Local Corticosteroid Injection Versus Dry Needling in the Treatment of Lateral Epicondylitis.

Background Lateral epicondylitis (LE) is an inflammation or micro-tearing of the tendons that join the forearm muscles on the lateral aspect of the elbow. Primary treatment of LE includes rest from offending activity and corticosteroid therapy for pain control. Dry needling (DN) is a relatively new therapy for LE. This study examined the results of DN therapy with corticosteroid injection. We aimed to compare pain relief and improvements in functional disability of LE patients treated via DN and corticosteroid injection in a tertiary care center. Methodology A prospective randomized control study was conducted among 54 patients in the Orthopaedics Department of R L Jalappa Hospital from January 2022 to May 2022. Patients received either DN or injectable corticosteroid therapy, and treatment groups were randomized using single-blinded randomization with sealed envelopes. Patients were evaluated using the Patient-Related Tennis Elbow Evaluation (PRTEE) score before the intervention and four and eight weeks after the intervention. Results A total of 54 patients were included in the final analysis. The mean age in the DN group was 43.96 ± 8.15 years and 44.74 ± 8.33 years in the corticosteroid group. In the DN group, 17 (62.96%) patients were male, and in the corticosteroid group, 16 (59.26%) patients were male. The differences in the PRTEE score at the fourth and eighth-week follow-up with baseline value (pre-injection) were statistically significant (p < 0.001). Conclusions DN is a low-cost, minimally invasive, and low-risk therapy whereas corticosteroid therapy is costly and produces systemic side effects in the long term. In this study, during the last follow-up visit, the PRTEE score improved in the DN group compared to the corticosteroid group.

Early Total Care Versus Damage Control Orthopedics in Floating Knee Injury: Analysis of Radiological and Functional Outcomes.

Introduction Floating knee injury (FKI) occurs as a result of a high-velocity impact. We assessed the radiological and functional outcomes of FKIs treated by various fixation methods, by damage control orthopedics (DCO) or early total care (ETC). Materials and methods We investigated 46 patients with FKI who were operated on between January 2013 and January 2018 at the RL Jalappa Hospital and Research Center, Kolar, India. Functional assessments were evaluated using Karlström and Olerud's criteria (KOC). Based on their treatments, the patients were divided into the damage control orthopedics group (n = 21) and the ETC group (n = 25). Statistical analyses were used to obtain and compare summary data. Results The data of 46 patients were collected. Fractures were classified using the modified Fraser's classification. Five patients were not included in the final analysis because of death due to complications in the immediate postoperative period. In patients managed by DCO, after radiological union, the functional outcome was excellent in three cases, good in eight, fair in seven, and poor in two. The average time required for radiological union of the femur was 10.75 ± 1.482 months (P = 0.001); for tibia union, it was 10.25 ± 1.682 months (P = 0.011). The average range of knee flexion was 85°± 16.059° (P = 0.001), which was statistically significant. In patients managed by ETC, there were six cases with an excellent functional outcome, 13 with a good outcome, and two with a fair outcome. The average time required for radiological union of the femur was 9.29 ± 1.765 months (P = 0.006); for the tibia, it was 9.05 ± 1.161 months (P = 0.012). The average range of knee flexion was 100° ± 10.954° (P = 0.001), which was statistically significant. Fat embolism was noted in eight cases; four of these patients died due to multiorgan dysfunction. This was the major life-threatening complication in the early definitive fixation group. In the DCO group, only three cases had fat embolism, with one death due to multiorgan dysfunction. Early postoperative infection was a concern in the ETC group, evident in six cases. Conclusion The classification system for FKI needs further research, which must include multiple parameters. Fracture classification and patient selection are crucial considerations in deciding the best treatment for a particular fracture.

Protein-ligand docking using mutually orthogonal Latin squares (MOLSDOCK).

The theoretical prediction of the association of a flexible ligand with a protein receptor requires efficient sampling of the conformational space of the ligand. Several docking methodologies are currently available. We have proposed a docking technique that performs well at low computational cost. The method uses mutually orthogonal Latin squares to efficiently sample the docking space. A variant of the mean field technique is used to analyze this sample to arrive at the optimum. The method has been previously applied to search through both the conformational space of a peptide as well its docking space. Here we extend this method to simultaneously identify both the low energy conformation as well as a high scoring docking mode for the small organic ligand molecules. Application of the method to 45 protein-ligand complexes, in which the number of rotatable torsions varies from 2 to 19, and comparisons with AutoDock 4.0, showed that the method works well.

Exploring conformational space using a mean field technique with MOLS sampling.

The computational identification of all the low energy structures of a peptide given only its sequence is not an easy task even for small peptides,due to the multiple-minima problem and combinatorial explosion. We have developed an algorithm, called the MOLS technique,that addresses this problem, and have applied it to a number of different aspects of the study of peptide and protein structure. Conformational studies of oligopeptides, including loop sequences in proteins have been carried out using this technique. In general the calculations identified all the folds determined by previous studies,and in addition picked up other energetically favorable structures. The method was also used to map the energy surface of the peptides. In another application, we have combined the MOLS technique, using it to generate a library of low energy structures of an oligopeptide, with a genetic algorithm to predict protein structures. The method has also been applied to explore the conformational space of loops in protein structures.Further, it has been applied to the problem of docking a ligand in its receptor site, with encouraging results.

Exploring the conformational space of protein loops using a mean field technique with MOLS sampling.

We have recently developed a computational technique that uses mutually orthogonal Latin square sampling to explore the conformational space of oligopeptides in an exhaustive manner. In this article, we report its use to analyze the conformational spaces of 120 protein loop sequences in proteins, culled from the PDB, having the length ranging from 5 to 10 residues. The force field used did not have any information regarding the sequences or structures that flanked the loop. The results of the analyses show that the native structure of the loop, as found in the PDB falls at one of the low energy points in the conformational landscape of the sequences. Thus, a large portion of the structural determinants of the loop may be considered intrinsic to the sequence, regardless of either adjacent sequences or structures, or the interactions that the atoms of the loop make with other residues in the protein or in neighboring proteins.