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Objective Although accurate measurement of cup anteversion in hip replacement requires CT scans, however, its routine application, especially during follow-up, remains economically and ethically unreasonable. Thus, several methods have been devised for making this measurement on plain radiographs. In recent years, several ways have been adopted using software on digital radiographs. We present one such method which uses open access mathematical software GeoGebra. Methods Anteversion was measured on 72 radiographs (36 cemented; 36 uncemented) by three different observers using this software. One observer repeated measurements at three weeks interval. Results The intraclass correlation coefficient for interobserver variability and intraobserver variability was 0.982 (0.973–0.989) and 0.986 (0.978–0.991) respectively. There was a significant difference in the reliability of the method for cemented and uncemented cups with higher reliability for cemented cups (p Conclusion GeoGebra software can be used as a reliable alternative for measuring acetabular cup anteversion on good quality well centred digital radiographs of the pelvis.

Background Vitamin D deficiency (VDD) is a major cause of poor bone health that could lead to fragility fractures, however, there is paucity of literature on prevalence of VDD and associated bone mass in patients of fragility fractures. Hip and spine are the commonest region affected by these fractures and the present study was conceptualised to ascertain the prevalence of VDD and bone mass in patients of hip fragility fractures (proximal femur) to evaluate their role in incidence of these fractures. Methods and materials Between January 2013 and December 2013, 66 patients of fragility fractures around hip with age more than 50 years presented to our out patient department. Baseline evaluation of calcium profile, renal function tests, parathyroid hormone and 25(OH)D were done. All patients underwent DXA scan of the non -fractured hip. Results Total number of male patients was 29 and females was 37, with mean age of 64.1 and 70.3 years, respectively. Intertrochanteric femur fractures were the most common type with 35 cases. Fall in bathroom was the most common mode of injury with 36 cases (54.5%). VDD was found in 74.2% of all patients. Prevalence of secondary hyperparathyroidism was observed in 27 patients. Osteopenia, osteoporosis and severe osteoporosis were observed in 15.2%, 62.1% and 18.2% of patients respectively. Sun light exposure was inadequate in 59% of patients with only 1 female patient having adequate exposure. Conclusion Prevalence of Vitamin D deficiency is very high in patients with hip fragility (proximal femur) fractures with secondary hyperparathyroidism and osteoporosis commonly associated. These fractures in our part of the world, occur at a younger age group as compared to the Western population. Majority of the patients sustain in-house fractures.

Hyperlipidemia is one of the major risk factors for cerebrovascular disease and it is common practice to obtain fasting lipid profile prior to starting lipid lowering therapy (LLT). Recent AHA Guidelines published in 2018 allow for a non-fasting value to be used.To determine if obtaining fasting lipid levels in addition to random lipid levels prompts changes in hyperlipidemia management of acute stroke patients.206 patients met the study criteria which included a diagnosis of acute ischemic stroke or transient ischemic attack on admission and availability of both random and fasting LDL levels collected within 72 h of each other. Patients were divided into three groups based on random LDL at admission: Group A: LDL 70, Group B: LDL 70-99, and Group C: LDL ≥ 100 mg/dL. The dataset was analyzed to conform to the 2018 AHA/ACC guidelines using an LDL cutoff of 70 mg/dL.In 206 patients, statin management would change based on the fasting LDL level in 12 patients, 11 of whom were in Group B. Our data suggests that lipid management is more likely to change if the initial random LDL falls between 70-99 mg/dL as compared to a value outside of this range (P 0.001). We present a decision algorithm to guide lipid management in acute stroke patients.Foregoing a fasting lipid panel to guide LLT in patients with ischemic stroke is appropriate in most cases but for select patients with random LDL levels between 70 and 99, fasting lipid profile should be obtained prior to deciding upon LLT.

Background: Healthcare workers are among the first group to receive coronavirus 2019 disease (COVID-19) vaccine, and their attitude towards the vaccine is likely to affect vaccine acceptance among general population. We aimed to study the attitude of HCWs towards COVID-19 vaccine and determine the factors associated with it.Methods: A cross-sectional study was conducted through a written questionnaire prior to first dose of COVID-19 vaccine in the month of January, 2021, at a district hospital in Ludhiana, Punjab. HCWs were categorized as having negative, positive or mixed attitude based on their response to a written questionnaire. Data was analysed using SPSS version 24.0.Results: More than half of the participants had negative attitude towards COVID-19 vaccine (N=274, 54.5%), while less than a third had positive attitude (N=141, 28.0%) and rest had mixed attitude (N=88, 17.5%). Younger HCWs (

Purpose: Total hip replacement (THR) is one of the most successful and cost-effective surgical procedures and remains the treatment of choice for long-term pain relief and restoration of function for patients with diseased or damaged hips. Acetabular fractures managed either conservatively or operatively by fixation tend to present later with secondary joint changes that require THR. In this study we evaluated the functional outcome and quality of life achieved by such patients. Methods: Our study was carried out as a retrospective trial by recruiting patients who underwent THR from June 2006 to May 2012. A total of 32 patients were included with a mean age of 46.08 years ranging from (25–65) years. We evaluated the quality of life in the patients using scoring techniques of Short Musculoskeletal Functional Assessment (SMFA) and the 12-Item Short Form Health Survey (SF-12). Functional outcome was assessed using Harris Hip Score (HHS). Results: The mean HHS of the patients was 84.3 with a range from 56 to 100. The SMFA averaged 13.3. The SF-12 score averaged 49.1. The correlation of the HHS with SF-12 was positive (p = 0.001) while with SMFA there was a negative correlation (p = 0.001). Conclusion: From this study it is inferred that the functional outcome of THR and quality of life in patients who had acetabular fractures and were initially managed by open reduction and internal fixation is good.

Drug resistance is a persistent threat to tuberculosis (TB) control program worldwide. Patients infected with multiple drug-resistant strains are less likely to become cured. Management of resistant cases is complex and presents therapeutic limitations. Patients with multidrug-resistant strains are more prone to treatment failure and progress to more chronic forms of the disease and death. According to the Global Tuberculosis Report 2018, about 3.5% of newly diagnosed patients had multidrug-resistant tuberculosis (MDR-TB) and 18% of previously treated TB cases were estimated to have MDR-TB. This case presented a rare occurrence of disseminated MDR-TB in a diabetic patient. A case of a 14-year-old female, who was an old-treated case of abdominal TB, presented with 5 months of history of fever, breathlessness, and pain in the abdomen with diabetes mellitus, in whom disseminated MDR-TB was documented with fine-needle aspiration cytology of abdominal lymph nodes and bronchoalveolar lavage fluid that showed drug-resistant TB. So this case emphasizes the importance of screening all extrapulmonary TB patients for drug resistance especially if the patient also has associated comorbid conditions.

Tuberculid is a cutaneous immunologic reaction to the presence of tuberculosis (TB), which is often occult, elsewhere in the body or their fragments released from a different site of manifest or past tuberculous infection. These eruptive lesions are due to hematogenous dissemination of bacilli in a host with a high degree of immunity against Mycobacterium tuberculosis. Although rare, these specific lesions are important diagnostic markers of TB. Lichen scrofulosorum (LS) is one of the recognized tuberculids, usually seen in children and young adults. We report a female who was diagnosed with LS and was treated appropriately. This case report highlights the uncommon, easily misdiagnosed but readily treatable case of LS and emphasizes its early diagnosis, detection, and treatment of otherwise an occult systemic TB in young patients.

After a steady decline throughout the 20th century, the incidence of tuberculosis (TB) in industrialized countries has started to rise again. However, in developing countries like India, the menace of TB had never been controlled. Gastrointestinal (GI) TB is rare, and the GI tract is considered only the sixth most frequent site of extrapulmonary TB. Esophageal TB (ET) is still rarer. This is a case report of a rare form of ET in a patient presenting with dysphagia. The patient was subjected to upper GI endoscopy, which revealed an ulcerative growth in the distal esophagus. Histopathology revealed ET. The patient was managed conservatively with anti-TB treatment (ATT). In spite of the rare nature of the disease, it can be managed effectively with ATT to avoid complications (fistula, stricture, and esophageal perforation), which might warrant surgery.

Aims In the UK National Breast Screening Programme, women aged 50–64 years are invited for breast screening mammography. This study aimed to determine whether current quality assurance guidelines for the Breast Screening Programme were being achieved. Method A prospective analysis of key outcome measures was performed in the 11 breast screening units in the Trent region, between 1 January 1995 and 31 December 1995. Results All 11 units exceeded the 70% target for screening attendance. Ten units matched the invasive cancer detection target for the prevalent screen, but this fell to three for the incident screen. Seven units achieved the 50% target for small invasive cancers, but for special type and well-differentiated cancers only three units matched the target of 30% and there was wide variation between units. Pre-operative diagnosis rates were short of targets in most units. Only one unit achieved outcome measures for clear histological margins in patients completing operations for breast-conserving surgery. No unit provided histological node status on all its patients undergoing surgery for operable breast cancer, or met the target for benign biopsy weights. Conclusion Although results as a whole are good, changes can be made to improve performance and reduce the variation between units. Particular attention should focus on those areas which can be influenced directly by surgeons.