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After witnessing the unruly and disruptive behaviour amongst college students on trivial topics, a study was conducted to find the reason behind it. The study consisted of students discussing topics like politics, situational problems etc. and it was observed that students lacked the concept of perception. Studying this even further, it was found that the cause for this was because our modern-day education focused more on literally manufacturing people for jobs and less on value systems and critical thinking. The present education system is finding it very difficult in ensuring the required quality that every student must possess. This also gives rise to students being confused about their career paths and life in general. They don't realise their true potential and abilities and thus start developing a "follow the crowd" mentality. To improve this situation, a radical change has to be brought into the education system and this change can only be supported by retrospection of India's ancient education system. The focus must now divert towards developing skills rather than just concentrating on academics. These ancient practices cannot be applied as it is in this modern era. Hence, their application calls for reinvention and resurgence to benefit today's students.

New Findings: What is the central question of this study?To what extent does musculoskeletal impairment occur (i.e., muscle mass, quality and function) in patients with end stage liver disease (ESLD) by comparison to a healthy age/sex‐matched control group?What is the main finding and its importance?Muscle mass, quality and function are impaired in patients with ESLD (compared to age/sex matched controls). Importantly, greater impairments were seen in lower limb compared to arm and trunk muscle groups. These findings may suggest that there should be greater consideration of muscle health in functionally relevant lower limb muscle groups. Sarcopenia is associated with reduced quality of life and increased mortality in patients with end stage liver disease (ESLD). Historically, sarcopenia identification in ESLD utilised L3 skeletal muscle index (SMI). There are few data on muscle quality and function within lower limb muscle groups with high functional relevance. The aim of this prospective case–control study was to evaluate the quadriceps muscle in patients with ESLD. Muscle mass and quality were evaluated using MRI (quadriceps anatomical cross sectional area (ACSA), quadriceps volume index, L3 SMI, quadriceps intermuscular adipose tissue (IMAT)), mid‐arm muscle circumference (MAMC) and ultrasonography (vastus lateralis (VL) thickness and quadriceps ACSA). Muscle strength/function was assessed by handgrip strength, peak quadriceps isokinetic torque and chair rise time. Thirty‐nine patients with ESLD (55 years, 61% male, 48% alcoholic related liver disease (ArLD), 71% Child–Pugh B/C) and 18 age/sex‐matched healthy control participants (HC) were studied. Quadriceps mass was significantly reduced in ESLD versus HC (−17%), but L3 SMI and MAMC were unchanged. Quadriceps IMAT percentage was increased in ESLD (+103%). Handgrip strength (−15%), peak isokinetic torque (−29%), and chair rise time (+56%) were impaired in ESLD. Ultrasound measures of VL thickness (r = 0.56, r = 0.57, r = 0.42) and quadriceps ACSA (r = 0.98, r = 0.86, r = 0.67) correlated to MRI quadriceps ACSA, quadriceps volume and L3 SMI, respectively. Quadriceps muscle mass, quality, and function were impaired in patients with ESLD, whereas conventional assessments of muscle (L3 SMI and MAMC) highlighted no differences between ESLD and HC. Full evaluation of lower limb muscle health is essential in ESLD in order to accurately assess sarcopenia and target future interventions. [ABSTRACT FROM AUTHOR]

Background There are no robust guidelines on strategies to prevent the adverse skeletal effects of glucocorticoids in children. Objectives To evaluate the role of prophylactic calcium and vitamin D on bone health in children with new-onset nephrotic syndrome (NS) treated with short-term (12 weeks), high-dose glucocorticoids. Methods Prospective, randomized, controlled, single blind, interventional study conducted on 41 steroid-naive pre-pubertal children (29 boys, 12 girls). All children received prednisolone for 12 weeks (60 mg/[m.sup.2]/day daily for 6 weeks, followed by 40 mg/[m.sup.2]/day alternate days for 6 weeks). Recruited children were randomized into the intervention group (IG; vitamin D 1,000 IU/day and elemental calcium 500 mg/day) and the control group (CG). Bone mineral content (BMC) and bone mineral density (BMD) at the lumbar spine (L1-L4) were estimated at baseline and at 12 weeks. Mean percentage changes in BMC and BMD in IG and CG were compared. Results Children in the IG showed an increase of 11.2% in BMC versus the CG, who showed an 8.9% fall (p < 0.0001). Net intervention-attributable difference in BMC was 20.1%. BMD increased in both groups (IG 2.8% vs CG 0.74%), but the difference was not statistically significant (p = 0.27). Conclusions Short-term, high-dose glucocorticoid therapy decreases the BMC of the lumbar spine in steroid-naive children with NS. Vitamin D and calcium co-administration not only prevents this decline, but also enhances BMC of the lumbar spine. Keywords Nephrotic syndrome * Glucocorticoids * BMC * BMD * DXA * Calcium * Vitamin D, Introduction Infancy and childhood are crucial periods for skeletal mineral acquisition. Threats to bone health during childhood are harmful in the long term, since the growth and development of the [...]

Introduction: Differentiating an acute from chronic compression fracture of the thoracolumbar (TL) spine can pose a dilemma for radiologists interpreting spinal imaging following trauma. Mild wedging of the vertebrae can be due to spondylosis or osteoporosis, whilst acute simple compression fractures may not always be associated with loss of body height. In this observational study, we hypothesize that the presence of a vertebral body cortical step is a reliable sign of an acute compression fracture on Computed Tomography (CT) scans. Methods: In a retrospective review of thoracolumbar CT scans following trauma, two observers analysed for the presence of a cortical step at the anterior or posterior vertebral body cortex, fracture morphology and associated injuries. A 'cortical step' is defined as a break of hyperdense cortex on CT scans, intervening non-sclerosed trabecular bone, and sharp overlap of the underlying cortex. MRI of the spine was used as gold standard. Results: 187 consecutive CT scans over 2 years were assessed. Sensitivity, specificity and accuracy of cortical step sign were 100%, 90.2% and 97% in diagnosing an acute thoracolumbar compression fracture, respectively. The interobserver reliability was high (kappa = 0.97). False positive cortical step was seen in Kummel's disease and large Schmorl's nodule. Conclusion: Our results demonstrate high sensitivity and specificity of 'cortical step sign' in diagnosing acute vertebral body compression fractures of TL spine on CT scans in patients with trauma. This sign can be useful to radiologists for safe clearance of the thoracolumbar spine following trauma, helping distinguish acute trauma from chronic causes of vertebral body height loss. [ABSTRACT FROM AUTHOR]

This study was designed to assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3D T2 Dual Echo Steady State (DESS), in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex, using arthroscopy as gold-standard. In a retrospective cohort review, patients who underwent wrist arthroscopy and MRI over 2 years (n=46) were identified. Dedicated axial and coronal reformats were obtained from 3D T2 DESS sequence for assessing intrinsic ligaments and triangular fibrocartilage (TFCC). At arthroscopy, tears were classified using Geissler's classification and compared to MRI findings. The sensitivity of unenhanced 3T MRI in detecting scapholunate ligament tears was 87%, specificity was 90% and negative predictive value of 93%. The lunate triquetral ligament was assessed with a high specificity (97%) and negative predictive value (93%), sensitivity was 63%. TFCC tears were assessed with a sensitivity of 100%. The overall diagnostic accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 91%. 3T wrist MRI with dedicated reformats from 3D T2 DESS has a high diagnostic accuracy in assessing acute intrinsic ligament and TFCC injuries. High strength 3T MRI with good technical quality isotropic 3D T2 DESS is critical for accurate wrist ligament assessment. Negative predictive values of 3T MRI of 95% can lead to reduced need for diagnostic arthroscopy of the wrist. This study assesses the diagnostic performance of unenhanced 3T MRI with 3D T2 DESS in assessing traumatic wrist ligament tears. The accuracy of T2 DESS in wrist imaging has not been previously reported. [ABSTRACT FROM AUTHOR]

Background: Metacarpal fractures are common, accounting for 40 % of all hand injuries. The use of plates for the fixation of these fractures allows early aggressive hand therapy post-operatively, reducing post-operative stiffness. Traditionally, bicortical fixation is the standard practice, where both dorsal and palmar cortices of the metacarpal are drilled through, with screws engaging both cortices. Recent biomechanical studies have shown that unicortical fixation, where only the near cortex is drilled and engaged by the screw, results in no difference in stiffness, load to failure or failure mechanism, when compared with bicortical fixation. This trial aims to compare fracture union, complication rate and functional outcomes between unicortical and bicortical fixation for adults with displaced metacarpal fractures.Methods/design: All adults with displaced diaphyseal metacarpal fracture requiring plate fixation are potentially eligible to take part in this study. A total of 315 consenting patients will be randomly allocated to either unicortical or bicortical plate and screw fixation. The surgery will be performed in specialist hand trauma units across the UK. Data regarding fracture healing, hand function, quality of life, and complications will be collected at 2 weeks, 6 weeks and 6 months following surgery.Discussion: This pragmatic, prospective, multi-centre, randomized controlled trial is expected to deliver results in 2018.Trial Registration: ISRCTN 18006607 . Registered on 19 Nov 2015. [ABSTRACT FROM AUTHOR]

Background: A scaphoid fracture is the most common type of carpal fracture affecting young active people. The optimal management of this fracture is uncertain. When treated with a cast, 88 to 90 % of these fractures unite; however, for the remaining 10-12 % the non-union almost invariably leads to arthritis. The alternative is surgery to fix the scaphoid with a screw at the outset.Methods/design: We will conduct a randomised controlled trial (RCT) of 438 adult patients with a "clear" and "bicortical" scaphoid waist fracture on plain radiographs to evaluate the clinical effectiveness and cost-effectiveness of plaster cast treatment (with fixation of those that fail to unite) versus early surgical fixation. The plaster cast treatment will be immobilisation in a below elbow cast for 6 to 10 weeks followed by mobilisation. If non-union is confirmed on plain radiographs and/or Computerised Tomogram at 6 to 12 weeks, then urgent surgical fixation will be performed. This is being compared with immediate surgical fixation with surgeons using their preferred technique and implant. These treatments will be undertaken in trauma units across the United Kingdom. The primary outcome and end-point will be the Patient Rated Wrist Evaluation (a patient self-reported assessment of wrist pain and function) at 52 weeks and also measured at 6, 12, 26 weeks and 5 years. Secondary outcomes include an assessment of radiological union of the fracture; quality of life; recovery of wrist range and strength; and complications. We will also qualitatively investigate patient experiences of their treatment.Discussion: Scaphoid fractures are an important public health problem as they predominantly affect young active individuals in the more productive working years of their lives. Non-union, if untreated, can lead to arthritis which can disable patients at a very young age. There is a rapidly increasing trend for immediate surgical fixation of these fractures but there is insufficient evidence from existing RCTs to support this. The SWIFFT Trial is a rigorously designed and adequately powered study which aims to contribute to the evidence-base to inform clinical decisions for the treatment of this common fracture in adults.Trial Registration: The trial is registered with the International Standard Randomised Controlled Trial Register ( ISRCTN67901257 ). Date registration assigned was 13/02/2013. [ABSTRACT FROM AUTHOR]

Objective: Atypical femoral fractures (AFFs) are important to diagnose early to avoid progression to complete fracture. We set out to determine the reporting accuracy of AFFs. Methods: We conducted a retrospective analysis of imaging performed between November 2010 and June 2013 to analyse the X-ray reporting of AFFs and to describe the key clinical considerations. Radiological reports were reviewed from the 3805 separate femoral images for search terms thought likely to identify AFFs. This identified 1558 patients. The identified radiographs were reviewed by radiologists with reference to the 2010 American Society of Bone and Mineral Research (ASBMR) criteria. Results: Within these 1558 patients, 16 patients met the radiological criteria for AFF according to the 2010 ASBMR task force statement of which, although all were identified as fractures, 15 were not reported as "atypical" by the original reporting author and none was formally classified as AFF by the original reporting author. Within the 1558 patients, there were an additional 17 patients labelled as having "atypical" fracture features originally, although only 1 patient met the 2010 ASBMR task force criteria for AFF. Only 13 of 16 patients had imaging of the contralateral femur, and there was a significant delay for those who were imaged (111 ± 44 days). Furthermore, two of the patients with an AFF had previous radiographs demonstrating cortical changes indicative of AFFs prior to formal diagnosis. Conclusion: Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low. Advances in knowledge: We have raised awareness of the importance of recognizing AFFs to guide management. [ABSTRACT FROM AUTHOR]

A 35-year-old female renal transplant recipient was referred to the metabolic bone clinic because of a 15 cm loss of height. She was noted to have thoracic kyphosis and vertebral X-ray confirmed a wedge fracture of the eighth thoracic vertebra. She was managed accordingly but on subsequent follow-up mentioned in passing that her gynaecologist had been unable to obtain a cervical smear for routine screening. This led to further questioning, and the patient reported intermittent urinary stress incontinence, feelings of vaginal fullness and severe dyspareunia. It became apparent that these symptoms had been ongoing for 4 years, but the patient had not brought them to the attention of a healthcare practitioner due to feelings of embarrassment and her religious beliefs. These complaints prompted radiological investigation, which revealed extensive bony pelvic deformity, thought to be an extreme manifestation of chronic kidney disease mineral and bone disorder. [ABSTRACT FROM AUTHOR]

The imaging of pelvic trauma is complex and may involve different radiological techniques depending on the severity and type of injury. Following high-energy blunt trauma, computed tomography (CT) is the investigation of choice as it can identify life-threatening findings such as arterial extravasation as well as bony and soft tissue injuries, in particular that of the urological system. In this overview of pelvic imaging in trauma, the role of CT, plain radiography and focussed assessment with sonography in trauma (FAST) are considered, as well as the role of interventional radiology for pelvic haemorrhage. [ABSTRACT FROM AUTHOR]

Introduction: End stage liver disease (ESLD) is associated with loss of muscle mass and function, known as sarcopenia, which can increase the risk of complications of ESLD, hospitalization and mortality. Therefore, the accurate assessment of muscle mass is essential to evaluate sarcopenia in ESLD. However, manual segmentation of muscle volume (MV) can be laborious on cross-sectional imaging, due to the number of slices that require analysis. This study aimed to investigate the impact of reducing the number of slices required for MV estimation. Further, we aimed to compare two equations utilized in estimating MV (cylindrical and truncated cone)., Methods: Thirty eight ESLD patients (23 males; 54.8 ± 10.7 years) were recruited from the Queen Elizabeth University Hospital Birmingham. A 3T MRI scan was completed of the lower limbs. Quadriceps MV was estimated utilizing 1-, 2-, 3-, and 4 cm slice intervals with both cylindrical and truncated cone equations. Absolute and relative error (compared to 1 cm slice interval) was generated for 2-, 3-, and 4 cm slice intervals. L3 skeletal muscle index (SMI) was also calculated in 30 patients., Results: Relative error increased with slice interval using the cylindrical (0.45 vs. 1.06 vs. 1.72%) and truncated cone equation (0.27 vs. 0.58 vs. 0.74%) for 2, 3, and 4 cm, respectively. Significantly, the cylindrical equation produced approximately twice the error compared to truncated cone, with 3 cm (0.58 vs. 1.06%, P < 0.01) and 4 cm intervals (0.74 vs. 1.72%, P < 0.001). Finally, quadriceps MV was significantly correlated to L3 SMI ( r 2 = 0.44, P < 0.0001)., Conclusion: The use of the truncated equation with a 4 cm slice interval on MRI offers an efficient but accurate estimation of quadricep muscle volume in ESLD patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Quinlan, Jones, Bissonnette, Dhaliwal, Williams, Choudhary, Breen, Lavery, Armstrong, Elsharkawy, Lord and Greig.)

Background: Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. Immediate surgical fixation of this fracture has increased., Objective: To compare the clinical effectiveness and cost-effectiveness of surgical fixation with cast treatment and early fixation in adults with scaphoid waist fractures that fail to unite., Design: Multicentre, pragmatic, open-label, parallel two-arm randomised controlled trial with an economic evaluation and a nested qualitative study., Setting: Orthopaedic departments of 31 hospitals in England and Wales recruited from July 2013, with final follow-up in September 2017., Participants: Adults (aged ≥ 16 years) presenting within 2 weeks of injury with a clear, bicortical fracture of the scaphoid waist on plain radiographs., Interventions: Early surgical fixation using Conformité Européenne-marked headless compression screws. Below-elbow cast immobilisation for 6-10 weeks and urgent fixation of confirmed non-union., Main Outcome Measures: The primary outcome and end point was the Patient-Rated Wrist Evaluation total score at 52 weeks, with a clinically relevant difference of 6 points. Secondary outcomes included Patient-Rated Wrist Evaluation pain and function subscales, Short Form questionnaire 12-items, bone union, range of movement, grip strength, complications and return to work., Results: The mean age of 439 participants was 33 years; 363 participants were male (83%) and 269 participants had an undisplaced fracture (61%). The primary analysis was on 408 participants with valid Patient-Rated Wrist Evaluation outcome data for at least one post-randomisation time point (surgery, n  = 203 of 219; cast, n  = 205 of 220). There was no clinically relevant difference in the Patient-Rated Wrist Evaluation total score at 52 weeks: the mean score in the cast group was 14.0 (95% confidence interval 11.3 to 16.6) and in the surgery group was 11.9 (95% confidence interval 9.2 to 14.5), with an adjusted mean difference of -2.1 in favour of surgery (95% confidence interval -5.8 to 1.6; p  = 0.27). The non-union rate was low (surgery group, n  = 1; cast group, n  = 4). Eight participants in the surgery group had a total of 11 reoperations and one participant in the cast group required a reoperation for non-union. The base-case economic analysis at 52 weeks found that surgery cost £1295 per patient more (95% confidence interval £1084 to £1504) than cast treatment. The base-case analysis of a lifetime-extrapolated model confirmed that the cast treatment pathway was more cost-effective. The nested qualitative study identified patients' desire to have a 'sense of recovering', which surgeons should address at the outset., Limitation: There were 17 participants who had initial cast treatment and surgery for confirmed non-union, which in 14 cases was within 6 months from randomisation and in three cases was after 6 months. Three of the four participants in the cast group who had a non-union at 52 weeks were not offered surgery., Conclusions: Adult patients with an undisplaced or minimally displaced scaphoid waist fracture should have cast immobilisation and suspected non-unions immediately confirmed and urgently fixed. Patients should be followed up at 5 years to investigate the effect of partial union, degenerative arthritis, malunion and screw problems on their quality of life., Trial Registration: Current Controlled Trials ISRCTN67901257., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 52. See the NIHR Journals Library website for further project information.