Retrospective analysis and risk of progression of partial anterior cruciate ligament injuries in a young population.

BACKGROUND: The anterior cruciate ligament (ACL) is a common knee ligament injury. Partial ACL tears are common, and at least 10-27% of isolated ACL tears are diagnosed as partial tears. Patients with partial tears have high risk of progression of tears to complete tears, which may require surgical reconstruction. The risk factors associated with the progression to a complete tear are poorly understood. METHODS: The present case-control study assessed the incidence and risk factors for the progression of conservatively treated partial ACL tears to complete tears in 351 patients younger than 45 years. The diagnosis of partial ACL tears was based on clinical evaluation, side-to-side difference on Rolimeter, and magnetic resonance imaging. These patients were managed conservatively and followed up for a mean of 17.5 months or until the progression of the tear into a complete tear, requiring surgery. The patients in whom the tear progressed to complete tear (group P) were compared with those in whom the tear remained stable for a minimum of 18-month follow-up period (group S). RESULTS: Of the 351 partial ACL tear patients, 166 (47.3%) patients progressed to a complete tear at a mean duration of 17.5 months, whereas the tear in 185 (52.7%) patients remained stable and did not progress to a complete tear. Group P had mean international knee documentation committee (IKDC) scores and Tegner scores of 95.7 ± 3.7 and 7.6 ± 1.6, respectively, before the injury, and scores decreased to 52.4 ± 4.1 and 5.7 ± 2.2, respectively, at the 24-month follow-up. CONCLUSION: Partial ACL tear progressed to a complete tear in 47.3% of evaluated patients. The associated risk factors were age less than 35 years, rigorous physical activities, high ACL-Return to Sport after Injury score during early rehabilitation days, early return to activity, and pivoting contact sports.

Hypoplastic femur with pathologic femoral shaft fracture associated with extensive arteriovenous malformations. A series of five cases.

Introduction: Extremities arteriovenous malformations are uncommon vascular lesions that usually go unnoticed until a fracture occurs or imaged for other medical problems. The lesion is invariably quiescent, infiltrative in nature, and leads to the destruction of soft tissue and bone. Worldwide 20-30 % incidence of arteriovenous malformations has been noted in bones. This arteriovenous malformation greatly affects bone growth as compared to the normal side and leads to pathological fracture. However, few reports on the management of such pathologic fractures associated with AVM have been published in the literature.The main problem is to decide the types of implants and whether open or closed reduction. Here, we present a case series of pathologic femoral shaft fracture associated with multiple hemangiomas in the thigh that was treated successfully by minimally invasive distal femoral locking plate fixation and teriparatide. Case Presentation: We are describing our one index case. A 39-year-old woman, otherwise healthy, sustained a fall and developed a left femoral shaft fracture. At the time of admission, she had swelling and venous varicosities and non-itchy, blanchable violet patches over the left thigh. Plain radiography of the left thigh revealed Hypoplastic femoral shaft with a markedly obliterated medullary canal with distal 1/3 rd fracture with calcification of soft tissue. We planned open reduction and distal locking femoral plating because medullary canal was very small to accommodate intramedullary nail following embolization of the feeding artery. While performing open reduction, a considerable amount of bleeding (1300 ml) after incision of subcutaneous tissue occurred. After successful fracture fixation, union was achieved with administration of teriparatide 12 months postoperatively. At present patient is able to walk using elbow support. Conclusion: We present the five cases of pathologic fracture associated with large AVMs that achieved fracture union using minimally invasive distal femoral locking plate fixation and teriparatide.

Does the immediate repair of Bankart lesion following first dislocation reduce the chances of recurrence after arthroscopic repair in soldiers?

PURPOSE: The study attempted to compare the effects of immediate and delayed arthroscopic Bankart repair on the shoulder dislocation recurrence. METHODS: In total, 465 soldiers with first-time anterior shoulder dislocation were included in the study. Of the total, 285 soldiers underwent a quick arthroscopic Bankart repair procedure, whether 180 soldiers underwent a delayed repair procedure. The initial dislocation was traumatic in both groups and operated using the standard arthroscopic suture anchor repair technique. Patient's age, repair time since the first dislocation, number of dislocations before surgery, number of suture anchors used during the repair, duration of surgical procedure, duration from surgery to return to work, and recurrence of dislocation after surgery were recorded. Rowe score, Constant score, and American Shoulder and Elbow Surgeons score were used for clinical assessment. RESULTS: The operating time and recurrence rate were higher in the group subjected to delayed repair procedure than in the group subjected to immediate repair procedure. Repair timing was found to be crucial for a successful outcome. CONCLUSIONS: The findings suggest that Bankart repair must be performed immediately to minimize recurrence and other degenerative changes, which may require an additional surgical procedure for satisfactory repair. More studies are required to reach a definitive conclusion. LEVELS OF EVIDENCE: Level III.

COVID-19 pandemic-Environmental perspective of COVID-19 and a primer for all of us.

Coronavirus Disease (COVID-19) spread worldwide has created a global pandemic. To reduce the transmission of the virus, the Indian government had imposed a countrywide lockdown on 24 Mar 2020 by suspending all public transport and industries temporarily resulting in loss of jobs in multiple sectors and looming threats to the nation economy. Lockdown on the opposite hand has removed pollutants from the air and thus improved air quality in many cities across the globe. The near-total shutdown of all economic activities except related to essential commodities like medicine and food was only allowed which resulted in the lowering of carbon emission and improvement in global warming and air pollution. This review article indented to bring important features of how the COVID-19 pandemic affects human civilization and the global environment. However, its epidemiology, symptom, possible prevention, and management will briefly describe. Authors have collected data from, PubMed, Embase, Scopus, WHO, and CDC (USA). Severe Acute Respiratory Syndrome is a result of COVID- 19 infection. This virus is transmitted through close contact by respiratory droplets from one person to another. The majority of symptoms of COVID-19 are very much similar to any viral upper respiratory tract infection ( Common Coryza). Any person with the slightest suspicion or has respiratory symptoms related to COVID-19 infection should wear a facemask, keep safe social distancing, observe cough/sneeze etiquettes. The COVID-19 pandemic has taught us a lesson to introspect the way humans are destroying the environment for their benefit. Whatever be the origin or cause, the occurrence of COVID-19 has made a foreground for us to improve the symbiotic relationship between humans, wildlife, and nature.

Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals - A multicentric study in India.

BACKGROUND: Roadside trauma in India is an increasingly significant problem, particularly because of bad roads, irregular road signs, overcrowding, overspeeding, and bad traffic etiquettes. Adequate information on the characteristics of victims, causes of accidents, frequency, vehicles involved, alcohol intake, and outcome of management is essential for understanding and planning for better management. AIM: This study aimed to determine the characteristics of trauma (roadside accidents) victims admitted to various trauma centers in India. The purpose of this study is to examine the epidemiology of trauma within a local community in India through data gained from the different emergency centers and to analyze trauma patients to find the predictors that led to the deaths of trauma patients. MATERIALS AND METHODS: The present observational study involved trauma victims over 1-year period in three centers. Demographical details recorded were age, sex, alcohol intake, systolic blood pressure on arrival, respiratory rate, Glasgow Coma Scale (GCS) score, the interval between injury and admission, Injury Severity Score (ISS) risk factors, hospital stay, and outcome. RESULTS: A total of 2650 injuries were recorded in 2466 patients. The mean age was 42.45 ± 15.7 years, the mean ISS was 13.82 ± 6.2, and the mean GCS was 12.20 ± 4.1. The mean time to admission at different trauma centres was 48.41 ± 172.8 h. The head injury was the most common (29.52%). CONCLUSION: Road side accidents due to overspeeding was the most common cause whereas driving under the effect of alcohol was the second most common cause. Accidents are common because of bad traffic etiquette on Indian roads.

Thymosin treatment of chronic hepatitis B: a placebo-controlled pilot trial.

Chronic hepatitis B is a severe and frequently progressive disease. We assessed the safety and efficacy of thymosin fraction 5 and thymosin-alpha 1 in a prospective, placebo-controlled trial in 12 patients with chronic hepatitis B. All patients had histological and biochemical evidence of active liver disease for at least 6 mo before treatment and were positive for serum hepatitis B virus DNA and HBsAg. Seven patients received thymosin fraction 5 or thymosin-alpha 1 and five patients received placebo twice weekly for 6 mo. By the conclusion of the study (1 yr), serum aminotransferase levels had improved significantly in thymosin-treated patients, but not in the placebo group. Six (86%) of the thymosin treated patients and one (20%) patient given placebo cleared hepatitis B virus DNA from serum (p less than 0.04, Fisher's exact test). After treatment, replicative forms of hepatitis B virus DNA were present in the liver specimens of four of five placebo-treated patients but in only one of seven thymosin-treated patients (p less than 0.04, Fisher's exact test). Response to thymosin therapy was associated with significant improvements in peripheral blood lymphocyte and CD3 and CD4 counts and in in vitro production of interferon-gamma over initial values. No significant side effects were observed in patients given thymosin or in placebo-treated patients. Clinical, biochemical and serological improvement in patients responding to thymosin were sustained during 26 +/- 3 mo of follow-up. The results of this pilot trial suggest that thymosin therapy promotes disease remission and cessation of hepatitis B virus replication in patients with chronic viral infection.

Candida-associated diarrhea in hospitalized patients.

Ten hospitalized patients with severe diarrhea associated with intestinal Candida overgrowth are reported. Candida-associated diarrhea is predominantly of the secretory type, characterized by frequent watery stools, usually without blood, mucus, tenesmus, or abdominal pain. The patients were elderly, malnourished, and critically ill, or suffered from chronic debilitating illness. Their hospital stays were prolonged, and the majority were being treated with multiple antibiotics or chemotherapeutic agents. Diarrhea often led to dehydration, prerenal azotemia, hyperchloremic metabolic acidosis, and electrolyte imbalance. Stool culture most frequently isolated Cand. albicans in association with decreased normal flora. Colonoscopy showed no evidence of colitis. Diagnosis was made based on the absence of diarrhea-producing medications, the continuation of diarrhea despite fasting, the exclusion of other infections, inflammatory conditions and other causes of secretory diarrhea, and a dramatic response to a short course of nystatin.

Efficacy of screening flexible sigmoidoscopy for colorectal neoplasia in asymptomatic subjects.

PURPOSE: Although flexible sigmoidoscopy is recommended in patients over age 40 to complement fecal occult blood screening for colorectal neoplasia, the yield of this procedure in asymptomatic, average-risk subjects has varied between studies. In addition, the efficacy of flexible sigmoidoscopy in detecting early curable carcinoma has been the subject of debate. We therefore undertook this study to assess the efficacy, safety, and cost of the procedure for early detection of colorectal neoplasia in asymptomatic subjects. PATIENTS AND METHODS: Flexible sigmoidoscopy with a 60-cm scope was performed in 412 asymptomatic veterans (mean age, 63.2 years). Subjects with positive fecal occult blood and those at increased risk for colorectal neoplasia were excluded. Costs were estimated on the basis of Medicare payments. RESULTS: A mean length of 56.1 cm of sigmoid and descending colon was examined. A total of 132 polyps were detected in 93 subjects (22.6%). Thirty-five percent of the polyps were located at a distance of greater than 30 cm from the anal verge. Of 122 polyps removed, 26% were 1 cm in size or larger. A total of 77 polyps (63%) were adenomas, and six polyps (5%) were carcinomas. Of the six carcinomas detected (two carcinoma in situ, one Astler Coller stage A, two stage B1, and one stage C1), five were in a localized stage and thus potentially curable. The cost of detecting each potentially curable carcinoma was $47,174. No complications from flexible sigmoidoscopy were noted. CONCLUSION: In conclusion, 60-cm flexible sigmoidoscopy is a safe, high-yield procedure for the initial screening of colorectal neoplasia in asymptomatic, average-risk subjects over the age of 50. Because the carcinomas detected were still in an early stage, such screening may improve survival.

Prevention of colon cancer in primary care practice.

Colorectal cancer is a common disease with a high mortality rate. Surgical resection in early stages is the only effective treatment, therefore, recent attention is focused on diagnosing early colon cancer by screening asymptomatic subjects. Principles and current technology supporting early detection of colorectal cancer are critically evaluated. Current guidelines for screening average risk asymptomatic subjects and high-risk groups are discussed.

Screening and surveillance for colorectal cancer.

Pathologic reviews and clinical studies demonstrate that groups with increased cancer risk can be identified. It is estimated that about 3.5 per cent of colorectal cancers in this country are the result of known heritable cancer syndromes, such as familial polyposis. Much effort is currently being devoted to evaluation of biologic markers, such as cell surface antigens and their antibodies, ornithine decarboxylase, errors in DNA repair, abnormalities in metabolism of polyadenosine diphosphate, and application of molecular genetic techniques to identify patients with genetic cancer susceptibility.