Role of Serum Micro-RNA-122-5p Expression as a Circulatory Biomarker in People Having Both Knee Osteoarthritis and Osteoporosis: A Case-Control Study.

Background Although knee osteoarthritis (KOA) and osteoporosis (OP) manifest distinct pathophysiologies, they share numerous similarities. These health conditions are commonly found in older individuals, particularly among women. The objective of this study is to explore the expression of micro-RNA (miRNA) 122-5p (miR-122-5p) in people affected by both KOA and OP. The main aim is to identify diagnostic biomarkers and potential therapeutic targets, which could help develop personalized treatment approaches. Methods As part of the study, a total of 268 serum samples were collected from the participants, who were divided into four groups: KOA, OP, KOA and OP, and controls, with 67 subjects per group. The miRNA species-containing total RNA was isolated from the serum samples using an miRNeasy serum/plasma kit by QIAGEN (Hilden, Germany). The expression of miR-122-5p was examined in each group using real-time quantitative polymerase chain reaction. Results Expression of miR-122-5p in all three groups (KOA, OP, and common group of KOA and OP) was significantly upregulated, and the fold change value was much higher in the group having both diseases. Conclusions These results might contribute to the identification of cases at risk, early diagnosis, and development, and might also contribute to the development of therapeutic targets in subjects having both KOA and OP.

Prevalence of Abnormal Bone-Specific Alkaline Phosphatase in Orthopaedic Trauma Patients: A Cross-Sectional Study From a Tertiary Trauma Centre.

INTRODUCTION: Bone-specific alkaline phosphatase (BALP) has been a sensitive and reliable marker of bone metabolic activity. The study aimed to study the epidemiology of orthopaedic trauma patients and estimate the level of BALP in these patients. MATERIAL AND METHODS: This hospital-based observational cross-sectional study was conducted on over 300 patients admitted to the orthopaedic trauma unit in the level I trauma centre of North India during the study period from January 2020 to January 2021. The level of BALP was assessed in serum samples of 258 patients. RESULT: A total of 300 patients were included in this study, with an average age of 33.52±17.16 years. Road traffic accidents were the most common mode of injury among admitted patients. We found a significant linear correlation between age and mean BALP levels (P-value < 0.005). The mean age of patients having abnormal BALP is 63.0±16.61 years. Females (22.61±16.23) had greater mean BALP levels than males (13.15±5.86). Among different fractures, fractures around the hip had a higher mean BALP level (23.17±15.07). Patients with diabetes mellitus have higher mean BALP levels. CONCLUSION: BALP is a cost-effective, readily available bone marker to assess the metabolic activity of orthopaedic trauma patients. Old age patients should undergo routine BALP estimation at admission to rule out metabolic disorders, and timely intervention will prevent complications associated with metabolic disorders.

Expression of Antimicrobial Peptides and Cytokines in Human Omentum Following Abdominal Surgery.

Introduction Omentum can secrete out biological agents like different growth factors, cytokines, and antimicrobial peptides. The aim of our study was to determine the expression of antimicrobial peptides and cytokines in human omentum tissue and its response to intra-abdominal infection. Methodology Omentum tissue was obtained from 60 patients: control (n=20) and cases (n=40). mRNA expression of antimicrobial peptides (LL-37, HBD-1, HBD-2, HNP1-3) and cytokines (TNF- α, IL-8, IL-10, IL1ß) was evaluated using Real-Time PCR. Protein quantification was done by Immunoblotting and ELISA. Results Significantly higher expression of antimicrobial peptides (LL-37, HBD-1, HBD-2, HNP1-3) and cytokines (TNF- α, IL-8, IL-10, IL1ß) was observed in cases as compared to control at both the transcriptional and translational level (p<0.0001). Conclusion Omentum governs a population of antimicrobial peptides with potent immunologic functions. The expression of antimicrobial peptides and cytokines is inducible and increases with the severity of infection. Omentum is thus an immunologically active and adaptable organ but its complete regulatory mechanism is still elusive.

Prevalence of Vitamin D Deficiency in a Young Adult With Acute Spinal Cord Injury.

INTRODUCTION: Vitamin D deficiency has been implicated as an etiologic factor responsible for osteoporosis and various skeletal and extra-skeletal issues in spinal cord injury patients. There is a dearth of publications regarding the prevalence of vitamin D deficiency in acute spinal cord injury (ASCI) patients, thus it becomes imperative to study the status of vitamin D in ASCI cases to make an early diagnosis and start treatment for osteoporosis. Apart from this, we also planned to evaluate other factors associated with vitamin D deficiency in our subset of patients. MATERIAL AND METHODS:  This cross-sectional cohort study included patients with acute thoracolumbar spinal cord injury patients admitted to a tertiary trauma centre between July 2019 and July 2020. Patients were assessed clinically and classified as per the American Spinal Cord Injury Association (ASIA) scale. Demographic details along with the mode of trauma and duration of injury were noted. Serum 25(OH) vitamin D3 levels were measured by chemiluminescence immunoassay. Depending upon serum 25(OH) vitamin D3 level, patients were classified into vitamin D deficient with serum level less than 20 ng/ml, vitamin D insufficient with serum level between 21-29 ng/ml and vitamin D sufficient with serum level greater than 30 ng/ml. RESULTS: Mean vitamin D level in 85 ASCI subjects (mean age 30.82 ± 6.77 years, 60 males) was 20.56 ± 11.22 ng/ml. Fifty subjects (58.82%) were vitamin D deficient, 15 subjects (17.64%) were vitamin D insufficient and the rest (n=20, 23.52%) were vitamin D sufficient. There was no significant difference in vitamin D levels as per gender, age, mode of trauma, type of injury and injury location. Patients admitted on the fifth day of injury had maximum vitamin D levels (mean 25.7143 ± 8.32 ng/ml), but it was also insignificant. The mean vitamin D level of subjects with samples taken during the summer season was significantly higher as compared to the winter season (p value <.05). CONCLUSION: Vitamin D deficiency is widely prevalent in ASCI patients at admission to the trauma centre. Seventy-six percent of patients had vitamin D levels below 30 ng/ml in our study. Routine measurement of 25(OH) vitamin D3 levels at the time of admission is recommended for early diagnosis of vitamin D deficiency. Early treatment will be helpful in the prevention of osteoporosis and its long-term related consequences.

Management of Grade IV Pressure Ulcers With a Novel Negative Pressure Device in Traumatic Paraplegia Subjects.

Introduction Pressure ulcers (PUs) are a major health problem for bedridden patients or persons with reduced mobility; individuals with spinal cord injury (SCI) are more prone to developing pressure ulcers. The purpose of this study was to determine the efficacy of a novel negative pressure wound therapy (NPWT) system for the treatment of Grade IV PUs. Methods A total of 34 SCI patients with Grade IV PUs were divided into two groups: 17 cases were managed by our bellows-powered negative pressure device (NPD) and 17 received wet-to-moist gauze dressing as standard wound care. Results Wound healing outcome measures were recorded every week (at seven days) and compared at weeks 3, 6, and 9. There were no significant changes in the length and width of PUs between the groups till week 3. Significantly reduced length and width of NPD-treated PUs were found at week 6 (p=0.04) that further reduced at week 9 (p=0.001) as compared to standard wound care. Similarly, significant reduction in the depth of PUs was found in the NPD-treated group at week 9 (p<0.05). Exudate levels were significantly (p=0.001) lower in the NPD-treated group as compared to the standard wound care group from week 3 (2.96±0.21 vs 2.62±0.49); this difference continued through week 9 (1.35±0.75 vs 0.14±0.35). Disappearance of slough and formation of healthy granulation tissue was significantly higher in the NPD-treated PUs after week 6 (p=0.001). Conclusion NPWT may be the future of wound healing. As an alternative to the existing electrically powered NPWT systems, our NPD is safe, easy to apply, and efficacious in treating the PUs.

A non-randomised, controlled clinical trial of an innovative device for negative pressure wound therapy of pressure ulcers in traumatic paraplegia patients.

The conventional methods of treatment of pressure ulcers (PUs) by serial debridement and daily dressings require prolonged hospitalisation, associated with considerable morbidity. There is, however, recent evidence to suggest that negative pressure wound therapy (NPWT) accelerates healing. The commercial devices for NPWT are costly, cumbersome, and electricity dependent. We compared PU wound healing in traumatic paraplegia patients by conventional dressing and by an innovative negative pressure device (NPD). In this prospective, non-randomised trial, 48 traumatic paraplegia patients with PUs of stages 3 and 4 were recruited. Patients were divided into two groups: group A (n = 24) received NPWT with our NPD, and group B (n = 24) received conventional methods of dressing. All patients were followed up for 9 weeks. At week 9, all patients on NPD showed a statistically significant improvement in PU healing in terms of slough clearance, granulation tissue formation, wound discharge and culture. A significant reduction in wound size and ulcer depth was observed in NPD as compared with conventional methods at all follow-up time points (P = 0·0001). NPWT by the innovative device heals PUs at a significantly higher rate than conventional treatment. The device is safe, easy to apply and cost-effective.

Does Serum Albumin Level Affect the Healing Outcomes of Simple Diaphyseal Tibial Fractures?

AIMS: To quantify the serum albumin level and its correlation with fracture healing progression and outcomes in adult patients. SETTINGS AND DESIGN: A prospective cohort study at an institutional trauma center. MATERIALS AND METHODS: A total of 50 adult patients with simple, fresh traumatic diaphyseal fractures of both bones of the leg managed conservatively were included in the study. Serum albumin was measured initially and at the 6th week postfracture. The clinico-radiological follow-up was done to analyze the fracture healing progression and their final outcomes, which were correlated with the quantified serum albumin level of the patients. STATISTICAL ANALYSIS USED: Student t-test, Mann-Whitney U-test and Pearson correlation coefficient. RESULTS: As per the last clinico-radiological follow-up at the 24th week, patients were grouped into two groups: Group I (normal union n = 38) and Group II (impaired healing n = 12). The mean serum albumin levels were significantly higher in Group I when compared to Group II. The association between the serum albumin level at baseline and at the 6th week was moderate. The best cut-off measure of serum albumin level was 3.45 g/dL, both at baseline and at the 6th week after fracture to predict the healing outcome. The correlation of serum albumin levels with fracture healing outcomes was statistically significant. CONCLUSION: Serum albumin is moderately associated with the baseline and 6th-week values and showed a positive correlation with the bony healing progression and may provide an early predictor of the healing outcomes of simple diaphyseal tibial fractures.

Management of late onset perthes: evaluation of distraction by external fixator-5-year follow-up.

Background. Hip distraction in Perthes' disease unloads the joint, which negates the harmful effect of the stresses on the articular surfaces, which may promote the sound healing of the area of necrosis. We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. Methods and Materials. Twelve children with age more than 8 years with Perthes' disease of less than one year were treated with hip distraction by a hinged monolateral external fixator. Observation and Results. Mean duration of distraction was 13.9 days. These children were evaluated by clinicoradiological parameters for a mean period of 32.4 months. There was a significant improvement in the range of movements and mean epiphyseal index, but the change in the percentage of uncovered head femur was insignificant. There was significant improvement in Harris Hip score. Conclusions. Hip distraction by hinged monolateral external fixator seems to be a valid treatment option in cases with Perthes' disease in the selected group of patients, where poor results are expected from conventional treatment.