A Simple and Cost-effective Approach to Make a Modified Suture Anchor in Orthopaedics.

The purpose of this study is to describe a technique of using an affordable suture anchor for various soft tissue repairs of both upper and lower limb surgeries in our series of patients. Eighteen patients with minimum 1-year follow-up after various upper limb surgeries using modified suture anchor were assessed both clinically and radiographically. In all 18 cases, the purpose of the suture anchor was served in terms of attachment of ligament or the tendon. There was no incidence of breakage of suture material or loosening of the implant seen during the insertion. There were no complications related to the implant noted. This novel technique turns a simple screw and suture material into an efficient suture anchor while saving time, being quick, easy, affordable and repeatable. Level of Evidence: Level V (Therapeutic).

Evaluation of modified RENAL nephrometry score in the prediction of perioperative outcomes of open partial nephrectomy.

Introduction: RENAL nephrometry score (RNS) is a standardized system to grade the complexity of renal masses, but it does not correlate well with the perioperative outcomes of open partial nephrectomy (OPN). To overcome these shortcomings, a modified RNS (MRNS) has been proposed. In this study, we evaluated the MRNS and its role in predicting the perioperative outcomes of OPN. Methods: This was a prospective observational study performed at a tertiary care hospital to evaluate the efficacy of MRNS in predicting the perioperative outcomes of OPN. Sixty-four cases were included in the study. Demographic parameters, tumor characteristics, and perioperative outcomes were analyzed. Correlation with the post-operative outcomes and the strengths of MRNS were compared with various other nephrometry scores. Results: The mean age of the patients was 52.89 years, 60.9% were male and 53.1% had a right-sided mass. The comorbidities, body mass index, and performance scores were evenly distributed across the complexity groups (P > 0.05). The mean tumor size was 4.13 cm and the mean MRNS and RNS were 9.45 and 6.1, respectively. 60.9% of the cases had no complications. Major complications (Clavien-Dindo grade [CDG] 3+) were noted in five cases (7.8%). The trifecta of neargin, ischemia, and complications (MICs) score was achieved in 85.9% and was achieved in 71.9% of the cases. MRNS was found to be an independent predictor of the trifecta outcomes (P = 0.04). Receiver-operating characteristic curve of MRNS analyzing the major complications as per the CDG showed an area under the curve of. 804, indicating good prediction of complications by the MRNS. Conclusions: MRNS improves the predicting power of RNS by attributing enhanced scores to key elements and by adding new elements. Also, MRNS has good ability to predict the achievement of the trifecta and MIC.

Operative stabilisation versus non-operative management of mid-shaft clavicle fractures.

INTRODUCTION: Fractures of the mid-shaft clavicle are commonly encountered in clinical practice. These can be managed either by conservative method or operative by internal fixation. This study aims to compare the outcomes of conservative and operative management. METHODS: Forty patients with displaced and comminuted mid-shaft clavicle fractures were included in the study, among which twenty-five patients were treated conservatively and 15 patients underwent surgery and were followed up for a period of 1 year. Time taken for union, functional outcome, complications, and patient satisfaction were compared. RESULTS: In the non-operative group, 28% of the fractures took less than twelve weeks to unite, whereas in the operative group 60% of them took less than 12 weeks to unite. At the end of 1 year, there was no statistical difference in mean UCLA (University of California and Los Angeles) score and the mean DASH score of the non-operative group and operative group. There were more complications in the operative group. Re-operative rate in the operative group was 40%. Patient satisfaction was 80% in the non-operative group, whereas 48% of patients were satisfied in the operative group. CONCLUSION: Displaced and comminuted mid-shaft clavicle fractures treated conservatively have more advantages when compared to surgically treated fractures.

Quantification of cytosol and membrane proteins in rumen epithelium of sheep with low or high CH4 emission phenotype.

BACKGROUND: Ruminant livestock are a major contributor to Australian agricultural sector carbon emissions. Variation in methane (CH4) produced from enteric microbial fermentation of feed in the reticulo-rumen of sheep differs with different digestive functions. METHOD: We isolated rumen epithelium enzymatically to extract membrane and cytosol proteins from sheep with high (H) and low (L) CH4 emission. Protein abundance was quantified using SWATH-mass spectrometry. RESULTS: The research found differences related to the metabolism of glucose, lactate and processes of cell defence against microbes in sheep from each phenotype. Enzymes in the methylglyoxal pathway, a side path of glycolysis, resulting in D-lactate production, differed in abundance. In the H CH4 rumen epithelium the enzyme hydroxyacylglutathione hydrolase (HAGH) was 2.56 fold higher in abundance, whereas in the L CH4 epithelium lactate dehydrogenase D (LDHD) was 1.93 fold higher. Malic enzyme 1 which converts D-lactate to pyruvate via the tricarboxylic cycle was 1.57 fold higher in the L CH4 phenotype. Other proteins that are known to regulate cell defence against microbes had differential abundance in the epithelium of each phenotype. CONCLUSION: Differences in the abundance of enzymes involved in the metabolism of glucose were associated with H and L CH4 phenotype sheep. Potentially this represents an opportunity to use protein markers in the rumen epithelium to select low CH4 emitting sheep.

Uterine externalization versus in situ repair of hysterotomy during cesarean delivery: a systematic review, equivalence meta-analysis, and trial sequential analysis.

BACKGROUND: Uterine positioning during hysterotomy repair is controversial, with both in situ and externalized approaches commonly performed. Despite many published trials, clinical equipoise remains. This meta-analysis and trial sequential analysis (TSA) summarizes studies comparing both techniques. METHODS: A systemic search for randomized controlled trials comparing in situ with externalized hysterotomy repair during cesarean delivery was performed. The primary outcomes were estimated blood loss (EBL) and surgical duration. Secondary outcomes were need for blood transfusion, incidence of endometritis, hospital length of stay, intra-operative hypotension, return of bowel function, intra-operative vomiting, intra-operative pain, and need for postoperative analgesia. Cochrane methodology was used to assess risk of bias. Data are presented as mean difference/standardized mean difference or odds ratio/risk difference with 95% confidence intervals (CI). RESULTS: Nineteen studies enrolling 20 739 patients were included. Estimated blood loss and surgical duration were equivalent between methods, with TSA confirming adequate information size for surgical duration but not EBL. In situ repair was associated with faster return of bowel function (MD -0.76 days; 95% CI -1.36 to -0.15; P=0.01) and a reduction in need for breakthrough postoperative analgesia (OR 0.44; 95% CI 0.28 to 0.68; P <0.01). CONCLUSIONS: This analysis revealed equivalence between methods for EBL and surgical duration. While the small reduction in EBL with externalized repair was not clinically or statistically significant, TSA analysis revealed an unmet information size, suggesting a potentially inconclusive result. In situ repair may be associated with less breakthrough postoperative analgesia requirement and faster return of bowel function.

Extended Surgical Implication of Tubercle of Zuckerkandl in Total Thyroidectomy.

The primary objective of the study was to assess the Tubercle of zuckerkandl (TZ) during thyroid surgeries and its relationship with RLN and Superior parathyroid (SP). A prospective study was done in, 30 consecutive cases of total thyroidectomy in whom per operatively TZ was identified. The presence of TZ, its laterality, size, relationship with RLN and parathyroid glands were documented. A grading system outlined by Pelizzo was applied in our current study. In majority of the cases the RLN was found to lie medial to TZ (26/30), followed by lateral position (3/30) and one case it was found to be posterior to TZ (1/30). The superior parathyroid was identified in close relation (< 2 cm) to the TZ in 27/30 cases. The distance between the TZ and SP was assessed. We proposed a classification for location of SP based on the distance between SP and TZ and also attempted to relate each class of SP location with TZ grade. There was strong association of Grade of TZ with the class of SP location (p value = 0.00046). TZ is constant surgical landmark with good reliability to identify the RLN and SP. RLN is found medial to TZ in majority of cases with few exceptions. SP is found to be closely associated with TZ in majority of cases and there is a strong relationship of proximity of SP and TZ with respect to TZ grade. Although this required further studies with larger population.

A comparative study of operative and conservative treatment of intraarticular displaced calcaneal fractures.

The treatment of intra-articular displaced calcaneal fracture is debatable. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modified Rowe's Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient's job was noted after one year and compared with pre-injury status. Fifty five patients with 61 calcaneal fractures were studied. Thirty of them were operated and 31 were treated conservatively. Out of 30 operated cases, Bohler's angle was restored in 25 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). Thirty one cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p < 0.001, VAS: 4.387 p < 0.001, AOFAS: 2.728 p = 0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler's angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative treatment.

Comparative study of orthopaedic trauma pattern in covid lockdown versus non-covid period in a tertiary care centre.

OBJECTIVES: Patterns of trauma during the covid-19 lockdown were reviewed. METHODS: Epidemiological factors, mechanism and pattern of injuries of 235 patients during the lockdown were compared with 627 patients during similar time frame in 2019. Protocols followed in treating these patients were reviewed. RESULTS: Significant increase were noted in domestic injuries due to slip and fall at home, fall from height, trees, snake bite and hip and spine fractures during the lockdown. CONCLUSION: Though the type of injuries during the lockdown were different, they warrant treatment on urgent basis even during the covid times to avoid long term morbidity.

Quest for the Ideal Nasal Pack in Post Operative Cases of Septo-Turbinoplasty: Study in a Tertiary Care Hospital.

To compare the efficacies and post operative outcomes of patients with nasal packing with merocel, intranasal splints and merocel along with intra-nasal infant feeding tubes following septo-turbinoplasty, in patients with nasal obstruction secondary to septal deviation and inferior turbinate hypertrophy. A prospective study was done in 60 patients of symptomatic deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty was performed. Patients' nasal cavity was packed for 48 h after being randomly divided into 3 groups: (1) packing using merocel, (2) intra-intra nasal septal silicone splint, (3) packing using truncated merocel along with infant feeding tube. Patients were given a questionnaire 24 h post operatively and their reponse was analysed to compare nasal blockage, epistaxis, epiphora and headache. Pain on pack removal was recorded after 48 h. We found that merocel with infant feeding tube had better tolerance than plain merocel in almost all cases, with symptoms of nasal blockage, epiphora, headache and pain on pack removal being lesser than with plain merocel, and comparable to the results produced by nasal splints. Also the epistaxis control in merocel with infant feeding tube was better than with nasal splints. Truncated merocel with infant feeding tubes provides a suitable and cheap replacement for nasal splints which may not be affordable to a lot of patients, or may not in available in many settings. The results are superior to plain merocel and the control of post operative bleeding is better than with intra nasal splints.

'Vanishing carpal bones' in a patient with congenital adrenal hyperplasia - A diagnostic dilemma.

The vanishing bone disease, also known as Gorhams disease usually involves long bones. Isolated carpal bone involvement is uncommon. A 14 year old male presented with pain in the right wrist joint since 4 months. He was a known case of Congenital Adrenal Hyperplasia on oral steroids for 3 years. X-rays showed deformed arthritic scaphoid, lunate and capitate. A proximal row carpectomy was performed to provide functional wrist mobility to the patient. Histopathological examination was consistent with Gorham's disease. In a patient with systemic disease receiving steroid therapy Gorhams disease poses a diagnostic challenge.

Evaluation of the re-mineralization capacity of a gold nanoparticle-based dental varnish: An in vitro study.

BACKGROUND: Dental caries is an infectious microbial disease caused by acidogenic bacteria. It leads to the dissolution of enamel, dentin, and cementum. Enamel demineralization is often appreciated as' 'White Chalky lesions or Chalky enamel''. Standard procedures for protection of these teeth are fissure sealing and topical fluoride application. A varnish is generally a material in which a resin such as copal is dissolved within an organic solvent such as ethanol. Gold is one of the most biocompatible dental materials. Gold nanoparticles were biosynthesised using aspartic acid in previous studies. AIM AND OBJECTIVES: To prepare a gold nanoparticle based dental varnish and to evaluate its re-mineralizing capacity. MATERIALS AND METHODS: Gold nanoparticle dental varnish was prepared using all the necessary constituents. This newly prepared dental varnish was compared with G.C Fuji/SnF2 dental varnish. Demineralizing capacity of the dental varnishes were analysed. The tooth specimens were prepared according to methodology and mounted on resin blocks. They were subjected to demineralization remineralization cycles. ICP-OES and Knoop Hardness tests were performed. RESULTS: AuNP dental varnish had a satisfactory remineralization effect on demineralised enamel. For calcium analysis, the AuNP group showed significantly more total calcium loss when compared to the SnF2 group (P < 0.05) and was statistically significant. For phosphorus analysis, AuNP group showed significantly greater net phosphorus loss compared to the SnF2 group (P < 0.05) and was statistically significant. It was also observed that the KHN increased more significantly in Group A (SnF2) as compared to Group B (AuNP) and was also statistically significant (P < 0.05). CONCLUSION: AuNP dental varnish showed considerable re mineralizing property; however, it was not superior to dental varnishes like SnF2 dental varnish. Further research needs to be done in vitro to better modify the AuNP dental varnish before proceeding to in vivo studies.

Short-term Seizure Outcomes in Childhood Epilepsy.

BACKGROUND AND OBJECTIVES: Seizure freedom is the optimal response to antiepileptic treatment. In previous studies, it has been shown that between 61% and 71% of children with epilepsy achieve seizure freedom, whereas 7% to 20% have drug-resistant epilepsy. The definition of drug resistance has not been consistent across studies, and there is a lack of contemporary population-based data. We used data from a large nationwide child cohort to provide such information, implementing the current standard definition of drug resistance. METHODS: The study was based on the Norwegian Mother and Child Cohort Study. Potential epilepsy cases were identified through registry linkages and parental questionnaires. Medical record reviews and parental interviews were used to collect clinical information and to classify seizures, epilepsies, and etiologies. RESULTS: The cohort included 112 745 eligible children aged 3 to 13 years (median age 7 years) at end of follow-up. Of these, 600 were epilepsy cases with at least 1 year of follow-up since epilepsy onset (median follow-up time: 5.8 years). There were 178 (30%) who had developed drug-resistant epilepsy, 353 (59%) who had been seizure free for ≥1 year, and 69 (12%) with intermediate seizure outcomes. Having an identified cause of epilepsy (genetic, structural, metabolic, or infectious) was associated with unsatisfactory seizure outcome (48% drug resistance) and influenced the relative risk associated with other prognostic factors. Sociodemographic characteristics were not associated with short-term seizure outcomes. CONCLUSIONS: Drug resistance occurs in 3 out of 10 children with epilepsy, whereas 6 out of 10 become seizure free. Having an identified cause of epilepsy is associated with poor response to treatment.

Cytokeratin 19 expression patterns of dentigerous cysts and odontogenic keratocysts.

BACKGROUND: Although numerous investigators have studied the pattern of keratin expression in different odontogenic cysts, the results have been variable. AIM: The present study was conducted to determine the pattern of expression of cytokeratin 19 (CK 19) in the epithelial lining of odontogenic keratocysts and dentigerous cysts. MATERIALS AND METHODS: The epithelial layers showing expression of the epithelial marker CK 19 was determined by immunohistochemical methods in 15 tissue specimens each of histopathologically confirmed cases of dentigerous cysts and odontogenic keratocysts. Statistical analysis was done to compare the CK 19 expression between dentigerous cyst and odontogenic keratocyst using the Chi-square test. P < 0.05 was considered to be statistically significant. RESULTS: All specimens of dentigerous cysts were positive for CK 19 with 20% (3/15) of the specimens showing expression only in a single layer of the epithelium, 40% (6/15) of the specimens showing expression in more than one layer but not the entire thickness of the epithelium, and the remaining 40% (6/15) showing expression throughout the entire thickness of the epithelium. In the case of odontogenic keratocysts, 40% (6/15) of the specimens were negative for CK 19, 40% (6/15) of the specimens showed expression only in a single layer of the epithelium, and 20% (3/15) of the specimens showed expression in more than one layer, but not the entire thickness of the epithelium. The observed differences in CK 19 expression by the two lesions were statistically significant (P < 0.01). CONCLUSION: The differences in CK 19 expression by these cysts may be utilized as a diagnostic tool in differentiating between these two lesions.

Association of aggressive periodontitis with reduced erythrocyte counts and reduced hemoglobin levels.

BACKGROUND AND OBJECTIVE: Studies have shown that erythrocyte counts and hemoglobin levels are reduced in patients with chronic periodontitis, suggesting that this condition may be associated with anemia of chronic disease. Although increased leukocyte counts have been reported in aggressive periodontitis, very little is known about the effects of aggressive periodontitis on erythrocyte counts. The present study was undertaken to determine whether generalized aggressive periodontitis is associated with reduced erythrocyte counts and reduced hemoglobin levels. MATERIAL AND METHODS: The present study was conducted as a case-control study in which 64 patients with generalized aggressive periodontitis were categorized as cases and 58 periodontally healthy individuals were categorized as controls. Erythrocyte parameters (such as erythrocyte count, hemoglobin concentration, and hematocrit and erythrocyte indices) and clinical parameters (such as gingival index, plaque index, probing depth, clinical attachment level and percentage of severe sites) were recorded. RESULTS: Significant differences were observed between cases and controls in mean erythrocyte count (4.45 ± 0.6 × 10(6) erythrocytes/µL and 4.78 ± 0.56 × 10(6) erythrocytes/µL respectively, p = 0.002) and hemoglobin level (12.43 ± 1.83 g/dL and 13.53 ± 1.64 g/dL, respectively, p = 0.001). Other erythrocyte parameters, such as hematocrit, mean corpuscular volume and mean corpuscular hemoglobin, were also significantly lower among cases compared with controls. Logistic regression analyses showed that generalized aggressive periodontitis was significantly associated with lower erythrocyte counts ( p = 0.032) and a lower hemoglobin concentration ( p = 0.017). CONCLUSION: The findings of the present study suggest that patients with generalized aggressive periodontitis tend to have lower erythrocyte counts and lower hemoglobin levels compared with periodontally healthy controls. This suggests that generalized aggressive periodontitis, like chronic periodontitis, may be associated with a risk for anemia of chronic disease.

Modified semilunar coronally advanced flap: A case series.

Dentists traditionally think of periodontal treatment as a means of saving the teeth while leaving the patient with an esthetic problem. The goal of gingival esthetics is to maintain normal healthy gingival appearance around teeth that must be restored. Gingival recession represents a significant concern for patients and a therapeutic problem for the clinician. Root coverage is the goal of periodontal plastic surgery when treating gingival recessions in the esthetic zone. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures have been described each demonstrating a variable degree of success. This case report presents to you the treatment outcomes and predictability of modified semilunar coronally advanced flap (Kamran Haghighat) techniques described for the treatment of recession defects on single and multiple adjacent teeth, respectively.

Comparison of periodontal destruction patterns among patients with and without the habit of smokeless tobacco use--a retrospective study.

BACKGROUND AND OBJECTIVE: The effects of tobacco smoking on the prevalence and severity of periodontal disease have been well documented. However, very few studies have assessed the effects of oral smokeless tobacco (ST) on the periodontium. Considering the widespread use of ST products globally, the effects of such products on the periodontal tissues may be important. The present study was performed to compare retrospectively the patterns of periodontal destruction among oral ST users and never-users with periodontitis. MATERIAL AND METHODS: Data from 149 patients with periodontitis (60 ST users and 89 never-users) were compared for mean scores of probing depth, recession (REC) and clinical attachment loss (CAL) and the mean percentage of sites with different ranges of probing depth, REC and CAL. RESULTS: For full-mouth scores, mean REC and CAL were significantly higher in ST users than in never-users (p < 0.001 and p = 0.008, respectively). For different regions of the dentition, mean scores of REC were significantly higher among ST users than among never-users (p < 0.001 for all regions), and mean scores of CAL were significantly higher for ST users in mandibular (p < 0.001), buccal (p = 0.008), lingual (p = 0.022), anterior (p = 0.012) and molar (p = 0.009) sites. Generally, there were higher percentages of sites with shallow pockets (0-3 mm), REC of ≥ 1 mm and CAL of ≥ 3 mm in ST users than in never-users. However, only differences for REC categories were significant for all regions (p < 0.001). ST users had a significantly higher proportion of sites with CAL of ≥8 mm for full-mouth sites (p = 0.003), mandibular teeth (p < 0.001), buccal sites (p = 0.002), anterior teeth (p = 0.040) and molars (p = 0.007). CONCLUSION: ST users tend to have more severe REC and CAL and a greater proportion of sites with higher values of REC and CAL compared with never-users. The greatest increase in severity of CAL was found to be localized to sites on mandibular teeth, buccal surfaces, anteriors and molars, which may be a result of the retention of the ST product in the oral cavity.

Innovative nerve approximator from external fixator: a quick fix solution.

The outcome of primary and secondary neurorrhaphy depends on the technical precision followed during the procedure. The aim of the surgery is to establish near-anatomic coaptation and to maintain it without tension at the anastomotic site. A nerve approximator can aid in peripheral neurorrhaphy with optimal tension at the anastomotic site and better maintenance of coaptation of fascicles, but their use is limited because of the high price of the commercially available ones. We describe a simple and inexpensive nerve approximator that can be prepared any time, and according to the need using the universal mini external fixator system. This fixator system is almost always available in an orthopedic and hand operation theater. It is an extremely handy, inexpensive, atraumatic, and user-friendly nerve approximator that can be used clinically to aid and augment the final results of peripheral neurorrhaphy. Its use can also be extrapolated for simulated tendon and nerve repair during microvascular laboratory training.

5,7-Dimethyl-2,3-dihydro-1H-1,4-diazepin-4-ium picrate.

In the cation of the title compound, C(7)H(13)N(2) (+)·C(6)H(2)N(3)O(7) (-), the seven-membered 1,4-diazepine ring forms a twist chair conformation. The two o-nitro groups in the anion are twisted by 35.0 (7) and 36.0 (9)° from the benzene ring. In the crystal, N-H⋯O hydrogen bonds between the cation and anion along with weak C-H⋯O hydrogen bonds produce chains along the b axis. C-H⋯O hydrogen bonds connecting the chains are also present.

2-Amino-4-meth-oxy-6-methyl-pyrimidin-1-ium picrate.

In the title salt, C(6)H(10)N(3)O(+)·C(6)H(2)N(3)O(7) (-), the dihedral angle between the mean planes of the benzene and pyridine rings is 3.1 (1)°. In the cation, the meth-oxy group is almost coplanar with the pyridine ring [C-O-C-N = -0.6 (2)°]. The p-nitro [C-C-N-O = -1.17 (19)°] and one o-nitro [C-C-N-O = 1.83 (19)°] group in the anion are essentially coplanar with the benzene ring. The other disordered o-nitro group containing the major occupancy [0.868 (6)] O atom is twisted -29.0 (2)° from the mean plane of the benzene ring. A bifurcated N-H⋯(O.O) hydrogen bond and weak C-H⋯O intermolecular inter-action between the cation and anion produce a network of infinite O-H⋯O-H⋯O-H chains along the c axis in the [101] plane which helps to establish crystal packing. Comparison to a DFT computational calculation indicates that significant conformational changes occur in the free state.

(2E)-1-(1,3-Benzodioxol-5-yl)-3-(2-bromo-phen-yl)prop-2-en-1-one.

The mol-ecule of the title compound, C(16)H(11)BrO(3), is essentially planar with a maximum deviation of 0.178 (4) Šand the configuration of the keto group with respect to the olefinic double bond is typically s-cis. In the crystal structure, inter-molecular Br⋯O inter-actions [3.187 (3)Å] give rise to chains parallel to the b axis. Adjacent chains are further linked along the a axis by C-H⋯π inter-actions. The crystal studied was a racemic twin with a 0.595 (13):0.405 (13) ratio.