Normal spino-pelvic parameters and correlation between lumbar lordosis (LL) and pelvic incidence (PI) in children and adolescents in Indian population.

PURPOSE: The purpose of this work is to describe normal spino-pelvic parameters for pediatric and adolescent Indian population (and compare it with a cohort of different ethnicity) and to find out the correlation of pelvis incidence (PI) and lumbar lordosis (LL) METHODS: 129 asymptomatic subjects (66 males, 63 females) with age 4-15 years were studied. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) were measured on lateral whole-spine standing radiographs using computer software and compared in relation to age, sex, and ethnicity. Using correlation and regression analysis, the association and predictability of LL with PI was studied within the entire sample and then among age groups 4-10 and 11-15 years. RESULTS: Mean PI was 42° ± 8.1°, whereas PT and SS were 12.9° ± 7.8° and 29.3° ± 9.62°, respectively. PI and SS were lower (p < 0.0001), but PT was higher than Caucasians. Overall PI remained unchanged in the age group > 10 years in comparison to the younger age. Mean PT was lower (p = 0.0020), but SS and LL were higher (p = 0.0027 and p = 0.0002 respectively). Angular spino-pelvic parameters were similar between sex groups. Overall correlation between PI and LL was 0.4 (p < 0.0001) which was 0.1 (p = 0.2345) and 0.5 (p < 0.0001) for ages 4-10 and 11-15 years, respectively. Overall, the prediction of PI based on LL is not very accurate with a simple linear term between PI and LL (R2 = 0.1) and only improve marginally with a restricted cubic spline function. CONCLUSIONS: In pediatric and adolescent' population, ethnicity and age-related variations of normal sagittal spino-pelvic parameters exist and should be considered in patient management.

Sensitivity and Specificity of Gene Xpert in the Diagnosis of Spinal Tuberculosis: A Prospective Controlled Clinical Study.

STUDY DESIGN: Prospective matched cohort study. OBJECTIVE: To evaluate the sensitivity and specificity of Gene Xpert in the diagnosis of spinal tuberculosis. METHODS: From January 2016 to August 2018, Gene Xpert results were prospectively studied in 68 patients of clinicoradiologically suspected spinal tuberculosis (STB) and a control group (CG) of 92 patients, all of whom underwent computed tomography-guided/C-arm-guided/open surgical biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value are obtained using standard equations. RESULTS: Out of 68 cases of STB, Gene Xpert was positive in 62 (true positive: 62/68) and negative in 6 (false negative: 6/68). Gene Xpert was negative for all 92 cases of CG (true negative: 92/92, false positive 0/92). Thus, in our series, sensitivity of Gene Xpert is 91.18%, specificity is 100%, positive predictive value is 100%, and negative predictive value is 93.88%. Out of all cases of STB, 62/68 (91.18%) were Gene Xpert positive, but only 35/64 (54.69%) was acid-fast bacilli (AFB) culture positive and 53/60(88.33%) was histopathologically conclusive of TB. Also, Gene Xpert was positive in 7/7 (100%) cases of STB in which histopathology were inconclusive and 25/29 (86.21%) cases of STB in which AFB culture was negative. CONCLUSION: In STB, Gene Xpert clearly outperforms AFB culture and histopathology due to its high sensitivity and specificity apart from being rapid in diagnosis. Hence it is justified to diagnose spinal tuberculosis by Gene Xpert though histopathology is confirmative and AFB culture remains the gold standard.

Anatomy of the Intertragic Notch of the Auricle May Protect the Ear Canal from Fluids as a Built-In Overflow Spout at an Appropriate Position.

To observe the utility of the intertragic notch during rain showers, an anatomic replica of the human auricle was studied under an artificial shower system with a video recorder. During the shower, water trickled out through the intertragic notch naturally, avoiding the ear canal. This study finds one utility of the intertragic notch may be the prevention of water flowing into the ear canal during rain showers.

The value of intraocular pressure asymmetry in diagnosing glaucoma.

PURPOSE: To investigate the amount of intraocular pressure (IOP) asymmetry in a large group of ethnically diverse patients with and without glaucoma, and to delineate the risk for glaucoma which increasing amounts of IOP asymmetry confer upon the patient. PATIENTS AND METHODS: Collaborative retrospective study of 326 glaucoma patients and 326 controls. Former Wills Eye Institute fellows collected single pre-treatment measurements of IOP on patients diagnosed as having definite glaucoma based on characteristic optic nerve damage and confirmatory visual field damage. Patients with a normal eye examination who had normal-appearing optic discs and no apparent glaucoma, or who had a normal eye examination in association with refractive error or cataract, were used as controls. RESULTS: Intraocular pressure asymmetry is a significant risk factor for having glaucoma (odds ratio, 2.14; 95% confidence interval, 1.86-2.47; P<0.001). Absence of IOP asymmetry between the fellow eyes is associated with a 1% probability of having glaucoma. A difference of 3 mm Hg is associated with a 6% probability of having glaucoma, and a difference of >6 mm Hg with a 57% probability of having glaucoma. The association between IOP asymmetry and glaucoma status is significant for subjects with both elevated IOP (P=0.014) and statistically normal IOP (maximum IOP ≤ 21 mm Hg; P<0.001). CONCLUSIONS: Inter-eye asymmetry of IOP is a common finding in patients with glaucoma. There is a direct relationship between the amount of IOP asymmetry between the fellow eyes and the likelihood of having glaucoma.