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Introduction Complex distal humerus fractures are rare and difficult to treat and traditionally requires an open reduction and internal fixation via a transolecranon approach. However, controversy remains regarding the better method of fixation of the chevron osteotomy. The purpose of the present study was to compare the clinical efficacy of tension band wiring (TBW) and 3.5 mm precontoured plate in treating the chevron osteotomy. Materials and Methods A consecutive series of 49 patients who required olecranon osteotomy for type C distal humerus fractures were identified and grouped according to the construct used. Clinic–radiological evaluation was done at 3 months, 6 months, 1 year, and 2 years. A total of 34 males and 15 females with a mean age of 36.9 ± 12.64 years (18–62 years) were included in the study. Surgical duration, range of motion, Mayo elbow performance score (MEPS), and complications were noted at the follow-up. Results The mean range of motion was initially lower in the plate group (105 degrees ± 9.9 in plate, 107 degrees ± 9.15 in TBW) that subsequently increased at 6 months. The forearm rotation was similar in both the groups. The mean MEPS was found to be higher in the plate group at 2 years (81.83 ± 5.85 in plate, 77.76 ± 8.02 in TBW). A significantly higher rate of complications, that is, nonunion (p = 0.03), loss of reduction (p = 0.03), and revision (p = 0.04) was observed in the TBW group. However, other complications such as symptomatic hardware, wound complication, and removal of hardware were found to be higher in the plate group. Conclusion Both TBW and 3.5 mm precontoured plate provide comparable functional outcomes; however, the complication rate in terms of nonunion, loss of reduction, and revision is seen in the TBW, whereas wound complication and symptomatic hardware are more commonly seen in the plate.

Medial pivot (MP) total knee arthroplasty (TKA) aims to restore native knee kinematics due to highly conforming medial tibio-femoral articulation with survival comparable to contemporary knee designs. Posterior stabilized (PS) TKAs use cam-post mechanism to restore native femoral rollback. However, there is conflicting evidence regarding the reported patient satisfaction with MP TKA designs when compared to PS TKAs. The primary aim of this study is to compare the patient satisfaction between MP and PS TKA and the secondary aim is to establish potential reasons behind any differences in the outcomes noted between these two design philosophies. In this IRB-approved single surgeon, single centre prospective RCT, 53 patients (mean age 62 years, 42 women) with comparable bilateral end-stage knee arthritis undergoing simultaneous bilateral TKA were randomized to receive MP TKA in one knee and PS TKA in the contralateral knee. At 4 years post-surgery, all patients were assessed using Knee Society Score (KSS)-Satisfaction and -Expectation scores, and Oxford Knee Score (OKS). In addition, all the patients underwent standardized radiological and in vivo kinematic assessment. Patients were more satisfied with the MP TKA as compared to PS TKA: mean KSS-Satisfaction [34.5 ± 3.05 in MP and 31.7 ± 3.16 in PS TKAs (p

Objectives To assess the utility of multiparametric MRI in detecting clinically significant prostate cancer (csPCa) by comparing PI-RADSv2 scores with International Society of Urological Pathology (ISUP) pathologic grading criteria. Methods Data from 137 patients were retrospectively analyzed. PI-RADSv2 scores were compared with pathologic grade using ISUP criteria. Pathologic grades were divided into clinically significant (groups 3-5) and clinically insignificant lesions (groups 1-2). Chi-squared analysis was performed for to assess correlation. Results Sensitivity and specificity of PI-RADSv2 score 3-5 lesions for detecting csPCa was 100% and 18.5%, respectively. Negative predictive value (NPV) is 100% for these lesions. When considering only PI-RADSv2 score 4-5 lesions, sensitivity decreases to 90% and specificity increases to 67.5%, with a NPV of 98.5%. When only PI-RADSv2 score 5 lesions are considered, sensitivity decreases to 50% and specificity increases to 90%, with a NPV of 95%. Conclusions Multiparametric MRI has excellent sensitivity for detecting csPCa. Specificity is poor for PI-RADSv2 score 3 lesions but improves significantly for PI-RADSv2 score 4 and 5 lesions. Overall, mpMRI is an excellent screening tool for csPCa, as designated by the recently validated ISUP criteria. Advances in Knowledge Multiple limitations of the longstanding Gleason pathologic scoring system have led to the development of new ISUP pathologic criteria, which is more focused on the clinical significance of lesions. There are currently insufficient studies evaluating and validating the ISUP criteria with PIRADS v2 evaluation of the prostate.

Trans-scaphoid perilunate dislocations are complex injuries; usually occur as a result of high-energy trauma and are frequently missed. Chronic trans-scaphoid perilunate dislocation is often difficult to manage and delayed presentation leads to poor functional outcomes. Various treatment modalities have been described which range from open reduction and internal fixation, staged reduction, proximal row carpectomy and wrist arthrodesis.

G-quadruplexes (G4s) are non-canonical nucleic acid structures that form in G-rich regions of the genome and threaten genome stability by interfering with DNA replication. However, the underlying mechanisms are poorly understood. We have recently found that G4s can stall eukaryotic replication forks by blocking the progression of replicative DNA helicase, CMG. In this paper, we detail the methodology of DNA unwinding assays to investigate the impact of G4s on CMG progression. The method details the purification of recombinantly expressed CMG from the budding yeast, Saccharomyces cerevisiae, purification of synthetic oligonucleotides, and covers various aspects of DNA substrate preparation, reaction setup and result interpretation. The use of synthetic oligonucleotides provides the advantage of allowing to control the formation of G4 structures in DNA substrates. The methods discussed here can be adapted for the study of other DNA helicases and provide a general template for the assembly of DNA substrates with distinct G4 structures.

R-loops are a major source of genome instability associated with transcription-induced replication stress. However, how R-loops inherently impact replication fork progression is not understood. Here, we characterize R-loop-replisome collisions using a fully reconstituted eukaryotic DNA replication system. We find that RNA:DNA hybrids and G-quadruplexes at both co-directional and head-on R-loops can impact fork progression by inducing fork stalling, uncoupling of leading strand synthesis from replisome progression, and nascent strand gaps. RNase H1 and Pif1 suppress replication defects by resolving RNA:DNA hybrids and G-quadruplexes, respectively. We also identify an intrinsic capacity of replisomes to maintain fork progression at certain R-loops by unwinding RNA:DNA hybrids, repriming leading strand synthesis downstream of G-quadruplexes, or utilizing R-loop transcripts to prime leading strand restart during co-directional R-loop-replisome collisions. Collectively, the data demonstrates that the outcome of R-loop-replisome collisions is modulated by R-loop structure, providing a mechanistic basis for the distinction of deleterious from non-deleterious R-loops.

Study Design Observational study of computed tomography (CT) data. Purpose We performed a CT-based radiographic analysis of sub-axial cervical lamina in the Indian population to assess the feasibility of laminar screws. Overview of Literature Morphometric studies have been performed for populations of various ethnic groups, but none exist for Indian populations. Methods Cervical spine CT scans of 50 adults with a minimum slice thickness of

Total hip arthroplasty (THA) has been described as the operation of the century. Despite significant advancement in the field of technology, hip instability remains second most common cause of revision hip surgery after infection. There is garning interest to identify role of hip-spine relationship in order to identify high-risk patients for instability after THA. Acetabular component position varies according to spinal alignment and mobility in order to decrease risk of impingement and instability. Preoperative work up includes standing pelvis anteroposterior radiograph and lateral spino-pelvic radiograph in standing and sitting position. The focus of this review is to develop an algorithm to address the spino-pelvic pathology and guide the treatment on the basis of sagittal movement of the spine-pelvis-hip complex and to minimise the rate of dislocation following THA.

Introduction Total knee arthroplasty (TKA) usually provides good pain relief and improved function but has generally been unable to fully restore normal knee kinematics. Does Medial or Lateral Pivot TKA designs guide us to native knee kinematics needs to be elucidated? Methods Kinematic assessment of 13 knees with Medial Pivot TKA and 13 knees with Lateral Pivot TKA was done. The subjects were asked to perform step-up and weight bearing deep knee bend exercise under fluoroscopy for kinematic assessment. Patellar Tendon Angle (PTA) was measured after correcting f luoroscopic images for distortion against Knee Flexion Angle (KFA). Results During the weight bearing deep knee bend, the average active maximum flexion achieved with Medial Pivot design was 113.8 as compared to 102.9 with Lateral Pivot design. There was no significant difference in PTA in step up and deep knee bend exercise between both the designs. Conclusion The kinematic assessment of both the Medial and Lateral Pivot TKA designs revealed linear trend of PTA with increasing KFA as described for normal knee. Both the designs were able to achieve functional knee range of motion.

GTP hydrolysis is the underlying basis for functioning of ‘biological switches’ or GTPases. Extensively studied GTPases, Ras and EF-Tu, use a conserved Gln/His that facilitates the activation of attacking water for nucleophilic attack. However, this is insufficient to explain catalysis in Hydrophobic Amino acid Substituted (HAS)-GTPases that naturally possess a hydrophobic residue in lieu of Gln/His. We had previously reported a bridging water-chain mediated catalytic mechanism for HAS-GTPase FeoB; which utilizes two distantly-located but conserved glutamates. Curiously, mutating these does not abolish GTP hydrolysis. Similarly, in this study we report our observations on another HAS-GTPase Era, wherein the mutants of catalytically important residues continue to hydrolyze GTP. We attempt to rationalize these inquisitive observations on GTP hydrolysis by FeoB and Era mutants. We propose a general theory that appears common to at least three classes of GTPases, where ‘alternative mechanisms’ emerge when the primary mechanism is disrupted. Based on the analysis of crystal structures of FeoB and Era mutants, bound to the transition state analogue GDP.AlFx, this work suggests that in the absence of catalytically important residues, the active site waters in both FeoB and Era undergo re-arrangements, which in turn helps in sustaining GTP hydrolysis. Similar employment of alternative mechanisms was also suggested for the catalytic mutants of hGBP1. Importantly, such alternatives underscore the robustness of GTP hydrolysis mechanisms in these systems, and raise important questions regarding the need for persistent GTP hydrolysis and the physiological relevance of structural plasticity seen here.

Medial pivot total knee arthroplasty aims to restore native knee kinematics through highly conforming medial tibiofemoral articulation with survival comparable to contemporary knee designs. The aim of this study was to report preliminary clinical results of medial pivot total knee arthroplasty in an Indian population.A retrospective analysis of 45 patients (average age, 62 years; 40 women and 5 men) with end-stage arthritis (Kellgren-Lawrence grade 4) operated with a medial pivot prosthesis was done. All patients were assessed using Knee Society Score (satisfaction, expectation, and functional scores) and Oxford Knee Score, and range of motion was recorded at the end of 5-year postoperative follow-up. In addition, all patients underwent standardized radiological assessment.At the final follow-up, patients reported significant improvement in mean Knee Society Score (satisfaction, expectation, and functional scores) and Oxford Knee Score (These results demonstrated satisfactory clinical and radiological outcomes at 5 years after total knee arthroplasty with a medial pivot design, which may be related to better replication of natural knee kinematics with the medial pivot knee and inherent advantages of this design.

Study DesignA retrospective computed tomography (CT)-based morphometric study of 82 occipital condyles in the Indian population, focusing on critical morphometric dimensions with relation to placing condylar screws.PurposeThis study focused on determining the feasibility of placing occipital condylar screws in an Indian population using CT anatomical morphometric data.Overview of LiteratureThe occipital condylar screw is a novel technique being explored as one of the options in occipitocervical stabilization. Sex and ethnic variations in anatomical structures may restrict the feasibility of this technique in some populations. To the best of our knowledge, there are no CT-based data on an Indian population that assess the feasibility of occipital condylar screws.MethodsWe measured the dimensions of 82 occipital condyles in 41 adults on coronal, sagittal, and axial reconstructed CT images. The differences were noted between the right and left sides and also between males and females. Statistical analysis was performed using the t-test, with a p-value of ResultsMean sagittal length and height were 17.2±1.7 mm and 9.1±1.5 mm, respectively. Mean condylar angle/screw angle was 38.0°±5.5° from midline, with mean condylar length and width of 19.6±2.6 mm and 9.5±1.0 mm, respectively. Average coronal height on the anterior and posterior hypoglossal canal was 10.8±1.4 mm and 9.0±1.4 mm, respectively. The values in females were significantly lower than those in males, except for screw angle and condylar width. Based on Lin et al.'s proposed criteria, eight of 82 condyles were not suitable for condylar screws.ConclusionsPreliminary CT morphometry data of the occipital condyle shows that condylar screws are anatomically feasible in a large portion of the Indian population. However, because a small number of population may not be suitable for this technique, meticulous study of preoperative anatomy using detailed CT data is advised.

BACKGROUND: Total Knee Arthroplasty (TKA) has been described as an effective and successful mode of treatment in alleviation of pain and restoration of function in patients with Rheumatoid Arthritis (RA). The array of bone and soft tissue deformities in RA patients can impact initial success and long term durability of TKA. Medial Pivot (MP) prosthesis is fixed bearing asymmetric pivoting design that provides anterior-posterior stability without any post and conserves bone on the femoral side. There are few reports of suitability of experience with MP in RA. METHODS: Twenty six patients (average age 55 years) with end stage arthritis secondary to RA operated with MP prosthesis were retrospectively followed up. At a minimum follow up of three years, all patients were assessed using Knee Society Score (KSS), Oxford Knee Score (OKS), Pain Catastrophising Scale (PCS) and radiological outcomes. RESULTS: At final follow-up, patients reported significant improvement in mean KSS-Objective and Functional scores, Oxford Knee Score and Pain Catastrophising Scale (p

Study DesignA retrospective computed tomography (CT)-based morphometric study of 84 C1pedicles in an Indian population focusing on critical morphometric dimensions vis-a-vis C1 pedicle screw placement.PurposeTo determine the feasibility of C1 pedicle screw placement in an Indian population and propose a novel classification system for the same.Overview of LiteratureAt present, C1 pedicle screws are rarely used, and very few studies have focused on the feasibility of pedicle screw placement in terms of racial, gender, and ethnic variations in anatomical structures. There are no CT-based data on C1 pedicles that assess the feasibility of pedicle screw placement in the Indian population.MethodsWe measured C1 pedicle diameter on CT coronal scan images of 42 adult patients. Extramedullary height (EMH) and intramedullary height (IMH) were measured. We examined the differences between the right and left atlas pedicles and compared measures between males and females. These data were analyzed using significance tests. Based on the results, we propose a novel classification system, which we believe will help in determining the feasibility of C1 pedicle screw placement.ResultsForty-two adult patients (84 pedicles) were examined. Average EMH and IMH were 4.48±0.91 and 0.86±0.77, respectively. Approximately, 32% of the C1 pedicles had bone thicknesses of p=0.004). Right and left pedicles were not significantly different.ConclusionsOur data indicate that approximately one-third of the Indian population may not be suitable candidates for C1 pedicle screw placement. Caution should be exercised while placing type 1B and type 2 pedicles based on our proposed classification system.

Objective To determine the number of articles published by Indian authors related to spine surgery and to enumerate the 15 most influential articles from India published in the field of spine surgery in national & international journals based on the citations they have received both in pubmed and google scholar. Material and methods A retrospective study using Pubmed database was performed for the years between 1960 and 2015, for the articles published from India in the field of spine surgery in various national and international journals. A total of 3181 citations were received for top 15 most influential articles in the field of spine surgery from India. Results A total of 885 papers from India were identified which were published by Indian authors related to spine surgery between year 1960 to 2015. The largest numbers of papers were published in International journals such as Spine (82) and in European Spine Journal (47). Conclusion There are an increasing number of papers from India in the field of spine surgery literature. Most of the highly cited papers were related to tuberculosis. We expect further contributions from our country to the medical literature in the future.

Employing hybrid quantum mechanics/molecular dynamics (QM/MM) molecular dynamics simulations and experimental mutational studies, we investigate the GTP hydrolysis mechanism in a hydrophobic amino-acid substituted (HAS)-GTPase, FeoB. We identify glutamates, Glu66 and Glu67, that are acting as bases and find that proton transfer occurs from the attacking water to either of the glutamates through a water chain. However, GTP hydrolysis is not abolished, despite mutating these glutamates; instead, an alternative substrate-assisted hydrolysis becomes active with the same rate. Thus, mutational studies would misinterpret the role of glutamates. We trace the origin of the alternative mechanism to a structural feature conserved across all HAS-GTPases, distinct from the Ras-like GTPases.

Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of the hip joint but is not studied frequently in relation to acetabulum fractures. The aim was to establish the relationship between obturator externus and piriformis muscle morphology in acetabulum fractures and potenital development of AVN of the femoral head. Twenty-five fractures were included in this prospective study and were subjected to radiological assessment and computed tomography of the pelvis. Magnetic resonance imaging (MRI) of the hip was performed to assess the morphology of obturator externus and piriformis, and findings were compared intraoperatively (in 15 cases). Serial radiographs were taken at monthly intervals to assess the development of avascular necrosis. The patients with no evidence of AVN on radiographs at 6 months had additional MRI scans to look for such changes. Three patients developed AVN of femoral head and two had complete tears of piriformis and/or obturator externus muscles on the pre-operative MRI with the findings confirmed intraoperatively (p = 0.013). None of the patients without changes of AVN at 6-month follow-up had complete tears of either or both muscles. Of these patients, there was one case each of T-type fracture, isolated posterior wall fracture with hip dislocation, and posterior wall with transverse fracture of the acetabulum. Complete tears of obturator externus and/or piriformis muscles are a strong predictor of future development of AVN of the femoral head.

Background Tran foraminal lumbar interbody fusion (TLIF) is a well accepted and standard technique of achieving spinal fusion using pedicle screws, cage and bone graft. We are presenting here a case of L4–L5 lumbar canal stenosis managed with TLIF that presented with sigmoid colon perforation due to bone graft migration 4 days after surgery. Case report A 35 years old female underwent open TLIF (from right side) with decompression for L4–L5 lumbar canal stenosis. On 4th post op day she started having abdominal pain and distension. After radiograph reveled gas under diaphragm emergency laparotomy was done and 1 by 1 cm sigmoid colon perforation seen near recto-sigmoid junction. Bony spicules with sharp edges were seen embedded inside the perforation. Discussion The purpose of this case report is to present a rare complication and to raise awareness and high index of suspicion among spine surgeons for prevention, early detection and treatment.

Purpose. To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). Methods. 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. Results. The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. However, in the CS group, the scores generally peaked at 3 months and then deteriorated slightly at 6 months indicating recurrence of symptoms, which involved 46.7% of the CS patients. At 6 months, the number of patients positive for various ulrasonographic findings generally decreased. However, in the CS group, the number of patients with reduced thickness of the common extensor tendon increased from 2 to 12, and the number of patients with cortical erosion at the lateral epicondyle increased from 9 to 11. Conclusion. PRP appeared to enable biological healing of the lesion, whereas CS appeared to provide short-term, symptomatic relief but resulted in tendon degeneration.

Glycorandomization is a process that improves the efficacy of glycoconjugates by the addition of a diverse array of sugars to secondary metabolites and antibiotics of pharmaceutical importance. This process, which employs sugar nucleotidylyltransferases (SNTs) and glycosyl transferases (GTs) in tandem, would benefit by the employment of promiscuous enzymes, i.e. those with the ability to utilize diverse noncanonical substrates. As promiscuous GTs are available, here we set out to identify promiscuous SNTs. For this, we began with a detailed family-wide characterization of SNTs. Earlier, we had proposed that SNTs could be classified into two major groups – I and II. They share a common structural framework and utilize a similar catalytic mechanism. Subtle variations in the way two magnesium ions — Mg2þ A and Mg2þ B — are stabilized by metal ion coordination motifs led to their classification into diverse subgroups viz. I-A, I-B, I-C, II-A, and II-B. Based on this classification, here we investigate promiscuity across the entire family of SNTs. We study the utilization of several sugar phosphates and nucleotides by the various subgroups of SNTs to understand substrate specificity and promiscuity in these. We find that promiscuity is prevalent among SNTs; and in particular, in the thermophilic homologs. In principle, promiscuity profiling identified four new SNTs that can be employed for the production of sugar-nucleotide libraries. However, assaying for their ability to simultaneously utilize multiple substrates in a single-pot reaction, we find two thermophilic SNTs- TMGA, an adenylyltransferase from Thermotoga maritima and PHGT, a thymidylyltransferase from Pyrococcus horikoshii that are readily employable for the production of diverse sugar-nucleotides.

Osteoporosis is a major public health problem. Last decade has seen rise in osteoporotic vertebral fractures. Pragmatic management of osteoporotic VCF is challenging to the surgeons. In clinical settings, the situation becomes more complex when it comes to managing painful osteoporotic vertebral compression fractures (VCFs) due to various co-morbid factors that may limit aggressive interventions. Patients with Osteoporotic vertebral fractures are often characterized by general/relative immobility and physical frailty. Osteoporotic VCF not only affects the quality of life (e.g. pain) but also decreases the lifespan of the individual. The present review critically evaluates the currently prevailing non-surgical management modalities (conservative) offered in acute symptomatic osteoporotic VCFs that occur either within (0-5 days) of any incident event or present with the onset of symptoms such as pain.

Purpose.To assess the outcome of open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fractures.Methods.20 men and 2 women aged 20 to 55 (mean, 28) years underwent open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fracture. The most common fracture pattern was bicolumnar (n=12), followed by transverse (n=6) and T-type (n=4). Femoral head chondral lesions were classified as grade 0 (no defect) to grade 4 (osteochondral defect). Fracture fragments were fixed with titanium plates and screws, and the femoral head was redislocated to inspect for intra-articular screws. The association between functional status and acetabular fracture pattern and femoral head chondral lesions was explored.Results.Nine patients had chondral lesions in the femoral head (mostly in the anterosuperior zone), but none in the acetabulum. All femoral heads were viable. Reduction was anatomic in 6 patients and satisfactory in 16. Functional outcome was very good in 6 patients, good in 13, medium in 2, and fair in one. No patient developed avascular necrosis of the femoral head. Four patients had iatrogenic sciatic nerve palsy. One patient developed early degenerative hip arthritis and underwent total hip arthroplasty 14 months later.Conclusion.Surgical dislocation of the hip facilitated anatomic reduction and inspection of any chondral lesions. It did not result in avascular necrosis of the femoral head.

In orthopedics management of surgical blood loss is an important aspect which has evolved along with modern surgeries. Replacement of lost blood by transfusion alone is not the answer as was considered earlier. Complications like infection and immune reaction due to blood transfusion are a major concern. Today numerous techniques are available in place of allogenic blood transfusion which can be employed safely and effectively. In this article we have reviewed these techniques, their merits and demerits.

The purpose of the study was to study demographics of tuberculosis of spine and analyze factors that might affect neurological improvement in such patients.Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least 1-year follow-up were selected for retrospective analysis. Two hundred cases who presented with neurological deficit were further divided into three groups-completely improved, partially improved and no improvement according to American Spinal Injury Association impairment scale (AIS) grading. All continuous variables and categorical variables were compared across groups.A total of 209 (66.99%) patients had typical clinical presentation. A total of 264 (84.62%) had typical magnetic resonance imaging (MRI) presentation. Among 356 involved vertebrae, thoracic levels (T1-10) were most commonly affected in 163 (45.78%) followed by thoracolumbar (T11-L2) vertebrae in 98 (27.52%). In 250 patients (80.12%), disease was restricted to one or two adjoining vertebrae. At presentation, 112 (35.89%) patients were neurologically intact, whereas 97 (31%) were AIS D, 65 (20.83%) were AIS C, 8 (2.5%) were AIS B and 30 (9.61%) were AIS A. On statistical analysis, although three groups of patients with complete improvement, partial improvement and no improvement were similar in age, sex, radiological presentation, and co-morbidities and the presence of pulmonary tuberculosis, they were significantly different with regard to the levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration.In management of patients suffering from tuberculosis of spine, levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly affect the final neurological improvement.

Objective To assess the larvicidal potential of various extracts prepared from the stem, roots and leaves of Parthenium hysterophorus ( P. hysterophorus ) against 3rd and 4th instars of Aedes aegypti (Ae. aegypti) . Methods The extracts from each part were prepared with four solvents; petroleum ether, hexane, acetone and diethyl ether. Each part was dried, powdered and soaked in different solvents, separately, for five days. The crude extracts thus formed were concentrated using rotary evaporator and stored as stock solution of 1 000 mg/L. Results All the extracts prepared from the leaves were found ineffective against both the instars causing only 10%-40% mortality. Against 3rd instars, the hexane and petroleum ether extracts prepared from the stem of P. hysterophorus were found effective exhibiting LC 50 values of 379.76 and 438.57 mg/L, respectively. Likewise the hexane and petroleum ether extracts from the Parthenium roots resulted in LC 50 values of 432.38 and 562.50 mg/L, respectively, against 4th instars of Ae. aegypti revealing their larvicidal potential. It was further found that the hexane extracts, whether from roots or stem, were 13-28% more effective than the petroleum ether extracts. The qualitative phytochemical study of the effective extracts from the stems and roots showed the presence of alkaloids, saponins, terpenoids and flavonoids in different combinations. Conclusions Our investigations demonstrated the potential of P. hysterophorus roots and stems against Ae. aegypti larvae and their benefits as new types of mosquito larvicides. Variety of types and levels of active constituents in each kind of extract may be responsible for the variability in their potential against Ae. aegypti . Further research is needed to identify these components.

Security is a major concern for protected communication between mobile nodes in a hostile environment. In hostile environments adversaries can bunch active and passive attacks against intercept able routing in embed in routing message and data packets. In this paper, we focus on fundamental security attacks in Mobile adhoc networks. MANET has no clear line of defense, so, it is accessible to both legitimate network users and malicious attackers. In the presence of malicious nodes, one of the main challenges in MANET is to design the robust security solution that can protect MANET from various routing attacks. However, these solution are not suitable for MANET resource constraints, i.e., limited bandwidth and battery power, because they introduce heavy traffic load to exchange and verifying keys. MANET can operate in isolation or in coordination with a wired infrastructure, often through a gateway node participating in both networks for traffic relay. This flexibility, along with their selforganizing capabilities, are some of MANET's biggest strengths, as well as their biggest security weaknesses. In this paper different routing attacks, such as active(flooding, black hole, spoofing, wormhole) and passive(eavesdropping, traffic monitoring, traffic analysis) are described.

We describe a case of xanthogranulomatous osteomyelitis (XO) of the proximal femur in a 65-year-old woman who presented with pain of 6 months' duration in the right hip. Plain radiographs showed a lytic well-defined lesion in the right peritrochanteric region suggestive of a benign neoplastic etiology. The gross and histopathologic examination of the curettage specimen was consistent with XO. Xanthogranulomatous osteomyelitis is a rare chronic inflammatory process that is characterized by the presence of a large number of lipid-containing macrophages with an admixture of lymphocytes, plasma cells, and neutrophils. Gross and radiologic examination of this entity can mimic malignancy, and differentiation should be confirmed by histopathologic evaluation. To the best of our knowledge, XO of the femur has not been reported in the English-language literature. The rarity of this condition and its resemblance to bone tumors form the basis of this case report.

A 40-year-old woman from India presented with a mass in the front of her left knee which had been present for 8 months. Local examination revealed a globular mass of approximate size 5 cm × 4 cm × 4 cm in front of the lower pole of left patella. The patient was investigated with imaging studies and laboratory tests. Plain radiograph of the chest was normal. In addition, contrast enhanced Magnetic Resonance Imaging (MRI) of the left knee was performed. Based on the history, physical examination, laboratory and imaging studies, what is the differential diagnosis?

Study design Retrospective study. Purpose The aim of this study was to analyze various diagnostic tools, including GeneXpert, for the management of tuberculosis of the spine. Overview of literature Traditional diagnostic methods of microscopy, histology, and culture have low sensitivity and specificity for the management of tuberculosis of the spine. Methods Of the 262 treated cases of spinal tuberculosis, data on 1 year follow-up was available for 217 cases. Of these, only 145 cases with a confirmed diagnosis were selected for retrospective analysis. Results In 145 of the 217 patients (66.80%), diagnosis was confirmed on the basis of a culture. Of the 145 patients with a confirmed diagnosis, 98 (66.20%) patients were diagnosed on the basis of clinical presentation, whereas 123 (84.8%) exhibited a typical magnetic resonance imaging (MRI) picture. In 99 surgically treated patients, the diagnosis was confirmed on the basis of an intraoperative tissue biopsy. Among the 46 patients treated conservatively, 35 underwent a transpedicular biopsy, 4 patients underwent computed tomography-guided biopsy, 6 patients were diagnosed on the basis of material obtained from a cold abscess, and 1 patient underwent an open biopsy. The sensitivity of the culture for the detection of Mycobacterium tuberculosis was 66.80% (145/217) in our patients. Among the cases in which GeneXpert was used, the sensitivity for the detection of Mycobacterium tuberculosis was 93.4% (43/46). Moreover, the sensitivity of GeneXpert to detect rifampicin resistance was 100% (7/7) in our study. Conclusions Majority of the patients with tuberculosis of the spine can be diagnosed on the basis of a typical radiological presentation via MRI. In our study, 84.8% cases exhibited typical MRI findings. For patients presenting with atypical MRI features, a rapid and accurate diagnosis is possible by combining GeneXpert with MRI. The combined use of MRI and GeneXpert is a rapid and highly sensitive tool to diagnose tuberculosis and rifampicin resistance in patients with tuberculosis of the spine. Furthermore, we achieved a 97.9% sensitivity for the detection of Mycobacterium tuberculosis and 100% sensitivity for the detection of rifampicin resistance in our study.