "safe trajectory" by Pontes and his colleagues in a recent study. OVERVIEW OF LITERATURE: Although previous CT-based morphometric studies on the S2AI screw have been published for a variety of ethnic groups, morphometric data specifically for the Indian population are scarce. METHODS: We used the three-dimensional multiplanar reformatting software to conduct a retrospective CT analysis of 112 consecutive patients who met our exclusion criteria for various abdominal and pelvic pathologies. CT imaging planes were rotated between the S1 and S2 foramen until they matched the ideal S2AI screw trajectory, which was represented by the longest and widest iliac osseous channel observed in the axial CT section. Following the concept of a safe trajectory, S2AI screw morphometric parameters were measured on both sides of the pelvis using corresponding axial and sagittal CT images. RESULTS: In the sagittal and transverse planes on both sides of the pelvis, females had significantly higher screw trajectory angulation than males (p<0.001). On both sides of the pelvis, males had significantly greater iliac width, maximum screw trajectory length, and intrascrotal length than females (p<0.001). On both sides of the pelvis, the S2AI screw entry point in females was significantly deeper than in males from the skin margin (p<0.001). CONCLUSIONS: Based on our methodology, we discovered that the S2AI screw trajectory is significantly more caudal and lateral in females, the maximum screw length is sufficient for use in clinical practice regardless of gender, and that 8.5 mm or even larger screw diameters are feasible in the majority of the Indian population.
ABSTRACT
Background: India is reporting the highest number of tuberculosis (TB) cases worldwide. The health belief model has proved beneficial to understand health-related behaviors among patients with TB. We explored the reasons and solutions for non-adherence to the treatment of TB using the constructs of the health belief model. Methods: We conducted in-depth interviews among patients who were reported 'lost to follow up' (LFU) and among the service providers under the national TB program in the Patan district based on the constructs of the health belief model - perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. All the interviews were audio-recorded and transcripts were analyzed using thematic analysis. Results: The analysis resulted in nine major reasons for LFU which were explained under the health belief model constructs. Perceived susceptibility was reflected by lack of support from health workers, losing faith in government, and dependence on alcohol. Negative counseling by quacks explained perceived severity, while improvement in symptoms corroborated with the perceived benefits. Side effects to anti-TB drugs, high pill burden, stigma, and financial constraints were the perceived barriers reported by the patients. Conclusions: The health belief model explains treatment non-adherence behavior among patients with tuberculosis in India. To eliminate TB, program managers in India need to design a comprehensive intervention model to counsel the patients on the benefits of completing treatment, generate awareness to dispel the myths surrounding the disease, and instill confidence through regular visits by health workers. Primary care physicians should try incorporating counselling of patients with TB in their routine care to reduce LFU.
ABSTRACT
BACKGROUND: The novel Oblique lumbar interbody fusion [OLIF] technique has been proposed as a solution to approach related complications of anterior lumbar interbody fusion [ALIF] and lateral lumbar interbody fusion [LLIF]. There exists no study concerning morphological evaluation of retroperitoneal oblique corridor for the Oblique lumbar interbody fusion (OLIF) technique in the Indian population. The aim of our study was (a) to measure magnetic resonance imaging (MRI) based anatomic parameters concerning OLIF operative windows from L2-L3 to L4-L5 level (b) to determine the feasibility of this technique following MRI-based morphometric evaluation in the Indian population. MATERIAL AND METHODS: We did retrospective MRI analysis of 307 consecutive patients following our exclusion criteria. Bare window, psoas major window and psoas major width were measured from axial T2 MRI image taken at mid disc level from L2-L3 to L4-L5 levels. RESULTS: The mean bare window size was largest at L2-L3 (1.39 cm) level followed by L3-L4 and L4-L5 level (1.28 and 0.62 cm respectively), and differences between them were statistically significant (P < 0.001). Females had statistically significant larger bare windows at L2-L3 and L3-L4 level than males (P < 0.001). With increasing age, there was a significant increase in bare window size at each level (P < 0.001). The mean psoas major window (PMO) and mean psoas major width (PMI) were largest at L4-L5 level (PMO = 1.27 cm, PMI = 3.61 cm) followed by L3-L4 and L2-L3 level (L3-L4: PMO = 1.19 cm, PMI = 2.36 cm; L2-L3: PMO = 0.88 cm, PMI = 1.39 cm), and differences among each level concerning both parameters were statistically significant (P < 0.001). Both parameters (PMO, PMI) were significantly larger in males than females at each level (P < 0.001). CONCLUSION: The OLIF technique is well suited for lumbar interbody fusion at L2 -L3 and L3-L4 level in the Indian population irrespective of age and sex. At L4-L5 level, overall 17.9 percent of the study population were unsuitable for this technique due to inaccessible bare window. In our opinion, this level may be better suited for OLIF approach in the elderly Indian population, especially for surgeons who are beginning to attempt this technique in their surgical practice. Preoperative MRI evaluation for the OLIF is important to assess its feasibility, as there exists significant age and gender differences in the Indian population for anatomic parameters concerning OLIF operative windows from L2-L3 to L4-L5 levels. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00393-7.
