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Introduction Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India.Research design and methods A cross-sectional national-level project ‘Save the Feet and Keep Walking’ campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023.Results Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet.Conclusions One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.

Background: There is a pressing need for systematic approaches for monitoring how much tuberculosis (TB) treatment is ongoing in the public and private sectors in India, Both to shed light on the true scale of the problem and to help monitor the progress of interventions currently being planned to address this problem. Aims and Objectives: (1) To estimate the incidence of TB in 2021 by using drug utilization data in the public and private sectors of the Shajapur district. (2) To calculate the decline in patient months from the base year 2015 to 2021; (3) To find out the recent trends and volumes (patient months) using drug sales data in the public and private sectors. Materials and Methods: Secondary data verification was done from December 2021 to March 2022 in Shajapur district, Madhya Pradesh, India. The district-level data on drug consumption in the public was obtained from the drug store records of the district TB Center and drug sales in the private sector were obtained from the DTO, which was prepared by the drug inspector in compliance with the letter of the Directorate of Health services, Madhya Pradesh, Bhopal, and CMHO Shajapur for the review of drug sale data in the private sector for subnational certification. Results: The incidence of TB increased from 113.7/lakh population in 2015 to 151.5 lakh population in 2021. The patient month of the public sector is increasing from 2015 (patient months 3653.4) to 2021 (patient months 6064.84), which indirectly denotes that more patients are taking antitubercular treatment form the government sector as compared to the private sector in the current year. The private sector sale of the drugs is decreasing from 2015 (patient months:- 9507) to 2021 (patient months: 2012.61), but still 24.91% of antitubercular drugs are provided by the private sector. Conclusion: Subnational verification of claims by Shajapur district for progress toward TB-free status in India showed that the incidence of TB is increasing from the base year to the year 2021. So it was not recommended for an award in the silver category by the verification team.

Problems considered: Global challenges posed by obesity, type 2 diabetes mellitus (T2DM), hypertension, and related metabolic diseases necessitate effective interventions. Pharmacotherapy often falls short, leading to a demand for innovative approaches. This study delves into the effects of an organized diet featuring a readily available food substitute blend over an eight-week span. Methods: The study implemented a low-calorie diet (800–830 calories), comprising three shakes, non-starchy vegetables, soups, reduced buttermilk, and limited fat. Assessments covered NCDs like T2DM, hypertension, dyslipidemia, and non-alcoholic fatty liver disease. WHO STEPS protocol guided anthropometric measures and blood pressure readings, while INBODY 230 Analyser determined body composition. SPSS 16 software facilitated analysis of baseline and two-month follow-up data. Results: Participants with an average baseline BMI of 31.9 kg/m2 witnessed substantial improvements. Weight, BMI, waist and hip circumferences, neck, arm, and thigh circumferences, and body fat percentage registered significant decreases. Positive changes were observed in diabetes indicators, including reduced HbA1c (7.2%–6.1%) and fasting/post-prandial blood glucose (p

Background: Medicinal herbs remain a vital source of new chemical entities, instead of the attempt of pharmaceutical companies using combinatorial and synthetic chemistry techniques for developing new drugs. Objectives: The primary aim of review is to highlight the different phytochemcial ingredients and their therapeutic potential in Cynara scolymus Methods: Cynara scolymus, commonly known as artichoke is a rich source of polyphenolic compounds, mainly caffeoylquinic acids and flavonoids, isolated in the polar extracts of the plant, together with the polysaccharide inulin. The worldwide scientific databases were comprehensively and systematically reviewed and summarized. Results: The beneficial effects of artichoke in experimental studies include antidiabetic, anti-obesity, anti-inflammatory, anti-hypercholesterolemic, hepatoprotective, nephroprotective, gastrointestinal protectant, reproductive, and anticancer properties. Studies with artichoke conducted in experimental animals reported no mortality or significant toxicity. Increasing attention is being paid to developing herbal medicines as a newly emerging treatment for the welfare of the patients in the last few decades. Conclusion: The present review detailed the versatile therapeutic efficiency and diverse application of C. scolymus. This medicinal herb has been appropriately used in conventional medicine for a long and helps cure various ailments.

Objective: To assess the clinical characteristics, risk factors, and comorbidities associated with type 2 diabetes mellitus (T2DM) in young adult patients. Methods: This is a retrospective, multicentric real-world study that included young adults (18–45 years) with T2DM. Primary information including demographics, medical and family history, biochemical measures (pre-and post-prandial blood glucose levels, glycosylated hemoglobin [HbA1c] and blood pressure, and lipid parameters) smoking and drinking habits were collected retrospectively from the medical records of the respective hospitals/clinics. Data were analyzed using descriptive and appropriate comparative statistics. Results: A total of 22,921 patients from 623 sites were included. The median age was 37.0 years and the majority were men (61.6%). The proportion of patients from the age group >35–≤45 years was 62.7%. Among all patients, 46.9% had only T2DM; however, 53.1% of patients had T2DM with other comorbidities (T2DM with hypertension, dyslipidemia, and both). The majority of patients had elevated body mass index (BMI) (overweight, 46.6%; and obese, 22.9%). Family history of T2DM (68.1%) was most common in overall population. Sedentary lifestyle (63.1%), alcohol consumption (38.9%), and regular smoking (23.1%) were the most common associations in patients with T2DM with dyslipidemia and hypertension. Uncontrolled HbA1c level (≥7%) were observed in 79.2% of patients. The level of HbA1c was significantly increased with the duration of T2DM and sedentary lifestyle (p < 0.001). Conclusion: Higher BMI, family history of T2DM, sedentary lifestyle, alcohol consumption, and smoking were the most common risk facors, while hypertension and dyslipidemia were the most prevalent comorbidities associated with T2DM in young Indian adults.

The study was aimed at assessing isoprenaline (ISO) induced oxidative damage in brain of Wistar rats and its protection by hydroethanolic hull extract of Juglans regia. Administration of ISO significantly increases catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR), malondialdehyde (MDA) and advanced oxidation protein product (AOPP) levels and significantly reduced activities of antioxidant status (TAS), total thiols (TTH), acetylcholinesterase (AChE), arylesterase (AE), and glutathione peroxidase (GPx) in rat brain. Histopathologically, neuronal degeneration, spongiosis and gliosis were seen in cerebral cortex after ISO administration. Pretreatment with hull extract restored TAS, TTH, AChE, CAT and SOD values. Additionally, significant reductions were noted in levels of MDA, AOPP, and severity of histomorphological changes in cerebral cortex following hull extract treatment. Altered antioxidant biomarkers along with histopathological changes indicate oxidative injury in rat brain following ISO administration. Repeated administration of J. regia hull extract demonstrating presence of neuroprotective properties against ISO induced oxidative damage in rat brain.

Calendula officinalis Linn. commonly known as marigold has long history of usage by the folklore system. It has a high economic value as herbal medicine and is widely used in cosmetics, perfumes, dyes, pharmaceutical preparations and food products for centuries. The plant has been approved for food use and appears in the food and drug administration (FDA) list of generally recognized as safe (GRAS) substances. The literature available for the comprehensive review study were taken from the different worldwide accepted scientific database, journals, books for botanical description, pharmacological properties and ethno-botanical uses of C. officinalis Linn. Natural products containing calendula either as extract or oil are complex mixtures containing hundreds of biologically active constituents such as carotenoids, flavonoids, saponins, sterols, phenolic acids, lipids, amino acids, carbohydrates, etc. These phytoconstituents have wide applicability in food and cosmetic industries besides their therapeutic applications viz. as antioxidant, antimicrobial, anti-inflammatory, anti-ulcer, anti-proliferative, antiparasitic, hypoglycemic, hypolipidemic and wound healing potential in experimental and clinical trials. Being useful therapeutic agents in their own right, an understanding of these traditional medicines has provided new plant derived drug leads to modern medicine for therapeutic application.

Abstract Background Coil embolisation of the internal iliac arteries prior to EVAR is considered standard treatment to prevent a type 2 endoleak when extending an iliac limb into the EIA. Type 2 endoleaks that arise from a non-coil-embolised internal iliac artery can be challenging to treat due to difficult access. Case presentation We present a case of a type 2 endoleak from the internal iliac artery that was not coiled prior to EVAR. This was treated with retrograde embolisation of the internal iliac artery via direct puncture of a branch from the buttock and closure of the arteriotomy was achieved using an Angio-Seal (Terumo) device that was deployed in an off-label manner to allow visualisation. Conclusion This is a viable technique for treating type 2 endoleaks when antegrade access to the internal iliac artery is lost due to the presence of the stent graft and the arteriotomy can be safely closed with an Angio-Seal.

Abstract Background Inconsistent fat‐free mass (FFM) and muscle strength responses have been reported in randomized clinical trials (RCTs) administering testosterone replacement therapy (TRT) to middle‐aged and older men. Our objective was to conduct a meta‐analysis to determine whether TRT improves FFM and muscle strength in middle‐aged and older men and whether the muscular responses vary by TRT administration route. Methods Systematic literature searches of MEDLINE/PubMed and the Cochrane Library were conducted from inception through 31 March 2017 to identify double‐blind RCTs that compared intramuscular or transdermal TRT vs. placebo and that reported assessments of FFM or upper‐extremity or lower‐extremity strength. Studies were identified, and data were extracted and validated by three investigators, with disagreement resolved by consensus. Using a random effects model, individual effect sizes (ESs) were determined from 31 RCTs reporting FFM (sample size: n = 1213 TRT, n = 1168 placebo) and 17 reporting upper‐extremity or lower‐extremity strength (n = 2572 TRT, n = 2523 placebo). Heterogeneity was examined, and sensitivity analyses were performed. Results When administration routes were collectively assessed, TRT was associated with increases in FFM [ES = 1.20 ± 0.15 (95% CI: 0.91, 1.49)], total body strength [ES = 0.90 ± 0.12 (0.67, 1.14)], lower‐extremity strength [ES = 0.77 ± 0.16 (0.45, 1.08)], and upper‐extremity strength [ES = 1.13 ± 0.18 (0.78, 1.47)] (P

Acute kidney injury (AKI) is independently associated with new-onset chronic kidney disease (CKD), end-stage kidney disease, cardiovascular disease, and all-cause mortality. However, only a minority of patients receive follow-up care after an episode of AKI in the developing world, and the optimal strategies to promote rehabilitation after AKI are ill-defined. On this background, a working group of the 18th Acute Dialysis Quality Initiative applied the consensus-building process informed by a PubMed review of English-language articles to address questions related to rehabilitation after AKI. The consensus statements propose that all patients should be offered follow-up within 3 months of an AKI episode, with more intense follow-up (e.g.,

A 39-year-old female patient with hepatitis B-related decompensated chronic liver disease underwent living donor liver transplantation. Preoperatively, she had a normal electrocardiogram (ECG) and echocardiography, and also a negative dobutamine stress echocardiography test. Intraoperative course went uneventful. Two hours postoperatively, she developed hypotension. Initially, hypotension was treated with fluids and blood products after confirming normal echocardiography, but with time, patient's haemodynamics worsened. Repeat echocardiography showed postero-inferior regional wall motion abnormality. Troponin I was significantly elevated, but ECG was normal. Suspecting myocardial infarction coronary angiography was done which was normal. Based on Mayo's criteria, patient was diagnosed with reverse Takotsubo cardiomyopathy since postero-inferior wall was involved. Inotropic support failed to maintain haemodynamics and intra-aortic balloon pump (IABP) was placed. Inotropes were gradually tapered and IABP was removed at day 4. Twenty days later, repeat echocardiography was normal and patient was subsequently discharged.

Central venous catheter (CVC) insertion is a common procedure in operation theaters and intensive care units (ICU). The procedure is performed through anatomical landmark technique, open surgical procedure, and ultrasound-assisted insertion. In the 1990s, ultrasound guidance of CVC insertion has been advocated as a means to reduce mechanical complications and placement failures compared with the landmark technique. Still CVC complications can be related to insertion, indwelling, or extraction. There is a need for continuous monitoring to avoid possible risk factors so as to minimize the morbidity and mortality.

Background: Atypical hemolytic uremic syndrome (aHUS), an important cause of acute kidney injury (AKI), is characterized by dysregulation of the alternative complement pathway. Autoantibodies to factor H (FH), a chief regulator of this pathway, account for a distinct subgroup. While high anti-FH titers predict relapse, they do not correlate well with disease activity and their functional characterization is required.Methods: Of 781 patients

Osmotic demyelination syndrome leading to central pontine/extra-pontine myelinolysis (CPM/EPM) occurs mainly in patients with history of alcohol abuse, malnourishment, following liver transplantation and less commonly, in association with other systemic diseases. Asymptomatic CPM/EPM is rare. Patients with end-stage renal disease (ESRD) who develop CPM/EPM are usually symptomatic with florid neurologic manifestations. Herein, we present a patient with ESRD on maintenance hemodialysis who was incidentally detected to have pontine and extra-pontine lesions suggestive of myelinolysis without any neurologic signs or symptoms.

Catatonia is a syndrome, comprised of symptoms such as motor immobility, excessive motor activity, extreme negativism, and stereotyped movements. Neuroleptic is able to induce catatonia like symptoms, that is, the neuroleptic malignant syndrome (NMS). In NMS, patients typically show symptoms such as an altered mental state, muscle rigidity, tremor, tachycardia, hyperpyrexia, leukocytosis, and elevated serum creatine phosphorous kinase. Several researchers have reported studies on catatonia and the association between catatonia and NMS, but none were from this part of the eastern India. In our case, we observed overlapping symptoms of catatonia and NMS; we wish to present a case of this diagnostic dilemma in a patient with catatonia, where a detailed history, investigation, and symptom management added as a great contribution to the patient′s rapid improvement.

Introduction: The waste produced in the course of health care activi- ties carries a higher potential for infection and injury than any other type of waste. Objectives: To assess the existing level of knowledge and evaluate the effectiveness of educational intervention and also find out asso- ciation between pre test and post test knowledge score. Methods: An interventional trail was conducted using video lecture and slide show as a tool. Pre and post questionnaire for evaluation was used with scoring. The study was conduct in a tertiary care hos- pital attached to the medical college, in Bhopal. All 1st year PG stu- dents were included in study from different departments. Total 30 PG students were included from all departments. Study was con- ducted in phase manner with objective of imparting knowledge re- garding waste management practices. Results: There was significant increase in knowledge about bio- medical waste management before and after educational intervention which was statistically highly significant (p

Introduction: The young people of today are tomorrow's adults. Tobacco use is the chief preventable cause of illness & death all over the world. Objective of the study to estimate the prevalence and type of tobacco use among adolescent students in grade 8th, 9th and 10th in Bhopal city. Methods: School-based cross-sectional descriptive study was carried out among 2285 Adolescent students in Bhopal city. Data was collected by an anonymous self administered modified Global Youth Tobacco Survey Questionnaire and Data were analyzed by frequency distribution tables, chi square test and univariate logistic regression as required. Result: Out of 2285 adolescent student’s 415 (18.2%) ever used the tobacco product in one or other form. The use of tobacco was significantly higher amongst boys 335 (80.7%) as compared to girls 80 (19.3%). Use of tobacco was more in governmental schools 257 (61.9%) as compared to non-governmental schools 158 (38.1%). The use of tobacco was most common in age group 12-15 years 355 (85.5%). It is observed in our study that amongst all tobacco users, maximum 199 (47.95%) were experimental users. maximum no. of students 271 (65.3%) were using pan masala and gutkha. Conclusion: Non-smoking forms of tobacco like pan masala and gutkha, were more commonly used by students. The majorities of them are experimental users, but if not addressed right now will be potential regular users in the future.

Adults with traumatic brain injury (TBI) are often severely impaired and inadequately rehabilitated due to deficits in memory and behavioral problems like apathy, irritability and depression, and it has been suggested that an acetylcholine deficit could be contributory to these deficits. Central Acetyl cholinesterase Inhibitors (CAI) are being reported to have a beneficial impact in treatment of memory deficits in adults with TBI, with Donepezil studied most extensively. The authors present two patients with TBI with long term static dysfunction of memory and behavior who responded to Donepezil in terms of attention, memory and apathy. Donepezil appears to be a valuable pharmacological option for treatment of memory and behavioral deficits in TBI.

Background: Biomedical waste (BMW) is waste generated during diagnosis, treatment or immunization of human beings or animals. Approximately 10-25% of the Bio-Medical waste is hazardous and can be injurious to humans or animals and deleterious to environment. It is estimated that annually about 0.33 million tones of hospital waste are generated in India. Objectives: To assess the knowledge regarding hospital waste management amongst hospital staff. Material and Methods: The study comprises of assessment of the knowledge regarding BMW management. For this purpose, a 10% sample of each of the 4 categories of staff on roll was randomly selected for the study; the sample consisted of 110 respondents: 38 doctors, 44 nurses, 21 Lab- technicians and 7 waste handlers/supporting staff. Results: The knowledge of doctors about BMW management & handling rule was much better (92.1%) as compared to nurses (54.5%) and Lab-technicians (47.6%) and it was statistically significant (p-value < 0.05). Conclusion: The doctors where observed to be good in theoretical knowledge. While in case of nurses and lab-technicians the reverse was true. Recommendation: The need of comprehensive training programs regarding Bio-Medical waste management is highly recommended to all hospital staff.

Background:. COVID-19 infection can cause long-term effects, cumulatively known as long COVID syndrome. One such sequela is osteonecrosis of the femoral head (also called avascular necrosis of the femoral head, or AVNFH). On the basis of our 20-year experience in using bisphosphonate therapy in the successful management of osteonecrosis, we conducted the present study to evaluate the efficacy of the therapy in the management of post-COVID osteonecrosis of the femoral head. In addition, we aimed to evaluate the cumulative dosage of corticosteroids and the duration between the commencement of corticosteroids and the development of osteonecrosis in COVID-19 survivors. Methods:. This was a retrospective evaluation of 48 patients (88 hips) diagnosed with osteonecrosis of the femoral head at a tertiary care center after COVID-19 infection between September 2020 and May 2021. Patients received intravenous zoledronic acid (5 mg) at the initiation of therapy and oral alendronate (35 mg) twice weekly, and were followed for a minimum of 6 months. Clinical evaluation was conducted using a visual analog scale (VAS) for pain and the Harris hip score (HHS). Radiographic evaluation was performed to assess the progression of the disease and collapse of the femoral head. Results:. At a mean follow-up of 10 months, 84 (95.5%) of the hips showed good clinical outcomes, and only 4 (4.5%) of the hips required surgical intervention. The mean VAS pain score and HHS improved at 6 weeks and steadily improved on subsequent follow-ups. In 16 (18%) of the 88 affected hips, radiographic progression was observed. The mean dose of corticosteroids administered to the patients to manage COVID-19 infection was 841.3 mg of prednisolone equivalents. The mean duration between the commencement of corticosteroid therapy and the development of osteonecrosis was 179 days. Conclusions:. Post-COVID osteonecrosis appears to be more aggressive, with COVID-19 itself contributing to its etiopathogenesis in addition to corticosteroids. However, it can be diagnosed by magnetic resonance imaging (MRI) in symptomatic patients and then effectively treated medically, especially if detected in the early stages. Level of Evidence:. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Medical imaging requires capturing different aspects of a human body. To capture tissues, cartilages, bones and nerves one needs different sensors and different modalities which results in different images from each modality of the same body part. Image fusion is a process by which one can fuse such images from different modalities in a single image. In this paper, a novel DWT-type2 fuzzy method is proposed to fuse two images (CT and MRI images). In this method, initially, the source images are decomposed into low-level and high-level subbands by discrete wavelet transformation (DWT). As the second step, for fusion, Type-2 fuzzy technique is applied on a low-level subband and average fusion method is applied on the high-level subbands in order to enhance the most prominent features present in CT image and MRI image. Finally, the fused low-level subband and highlevel subbands are reconstructed to form the final fused image using inverse-DWT. To test the proposed fusion method, the experiment is carried out on the MRI-T2 image, functional MRI image and CT image. The fused images have been subjectively and objectively evaluated based on certain evaluation measures and the obtained results have been presented in the paper. From the results, one can observe that the proposed method provides an improvement over other primitive fusion methods. [ABSTRACT FROM AUTHOR]

Abstract Objective The literature entails various intramedullary and extramedullary methods for distal fibula fracture fixation; with no consensus yet over the ideal method of fixation. We have retrospectively analyzed the results of using a twisted and contoured 3.5 mm locking compression plate (LCP) as a posterior buttress plate. Methods Of the 62 cases with ankle fractures managed at our institute by the senior author from 1st January 2012 to 31st December 2015, 41 patients met our inclusion criteria (Danis-Weber types B and C). Results All 41 distal fibular fractures healed uneventfully, at a mean of 10.4 weeks (8-14 weeks) (Figs. 6, 7, 8 to 9) with no complications. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 92.6 (86-100) at a mean follow-up of 31.5 months (14-61 months). Conclusions We have achieved excellent clinical and radiological outcomes using a twisted 3.5 mm LCP as a posterior buttress by combining the advantages of posterior antiglide plating and lateral LCP.

Background:. Bisphosphonates are proven to be effective in obviating the need for surgical intervention in osteonecrosis of the femoral head. However, the late onset of pain relief hampers compliance. We present the clinical and radiographic outcome of a combination therapy compared with alendronate-only therapy for the management of osteonecrosis of the femoral head. Methods:. The data of patients diagnosed with osteonecrosis of the femoral head from January 2001 to January 2017 were retrospectively analyzed. The first group, the alendronate treatment group, comprised 432 hips (358 patients) diagnosed from January 2001 to January 2009 and treated with 10-mg oral alendronate daily for 3 years. The second group, the combination treatment group, comprised 442 hips (386 patients) diagnosed from February 2009 to January 2017 and treated with a combination therapy of 35-mg oral alendronate twice weekly and 5-mg intravenous zoledronic acid once annually for 3 years. Clinical assessment was performed using the Harris hip score, the visual analog scale (VAS) pain score, and the clinical failure rate. Radiographic assessment was performed for progression and collapse. Results:. In the alendronate treatment group, at a mean follow-up of 129.6 months (range, 60 to 220 months), 74.5% did not require a surgical procedure, and, in the combination treatment group, at a mean follow-up of 69 months (range, 37 to 105 months), 88.9% did not require a surgical procedure. The clinical failure rate at 3 years was 4% for stage I, 11% for stage II, and 29% for stage III in the alendronate treatment group, and it was 5% for stage I, 9% for stage II, and 32% for stage III in the combination treatment group. Patients in the combination treatment group had a significantly better improvement in VAS score at 6 weeks (from 7.10 to 3.66) compared with patients in the alendronate treatment group (from 7.93 to 7.00). Conclusions:. Our study shows that both oral alendronate-only therapy and bisphosphonate combination therapy retard the progression of disease, reduce the rate of collapse, and, hence, reduce the need for joint replacement surgery. However, bisphosphonate combination therapy offers earlier improvement in pain and functional scores compared with oral alendronate therapy only. Level of Evidence:. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective To shorten the natural course of transient osteoporosis of hip (TOH), which is a self-limiting idiopathic condition and requires 6–12 months for the resolution of symptoms, various therapies including treatment with bisphosphonates have been attempted. There exist fewer case reports evaluating the effect of bisphosphonates in TOH and most of them lack radiographic evidence of resolution of disease. The present study was carried out with an aim to evaluate the clinical and radiological outcomes of TOH patients subsequent to treatment with a single dose of zoledronic acid. Methods Data of 19 adult male and non-pregnant female patients with TOH treated with zoledronic acid were included in the study. Efficacy was assessed using changes in clinical signs and symptoms, visual analogue scale pain score, and changes in bone marrow edema (BME) in magnetic resonance imaging (MRI). Results Mean age of the patients was 42.1 years, 17 being males. The mean time of onset of symptom was 4 weeks. Subsequent to treatment, the patients were pain-free and had no limp within an average of 2.8 weeks (range, 2–5 weeks) and remained asymptomatic at a mean follow-up of 35 months (range, 6–54 months). The post-treatment MRI showed resolution of BME in approximately 84% (16/19) of patients at 3 months. No major adverse events were reported. None of the patients progressed to avascular necrosis at their last follow-up. Conclusion Intravenous single dose administration of zoledronic acid provides early pain relief and complete reversal of TOH. Consequently, zoledronic acid is proposed as a new paradigm in the management of TOH.

Abstract Background Avascular necrosis at sites other than femoral head (AVNOFH)/Non-Femoral AVN is a rare entity. No standard of treatment still exists for treating early stages of AVNOFH with most of the cases eventually progressing to a late arthritic stage needing surgical intervention. Bisphosphonates have been shown to prevent disease progression, bone collapse, and the requirement for surgery in avascular necrosis of femoral head. The present study is conducted to evaluate the response of bisphosphonates in the non-surgical management of the early stages of AVNOFH. Materials and methods Prospectively collected data of 20 patients diagnosed with an early stage of AVNOFH and treated with the combination of oral alendronate 70 mg weekly and intravenous zolendronic acid (ZA) for 1 year, between Jan 2009 to Dec 2015, was evaluated retrospectively. Clinical evaluation was done using the visual analogue scale (VAS), mean analgesic requirement, and range of motion. Radiographs and magnetic resonance imaging (MRI) were taken to classify the stage of AVN, monitor radiological collapse, and evaluate radiological progression and bone marrow edema changes. Results In our analysis of 18 patients (2 lost to follow-up), 5 patients had AVN of the humeral head, 4 patients of the talus, 3 of the lunate, and 2 each of the scaphoid, medial tibial plateau, and second metatarsal head. Pain relief with the drop in VAS score was seen at a mean duration of 4.3 weeks (range 3–13 weeks) after the start of therapy. A 50% reduction in mean analgesic requirement was achieved in the first 6 weeks (2-11 weeks). MRI showed complete resolution of BME in 13 patients at 6 months and in 17 patients (94.4%) at 1 year. Radiological collapse was seen in 6 out of 18 patients at a mean follow-up of 35.3 months (range 14–56 months). Only one out of 18 patients enrolled required surgery. Conclusion A combination of oral alendronate and intravenous zolendronic acid provides a pragmatic solution to this rare entity of AVNOFH, where no standard treatment exists.

Purpose: With improved survival after chemotherapy for acute lymphoblastic leukemia (ALL), it is imperative to maintain good quality of life as part of the management of post-therapy adverse effects. Avascular necrosis of the femoral head (AVNFH) is one such adverse effect. A need exists for a therapy that ameliorates discomfort, provides a productive life, is cost effective, and is joint preservative. We conducted the current study to evaluate the response to bisphosphonate in the nonsurgical management of AVNFH in adolescents and young adults (AYA) who receive treatment for ALL. Materials and Methods: This is a retrospective study of 20 AYA patients—34 affected hips—who received zolendronic acid 5 mg intravenously each year along with oral alendronate 70 mg weekly for 3 years. Clinical evaluation was performed by using the Visual Analog Scale and the Harris Hip Score. Radiographs were used to classify the Ficat-Arlet stage, monitor radiologic collapse, and evaluate the rate of progression. Results: Pain relief with a drop in the Visual Analog Scale score was observed at a mean duration of 5.2 weeks (range, 3 weeks to 11 weeks) after the start of therapy. Radiologic progression by one grade was observed in 12 hips (35.3%), and only one hip (2.94%) showed progression by two grades. At a mean follow-up of 50.3 months, 31 affected hips (91.1%) had a satisfactory clinical outcome and had not required any surgical intervention. The proportion of hips that required total hip arthroplasty were 0%, 5%, and 22.2% in Ficat-Arlet stage I, II, and III, respectively. Conclusion: The combination of intravenous zolendronic acid and oral alendronate provides a pragmatic solution for the management of AVNFH after therapy for ALL in AYA patients. This therapy is safe, effective, and well tolerated.

Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults. They are usually caused by direct trauma or twisting injuries of the knee. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Adequate exposure was achieved by doing Z-plasty of quadriceps apparatus. The fracture was treated with open reduction and internal fixation using Herbert's screws. Medical management in the form of vitamin D and calcium along with testosterone was given. After the surgery, full weight-bearing was allowed at three months. At one year followup, patient has good quadriceps function without any weakness of the muscle.

Tungsten substrates were coated with an Ni or Ni-Co catalyst by the electroless dip coating technique. Various carbon nanotubes were synthesized by the catalytic chemical vapor deposition (CVD) method under different growth conditions. It was observed that Ni-and Ni-Co-coated tungsten substrates give very good growth of carbon nanotubes (CNT) in terms of yield, uniformity and alignment at a growth temperature of 600 degC. We fabricated a field-emission-based luminescent light bulb where a tungsten wire coated with carbon nanotubes served as a cathode. Results show lower threshold voltage, better emission stability and higher luminescence for CNT cathodes in comparison with uncoated tungsten cathodes. We found that aligned-coiled carbon nanotubes are superior to straight CNTs in terms of field emission characteristics and luminescence properties. [ABSTRACT FROM AUTHOR]

ABSTRACT The authors report the first case of traumatic late dissociation of the polyethylene insert with patellar tendon rupture after total knee arthroplasty using a high-flex posterior-stabilized Genesis II prosthesis in a 60-year-old Parkinson's disease patient. Insert dislodgement has been described most commonly with mobile-bearing and cruciate-retaining TKAs. Only four cases of insert dissociation in a high-flex fixed-bearing prosthesis have been described to date. This case report paves the way to understanding the potential reasons for insert dissociation and its management strategy.

Abstract Objective The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment. Methods A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks. Results The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant (p= 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant (p= 0.03). Conclusion Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.