Evaluating the Efficacy and Safety of Combined Administration of Systemic and Topical Tranexamic Acid in Total Knee Arthroplasty.

Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent, thatagent that reduces substantial blood loss in total knee arthroplasty (TKA) surgeries without increasing the risk of thromboembolic complications. The purpose of our study was to assess the effectiveness and safety of the combined use of intravenousIV and topical TXAtranexamic acid in uncomplicated primary Total knee Arthroplasty (TKA) without complications. Materials and Methods: In this prospective study, we enrolled 61 patients who underwent unilateral primary TKR and were randomly divided into two groups: Group I received intravenous (IV) TXA and Group II received both IV and intraarticular (IA) TXA. Patients assigned to Group I received IV TXA preoperatively 30 mins before surgery and postoperatively at 3 and 6 hours after surgery, whereas in the combined group, in addition to IV doses, topical TXA was applied as mop 2 g of TXA diluted in 30 mL of isotonic sodium chloride solution) intraarticularly for about 5 minutes before closing the arthrotomy. We measured total blood loss (TBL), ) and mean reduction in haemoglobin (Hb) levels as primary outcomes. Transfusion rates, incidence of thromboembolic events (TE), and other adverse effects as secondary outcomes. Total blood loss TBL and Hb drops was were noted on the 3rd post-operative day. All the patients were followed-up for 6 months to note the incidence of deep venous thrombosisDVT and Thromboembolic Events (TE). An Iindependent t-test was used to evaluate between--group differences. P < 0.05 as is the cut-off for statistically significant differences. Results: The Total blood loss (TBL) in Group I was 780.05 ± 158.05 mL, compared to 660.80 ± 156.45 mL in Group II. (P < 0.001). The Hb drop was significantly lower in IV TXA group (2.3 ± 0.37) than the combined TXA group (1.40 ± 0.32). Furthermore, both groups required no transfusions. No thromboembolic complications was were noted postoperatively and at 6 6-month follow-up. Conclusion: TXATranexamic acid in total knee replacement surgery effectively decreases blood loss and significantly reduces the need for blood transfusions. Based on our study, the combined use of intravenous (IV) and IAintraarticular TXA in total knee replacement was found to be superior in reducing blood loss and significantly reducing the need for blood transfusions in TKA.

The Functional Outcome of Surgical Management of Spondylolisthesis with Posterior Stabilization and Fusion.

Introduction: Spondylolisthesis is a spinal condition characterized by the forward displacement of one vertebra over another, leading to instability and associated symptoms. Surgical intervention is often recommended for patients with symptomatic spondylolisthesis unresponsive to conservative treatment. The objective of this study was to analyze the functional outcomes of surgical management utilizing posterior stabilization and fusion techniques in patients with spondylolisthesis. Materials and Methods: This is a prospective study conducted on 30 patients who underwent surgical treatment for spondylolisthesis with posterior trans-pedicular screw fixation with conventional or reduction screws and fusion. Meyerding's grade of listhesis, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI) score and pain scores such as visual analog scale (VAS), numerical rating scale 11 (NRS-11), and pain relief rate were used to analyze the functional outcome. Results: Postoperatively, Meyerding's grade of listhesis and the JOA score had improved significantly. The ODI score and pain scores such as VAS, NRS-11, and pain relief rate were better after surgical interventions. There was full motor recovery in 13 patients and 14 patients had full sensory recovery, while six patients had sensory blunting at the time of the time of the last follow-up. Twenty-six (80.7%) patients had clinically successful results and radiological/clinical fusion while four of the patients did not achieve a clinically successful result and radiological/clinical fusion. The average time for bony fusion was 5.58 months with the earliest being 4 months and the latest 12 months. Intraoperatively, one patient had screw slippage and one had a dural tear. Postoperatively, four patients had infection, two patients were presented with deep infection, and the instrumentation had been removed. Conclusion: This study demonstrated favorable functional outcomes and improvements in pain, disability, and quality of life measures following surgical intervention.

Eliminating Leprosy in India--Is it a Dream?

In recent years there have been considerable discussions on the current leprosy situation in India and the status of the country's attempts to eliminate or eradicate the disease. In this connection it is very important to analyze the background and various developments relevant to leprosy elimination in India.

Leprosy research and elimination.

The contribution of leprosy research to the progress being made toward elimination of leprosy has been critical. A major development in the promotion of leprosy research during the last 25 years has been the initiative taken by the WHO Special Programme for Research and Training in Tropical Diseases (TDR) through two of its scientific working groups, one on the immunology of leprosy (IMMLEP) and the other on the chemotherapy of leprosy (THELEP), which were set up in 1974 and 1976, respectively. IMMLEP and THELEP have greatly facilitated inputs from scientists not usually active in leprosy research. The coordinated efforts of IMMLEP and THELEP also facilitated goal-oriented research toward high-priority target areas such as an anti-leprosy vaccine and newer and better drug-combinations for the treatment of leprosy. Whereas the prospects for a leprosy vaccine appeared very promising in the early years, the first vaccine produced did not meet expectations for several reasons. Moreover, the possibility of using a vaccine in leprosy is not bright, because of both the technical problems as well as the reduced relevance of a vaccine at a time when leprosy is becoming less and less common. On the other hand, the modest expectations for newer and better drug combinations led to multi-drug therapy (MDT) for the control of leprosy. It is the introduction of MDT that is credited with the current global reduction of leprosy and the progress thus far made toward eliminating the disease as a public health problem. Nevertheless, many areas in leprosy, such as nerve damage, remain that require major research inputs in the future.

Prophylaxis--scope and limitations.

Attempts to prevent leprosy by one or another prophylactic method began with the use of dapsone as a chemoprophylaxis. Following early, small-scale studies, which were promising, large-scale studies with dapsone and acedapsone, both among contacts and in the general population, demonstrated that it is possible to prevent the occurrence of leprosy to a modest extent. With regard to immunoprophylaxis, BCG had long been considered a possibility, particularly in view of its potential to convert the skin test reaction to lepromin. Over the years, major, large-scale field trials of BCG had been carried out in Uganda, Burma, Papua New Guinea and India. All of the studies demonstrated that BCG was capable of preventing leprosy. However, protective efficacy varied from around 20% to greater than 80%. Killed Mycobacterium leprae mixed with BCG has also given varying results. Other vaccines based on cultivable mycobacteria have also been tried, and at least one of them appears promising. An approach to prophylaxis must take into account (a) the level of risk addressed and the perception of risk by the community; (b) the level of efficacy of the method of prophylaxis; (c) the possibility of easily identifying high-risk groups; (d) the operational feasibility; and (e) the focus of the prophylaxis, whether the individual or the community, or both. However, in view of the enormous progress being made towards elimination of leprosy by the widespread application of MDT, prophylaxis is becoming less and less relevant and less and less cost-effective, except in very special situations.