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OBJECTIVE The US-based Spinal Laminectomy versus Instrumented Pedicle Screw (SLIP) trial reported improvement in disability following laminectomy with fusion versus laminectomy alone for patients with lumbar spondylolisthesis. Despite using similar methods, a concurrent Swedish trial investigating the same question did not reach the same conclusion. The authors performed a simulation-based analysis to elucidate potential causes of these divergent results. METHODS The mean and standard deviation of the preoperative and 2-year postoperative Oswestry Disability Index (ODI) scores for each study group (laminectomy with fusion and laminectomy alone) were collected from the spondylolisthesis stratum of the Swedish trial and used to create a MATLAB simulator using linear transformations to predict postoperative ODI distributions. Applying this simulator to both varied and published preoperative ODI distributions from the SLIP trial, the authors simulated the results of the US-based trial using treatment effects from the Swedish study and compared simulated US results to those published in the SLIP trial. RESULTS Simulated US results showed that as preoperative disability increased, the difference in postoperative ODI scores grew between treatment groups and increasingly favored laminectomy alone (p < 0.0001). In 100 simulations of a similarly sized US trial, the average mean change in ODI scores postoperatively was significantly higher than was published for laminectomy alone in the SLIP trial (−21.3 vs −17.9), whereas it was significantly lower than published for fusion (−16.9 vs −26.3). CONCLUSIONS The expected benefit of surgical treatments for spondylolisthesis varied according to preoperative disability. Adapting Swedish-estimated treatment effects to the US context mildly overapproximated the improvement in postoperative disability scores for laminectomy, but more severely underapproximated the improvement reported for laminectomy and fusion in the SLIP trial. The observed heterogeneity between these studies is influenced more by patient response to fusion than response to laminectomy. This analysis paves the way for future studies on the impact of preoperative treatment group heterogeneity, differences in surgical methods, and empirical design on reported clinical benefits. Although bayesian reanalysis of published randomized controlled trial data is susceptible to biases that typically limit post hoc analyses, the authors’ method offers a simple and cost-effective approach to improve the understanding of published clinical trial results and their implications for future studies.

Dry eye can initially cause mild symptoms of irritation and may rapidly progress to corneal scarring and blindness. Tear substitutes can only help for mild cases. With the advancement in microsurgical techniques, an option of transferring vascularized salivary glands has shown positive results. We present a case of a 5-year-old boy with congenital alacrimia with ocular surface damage. Vascularized autologous submandibular gland transfer was considered as a viable option for this patient. We performed the gland transfer in two separate stages for the two eyes (1 year 5 months apart). The patient was evaluated for up to 2 years for the right eye and for 7 months for the left eye. Dry eye workup showed drastic improvement (right > left). Biochemical analysis showed gradual transition to resemble that of natural tears. This procedure can result in significant symptomatic improvement and can be a promising treatment option for cases of severe dry eye.

High-quality interactions and relationships with others, such as intimacy with a spouse, friends, or family members, are referred to as social intimacy, and it can help predict mental health. Altruism is described as a motivational condition that a person holds with the intention of enhancing the wellbeing of another person. The purpose of the current study is to determine whether there is a substantial difference between first and second born emerging adults in terms of social intimacy and altruism. The sample included 126 college students who were emerging adults, of whom 63 were firstborn and another 63 were second-born. Convenient sampling techniques were used to gather the sample. Miller's Social Intimacy Scale and Altruism Scale were the instruments employed. Using SPSS, the data that were gathered were examined. The results demonstrated that there is a 0.01 level significant difference in altruism between first and second born emerging adults. When compared to first-born emerging adults, second-born emerging adults had more altruism. The analysis of the mean values revealed that first-born and second-born emerging adults differed in their levels of social intimacy. However, the variation is insignificant. Social intimacy was shown to be higher among second born than first born after analyzing the mean values.

The goal of the study is to see how parental participation affects the relationship between parenting styles and academic success in Malaysian primary school students. A quantitative technique was applied in this investigation. Private tuition centres in an urban area were used to recruit students. The information gathered for this investigation was numerically assessed and interpreted. Families are divided into four groups by the Parenting Style Index: authoritative, authoritarian, permissive, and indulgent. The relationship between parenting styles and academic success was studied using Pearson's correlation coefficient matrix. It was discovered that it completely mediates the relationship between authoritative and authoritarian parenting styles and student academic attainment. The study's findings show that understanding and receiving knowledge about how parenting styles and parental involvement affect children's academic achievement is crucial for parents.

Dilated and dysfunctional gut lymphatic vessels (LVs) have been reported in experimental cirrhosis. Here, we studied LVs in duodenal (D2)-biopsies of liver cirrhosis patients and investigated the prognostic role of a LV marker, podoplanin (PDPN), in predicting the mortality of patients with cirrhosis. A prospective, single-center cohort study was performed in liver cirrhosis patients (n = 31) and matched healthy controls (n = 9). D2-biopsies were obtained during endoscopy procedure, immunostained with PDPN, and scored based on 1) intensity and 2) density of positively-stained LVs per high power field. Gut and systemic inflammation were estimated by quantifying duodenal CD3+ intraepithelial lymphocytes (IELs), CD68+ macrophages, and serum TNF-α and IL-6 levels, respectively. Gut permeability and inflammation as assessed by quantifying gene expression of TJP1, OCLN, TNF-α, and IL-6 in D2-biopsies. Gene expression of LV markers, PDPN (8-fold), and LYVE1 (3-fold) was enhanced in D2-biopsies of cirrhosis patients compared to control (p < 0.0001). The mean PDPN score in decompensated cirrhosis patients (6.91 ± 1.26, p < 0.0001) was significantly increased as compared to those with compensated (3.25 ± 1.60). PDPN score positively and significantly correlated with the number of IELs (r = 0.33), serum TNF-α (r = 0.35), and IL-6 (r = 0.48) levels, while inversely correlated with TJP1 expression (r = -0.46, p < 0.05 each). In Cox regression, the PDPN score was a significant and independent 3-month-mortality predictor in patients (HR: 5.61; 1.08-29.109; p = 0.04). The area under the curve for the PDPN score was 84.2, and cutoff value for predicting mortality was ≥6.5 with 100% sensitivity and 75% specificity. Collectively, dilated LVs with high PDPN expression in D2-biopsies is a characteristic feature of patients with decompensated cirrhosis. PDPN score correlates with enhanced gut and systemic inflammation and also associates with 3-month mortality in cirrhosis.

Arthroscopic surgeries can be made cost effective by avoiding the use of implants whenever possible. Usage of confluent tunnels, suture bridges, bone bridges, and modifications in standard arthroscopic procedures will help us in achieving comparable mechanical as well as the functional outcome at the same time have technical advantages and cause less financial burden to the patient. On this technical note, we propose the use of various implant free techniques in arthroscopic and other sports related surgeries of the knee.

Objectives: The objectives of the study were to describe the surgical technique of our modification of isolated medial patellofemoral ligament (MPFL) reconstruction, in patients with patellar instability. As per literature, isolated MPFL reconstruction is advocated if tibial tubercle-trochlear groove (TTTG) Materials and Methods: A retrospective analysis of 52 patients with patellar instability (TT-TG Results: The mean age of the study population was 21.98 years, with a female (63.5%) majority. Among the 52 patients included in the study, 39 patients (75%) had TT-TG Conclusion: MPFL reconstruction without concomitant bony procedures can be safely performed in patients with a TT-TG

At present, coal based thermal power plants share about 57% of total electricity demand in India and day to day, coal consumption increases for fulfilling the increasing trend of electricity demand in India. Indian power plants are facing the problem of ash disposal as the coal having high ash concentration. To safe guard the environment and following the stringent environmental norms issued by Govt. of India, 100% ash utilization in power sector is to be made in timely. Considering the matter, the present work proposes a development of legacy ash based organic washing powder for utensil cleaning at low cost. Study shows that the accumulated unused legacy ash present in ash pond can used as organic based utensils cleaning washing powder where clay, dry reetha fruits and orange peel off powder are used as additional compositions. The used water from the cleaning may also be used for gardening / plantation purpose only. Due to the low foaming characteristic of the developed washing powder, water consumption of the hotel, house hold will be reduced and cut down the water bill and energy bill as well. Water pollution and skin etching issue on human health will be avoided by using the developed washing powder. High efficacy of cleaning is found in the composition ratio of 80%, 14%, 4% and 2% of legacy ash, clay powder, reetha powder and orange fruit peel off powder, respectively at the cost of Rs. 6.28 /kg which comparatively lower than the present market value. For promoting the Corporate Social Responsibility (CSR) activities, the washing powder composition ratio of 80%, 16%, 2% and 2% of legacy ash, clay powder, reetha powder and orange fruit peel off powder, respectively may be considered for its less cost (Rs. 3.82 /kg) and good cleaning. About 25% of 8.46 LMT legacy ash can be used for production of herbal washing powder of about 2.44 LMT and annual profit of the power station can be tune of about 170 crores. Hence, the proposed work can be useful for utilization of legacy ash and a way out for enhancing profit of the power station.

Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis.140 cirrhotic males with ED were randomized into tadalafil 10 mg daily (n = 70) or placebo (n = 70) for 12 weeks. ED was diagnosed if erectile function (EF) domain score was 25 in International Index of Erectile Function (IIEF) questionnaire. The erectile function domain consists of six questions concerning erection frequency, erection firmness, frequency of partner penetration, frequency of maintaining erection after penetration, ability to maintain erection to completion of intercourse and confidence in achieving and maintaining erection. Primary outcome was proportion of patients having an increase in 5 points in EF domain of the IIEF. Generalized Anxiety Disorder 7 (GAD-7) questionnaire was used for screening and severity measuring of GAD. The presence of depression was screened using the Patient Health Questionnaire (PHQ-9) and the assessment of health related quality of life was done using the Short Form (36) Health Survey.At the end of 12 weeks, more patients in tadalafil group achieved 5 points increase in the EF domain of the IIEF when compared with the placebo group [44(62.9%) vs. 21(30%), p 0.001]. At the end of 12 weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ-9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional and mental health) and the mental component summary rates when compared with placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups.Tadalafil therapy may enhance erectile function, improve anxiety, depression and quality of life; and is well tolerated by men with cirrhosis (CTP score 10) and ED. However, further larger and long-term studies are needed to confirm these results and look for rarer side effects of using tadalafil in patients with cirrhosis.ClinicalTrials.gov identifier number NCT03566914; first posted date: June 25, 2018.

With the well-established fact that meniscectomy predisposes patients to early osteoarthritis, there has been an increase in the incidence of meniscal repairs in recent years, even in active older patients, and in avascular zones. Although many techniques have been described for meniscal repair, even experienced surgeons face difficulties in certain scenarios. In this technical note, we present some techniques to facilitate the arthroscopic treatment of meniscal repair in general and introduce some novel techniques in some special scenarios.

Options for meniscal repair are plenty, but optimal usage of these techniques is imperative to achieve meniscal healing and simultaneously minimize meniscal trauma. In this technical note, a particular suture configuration called the Peacock Crown feather stitch has been described especially for the oblique flap tears.

Background: The COVID-19 pandemic, is a pandemic in progress! There is a general consensus that all health-care workers should wear N-95 masks and gloves for all patient interactions. The primary purpose of this study was to determine the physiological burdens on a surgeon of wearing N-95 masks throughout the day. Methods:We conducted an observational prospective study among 25 healthy orthopaedic surgeons at our centre. Heart rate, oxygen saturation, respiratory rate and end-tidal carbon dioxide (ETCO ) of the surgeons were measured using a vitals-parameter patient-anaesthetic monitor at the 2 start and end of the day on 3 consecutive days in two different scenarios; i.e., (a) Out-patient department (b) Operating theatre. Results:All the orthopaedic surgeons taking part in the study were males, with a mean age of 32.64 years. In both scenarios, there was an average increase of 4.74 mmHg in ETCO and this was found to be statistically signicant (p-value

Natural dengue virus (DENV) infections occur by mosquito bite but how the inoculation route affects the humoral immune response is unknown. We serologically profiled 20 non-human primates (NHP) from a prior study of DENV1 infection where animals were inoculated by mosquito (N = 10) or subcutaneous injection (N = 10). Using a comprehensive, densely tiled and highly redundant pan-flavivirus programmable phage library containing 91,562 overlapping 62 amino acid peptides, we produced a high-resolution map of linear peptide sequences enriched during DENV seroconversion. Profiles in mosquito-inoculated and subcutaneously-inoculated animals were similar up to 90 days after primary infection, but diverged at 1 year with differences in sero-reactivity in the Envelope (E; residues 215–406; p p 99% of the observed sero-reactivity difference. Antibody breadth did not vary by mode of inoculation. The differential reactivity to E domain III seen by phage display validated orthogonally by ELISA, but did not correlate with late neutralization titers. Serological profiling of humoral immune responses to DENV infection in NHP by programmable phage display demonstrated durable differences in sero-reactivity by route of inoculation.

BACKGROUND: The number of people injured following a road traffic accident (RTA) are as high as 2–5 crores around the world every year. The literature from western population suggests that ACL injuries are encountered mostly following high velocity sports injuries in clinical practise. But, in India there are a large group of individuals presenting with ACL injuries following RTAs. METHODS: We performed a retrospective analysis of all patients with ACL injuries presenting to our hospital following RTAs. All the information pertaining to the ligaments injured, vehicular factors, time of the day and environmental factors were recorded. The data was then analysed statistically. RESULTS: Most injuries occurred in the 31–40 year age group and velocity in the same range. Injuries due to bike skid predominated in our study amounting to 55.9%. Interestingly, very low velocities accidents due to stray dogs accounted to 43.8% and they occur mostly at night. CONCLUSION: The number of patients presenting with RTA related ACL injuries in our country are numerous. Hence, we have made an attempt to show that ACL injuries can occur even at low velocity following motor vehicle accidents in contrast to the western population, where sports related injuries are the most common etiology for such mishaps.

INTRODUCTION: Latarjet procedure is commonly performed for recurrent anterior shoulder instability with glenoid side bone loss. Classic Latarjet procedure can be performed using specially designed drill guides, jigs, or by freehand technique. Here we have described a technical note on classic Latarjet procedure performed with freehand technique utilizing simple rulers and caliper. The functional and radiological outcomes of our patients have also been analysed. MATERIAL AND METHODS: 149 open classic Latarjet procedures were performed using our technique between March 2015 and July 2018. The mean age of the patients was 32.95 years (Range 22–59 years). The functional outcome of the patients was measured using Western Ontario Shoulder Instability (WOSI) and Oxford Shoulder Instability Score (OSIS) at 2 years of follow-up. Screw and graft positioning were studied in 24 consecutive patients with a postoperative computed tomography (CT) scan. RESULTS: There was no incidence of recurrent subluxation or dislocation post-surgery. Mean OSIS score increased from 15.63 ± 3.20 preoperatively to 42.44 ± 3.88 postoperatively (p value

Protection against Plasmodium falciparum, which is primarily antibody-mediated, requires recurrent exposure to develop. The study of both naturally acquired limited immunity and vaccine induced protection against malaria remains critical for ongoing eradication efforts. Towards this goal, we deployed a customized P. falciparum PhIP-seq T7 phage display library containing 238,068 tiled 62-amino acid peptides, covering all known coding regions, including antigenic variants, to systematically profile antibody targets in 198 Ugandan children and adults from high and moderate transmission settings. Repeat elements – short amino acid sequences repeated within a protein – were significantly enriched in antibody targets. While breadth of responses to repeat-containing peptides was twofold higher in children living in the high versus moderate exposure setting, no such differences were observed for peptides without repeats, suggesting that antibody responses to repeat-containing regions may be more exposure dependent and/or less durable in children than responses to regions without repeats. Additionally, short motifs associated with seroreactivity were extensively shared among hundreds of antigens, potentially representing cross- reactive epitopes. PfEMP1 shared motifs with the greatest number of other antigens, partly driven by the diversity of PfEMP1 sequences. These data suggest that the large number of repeat elements and potential cross-reactive epitopes found within antigenic regions of P. falciparum could contribute to the inefficient nature of malaria immunity.

Introduction: Critically ill patients with liver disease commonly present to the intensive care unit (ICU) with need for prolonged ventilation, difficult weaning, and refractory coagulopathy. These patients experience both bleeding and thrombotic complications with a precariously balanced state of coagulopathy. The purpose of this study was to assess the bleeding complications of tracheostomy in critically ill patients with liver disease. Methods: A retrospective study was conducted in liver ICU of a tertiary teaching institute. Medical records were analyzed to assess postprocedure complication rate among 73 critically ill liver disease patients who had undergone tracheostomy during the period of October 2017 to September 2018. Results: Ten out of 73 patients (13%) required transfusion of blood products after 12 h of procedure, despite thromboelastography (TEG)-based correction prior to procedure. Of these, 7 patients (9%) underwent surgical tracheostomy (ST) and three patients (4%) underwent percutaneous tracheostomy. Statistically no significant difference in bleeding was seen among the two groups, but a rising trend was seen with the ST group (P = 0.52). None of the patients experienced procedure-related pneumothorax and subcutaneous emphysema, as observed in the chest X-ray. Conclusion: We conclude that coagulopathy should not be deterrence for the performance of tracheostomy in critically ill patients with liver disease. Adequate clotting support guided by the global tests of coagulation, such as TEG, ensures lesser incidence of bleeding.