Large Diameter Head in Primary Total Hip Arthroplasty: A Systematic Review.

INTRODUCTION: The literature around use of Large Diameter Heads (LDH) is abundantly available for revision Total Hip Arthroplasty (THA) but is lacking for primary uncomplicated THA. This systematic review was undertaken to synthesize data around primary THA involving LDH and analyze the associated complications (dislocation, volumetric wear, implant survivorship and functional score) along with reported effects on range of motion (ROM), patient reported outcomes and impingement rate/groin pain. METHODS: A PRISMA compliant systematic review was done using extensive search in PubMed database, along with offline search looking for the literature published in English language between 2008 and 2018. The articles providing data on the use of large diameter heads (LDH) (36 mm or larger) on various bearing surfaces were collected. This included robust national joint registries of different countries. Narrative approach to data synthesis was used. RESULTS: A total of 23 papers met our inclusion criteria, including six national joint registries. It was observed that LDH had significantly low dislocation rates, excellent implant survival rate as per Kaplan-Meier survivorship (> 90% at five years). Surgical approaches, except Minimally Invasive Surgery (MIS), did not increase any risk of dislocation as long as it was meticulously repaired. There was no significant improvement in any functional scores or improved ROM. CONCLUSIONS: LDH of 32-36 mm are now commonly used in primary THA and is accepted as a popular size. The beneficial effects of a large head size are negated beyond 38 mm. The most favored size for LDH THA, therefore, is 36 mm contrary to the older literature favoring 28 mm.

Quantitative PCR and in vivo efficacy of antibiotics in the treatment of Vibrio vulnificus infection in a mouse model.

The Centers for Disease Control and Prevention (CDC) recommend oral or intravenous doxycycline plus a third-generation cephalosporin or fluoroquinolone alone for the treatment of Vibrio vulnificus infections. Until now, no study has compared oral with parenteral administered doxycycline with respect to their in vivo efficacy. In the present work, ICR mice infected with a high dose of V. vulnificus were administered ciprofloxacin, ceftriaxone, and doxycycline. The bacterial DNA copy number in surviving and non-surviving mice was determined using quantitative polymerase chain reaction (qPCR). In this setting, ciprofloxacin was the most effective monotherapeutic drug, but a higher survival rate (50%) was achieved using the combination therapy of intraperitoneal doxycycline plus ceftriaxone. The blood of non-surviving mice at 12 h post-infection contained at least 10(4) DNA copies/µL, in contrast to 10(2) to 10(3) DNA copies/µL in surviving mice. Thus, in the treatment of V. vulnificus infections in humans, when the intravenous form of doxycycline is unavailable, ciprofloxacin might be a better option than oral doxycycline to lower mortality. In addition, our results demonstrate that qPCR can be a useful tool for identifying the V. vulnificus load in infected patients, with the DNA copy number providing a marker of either disease severity or mortality.

Intestinal parasitic infection among school age children.

BACKGROUND: World Health Organization estimates one-fourth of world's population harbors one or more intestinal parasites. Intestinal parasites are among the most common infections of school age children causing-nutritional deficiency, chronic dysentery, rectal prolapse, poor weight gains, retarded growth and mental retardation. METHODS: The stool samples were collected from school going children and examined for intestinal parasite by normal saline wet mount, formalin ether sedimentation technique was performed for the concentration. RESULTS: Among 360 school age students, the prevalence of intestinal parasite was found 40%. Among the positive cases of which 60% were female. It was observed that the rate of parasitic infection among positive cases, Newar was 35(36.84%), Chettri 31(32.97%) and Brahmin and others 29(33.72%) respectively. The study detects an association between intestinal parasitic infection and drinking tape water. CONCLUSIONS: The findings of this study showed that intestinal parasitic infections remain prevalent in the study area. The high prevalence of parasitic infections seems directly related to the unhygienic living conditions. This strongly indicates a need for intervention measures likely-to take up sustained health education, provision of safe drinking water and improvement in environmental sanitation and to provide the school student with health education.

In vitro time-kill activities of ciprofloxacin alone and in combination with the iron chelator deferasirox against Vibrio vulnificus.

Iron plays a major role in the growth and virulence of ferrophilic organisms like Vibrio vulnificus. People who reside in the coastal areas with raw fish eating habits have a high risk of Vibrio infection and aggressive therapy can only reduce their mortality. We investigated the in vitro efficacy of ciprofloxacin, a bactericidal drug used in V. vulnificus patients, and the orally active iron chelator deferasirox against V. vulnificus infection. We performed in vitro time-kill studies on two ATCC strains and one clinical isolate of V. vulnificus collected from a patient admitted to Chosun University Hospital with either ciprofloxacin or iron chelator deferasirox alone and the two drugs in combination. The combination of an iron chelator plus an antibiotic creates a novel form of synergism at 24 h. The antimicrobial effect of deferasirox may be ascribed to its ability to deplete iron that would otherwise be used for bacterial growth. Combination therapy with ciprofloxacin plus deferasirox has potential clinical application by lowering the iron availability against a ferrophilic organism like V. vulnificus infections.