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OBJECTIVE: The objective of this study is to evaluate the prognostic value of nutritional scores comprising the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI), in prediction of multilevel vertebral involvement (> 2 vertebra) in Spinal Tuberculosis (STB). METHODS: Retrospective analysis of 39 STB patients was conducted to assess nutritional indices (CONUT and PNI) and the numbers of vertebral affection. Spearman's correlation was used to examine the association between these variables. Receiver Operating Characteristic (ROC) curves were utilized to determine optimal cutoff values, with Area Under the Curve (AUROC) evaluation. Additionally, multiple logistic regression was performed as a predictive model. RESULTS: There were 24 males and 15 females, with a mean BMI of 18.88 kg/m² (± 1.37). Spearman's correlation analysis revealed negative correlations between BMI, PNI (rho - 0.68, p < 0.001) and multilevel vertebra involvement, while ESR (rho 0.83, p < 0.001), CRP (rho 0.81, p < 0.001), and CONUT score (rho 0.83, p < 0.001) positively correlated with multilevel vertebral affection (> 2 vertebra). Age and comorbidities showed no correlation with the level of vertebral affection. ROC analysis revealed a CONUT Score ≥ 3 cutoff (sensitivity-95.7%, specificity-87.5%) and PNI ≤ 38.605 (sensitivity-78.3%, specificity-93.8%) for predicting multilevel STB (> 2). PNI exhibited superior specificity and positive predictive value where as CONUT score was a better parameter for sensitivity, negative predictive value and diagnostic accuracy. Both CONUT score and PNI were significant predictors of vertebral involvement in univariate analysis, with multivariate analysis identifying CONUT score as the sole predictor of multilevel vertebral affection. CONCLUSION: Nutritional scores, including CONUT score and PNI, emerged as significant predictors of multilevel STB. CONUT score displayed superior sensitivity, negative predictive value, and overall diagnostic accuracy, while PNI served as a nutritional marker with high specificity and positive predictive value in predicting multilevel involvement in spinal tuberculosis.
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Due to their persistence in the environment, and their highly toxic and bioaccumulative nature, heavy metals are well known to the environment. Vermicompost has gained popularity because it improves soil properties and, most importantly, remediates and immobilizes heavy metals. The present study assessed vermicompost effects on heavy metal bioaccumulation in tomato plants irrigated with wastewater. A plastic bag experiment was carried out with 5 kg of growing media in each bag. Growing media contain garden soil with four levels of vermicompost mixed at 0%, 5%, 15%, and 25%. The pots were irrigated with wastewater from different industries and tap water, which was taken as control. Wastewater was collected from the pharmaceutical industry, plastic industry, and sewage water of Hayatabad Industrial Estate, Peshawar. Vermicompost application significantly affected all tomatoes' growth attributes and heavy metals concentration. Results revealed that minimum Cd (2.48 mg kg-1), Cr (1.27 mg kg-1), Cu (4.10 mg kg-1), and Pb (0.62 mg kg-1) concentrations were recorded in tomatoes cultivated in 25 % vermicompost amended soil, while, maximum Cd (5.23 mg kg-1), Cr (2.29 mg kg-1), Cu (8.84 mg kg-1) and Pb (2.18 mg kg-1) concentrations were reported in sewage water irrigated plants., Overall, vermicompost applied at 25% significantly enhanced plant growth and yield, reducing the bioavailability and bioaccumulation of heavy metals. From the finding of this study, it is observed that wastewater irrigation of plants should be avoided because of the high level of heavy metals; in contrast, the application of vermicompost is highly recommended as compost reduces heavy metals bioaccumulation and enhances productivity.
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Bioacumulación , Metales Pesados , Contaminantes del Suelo , Suelo , Solanum lycopersicum , Aguas Residuales , Solanum lycopersicum/metabolismo , Solanum lycopersicum/crecimiento & desarrollo , Aguas Residuales/química , Metales Pesados/metabolismo , Metales Pesados/análisis , Contaminantes del Suelo/metabolismo , Contaminantes del Suelo/análisis , Suelo/química , Riego Agrícola/métodos , Compostaje , Contaminantes Químicos del Agua/metabolismo , Contaminantes Químicos del Agua/análisisRESUMEN
Background: The management of neglected traumatic knee dislocations is challenging and is commonly associated with suboptimal outcomes. In this article we present two cases of neglected knee dislocations in two young trauma victims who presented late due to restrictions during the COVID-19 pandemic. Methods: Two young patients presented at our center with neglected knee fracture-dislocations after eight weeks and six months of trauma. Comprehensive evaluation was performed using radiographs, computed tomography scans, and magnetic resonance imaging. Surgical intervention included open reduction and internal fixation of the mal-aligned intra-articular fracture fragments. Additionally, articular congruency was restored and repair or reconstruction of the posterior cruciate ligament, anterior cruciate ligament, and meniscus was conducted using suitable tendinous autografts and implants. Following surgery, the knees were immobilized for six weeks, followed by aggressive physical therapy. Results: After three months of surgical intervention, fracture union and joint stability were achieved. At the >36-month follow-up appointments, both patients were pain-free at rest with a stable knee joint, achieving ≥90 degrees of knee flexion and without extensor deficits. Concurrent with radiographic evidence of osteoarthritic changes in the knee joint, there was mild pain (VAS 2) after prolonged knee movement activities and walking for long distances (>1 km). Conclusion: Open reduction and internal fixation, along with simultaneous menisco-ligamentous reconstructions in neglected fracture-dislocations of the knee result in satisfactory clinical outcomes. This approach proves to be an effective joint preservation procedure in young patients, even in delayed and neglected conditions.
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In addition to enhancing diagnostic accuracy, deep learning techniques offer the potential to streamline workflows, reduce interpretation time, and ultimately improve patient outcomes. The scalability and adaptability of deep learning algorithms enable their deployment across diverse clinical settings, ranging from radiology departments to point-of-care facilities. Furthermore, ongoing research efforts focus on addressing the challenges of data heterogeneity, model interpretability, and regulatory compliance, paving the way for seamless integration of deep learning solutions into routine clinical practice. As the field continues to evolve, collaborations between clinicians, data scientists, and industry stakeholders will be paramount in harnessing the full potential of deep learning for advancing medical image analysis and diagnosis. Furthermore, the integration of deep learning algorithms with other technologies, including natural language processing and computer vision, may foster multimodal medical data analysis and clinical decision support systems to improve patient care. The future of deep learning in medical image analysis and diagnosis is promising. With each success and advancement, this technology is getting closer to being leveraged for medical purposes. Beyond medical image analysis, patient care pathways like multimodal imaging, imaging genomics, and intelligent operating rooms or intensive care units can benefit from deep learning models.
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A man in his 30s came to our clinic with a year-long history of progressive pain and swelling in his knee. Diagnostic imaging revealed a displaced patellar fracture with an osteolytic, septated lesion and thinned expanded cortex in both fracture fragments. A core needle biopsy confirmed the diagnosis of giant cell tumour. Treatment involved wide excision of the tumour and the use of polypropylene mesh and a peroneal longus tendon autograft to reconstruct the extensor mechanism of the knee joint. One year postoperatively, the patient experienced no pain, demonstrated full range of motion and showed no signs of functional impairment or local tumour recurrence. This case highlights that reconstruction of the extensor mechanism of the knee after tumour excision with synthetic mesh is an affordable, user-friendly and widely accessible method. It can address large defects effectively while minimising the risks of disease transmission and graft lengthening, resulting in satisfactory outcomes.
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Neoplasias Óseas , Rótula , Polipropilenos , Mallas Quirúrgicas , Humanos , Masculino , Rótula/cirugía , Rótula/lesiones , Rótula/diagnóstico por imagen , Neoplasias Óseas/cirugía , Neoplasias Óseas/complicaciones , Adulto , Tumor Óseo de Células Gigantes/cirugía , Fracturas Espontáneas/cirugía , Fracturas Espontáneas/etiología , Fracturas Espontáneas/diagnóstico por imagen , Procedimientos de Cirugía Plástica/métodos , Resultado del TratamientoRESUMEN
Introduction: Knee arthrodesis following failed total knee arthroplasty is a viable limb salvage option, and this procedure is reserved for failed two-stage revision surgery in severe comorbid patients with irreparable extensor mechanism disruption, severe instability, and extensive soft tissue loss. Knee arthrodesis using a dual-plate construct has been scarcely reported. We report a case of knee arthrodesis using a dual-plate construct in a male in his 20s who presented to us with a broken distal femur megaprosthesis. Case Report: An anterior midline incision was given. The cement mantle and broken prosthetic components were removed. The bone surfaces were freshened up and fixed using two orthogonal locking plates. After 4 months, there was a solid fusion in the knee, and the patient started walking independently with a short limb gait. The patient was advised limb lengthening for a shortening of 3 cm, but he denied it and managed with a shoe raise. After 4 years, he was pain free, and radiographs revealed a solid knee fusion. The patient was fully satisfied with the procedure, and he resumed manual work. Conclusion: This case report revealed that knee arthrodesis using a dual-plate construct is an economically viable salvage option for failed distal femur megaprosthesis.
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PURPOSE: The aim of this systematic review and meta-analysis was to compare joint awareness in patients who underwent total hip arthroplasty (THA) via the anterior approach (AA) versus the posterior approach (PA). The hypothesis was that patients who underwent THA via AA would have better forgetfulness of the artificial joint. METHODS: A comprehensive search of major literature databases and bibliographic details was conducted to identify studies evaluating the forgotten joint score (FJS-12) in total hip arthroplasty (THA) patients operated through the anterior approach (AA) and posterior approach (PA). Out of 234 studies identified, seven studies met the inclusion criteria for review. The Newcastle-Ottawa Scale was used to evaluate the quality of evidence and the risk of bias in the included studies. The FJS-12 was evaluated at three months, one year, and beyond 2 years. RESULTS: The mean FJS-12 at > 2 years was 82.03 in the AA group and 80.32 in the PA group. The forest plot analysis (n = 819 patients) revealed no significant difference in FJS-12 score between these two approaches (MD 2.13, 95% CI [- 1.17, 5.42], p = 0.21; I2 = 60%). However, the joint awareness was significantly lesser in the AA group at 3 months (MD 12.56, 95% CI [9.58, 15.54], p < 0.00001, I2 = 0%) and 1 year (MD 9.55, 95% CI [7.85, 11.24], p < 0.0001, I2 = 0%). CONCLUSIONS: After analyzing the available literature, it was found that THA patients operated through the AA approach have significantly lower joint awareness than those operated through the PA approach in the first year of surgery. However, there is no significant difference in joint awareness between these two approaches after 2 years. LEVEL OF EVIDENCE: III.
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Artroplastia de Reemplazo de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/métodosRESUMEN
The current study used the major target protein lactate dehydrogenase Cryptosporidium parvum to identify potential binders. Our approach was a comprehensive three-step screening of 2,569 natural compounds. First, we used molecular docking techniques, followed by an advanced DeepPurpose ML model for virtual screening. The final step involved meticulous re-docking and detailed interaction analysis. The known inhibitor FX11 was considered as a control that was used for comparative analysis. Our screening process led to the identification of three promising compounds: 5353794, 18475114, and 25229652. These compounds were chosen due to their exceptional ability to form hydrogen bonds and their high binding scores with the protein. Here, all three hits showed H-bonds with the functional residues (Asn122 and Thr231) of protein, while 25229652 also showed H-bond with the catalytic site residue (His177). RMSD behaviour reflected stable and consistent complex formation for all the compounds in their last 30 ns trajectories. Principal component analysis (PCA) and free energy landscape (FEL) showed a high frequency of favourable low free energy states. Using the MM/GBSA calculation, compounds 5353794 (ΔGTOTAL = -34.92 kcal/mol) and 18475114 (ΔGTOTAL = -34.66 kcal/mol) had the highest binding affinity with the protein however, 25229652 (ΔGTOTAL = -22.62 kcal/mol) had ΔGTOTAL comparable to the control FX11. These natural compounds not only show the potential for hindering C. parvum lactate dehydrogenase but also open new avenues in its drug development. Their strong binding properties and stable interactions mark them as the prime candidates for further research and experimental validation as anti-cryptosporidiosis agents.Communicated by Ramaswamy H. Sarma.
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Introduction: Vacuum-assisted closure (VAC) dressings are used for many indications nowadays in wound management. However, there are complications with VAC dressings also. In this study, we report a 44-year-old patient with a vertical shear injury with post-operative wound complication of adherent polyurethane sponge over her wound which was removed by piecemeal dissection. Case Report: A 44-year-old patient sustained a vertical shear pelvic injury following which spinopelvic fusion surgery was performed. The patient developed wound dehiscence along with discharge on POD 4. Following this, VAC dressing was applied to the wound. After 3 days, the polyurethane sponge became adherent to the wound. The sponge was removed gradually through daily debridement in a piecemeal manner. The wound was found to be healthy and a keystone flap was raised to cover the wound. Conclusion: Although such complication of an adherent sponge has not been reported to date, one must keep in mind this complication while making improvisations to commercially available VAC dressings.
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Evaluating the lifespan distribution of highly reliable commodities under regular use is exceedingly difficult, time consuming, and extremely expensive. As a result of its ability to provide more failure data faster and at a lower experimental cost, accelerated life testing has become increasingly important in life testing studies. In this article, we concentrate on parametric inference for step stress partially life testing utilizing multiple censored data based on the Tampered Random Variable model. Under normal stress circumstances, the lifespan of the experimental units is assumed to follow the Nadarajah-Haghighi distribution, with and being the shape and scale parameters, respectively. Maximum likelihood estimates for model parameters and acceleration factor are developed using multiple censored data. We build asymptotic confidence intervals for the unknown parameters using the observed Fisher information matrix. To demonstrate the applicability of the different methodologies, an actual data set based on the timings of subsequent failures of consecutive air conditioning system failures for each member of a Boeing 720 jet aircraft fleet is investigated. Finally, thorough simulation studies utilizing various censoring strategies are performed to evaluate the estimate procedure performance. Several sample sizes were studied in order to investigate the finite sample features of the considered estimators. According to our numerical findings, the values of mean squared errors and average asymptotic confidence intervals lengths drop as sample size increases. Furthermore, when the censoring level is reduced, the considered estimates of the parameters approach their genuine values.
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Total hip arthroplasty (THA) in patients with ipsilateral mid-thigh amputation is surgically challenging. We report a case of same setting THA and ipsilateral above-knee amputation in a male patient. The patient had 8 months old neglected neck femur fracture and ipsilateral femur shaft fracture with 14 cm bone loss. There was an associated neurovascular (femoral artery injury and sciatic nerve palsy) deficit at the initial insult; however, the limb survived because of well-formed collaterals. The limb was insensate at the time of presentation because of complete sciatic nerve palsy. The decision to undergo amputation was taken based on insensate limb, compromised circulation and huge bone loss with healed open fracture. After 10 months follow-up, the patient was walking with prosthesis limb fitted to the amputated mid-thigh stump and there were no incidences of osteolysis, subsidence or infection in the THA site.
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Artroplastia de Reemplazo de Cadera , Enfermedades Óseas Metabólicas , Fracturas del Fémur , Fracturas del Cuello Femoral , Humanos , Masculino , Lactante , Fracturas del Fémur/cirugía , Muslo , Extremidad Inferior , Amputación Quirúrgica , Fracturas del Cuello Femoral/cirugíaRESUMEN
Giant cell tumor (GCT) of the distal tibia can result in significant bone loss and soft tissue compromise, which can present a challenge for reconstruction. Various techniques have been described for the reconstruction of large defects, including the use of allografts. In this article, we describe a novel technique of reconstruction of a large defect in the distal tibia using two femoral head allografts after resection of GCT. The technique involves using two femoral head allografts, which are shaped to fit the defect and secured with a locking plate and screws. Using this technique, we present a case report of a patient with GCT of the distal tibia who underwent resection and reconstruction. At the 18-month follow-up, the patient had good functional outcomes and no evidence of tumor recurrence. This technique offers a viable option for reconstructing large defects in the distal tibia after GCT resection, particularly in cases where autograft is not available or not feasible. Further studies are needed to evaluate the long-term outcomes and complications associated with this technique.
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Neoplasias Óseas , Tumores de Células Gigantes , Humanos , Tibia/cirugía , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Resultado del Tratamiento , Trasplante Óseo/métodos , Recurrencia Local de Neoplasia , Aloinjertos , Estudios RetrospectivosRESUMEN
We describe herein a chemo- and regioselective cascade annulation between ß-ketothioamides and diazo-substituted hypervalent iodine reagents under transition-metal-free and base-free conditions at room temperature. Thus, a divergent construction of fused-heterocyclic scaffold thiazolothiadiazoles has been achieved with the advantages of operational simplicity, scalability, broad substrate compatibility, and mild reaction conditions. This one-pot strategy not only avoids potential toxicity but also broadens the arsenal of synthetic methods to obtain fused N,S-heterocyclic frameworks.
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Base promoted one-pot annulative coupling of 1,2,3,4-tetrahydroisoquinolines (THIQs) with hypervalent iodine(III) species aryliodonio diazo compounds has been devised for the direct construction of 1,2,4-triazolo[3,4-a]isoquinoline derivatives at room temperature in open air for the first time. This approach involves [2 + 3] cascade annulation of nucleophilic THIQ with an electrophilic aryliodonio diazo compound via N-H and α-C1(sp3)-H difunctionalization of THIQ.
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Yodo , Tetrahidroisoquinolinas , Compuestos Azo , Yoduros , IsoquinolinasRESUMEN
Cariprazine hydrochloride is a second-generation antipsychotic drug and has been approved by the US Food and Drug Administration and the European Medicines Agency. Herein, we have reported a stability-indicating assay method for the Cariprazine hydrochloride and characterization of its major degradation products using LC-HRMS/MS. The drug substance Cariprazine hydrochloride was subjected to acid, base, oxidation, thermal and photolytic stress degradation. A total of five novel degradation products (DP-1 to DP-5) of Cariprazine hydrochloride drug substance were formed under various acid, base and oxidative conditions. In silico toxicity of the degradation products was evaluated using Leadscope prediction platform. We successfully separated Cariprazine Hydrochloride peak from degradation products (DP-1 to DP-5) by using gradient elution on an Inertsil C18 column (150 × 4.6 mm, 5 µm). The drug substance was found to be labile to acidic, alkaline hydrolytic, and oxidative conditions and stable to photolytic and thermal stress conditions. The degradation pathways were delineated by explaining the putative mechanism of degradation in various conditions. The stability-indicating assay method was validated according to the ICH guideline and hence can be used for routine quality control and stability study analysis of Cariprazine hydrochloride in pharmaceutical industries and research laboratories.
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Piperazinas , Cromatografía Líquida de Alta Presión/métodos , Cromatografía Liquida/métodos , Estabilidad de Medicamentos , Hidrólisis , Espectrometría de Masas/métodos , Oxidación-Reducción , FotólisisRESUMEN
Global warming and climate change have become one of the most embarrassing and explosive problems/challenges all over the world, especially in third-world countries. It is due to a rapid increase in industrialization and urbanization process that has given the boost to the volume of greenhouse gases (GHGs) emissions. In this regard, carbon dioxide (CO2) is considered a significant driver of GHGs and is the major contributing factor for global warming. Considering the goal of mitigating environmental pollution, this research has applied multiple methods such as neural network time series nonlinear autoregressive, Gaussian Process Regression, and Holt's methods for forecasting CO2 emission. It attempts to forecast the CO2 emission of Bahrain. These methods are evaluated for performance. The neural network model has the root mean square errors (RMSE) of merely 0.206, while the Gaussian Process Regression Rational Quadratic (GPR-RQ) Model has RMSE of 1.0171, and Holt's method has RMSE of 1.4096. Therefore, it can be concluded that the neural network time series nonlinear autoregressive model has performed better for forecasting the CO2 emission in the case of Bahrain.
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Gases de Efecto Invernadero , Bahrein , Dióxido de Carbono/análisis , Electricidad , Predicción , Calentamiento GlobalRESUMEN
Background: The second wave of SARS-CoV-2 pandemic has posed new challenges in the management of Orthopedic trauma patients due to the overburdened healthcare facilities and we aim to present the differences in demographics between the first wave and the initial part of the second wave. Methodology: This study was a retrospective cross-sectional study of our trauma registry from June 19, 2020 to October 13, 2020 (1st study period) and from April 1, 2021 to the first week of May 2021 (2nd study period). We looked into differences in the following three parameters: (1) infection rate among Orthopaedic patients in the first and second study period of SARS-CoV-2 pandemic, (2) infection rate among the Health Care Workers and (3) hospital-acquired SARS-CoV-2 infections in admitted Orthopaedic trauma patients. Results: 35 out of 852 patients (4.1%) were positive for SARS-CoV-2 infection in 1st study period as compared to 48 out of 262 patients (18.3%) in the 2nd study period (p < 0.001). 23 HCW's involved in management of Orthopaedic trauma patients tested positive in the second study period compared to none in the first study period. 17 patients had Hospital-acquired SARS-CoV-2 infection in 2nd study period compared to 7 in 1st study period. There were more asymptomatic patients for SARS-CoV-2 infection in the 2nd study period. Conclusion: Significant increase in the number of SARS-CoV-2 infection in Orthopaedic trauma patients, and the increased number of HCW's affected with SARS-CoV-2 infection have been the challenges in 2nd study period.
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Transolecranon fracture-dislocations are a result of high-energy trauma, caused due to axial loading of the flexed forearm, with associated anterior dislocation of the ulna with respect to the distal humerus. The usual management of these comminuted and unstable fractures is by using locking compression plates via the dorsal approach. However, plating in cases of poor soft tissue coverage and open wounds can be precarious. In this study, we aimed to evaluate outcomes of cerclage wiring in the management of comminuted trans-olecranon fracture-dislocations in such scenario. A total of seven patients diagnosed with trans-olecranon fracture-dislocation with poor soft tissue coverage who underwent cerclage wiring were included in the study. The aim was to realign the proximal portion of the olecranon to the trochlea and restore the normal ulnohumeral articular relationships accomplished by the anatomical reconstruction of the greater sigmoid notch. Reconstruction of the proximal ulna was started from the distal to the proximal direction so as to convert an unstable fracture into a stable one. After the reduction of the proximal fragment, two long 2 mm K wires were inserted from the tip of the olecranon into the intramedullary canal (with at least 1 wire passed subchondrally), and later cerclage was done. Postoperatively the patient was immobilized for a duration of two weeks and was later started on active assisted mobilization of the elbow. All patients showed fair-to-excellent outcome on the Mayo elbow performance score (MEPS) at the final follow-up (five patients had an excellent score, one had a good score, and one had a fair score). At the final follow-up, the mean extension, flexion, pronation and supination were -20, 117.14, 82.85 and 78.57 degrees respectively. The key components of such management are the restoration of articular congruity, including continuity of the sigmoid cavity, ulnar length, and early initiation of active elbow movements to avoid joint stiffness. Optimal functional results can be achieved with K wire and cerclage when a stable anatomic reconstruction is accomplished, as a feasible alternative to plating.
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OBJECTIVE: This study was conducted to investigate and compare the effects of add-on folic acid and vitamin B12 supplementation on glycaemic control, insulin resistance and serum lipid profile in subjects with type 2 diabetes mellitus. STUDY DESIGN & INTERVENTION: This study was a randomized, multi-arm, open-label clinical trial. 80 patients with type 2 diabetes and on stable oral antidiabetics were enrolled and 20 patients each were randomly allocated to one of the four groups - Group A: add-on Folic acid (5â¯mg/day); Group B: add-on Methylcobalamin (500 mcg/day); Group C: add-on Folic acid (5â¯mg/day) + Methylcobalamin (500 mcg/day) and Group D: Standard oral anti-diabetic drugs. The patients were followed up after 8 weeks. RESULTS: HbA1c improved significantly in Groups B and C [median changes from baseline - 1.2 % (- 13â¯mmol/mol) and - 1.5 % (- 16â¯mmol/mol) respectively, p values 0.04 and 0.02 respectively] compared to Group D. Groups B and C also showed significant improvements in plasma insulin, insulin resistance and serum adiponectin compared to Group D. Serum homocysteine declined significantly in all three groups with add-on supplementation compared to standard treatment. No improvement in the lipid profile was noted in any of the groups. CONCLUSIONS: Add-on supplementation with vitamin B12 improved glycaemic control and insulin resistance in patients with type 2 diabetes mellitus.
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Ácido Fólico/uso terapéutico , Vitamina B 12/uso terapéutico , Adulto , Suplementos Dietéticos , Quimioterapia Combinada , Control Glucémico , Humanos , Resistencia a la Insulina , Lípidos/sangre , Persona de Mediana EdadRESUMEN
OBJECTIVES: To identify epigenetic and transcriptional factors controlling osteoclastogenesis (OCG), that have been shown to play a role in the pathogenesis of skeletal diseases. METHODS: A systematic review was conducted in accordance with the PRISMA guidelines. The PubMed and EMBASE databases were searched up to 30th April 2020; references of included articles and pertinent review articles were also screened to identify eligible studies. Studies were included if they described epigenetic and/or transcriptional regulation of OCG in a specific skeletal disorder, and quantified alterations in OCG by any well-described experimental method. Risk of bias was assessed by a previously described modification of the CAMARADES tool. RESULTS: The combined searches yielded 2265 records. Out of these, 24 studies investigating 12 different skeletal disorders were included in the review. Osteoporosis, followed by osteopetrosis, was the most commonly evaluated disorder. A total of 22 different epigenetic and transcriptional regulators of OCG were identified; key epigenetic regulators included DNA methylation, histone methylation, histone acetylation, miRNAs and lncRNAs. In majority of the disorders, dysregulated OCG was noted to occur at the stage of formation of committed osteoclast from preosteoclast. Dysregulation the stage of formation of the preosteoclast from late monocyte was noted in rheumatoid arthritis and fracture, whereas dysregulation at stage of formation of late monocyte from early monocyte was noted in osteopetrosis and spondyloarthritis. Quality assessment revealed a high risk of bias in domains pertaining to randomization, allocation concealment, blinding of outcome assessors and determination of sample size. CONCLUSIONS: A variety of epigenetic and transcriptional factors can result in dysregulated osteoclastogenesis in different skeletal disorders. Dysregulation can occur at any stage; however, the formation of committed osteoclasts from preosteoclasts is the most common target. Although the published literature on this subject seems promising, the overall strength of evidence is limited by the small number of studies evaluating individual skeletal disorders, and also by deficiencies in key aspects of study design.