Search

Introduction: Anterior Cruciate Ligament (ACL) injuries are common, particularly among athletes and can significantly affect an individual’s functional abilities and sports career. ACL reconstruction using a four-strand hamstring tendon graft has become the gold standard for restoring knee stability and function. Aim: To assess the functional outcomes resulting from arthroscopic ACL reconstruction using a four-strand hamstring tendon graft. Materials and Methods: This prospective cohort study was conducted at SRM Medical College and Hospital, Chennai, Tamil Nadu, India, including 33 patients with Grade II and Grade III ACL tears with or without associated meniscal injuries, who underwent ACL reconstruction using a four-strand hamstring tendon graft. The study population included patients aged 20-55 years, with follow-up assessments conducted at three and six months postoperatively. Knee function was measured using the Tegner Lysholm Knee Score, and pain levels were assessed using the Visual Analogue Scale (VAS). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 16.0, employing Analysis of Variance (ANOVA) to evaluate clinical outcomes. Results: The majority of patients, i.e., 18 (54.55%), were between 21 and 30 years of age. Most of the participants were male, 29 (87.88%). The involvement of the right knee was slightly higher, with 17 (51.52%) compared to the left knee, which had 16 (48.48%). Isolated ACL tears were diagnosed in 21 (63.64%) of the patients. The Tegner Lysholm Knee Score improved significantly from a preoperative mean of 35.97 to 71.97 at three months and 88.85 at six months (p-value

During the Coronavirus Disease 2019 (COVID-19) pandemic, Caesarean Sections (CS) were prioritised over other elective surgeries, leading to the identification and management of asymptomatic COVID-19 positive parturients. The present case series aimed to explore the possibility of laboratory abnormalities and adverse events that can occur in asymptomatic COVID-19 positive cases in the post-pandemic era when routine screening is no longer in place. Out of 141 asymptomatic COVID-19 positive CS patients, 15 cases were selected based on specific criteria. Demographic characteristics and clinical indicators were analysed, including age, gravidity, indications for CS, laboratory values {such as D-dimer, C Reactive Protein (CRP), and platelet count}, blood transfusion requirements, and obstetric outcomes. Indications for CS were predominantly previous CS and failure to progress. Laboratory abnormalities included elevated D-dimer, CRP, leukocyte count, and thrombocytopenia in some cases. Haemodynamic stability was maintained in all patients. The use of prophylactic anticoagulation was noted, potentially offering protection against thrombosis. Asymptomatic COVID-19 positive parturients can exhibit significant laboratory abnormalities. Thromboprophylaxis may play a role in mitigating thrombotic risks. The significance of the present case series lies in the fact that the laboratory abnormalities could only be detected since all positive patients were investigated as per hospital protocol, which will be missed in the post-COVID-19 era where routine investigations are not performed on asymptomatic patients. Therefore, healthcare workers should be aware of this possibility.

Since the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic many elective cases were postponed worldwide. But emergency Lower Segment Caesarean Sections (LSCS) is one surgery which can’t be postponed at any cause, since two lives are at risk. The present case series reports 16 symptomatic COVID-19 patients in whom emergency LSCS was performed. The aim of presenting the series was to analyse how far the clinical and laboratory findings were deranged in such patients and to find out whether the current anaesthetic techniques were safe in these patients. Out of a total of 157 COVID-19 positive patients who had undergone LSCS in the study, 16 presented with symptoms such as fever, cough, dyspnoea, rhinitis, headache and palpitation. Six (37.5%) were preterm. Seven patients had elevated C-Reactive Protein (CRP) (>5 mg/L). Liver function tests abnormalities were seen in 5 (31.25%). Most of the patients had elevated D-dimer of which (>1500 ng/mL) were seen in seven. The most common indication was foetal distress. COVID pneumonia was an indication for LSCS in 3 (18.75%). All the surgeries were performed under subarachnoid block. Of the four patients who had fall in oxygen saturation two were admitted in Intensive Care Unit (ICU) and one required Non Invasive Ventilation (NIV). There were no mortalities. Thus, LSCS can be done safely under subarachnoid block even in symptomatic COVID-19 parturients. Elevation of D-dimer is common in pregnancy and it does not always indicate severe COVID-19 disease.

Laser welding is used in critical component production when tight tolerances like minimal distortions and residual stresses are required. Laser beam welding offers a lower heat input, a smaller heat affected zone, lower residual stresses, minimum distortions, and greater mechanical joint characteristics than conventional welding does. In order to simulate the laser welding process used on SS316L plates, the Gaussian heat source model was used. The model is developed and simulated with volumetric heat source model with APDL coding using ANSYS. The thermal profiles at the joint cross sections via welded area, interface across joints is taken for the analysis. The maximum temperature was observed at the fusion zone and associated zones. The residual stresses are analysed in the same path and found the stresses are in safe limits of base material. Predicted and experimentally measured residual stresses are close agreement with 10%.

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

SARS-CoV-2 is the third major coronavirus epidemic to affect humans. There had been multiple instances of patients turning positive after recovering from SARS-2-CoV infection. Though many different theories emerge, false positive RT-PCR is logically the foremost cause and there is a general consensus that during quarantine re-infection from outside seems unlikely when strictly adhered to. As many new strains emerge worldwide during the course of on-going pandemic, the chances of re-infection cannot be ignored as it may contribute to false negative RT-PCR test results. SARS-2-CoV though a novel virus, is phylogenetically similar to SARS-like CoV with around 79% similarity. Studies on immunological response to these infections suggest that antibodies formed after infection confers immunity only for a short period of time before it starts to wane. Also studies on SARS-CoV-2 suggest that antibody formation and longevity of immunity in an individual is dependent on the strain of coronavirus, its severity and age of the person infected. All these considerations demand reviewing the treatment duration, discharge criteria, appropriate use of imaging techniques and importance of risk communication and health education to those recovered.

SARS CoV2 is an emerging infectious pandemic. The preemptive measures taken to curtail the spread has its effects far and wide across different sectors and all age groups. The most unspoken sufferers are adolescents. In this article, we have reflected on how adolescent issues addressed by the government's dynamism, have had collateral damage due to the COVID initiatives. Globally, around 89% are currently not in school because of COVID-19. They will pave a way to unforeseen collateral effects on the physical, social, psychological health, and future of the young minds. From an increase in school drop-outs, interrupted learning, worsening of the gender gap in education to technology dependence and addictions, this pandemic is going to unravel the uninvited social evils. The regular benefits of adolescents from the government have not been paid heed to. Supply of IFA tablets, sanitary napkins, provision of supplementary nutrition, health education, and implementation of immunization activities are a few of the services to mention which are being hampered. We have recommended a few strategies like establishing the peer educator system in disseminating COVID-related awareness, engaging them in a smooth public distribution system, and act as a potential linkage for the families in distress. We have proposed a few modus operandi like direct cash transfer or food supplements as take-home rations will be able to sustain the nutrition of the adolescents to keep the flow of uninterrupted amenities to adolescents in education, nutrition, mental health, personal hygiene, and other such sectors.

India with 8.6% of tribal population is finding it difficult to bridge the gap that exists between tribal and non-tribal population in regards to healthcare. Tribal population suffers triple burden of disease; in fact it is quadruple, namely, communicable diseases, non-communicable diseases, malnutrition, mental health, and addictions complicated by poor health seeking behavior. With increasing needs, an Expert committee on Tribal health has given recommendations with the goal to bridge the current gap in the health status of tribal people latest by the year 2027. An entirely parallel health system has been proposed with key focus areas, governance, and financing. To summarize and report the present scenario in terms of disease burden, health-seeking behavior, healthcare delivery system, and a roadmap for the future along the importance of primary healthcare in achieving it. Mere establishment of more health facilities cannot overcome the poor health of tribal population and so the role of trained manpower to deliver quality healthcare, in which case the role of traditional healers, local Tribal boys and girls comes in handy. It is high time and states should act swiftly to assess the needs, priorities of their own tribal population and set goals, targets to achieve the same through proven public health strategies.

The low-and-middle-income country (LMIC) context is volatile, uncertain and resource-constrained. India, an LMIC, has put up a complex response to the COVID-19 pandemic. Using an analytic approach, we have described India’s response to combat the pandemic during the initial months (from 17 January to 20 April 2020). India issued travel advisories and implemented graded international border controls between January and March 2020. By early March, cases started to surge. States scaled up movement restrictions. On 25 March, India went into a nationwide lockdown to ramp up preparedness. The lockdown uncovered contextual vulnerabilities and stimulated countermeasures. India leveraged existing legal frameworks, institutional mechanisms and administrative provisions to respond to the pandemic. Nevertheless, the cross-sectoral impact of the initial combat was intense and is potentially long-lasting. The country could have further benefited from evidence-based policy and planning attuned to local needs and vulnerabilities. Experience from India offers insights to nations, especially LMICs, on the need to have contextualised pandemic response plans.

Objective To quantify the implementation of the third Joint British Societies’ Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3) after coronary event.Methods Using a cross-sectional survey design, patients were consecutively identified in 36 specialist and district general hospitals between 6 months and 2 years, after acute coronary syndrome or revascularisation procedure and invited to a research interview. Outcomes included JBS3 lifestyle, risk factor and therapeutic management goals. Data were collected using standardised methods and instruments by trained study nurses. Blood was analysed in a central laboratory and a glucose tolerance test was performed.Results 3926 eligible patients were invited to participate and 1177 (23.3% women) were interviewed (30% response). 12.5% were from black and minority ethnic groups. 45% were persistent smokers, 36% obese, 52.9% centrally obese, 52% inactive; 30% had a blood pressure >140/90 mm Hg, 54% non-high-density lipoprotein ≥2.5 mmol/L and 44.3% had new dysglycaemia. Prescribing was highest for antiplatelets (94%) and statins (85%). 81% were advised to attend cardiac rehabilitation (86%

Dengue fever, the most notorious of vector borne diseases is under global resurgence. Incidence has increased 30 fold with global expansion. It is thus imperative to review the origin, history and current epidemiology of dengue, its transmission, factors responsible for resurgence, surveillance and the treatment options available. India being hyperendemic, national level comprehensive studies to estimate the true burden of dengue along with its geographical mapping is the need of the hour. Through integrated and combined efforts from various sectors and policy makers, prevention of dengue must be identified and intensified to control further disease transmission as there is no specific antiviral treatment or vaccine against dengue is available in India.

Introduction Approximately 20% of patients with tracheostomy are discharged from hospital with the tracheostomy tube in situ. Proper long term care and management of such tracheostomy patients remains as a challenge to care givers. Fracture of metallic tracheostomy tube (TT) with aspiration of the fragment into tracheobronchial airway is a rare complication of tracheostomy. Case Report Here we are presenting a case of a 42-year-old male patient, presented to the emergency department with complaint of mild respiratory distress following aspiration of fractured metallic TT and a novel method in removing the dislodged fragment. Discussion A detailed review of literature has been included to discuss different aspects of aspiration of fractured fragment of tracheostomy tube and best practice recommendations for proper tracheostomy care. Conclusion Educating the care-giver about care of the tracheostomized patient in general and care of the tracheostomy tube in particular, may help reduce accidental complications.

Background: COVID-19 is an unprecedented pandemic that has taken the modern world under seize. In spite of lack of solid evidence, certain federal governments had recommended the use of hydroxychloroquine (HCQ), chloroquine, and azithromycin as prophylactic medications either for contacts or for healthcare providers in particular. The objective of this study is to assess the issues related to intake of prophylactic medications in view of COVID-19 and the proportion and pattern of side effects. Methods: A descriptive cross-sectional study was conducted using mixed methods approach among healthcare workers in Puducherry, India. Results: HCQ was the prophylactic drug taken by all the participants (n = 26). Of the 26, 15.4% had a baseline ECG, 26.9% took HCQ based on the recommended Day 1 dose of 800 mg and 61.5% of the participants had the drug provided by the hospital where they work. Reasons for taking prophylaxis were sense of vulnerability (due to co-morbidities, lack of PPE kits) and peer practice. However, the participants did not recommend prophylactic medication to others due to lack of evidence, death claims related to prophylactic drugs in media, hospitals not taking responsibility of baseline monitoring and need for long follow-up. Conclusions: The data on assessment of HCQ prophylaxis indicates only minor side-effects, though limited by sample size. Evidence-based recommendations on prophylactic drugs for COVID-19, effective risk communication, peer education and support, accountability, ease of baseline, and follow-up investigations were the need of the hour to improve intake and adherence to prophylactic regime for COVID-19.

Introduction: Anterior Cruciate Ligament (ACL) is considered as very important ligament for knee joint to maintain the knee stability. But their recurrent injuries lead to study its structure, attachment and its function for reconstructive surgical procedures. Over the past decades, several studies have shown inconclusive evidence on gender predisposition to ACL injury. Aim: To determine if anterior cruciate ligament tear is common at tibial or femoral end, and to find out if there is any gender based difference in the incidence of ACL tear. Material and Methods: This retro-prospective cohort study was conducted in the Departments of Anatomy and Radio-Diagnosis from August 2012 – August 2016. The cases above 18 years who required Magnetic Resonance Imaging (MRI) of knee for ACL tear were selected for this study. A total of 100 patients were included in the study. The data was presented as frequencies and proportions, mean and standard deviations. Difference in distribution based on gender and anatomical site was tested using chi square test. Statistical significance (p-value) was considered at 0.05 levels. Results: Total of 86 males and 14 females were included, Average age of cases included in the study in male 34.99±10.4 and in female was 39.57±12.41 of the 100 cases. ACL injury at femoral end was significantly more compared at tibial end (Femoral end 59% vs. Tibial end 41%, p-value = 0.01). There was trend of male predilection towards femoral end detachment and female predilection towards tibial detachment and these observations were statistically significant (Femoral end: Male (62.8%Vs Female 35.7% p-value = 0.06) Tibial end: Male (37.2% vs. Female 64.3%, p-value=0.06). Conclusion: Our study shows the higher incidence of ACL tear or detachment at femoral than tibial end of the ligament. The anterior cruciate ligament tear need reconstructive surgical procedure to preserve the permanent function of the knee with long duration of remedial treatment.

Introduction: Total knee replacement (TKR) surgery has become the most successful surgery for patients with severe debilitating arthritis. The guidelines for rehabilitation progression should be tailored respecting the tissue healing parameters. Hence, the current literature states a need for protocol to mitigate these impairments and ultimately result in improved functional outcomes. Objective: The present study aimed to validate the content of TKR rehabilitation protocol in Indian population. Materials and Methods: The process of content validation involves development stage and expert judgment stage. The protocol was designed into three stages with extensive review of literature. After designing the protocol, nine experts in field of musculoskeletal Physiotherapy performed the judgemental process. The process of validation includes rating of experts in a 5 point likert grading on two parameters namely relevance and ease of performance. Based on expert’s inputs on TKR protocol, the level of agreement, content validation index and kappa value was calculated. Results: The three staged TKR protocol almost exhibited an excellent agreement on all stages. However, muscle activation exercises (except Vastus medialis obliques activation), stretching, strengthening program and functional training showed 100% agreement than other stages. Conclusion: The structured TKR protocol exhibited excellent content validity to its use in Indian population.

Laryngotracheoesophageal cleft (LTEC) is a uncommon congenital malformation of the posterior part of the larynx, creating an abnormal communication between the laryngotracheal axis and the pharyngo- oesophageal axis. Tins condition manifest with non-specific respiratory symptoms, posing diagnostic challenge. Here we report a case of 75 days old infant with recurrent pneumonia and acute life threatening event manifested as milk aspiration. On endoscopic evaluation type 1 LTEC (Laryngeo trachea esophageal cleft) was diagnosed. Intervention/Outcome : Infant was managed conservatively and doing well on follow up.

Field populations of cotton leafhopper [Amrasca biguttula biguttula (Ishida)] exposed to heavy applications of imidacloprid, acephate, acetamiprid and dimethoate were collected from the seven cotton (Gossypium spp ) growing areas of the country. Thirty culturable bacteria were isolated from the guts of 16 populations of leafhoppers and were characterized through morphological and molecular methods. A good diversity of microflora was recorded across the location and is unique with respect to the locations. None of them are repeated except the genera Bacillus and Enterobacter. There was more number of gut microflora associated with the leafhoppers collected from Dharwad where the insecticide usage pattern and the number of sprays were very high as compared to other locations. Various Bacillus spp. were reported in the Dharwad population. The association of Enterococcus asburiae, Enterobacter silesiacus from the guts of leafhoppers of Guntur which was exposed to nine rounds of sprays of acephate, imidacloprid and dimethoate as compared to Bangalore which was not exposed to insecticides at all. Enterococcus hormaechei was isolated from the insects of Bangalore. The predominant bacterial genera identified in A.biguttula biguttula were Serratia, Bacillus, Enterococcus, Enterobacter, Pantoea, Methylobacterium, Stenotrophomonas, Pseudomonas and Paenibacillus.

Purpose. To evaluate outcome of 6-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation. Methods. 25 men and one woman (36 fingers) underwent 6-strand triple Kessler repair for flexor tendon injuries in zones 2 to 5, followed by early active motion rehabilitation. Rehabilitation was started at days 3 to 5. Patients were instructed to passively flex all the fingers with the uninjured hand and to actively retain this position for 10 seconds. Active extension within the confines of the splint was allowed. At the end of week 8, strength training was commenced until a satisfactory range of motion was regained. Outcome measures included total active motion, grip strength, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complications such as infection and wound dehiscence were recorded. Results. The mean follow-up was 1.2 (range, 1–2) years. Outcome was excellent in 24 digits, good in 4, and poor in 8. The mean grip strength was 80% (range, 60–100%) of normal in dominant hands and 60% (range, 50–65%) of normal in non-dominant hands. The mean DASH score was 15 (range, 0–52). One patient had wound dehiscence and superficial infection. Conclusion. Six-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation yields satisfactory results.

Osteochondromas are the most common benign bone tumours and account for 20 to 50% of benign bone tumours and 10 to 15% of all bone tumours. They usually occur in long bones; 40% occur around the knee joint, but in the hand they are uncommon and usually affect the proximal phalanx. The metacarpal is rarely involved. We report a 32-year-old man with a recurrent solitary osteochondroma of the metacarpal.

This study investigates the mechanical, fatigue, and creep properties of commercial plywood (6 mm) alternative polyester composite prepared using waste plastic core, hemp fiber, and shrimp shell powder. The primary aim of this research was to develop an exact replacement for plywood building material and study the effect of fiber stacking order as well as the volume fraction of shrimp shell biopolymer on load-bearing and time-dependent properties. Composites' distinct quasi-isotropic stacking orders with varying hemp fiber angles and shrimp filler contents of 0%, 1.0%, and 3.0% were prepared via compression molding and tested based on ASTM standards. Results revealed that the "D" stacking order {(−45/45) + (−30/60) + WPC + (−60/30) + (−45/45)} composite consistently outperformed others, exhibiting superior mechanical strength. Specifically, the D2 composite exhibited elevated strength, including a tensile strength of 168 MPa, flexural strength of 199 MPa, compression strength of 181 MPa, impact energy of 6.23 J, interlaminar shear strength of 25.9 MPa, and v-notch rail shear of 19.7 MPa. The addition of shrimp filler, rich in hydroxyl groups, enhanced intermolecular interactions, contributing to a resilient network and improved fatigue resistance. Moreover, the creep resistance was notably influenced by the quasi-isotropic arrangement, with the "D" designation showcasing optimal performance. Microscopic analysis revealed the critical role of shrimp shell content in promoting cohesion and interlocking fiber structures. The findings underscore the intricate synergy between stacking angles; filler composition and content in achieving robust and eco-friendly polyester composite building material to replace the termite, weather, and water affect commercial plywood. [ABSTRACT FROM AUTHOR]

Background: Olanzapine is an atypical antipsychotic used in schizophrenia and bipolar affective disorder, but it is associated with weight gain and metabolic syndrome. Metformin is known to decrease insulin resistance and abnormal glucose metabolism. Therefore, it is thought that metformin might prove useful in preventing weight gain induced by olanzapine. Hence, this study was undertaken to assess the effect of metformin on body weight, body mass index (BMI), waist and hip circumference, waist-to-hip ratio, and blood glucose levels in patients receiving olanzapine and to observe their adverse effects. Methods: Sixty-five patients with schizophrenia or bipolar mania were randomly assigned for 12 weeks of treatment with olanzapine 10 mg/day plus metformin 850 mg/day (n = 33) or olanzapine alone (n = 32). Body weight, BMI, waist circumference, hip circumference, and waist-to-hip ratio were measured at baseline, weeks 4, 8, and 12. Fasting plasma glucose was estimated at baseline and end of the study. Results: 59/65 (90.8%) patients completed the study. The body weight, BMI, waist circumference, hip circumference, and waist-to-hip ratio increased in both groups but it was relatively less in patients receiving metformin along with olanzapine. In patients who received olanzapine plus metformin, weight gain of more than 7% was observed in 43.3%, and 86.2% in those who received only olanzapine, the difference in this parameter was statistically significant (P = 0.001). Fasting plasma glucose had decreased significantly with olanzapine plus metformin at week 12. Conclusion: The metformin plus olanzapine group patients had relatively less weight gain compared to those who received only olanzapine. [ABSTRACT FROM AUTHOR]