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Purpose: Hip fractures in elderly have a high mortality. However, there is limited literature on the excess mortality seen in hip fractures compared to the normal population. The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population. Methods: There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study. Patients were followed up for 1 year and the follow-up record was available for 279 patients. Mortality was assessed during the follow-up from chart review and/or by telephonic interview. One-year mortality of Indian population was obtained from public databases. Standardized mortality ratio (SMR) (observed mortality divided by expected mortality) was calculated. Kaplan-Meir analysis was used. Results: The overall 1-year mortality was 19.0% (53/279). Mortality increased with age (p

Abstract Misfolded protein aggregates may cause toxic proteinopathy, including autosomal dominant tubulointerstitial kidney disease due to uromodulin mutations (ADTKD-UMOD), a leading hereditary kidney disease. There are no targeted therapies. In our generated mouse model recapitulating human ADTKD-UMOD carrying a leading UMOD mutation, we show that autophagy/mitophagy and mitochondrial biogenesis are impaired, leading to cGAS-STING activation and tubular injury. Moreover, we demonstrate that inducible tubular overexpression of mesencephalic astrocyte-derived neurotrophic factor (MANF), a secreted endoplasmic reticulum protein, after the onset of disease stimulates autophagy/mitophagy, clears mutant UMOD, and promotes mitochondrial biogenesis through p-AMPK enhancement, thus protecting kidney function in our ADTKD mouse model. Conversely, genetic ablation of MANF in the mutant thick ascending limb tubular cells worsens autophagy suppression and kidney fibrosis. Together, we have discovered MANF as a biotherapeutic protein and elucidated previously unknown mechanisms of MANF in the regulation of organelle homeostasis, which may have broad therapeutic applications to treat various proteinopathies.

The Horticulturae Editorial Office wishes to make the following changes to the author’s paper [...]

Oestrogen receptor (ER)-positive breast cancer (BC) is generally well responsive to endocrine therapy. Neoadjuvant endocrine therapy (NAET) is increasingly being used for downstaging ER-positive tumours. This study aims to analyse the effect of NAET on a well-characterised cohort of ER-positive BC with particular emphasis on receptor expression. This is a retrospective United Kingdom (UK) multicentre study of 391 patients who received NAET between October 2012 and October 2020. Detailed analyses of the paired pre- and post-NAET morphological changes and hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) expression were performed. The median duration of NAET was 86 days, with median survival and overall survival rates of 380 days and 93.4%, respectively. A total of 90.3% of cases achieved a pathological partial response, with a significantly higher rate of response in the HER2-low cancers. Following NAET, BC displayed some pathological changes involving the tumour stroma including central scarring and an increase in tumour infiltrating lymphocytes (TILs) and tumour cell morphology. Significant changes associated with the duration of NAET were observed in tumour grade (30.6% of cases), with downgrading identified in 19.3% of tumours (p < 0.001). The conversion of ER status from positive to low or negative was insignificant. The conversion of progesterone receptor (PR) and HER2 status to negative status was observed in 31.3% and 38.1% of cases, respectively (p < 0.001). HER2-low breast cancer decreased from 63% to 37% following NAET in the paired samples. Significant morphological and biomarker changes involving PR and HER2 expression occurred following NAET. The findings support biomarker testing on pre-treatment core biopsies and post-treatment residual carcinoma.

A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries. On radiological evaluation, the patient had symmetrical quadruple limb involvement with bilateral humerus shaft, bilateral olecranon, bilateral femur shaft, and bilateral patella fractures. The patient was actively managed using damage control orthopaedics, and a sequence of skeletal fixation was planned based on the hemodynamic stability and periodical serum lactate assessment. Symmetrical quadruple limb fractures are very rare, which could be associated with higher mortality. A meticulous clinical evaluation, periodical blood parameter assessment and strict adherence to the principles of damage control orthopaedics can be conducive to prevent life-endangering complications.

Waterlogging represents a substantial agricultural concern, inducing harmful impacts on crop development and productivity. In the present study, 142 diverse sesame genotypes were examined during the early vegetative phase to assess their response under waterlogging conditions. Based on the severity of symptoms observed, 2 genotypes were classified as highly tolerant, 66 as moderately tolerant, 69 as susceptible, and 5 as highly susceptible. Subsequent investigation focused on four genotypes, i.e., two highly tolerant (JLT-8 and GP-70) and two highly susceptible (R-III-F6 and EC-335003). These genotypes were subjected to incremental stress periods (0 h, 24 h, 48 h, 72 h, and 96 h) to elucidate the biochemical basis of tolerance mechanisms. Each experiment was conducted as a randomized split-plot design with three replications, and the statistical significance of the treatment differences was determined using the one-way analysis of variance (ANOVA) followed by the Fisher least significant difference (LSD) test at p ≤ 0.05. The influence of waterlogging stress on morphological growth was detrimental for both tolerant and susceptible genotypes, with more severe consequences observed in the latter. Although adventitious roots were observed in both sets of genotypes above flooding levels, the tolerant genotypes exhibited a more rapid and vigorous development of these roots after 48 h of stress exposure. Tolerant genotypes displayed higher tolerance coefficients compared to susceptible genotypes. Furthermore, tolerant genotypes maintained elevated antioxidant potential, thereby minimizing oxidative stress. Conversely, susceptible genotypes exhibited higher accumulation of hydrogen peroxide (H2O2) and malondialdehyde content. Photosynthetic efficiency was reduced in all genotypes after 24 h of stress treatment, with a particularly drastic reduction in susceptible genotypes compared to their tolerant counterparts. Tolerant genotypes exhibited significantly higher activities of anaerobic metabolism enzymes, enabling prolonged survival under waterlogging conditions. Increase in proline content was observed in all the genotypes indicating the cellular osmotic balance adjustments in response to stress exposure. Consequently, the robust antioxidant potential and efficient anaerobic metabolism observed in the tolerant genotypes served as key mechanisms enabling their resilience to short-term waterlogging exposure. These findings underscore the promising potential of specific sesame genotypes in enhancing crop resilience against waterlogging stress, offering valuable insights for agricultural practices and breeding programs.

Abstract Breast cancer is the commonest malignancy of women and with its incidence on the rise, the need to identify new targets for treatment is imperative. There is a growing interest in the role of lipid metabolism in cancer. Carnitine palmitoyl-transferase-1 (CPT-1); the rate limiting step in fatty acid oxidation, has been shown to be overexpressed in a range of tumours. There are three isoforms of CPT-1; A, B and C. It is CPT-1A that has been shown to be the predominant isoform which is overexpressed in breast cancer. We performed a bioinformatic analysis using readily available online platforms to establish the prognostic and predictive effects related to CPT-1A expression. These include the KM plotter, the Human Protein Atlas, the cBioPortal, the G2O, the MethSurvand the ROC plotter. A Network analysis was performed using the Oncomine platform and signalling pathways constituting the cancer hallmarks, including immune regulation as utilised by NanoString. The epigenetic pathways were obtained from the EpiFactor website. Spearman correlations (r) to determine the relationship between CPT-1A and the immune response were obtained using the TISIDB portal. Overexpression of CPT-1A largely confers a worse prognosis and CPT-1A progressively recruits a range of pathways as breast cancer progresses. CPT-1A’s interactions with cancer pathways is far wider than previously realised and includes associations with epigenetic regulation and immune evasion pathways, as well as wild-type moderate to high penetrant genes involved in hereditary breast cancer. Although CPT-1A genomic alterations are detected in 9% of breast carcinomas, both the alteration and the metagene associated with it, confers a poor prognosis. CPT-1A expression can be utilised as a biomarker of disease progression and as a potential therapeutic target.

The integrity of the patella is pivotal for the efficient functioning of the knee extensor mechanism. Thus, patella fracture management cannot be neglected and utmost priority should be determined for its preservation and maintenance of knee functioning. Tension band wiring (TBW) is the most widely and commonly used mode of fixation of patella fractures with consistently favourable outcomes. However, the complications associated with the same could be challenging and may compromise the integrity of the patella. This case report highlights the salvage of the failed TBW for a patella fracture with biomechanically stronger angular stable Star-shaped patella plate.

Eight field pea parental lines and their twenty-eight F1s resulting from diallel design (excluding reciprocal) were analyzed for their combining ability and heterosis for yield and associated traits. ANOVA revealed significant variation among parents and among hybrids for days to 50% flowering, plant height, total number of pods, effective pods, seeds per pod, 100-seed weight, biological yield and seed yield; pod length also revealed significant differences among hybrids, suggesting the occurrence of considerable variability for studied traits. Crosses P-1541-16 × P-92-97-11 and P-1541-16 × P-1297-97 displayed significant heterosis over better-parent and control varieties for seed yield and associated traits. Combining ability analysis showedthat SCAvariance was considerably higher than corresponding GCAvariance for all traits. Genotype Aman and P-1297-97 were identified as good general combiners for seed yield, while cross P-1541-16 × P-1297-97, Aman × EC-564817, P-1541-16 × P-92-97-11 and P-1297-97 × P-92-97-11 were identified as specific cross-combiners for most of the studied traits. Consequently, these crosses might be exploited in future breeding programs to find desired segregants. PCA explained 81.68% and 83.34% variability in parents and crosses, respectively, for yield component. Furthermore, trait association between GCA effects and SCA effects demonstrates that biological yield, total number of pods, and effective pods exhibit additive gene action, but 100-seed weight exhibits non-additive gene action.

Ankylosing spondylitis (AS) is an underdiagnosed inflammatory condition in the initial stages of disease that can cause vertebral fractures in young adults after trivial trauma. Hence, low-energy spinal fractures in young patients must be carefully evaluated to exclude AS as the treatment protocol (fixation levels, period of immobilization) may change drastically if AS is diagnosed. Here, we present cases of 3 patients who presented at emergency after low-velocity spinal trauma and diagnosed as AS during workup for fracture management. This cases series indicates underdiagnosis of AS in general population as well as importance of strong suspicion of AS in low-energy spinal fractures in the younger age-group.

Abstract The current investigation entail systematic Quality by Design (QbD)-enabled approach for the development of Sustained released embedded drug delivery systems of L-Arginine employing ionic gelation technique to attain improved patient compliance. Hence, in this QbD enabled systematic approach; quality target product profile (QTTP) was defined and critical quality attributes (CQAs) were identified. Further the risk assessment studies were undertaken through Ishikawa fish bone diagram to locate the critical material attributes (CMAs) and/or critical process parameters (CPPs) for the formulation of beads that may affect CQAs of drug product. A face centered central composite design (CCD) for two factors at three levels each with α =1 was employed for the optimization process to checkout the impact of concentration of sodium alginate and concentration of chitosan as CMAs which wereprior identified from risk assessment study and further evaluated for CQAs viz. bead size, swelling index and percent drug entrapment. The optimum formulation was embarked upon by using mathematical model being developed yielding desired CQAs. Thereby chitosan coated calcium-alginate delivery system was successfully developed by strategically employing QbD approach.In a nutshell, the presentinvestigation reports the successful development of optimized chitosan coated alginate beads employing QbD approach which can serve as a platform for other drugs too.

Fractures of the supracondylar and intercondylar region of the distal femur usually result from high velocity injury that is uncommonly associated with violation of the integrity of the extensor mechanism. The consequences of missed quadriceps injury associated with a distal femur fracture are devastating. The present case report illustrates the importance of recognizing the rare association of quadriceps tear with distal femoral fractures, an appropriate surgical approach to repair the tear as well as fixation of fracture, and a protocol of postoperative rehabilitation to achieve a successful outcome.

The recent emergence of Radio Frequency Identification (RFID) applications have attracted the attention of all the stakeholders, namely developers, manufacturers, and end-users. In essence, RFID has permeated the broad spectrum of item tracking, identification, and sensing. Alternatively, it is safe to say that RFID has revolutionized item tracking, sensing, and monitoring mechanisms. However, RFID’s proliferation often faces a roadblock due to its associated cost due to silicon-based integrated circuits. This aspect can be addressed by the emerging design techniques and performance enhancement approach adopted for the realization of Chipless RFIDs. This has catapulted the Chipless RFIDs at the forefront in recent years. The chipless RFID tag uses electromagnetic properties to store the information and eliminate memory chips. It is anticipated that the usage of Chipless RFIDs will increase by leaps and bounds in the coming years. Therefore, this paper discusses some of the critical applications that can be directly served by Chipless RFIDs. This paper also elaborates on the associated constraints which limit the mass deployment of the Chipless RFIDs. Furthermore, this paper throws some light on some of the exciting research directions for future development.

RFID has permeated in wide-ranging applications that may eventually fall under the broad IoT umbrella. However, the adaption of RFID for commercial purposes of IoT-centric applications still faces numerous technical challenges due to its high cost. The Chipless RFID can become a boon considering its significantly reduced cost and tag complexity in this context. In this article, therefore, different aspects of the chipless RFID are discussed and analyzed, and a potential road map is explored for the effective seamless integration of chipless RFID in the amalgamated IoT. At first, a brief theoretical preliminary about the Chipless RFID is presented, and it is succeeded by the application’s specific roles of this emerging RFID in the wide variety of domains. Subsequently, the analysis of various physical parameters shows that chipless RFID technology can greatly broaden IoT’s horizon. It essentially shows that it has the potential to bring a paradigm shift in the way RFID can coexist with IoT. Finally, a section which briefs about the future directions is also included to throw some light on Chipless RFID’s direct fitment in the IoT.

Field pea is one of the important short-duration cool season pulse crops which contributes significantly towards food and nutritional security. Two heat-susceptible (HS) and two heat-tolerant (HT) genotypes were selected from the previous study for further characterization. A significant variation was observed for morpho-physiological traits studied. Principal component analysis explained that first two principal components, i.e., PC1 and PC2 showed 76.5% of the total variance in optimal condition, whereas 91.2% of the total variance was covered by the first two PCs in heat stress environment. The seed yield per plant determined significant and positive association with superoxide dismutase and number of seeds per pod under optimal conditions, whereas under heat stress condition, it was positively associated with number of effective pods per plant, biological yield per plant, proline, pod length, number of seeds per pod, superoxide dismutase, and peroxidase. The significant reduction was noticed in the susceptible genotypes, whereas tolerant genotypes showed stable and non-significant reduction in chlorophyll content. Further, minimum cell damage and higher hydrogen peroxide production was noticed in the susceptible genotypes. In addition, the biochemical characterization of HS and HT genotypes revealed that the higher expression of peroxidase, superoxide dismutase, and catalase modulates the tolerant responses in HT genotypes. These genotypes were further used in developing heat-tolerant field pea genotypes.

Purpose: This case report describes the therapeutic management of a 61-year-old male who experienced aquarium coral keratoconjunctivitis caused by exposure to palytoxin and provides an additional resource to raise awareness and treat patients with ocular exposure to palytoxin. Observations: A 61-year-old male inadvertently touched his left eye while cleaning an aquarium. Within 24 hours, pain, redness and visual blurring was noted. After 48 hours his best corrected visual acuity was measured at 20/25 on the right eye and 20/200 on the left. A thick mucopurulent discharge was present with associated conjunctival edema. The corneal epithelium was denuded centrally and inferiorly with subepithelial infiltrates peripherally. The patient was treated with topical moxifloxacin (0.5%) drops 6x/day and prednisolone acetate (1%) 4x/day. He was seen for follow up 48 hours later with a significant improvement in discomfort. Vision had improved to 20/60 with resolution of conjunctival edema, partial corneal epithelialization and reduced erythema. Cultures for culture and sensitivity returned as normal. The patient's steroid regime was gradually tapered during reassessments at four and ten days by which time the left eye acuity had returned to 20/25 with no symptoms. Therapy was discontinued with the exception of artificial tears. The patient continued to do well at his 42-day follow-up appointment with persistent corneal epithelialization, absence of infiltrates and a stable visual acuity of 20/25 in the affected eye. His local optometrist confirmed that the acuity was consistent with measurements obtained prior to the insult. Conclusions: The combination of moxifloxacin eye drops and prednisolone acetate eye drops were effective in treating the patient's aquarium coral keratoconjunctivitis as after being treated the patient regained his baseline visual acuity in the affected eye (best corrected visual acuity of 20/25). Importance: Currently, there are only a handful of case-reports published on ocular exposure to palytoxin. This case report will add to the literature by providing an additional resource for health care providers, in the treatment of patients with ocular exposure to palytoxin and increasing awareness to this rare condition.

PurposeThe vasodilatory response to inhaled CO2 occurs in the acute stroke ischemic penumbra and may be a potential therapeutic modality.MethodsTwenty-two Sprague-Dawley rats were subjected to 90-min occlusion of the M2 segment of the middle cerebral artery (M2CAO) by endovascular technique. The animals were administered different C02 concentrations and scanned serially with 9.4 T MRI. Infarct tissue was determined by diffusion-weighted imaging (DWI) and hypoperfused tissue was determined by arterial spin labeling (PWI).Results4 animals were administered room air (RA)+ 6% CO2 (group 1), 6 animals RA+12% CO2 (Group 2) and 4 animals only RA (group 3). In the rats with CO2 administered (groups 1 and 2), the DWI lesion to cerebral hypoperfusion volume ratio (SD) at pre-CO2 administration, was 0.145(0.168), which increased to 0.708(0.731) during CO2 administration and reduced to 0.533(0.527) post-CO2 administration. In 9 of 10 rats the hypoperfused volume decreased when CO2 was administered. When CO2 was stopped the hypoperfused volume became larger again. Administration of RA+12% CO2 (Group 2) decreased the volume of CBF hypoperfusion significantly compared to the control group (95%CI: 0.084 ± 0.0213, p = 0.004).ConclusionInhaled CO2 appears to reduce the size of the hypoperfused tissue volume during acute stroke and may be a potential modality for treatment of acute ischemic stroke. These findings will nonetheless need to be validated in a larger cohort in other centers.

Thirty-eight genotypes of wheat including 8 parents, their 28 F1s and 2 checks evaluated in 4 different environments i.e. early sown, normal sown, late sown and very late sown conditions was undertaken to study the combining ability in bread wheat for grain yield and its component traits. From pooled analysis, it was found that mean square due to GCA and SCA were significant for all characters which revealed difference between parents for GCA and difference between crosses for SCA. Significant mean square for GCA x E and SCA x E for proline content, chlorophyll content, chlorophyll stability index and heat injury was observed. In addition, SCA x E for grain yield was also significant. This suggested that additive and non-additive genetic components were sensitive to environments. Variance for GCA was higher than their respective SCA variance for grain yield per plant, leaf canopy temperature, proline content and chlorophyll stability index which suggested that additive component was less stable over the environment than dominant component. Parents HD 2987 was good general combiners for grain yield over different environments. Cross HI 1544 x HD 2987 was the best specific combiner for grain yield per plant followed by HI 1544 x RAJ 4079.

Globally, abiotic stresses, such as temperature (heat or cold), water (drought and flooding), and salinity, cause significant losses in crop production and have adverse effects on plant growth and development. A variety of DNA-based molecular markers, such as SSRs, RFLPs, AFLPs, SNPs, etc., have been used to screen germplasms for stress tolerance and the QTL mapping of stress-related genes. Such molecular-marker-assisted selection strategies can quicken the development of tolerant/resistant cultivars to withstand abiotic stresses. Oilseeds such as rapeseed, mustard, peanuts, soybeans, sunflower, safflower, sesame, flaxseed, and castor are the most important source of edible oil worldwide. Although oilseed crops are known for their capacity to withstand abiotic challenges, there is a significant difference between actual and potential yields due to the adaptation and tolerance to severe abiotic pressures. This review summarizes the applications of molecular markers to date to achieve abiotic stress tolerance in major oilseed crops. The molecular markers that have been reported for genetic diversity studies and the mapping and tagging of genes/QTLs for drought, heavy metal stress, salinity, flooding, cold and heat stress, and their application in the MAS are presented.

Considering the significance of sunflower (Helianthus annuus L.) cultivation under diverse agro-climatic conditions, present study was done to recognize assorted parental lines utilizing RAPD and ISSR markers to lessen environmental effects or test blunders at Rajasthan College of Agriculture, MPUA & T, Udaipur, Rajasthan during 2016. In the present study, RAPD primers produced 334 polymorphic band and ISSR primers produced 160 polymorphic bands. RAPD primers detected more polymorphic loci (56.88%) than the ISSR primers (52.24%). The dendrograms constructed by RAPD, ISSR primers and pooled data were associated with each other, indicating the efficacy of both marker systems in genetic diversity study of sunflower. Based on RAPD, ISSR and pooled data analysis, the restorer line EC 623023, R 16 and seed parental line CMS 234B, PET 2-7-1B were found to be genetically most diverse and fall into different groups. Therefore, their genetic origin seems to be different and could be efficiently used in sunflower breeding programs.

Introduction: To study the ocular changes in patients on long term treatment with Hydroxychloroquine (HCQ); and detect means for early detection of toxicity. Methods: We conducted a cross-sectional observational study at a tertiary care hospital, in which 100 patients, male and female, aged 35 years or more, taking HCQ for 5 years or more were included. Patients with any known ocular or systemic diseases were not included. Indication, dosage, duration and cumulative dose of HCQ intake were recorded. History of ocular symptoms, visual acuity, colour vision, complete ophthalmic examination, visual field using Amsler grid and 10-2 Humphrey’s automated fields (HVF), Spectral Domain Optical Coherence Tomography (SD-OCT), colour fundus photography, fundus fluorescein angiography (FFA) and fundus autofluorescence (FAF) were recorded. The data was analyzed using descriptive and inferential analysis. Result: 15% of the study population showed signs of HCQ related ocular toxicity. 17%, 21% and 10% patients had abnormal SD-OCT, HVF and FAF findings respectively. Conclusion: HCQ related ocular toxicity has been found in patients in the absence of symptoms. Objective tests like HVF, SD- OCT and FAF were more useful in early detection of toxicity than subjective tests such as Amsler grid, colour vision and FFA.

Aims: The aim of this study is to compare urodynamic changes after valve fulguration alone and valve fulguration with bladder neck incision (BNI). Settings and Design: A total of 81 patients with posterior urethral valve were treated at our center from July 2010 to July 2016. Patients were randomized into two groups using simple randomization. Forty patients underwent BNI in addition to valve fulguration (Group I), and the remaining 41 patients underwent conventional transurethral valve fulguration (Group II). Subjects and Methods: The exclusion criteria for both the groups were the presence of simultaneous urogenital anomalies, any neurological condition, history of any urethral manipulation, and urinary diversion. Urodynamic changes were compared in both groups postoperatively. All patients were evaluated throughout their follow-up, according to the following protocol: (a) Voiding cystourethrography at 6 weeks after surgery; (b) Renal function test and urine culture at 6 weeks and then 3 monthly; (c) Ultrasound kidney, ureter, and bladder region and urodynamics at 3 and 6 months after surgery and then yearly. Median follow-up period for Group I was 27.5 months (13–72 months) and 14 months (14.5–72 months) for Group II. Statistical Analysis Used: Statistical analysis was done using the Student's t-test for parametric data and Chi-square test for categorical variable. P ≤ 0.05 was considered as statistically significant. Results: The mean age was 7.26 years in Group I and 7.66 years in Group II at the end of follow-up. There was no statistically significant difference found regarding detrusor overactivity (P = 0.68), compliance (P = 0.052), end-filling pressure (P = 0.08), and max Pdet at Qmax (P = 0.08) in the both groups. However, there was a statistically significant difference regarding improvement of peak flow (P = 0.038) and postvoid residue (PVR) (P = 0.045) in Group I in comparison to Group II. Conclusions: Valve ablation with BNI gives statistically significant better urodynamics in voiding phase regarding flow and lesser PVR in comparison to valve ablation.

The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and 'other clinical' (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.

Overproduction of reactive oxygen species (ROS) is a well-established indicator of ongoing tissue inflammation. However, there is a scarcity of molecular imaging probes capable of providing noninvasive sensitive detection of ROS for allowing longitudinal studies of disease pathology and/or monitoring therapeutic efficacy of ROS scavengers. Herein, we report synthesis and chemical characterization of a novel metalloprobe, Galuminox, a moderately fluorescent agent that detects superoxide and hydrogen peroxide generation. Using live-cell fluorescence imaging analysis, Galuminox demonstrates ability to detect superoxide and monitor effects of ROS-attenuating agents, such as Carvedilol, Dexrazoxane, and mitoTempo in lung epithelial A549 cells. Furthermore, LPS stimulation of A549 cells that either express the mitochondria targeted fluorescent protein Keima or are stained with MitoSOX, a mitochondria-specific superoxide probe, indicates preferential co-localization of Galuminox with mitochondria producing elevated amounts of superoxide. Dynamic PET/CT scans 45 min post tail-vein administration of 68Ga-Galuminox show 4-fold higher uptake and stable retention in lungs of LPS treated mice compared to their saline-only treated counterparts. Post preclinical PET imaging, quantitative biodistribution studies also correlate with 4-fold higher retention of the radiotracer in lungs of LPS treated mice compared with their saline-only treated control counterparts. Consistent with these observations, lung cells isolated from LPS-treated mice demonstrated elevated ROS production deploying CellROX, the ROS probe. Finally, Galuminox uptake correlates with histological and physiological evidence of acute lung injury as evident by polynuclear infiltration, thickening of the alveolar epithelial membranes and increased bronchioalveolar lavage protein content. Taken collectively, these data indicate that 68Ga-Galuminox tracer uptake is a measure of ROS activity in acutely injured lungs and suggests its potential utility in monitoring oxidative stress in other diseases.

Summary: Background: The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. Methods: In this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings: Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31–62), of whom 19 937 (63·8%) were men, and 14 524 (46·5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71·9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27·5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88·7%] of 195 patients with open fractures; 426 [44·7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47·7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50·5%]), while Second Delays (delays in reaching care) were the least common (423 [5·4%]). Compared with other methods of transportation (eg, walking, rickshaw), ambulances led to delay in transporting patients with open fractures to a treating hospital (adjusted RR 0·66, 99% CI 0·46–0·93). Compared with patients with closed lower limb fractures, patients with closed spine (adjusted RR 2·47, 99% CI 2·17–2·81) and pelvic (1·35, 1·10–1·66) fractures were most likely to have delays of more than 24 h before admission to hospital. Interpretation: In low-income and middle-income countries, timely hospital admission remains largely inaccessible, especially among patients with open fractures. Reducing hospital-based delays in receiving care, and, in particular, improving interfacility referral systems are the most substantial tools for reducing delays in admissions to hospital. Funding: National Health and Medical Research Council of Australia, Canadian Institutes of Health Research, McMaster Surgical Associates, and Hamilton Health Sciences.

The architectures of two innovative compact orientation independent chipless radio frequency identification device (RFID) tags for emerging applications such as the internet of things are presented. These tags, when illuminated, generate resonant frequencies in the radar cross-section backscattered spectrum, which are used to encode the data. These are based around L-type resonators, which can be read from front and back using linear polarisation waves as they do not have the ground plane. The first tag design consists of L-resonators in the lower triangular of the substrate, and thereby mutual coupling is increased as a reduction in the size. The second tag design incorporates alternate L-resonators in both halves of the substrate and exhibits reduced mutual coupling and enhanced printing strength but with a reduction in bit density. The proposed concept is demonstrated through prototypes of 8-bit chipless tags on Rogers substrate. These tags require very low bandwidth to encode 8-bit and occupy a small board size of 20 mm × 20 mm, and these are considerable improvements in the development of chipless RFID.

Background: Primary small cell ovarian cancer of pulmonary type (SCCOPT) is a rare aggressive ovarian tumour with an incidence of

Purpose: This study aims to study the prevalence of DED and analyze risk factors in North Indian population. Methods: This was a cross-section hospital-based, observational study. Cases enrolled over 2 years (systematic random sampling) were administered ocular surface disease index questionnaire to evaluate the prevalence and risk factors of DED. Schirmer's test and tear break-up time were performed only in the subset of patients giving consent. Categorical data were assessed with Chi-square/Fisher's Exact test, and odds ratio was analyzed using bivariate and multivariate logistic regression. P < 0.05 was statistically significant. Results: A total of 15,625 patients were screened. The prevalence of DED was 32% (5000/15625); 9.9% (496/5000) had mild DED; 61.2% (3060/5000) had moderate DED; and 28.9% (1444/5000) had severe DED. Age group of 21–40 years, male sex, urban region, and desk job were associated with increased risk of DED. Hours of visual display terminal (VDT) usage significantly correlated with DED (P < 0.001), and 89.98% of patients with 4 h or more of VDT use had severe dry eye. Cigarette smoking and contact lens usage had increased odds of developing severe DED (P < 0.001). Objective tests were undertaken in 552 patients; of these, 81.3% (449/552) had severe DED. Conclusions: The prevalence of DED in North India is 32%, with the age group of 21–40 years affected most commonly. VDT use, smoking, and contact lens use were associated with increased odds of developing DED.

In rheumatoid arthritis (RA), inflammatory cytokines play a pivotal role in triggering abnormal osteoclastogenesis leading to articular destruction. Recent studies have demonstrated enhanced levels of interleukin-9 (IL-9) in the serum and synovial fluid of patients with RA. In RA, strong correlation has been observed between tissue inflammation and IL-9 expression in synovial tissue. Therefore, we investigated whether IL-9 influences osteoclastogenesis in patients with RA. We conducted the study in active RA patients. For inducing osteoclast differentiation, mononuclear cells were stimulated with soluble receptor activator of NF-kB ligand (sRANKL) and macrophage-colony-stimulating factor (M-CSF) in the presence or absence of recombinant (r) IL-9. IL-9 stimulation significantly enhanced M-CSF/sRANKL-mediated osteoclast formation and function. Transcriptome analysis revealed differential gene expression induced with IL-9 stimulation in the process of osteoclast differentiation. IL-9 mainly modulates the expression of genes, which are involved in the metabolic pathway. Moreover, we observed that IL-9 modulates the expression of matrix metalloproteinases (MMPs), which are critical players in bone degradation. Our results indicate that IL-9 has the potential to influence the structural damage in the RA by promoting osteoclastogenesis and modulating the expression of MMPs. Thus, blocking IL-9 pathways might be an attractive immunotherapeutic target for preventing bone degradation in RA.

Purpose: To report complications in the management of complex closed proximal tibial fractures. Method: A retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted. Results: The overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention. Conclusion: Proximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

The present research aimed to improve the dissolution rate and bioavailability of curcumin using the potential of liquisolid technology. Twelve drug-loaded liquisolid systems (LS-1 to LS-12) were prepared using different vehicles (PEG 200, PEG 400 and Tween 80) and curcumin concentrations in vehicle (40%, 50%, 60% and 70%, w/w). The carrier [microcrystalline cellulose (MCC) PH102] to coat (Aerosil®) ratio was 20 in all formulations. The systems were screened for pre-compression properties before being compressed to liquisolid tablets (LT-1 to LT-12). Post compression tests and in vitro dissolution of LTs were conducted and the results compared with those obtained for a directly compressed tablet (DCT) made of curcumin, MCC PH102 and Aerosil®. LTs exhibited higher cumulative drug release (CDR) than the DCT and the optimum formulation, LT-9 (made using Tween 80), was studied by powder XRD, DSC, SEM and FTIR. Ex-vivo permeation of curcumin from LT-9 through goat gastrointestinal mucosa was significantly (P

BackgroundCancer patients undergoing Doxorubicin (DOX) treatment are susceptible to acute and chronic cardiac anomalies, including aberrant arrhythmias, ventricular dysfunction, and heart failure. To stratify patients at high risk for DOX -related heart failure (CHF), diagnostic techniques have been sought. While echocardiography is used for monitoring LVEF and LV volumes due to its wide-availability and cost-efficiency, it may not identify early stages of the initiation of DOX-induced systolic heart failure. To address these limitations, PET tracers could also provide noninvasive assessment of early and reversible metabolic changes of the myocardium.ObjectiveHerein, we report a preliminary investigation of 68Ga-Galmydar potential to monitor Dox-induced cardiomyopathy in vivo, ex vivo, and in cellulo employing both nuclear- and optical imaging.Methods and resultsTo assess 68Ga-Galmydar ability for monitoring DOX-induced cardiomyopathy, microPET imaging was performed 5 d post treatment of rats either with a single dose of DOX (15 mg/kg) or vehicle as a control (saline) and images were co-registered for anatomical reference using CT. Following tail-vein injection of the radiotracer in rats at 60 min, micro-PET/CT static scan (10 min acquisition), 68Ga-Galmydar demonstrated 1.91-fold lower uptake in hearts of DOX-treated (standard uptake value; SUV: 0.92, n = 3) rats compared with their vehicle treated (SUV: 1.76, n = 3) control counterparts. For correlation of PET imaging data, post-imaging quantitative biodistribution studies were also performed, wherein excised organs were counted for γ activity, and normalized to injected dose. The post imaging pharmacokinetic data also demonstrated heart uptake values of 2.0 fold lower for DOX treated rats(%ID/g; DOX: 0.44 ± 0.1, n = 3) compared to their vehicle-treated controls (%ID/g; Control: 0.89 ± 0.03, n = 3, p = 0.04). Employing the fluorescent traits of Galmydar, live cell fluorescence imaging indicated a gradual decrease in uptake and retention of Galmydar within mitochondria of H9c2 cells following DOX-treatment, while indicating dose-dependent and time-dependent uptake profiles. Following depolarization of electronegative transmembrane gradients at the mitochondrial membrane, the uptake of the probe was decreased in H9c2 cells, and the uptake profiles were found to be identical, using both fluorescence and radiotracer bioassays. Finally, the decreased uptake of the metalloprobe in H9c2 cells also correlated with caspase-3 expression resulting from DOX-induced cardiotoxicity and cell death.Conclusions68Ga-Galmydar could provide a noninvasive assessment of DOX-related and likely reversible metabolic changes at earliest stages. Further studies with other chemotherapeutics (potentially capable of inducing cardiomyopathy) are underway.

In this review, the efforts done by different research groups to enhance the performance of the electric double-layer capacitors (EDLCs), regarding the effect of the modification of activated carbon structures on the electrochemical properties, are summarized. Activated carbon materials with various porous textures, surface chemistry, and microstructure have been synthesized using several different techniques by different researchers. Micro-, meso-, and macroporous textures can be obtained through the activation/carbonization process using various activating agents. The surface chemistry of activated carbon materials can be modified via: (i) the carbonization of heteroatom-enriched compounds, (ii) post-treatment of carbon materials with reactive heteroatom sources, and (iii) activated carbon combined both with metal oxide materials dan conducting polymers to obtain composites. Intending to improve the EDLCs performance, the introduction of heteroatoms into an activated carbon matrix and composited activated carbon with either metal oxide materials or conducting polymers introduced a pseudo-capacitance effect, which is an additional contribution to the dominant double-layer capacitance. Such tricks offer high capacitance due to the presence of both electrical double layer charge storage mechanism and faradic charge transfer. The surface modification by attaching suitable heteroatoms such as phosphorus species increases the cell operating voltage, thereby improving the cell performance. To establish a detailed understanding of how one can modify the activated carbon structure regarding its porous textures, the surface chemistry, the wettability, and microstructure enable to enhance the performance of the EDLCs is discussed here in detail. This review discusses the basic key parameters which are considered to evaluate the performance of EDLCs such as cell capacitance, operating voltage, equivalent series resistance, power density, and energy density, and how these are affected by the modification of the activated carbon framework.

Study DesignRetrospective study.PurposeTo outline the etiology, complications and management difficulties encountered in the management of neglected thoracolumbar spine injuries.Overview of LiteratureThe English literature describes overlooked diagnosis as the most common cause of neglected spine injuries. However, the reasons differ in developing or under-developed nations. Moreover, there is scarcity of literature about the neglected spinal injuries.MethodsPatients presenting with thoracolumbar traumatic injuries who had not received any form of treatment for more than three weeks were included in the study. The demographic details, operative procedure performed and complications encountered, along with American Spinal Injury Association grade and spinal cord independence measure score recorded on the history sheets were noted. The data were analyzed.ResultsForty patients were included in the study. Inadequate treatment at the first contact hospital (45%) followed by late presentation (38%) and missed injury (17%) were the major etiological factors for the neglected traumatic injuries in the thoracolumbar spine. The most common complications seen in the management of these cases were pressure sores (58%), back pain (57%), urinary tract infection (42%) and residual kyphotic deformity (42%).ConclusionsManagement of neglected thoracolumbar injuries is challenging. The delay in presentation should not prevent spine surgeon in proceeding with operative intervention as good results can be expected.

The objective of research was to explore the suitability of lipids like compritol 888 ATO and stearic acid as release retardant to develop sustained release (SR) tablets. The SR micromatrices of lipid (s) and glipizide were prepared (LM1- LM6) as intermediate product by fusion method and assessed for various pharmacotechnical properties. Micromatrices were formulated as SR tablets (F1-F6) by direct compression method and subjected to Pharmacopoeial and Non Pharmacopoeial tests. In vitro drug release behavior of SR tablets demonstrated incomplete release of drug from compitrol based formulations whereas stearic acid based formulations (F4-F6) released more than 90% drug in 12 h with F5 displaying maximum %CDR of 95.70 ± 0.78%. A t50% of 3 h exhibited by F5 was significantly lower (2.7 h) than of marketed formulation (Glytop SR® (t50% = 5.7 h)). Similarity and dissimilarity factor for F5, with reference to Glytop SR® was 21.65% and 26.34% respectively, suggesting F5 has potential to exercise better control on drug release. Scanning Electron Microscopy (SEM) revealed drug particles embedded in stearic acid micromatrices that were confirmed by The X-ray powder diffraction (XRPD) and simultaneously Diffuse Reflectance Infrared Fourier Transform (DRIFT) confirmed the stability of F5. Conclusively, stearic acid explored as a suitable lipidic release retardant for development of SR tablet of glipizide that were stable for the test period of 6 months.

The present investigation was focused to formulate semi-solid capsules (SSCs) of hydrophobic drug telmisartan (TLMS) by encapsulating semi-solid matrix of its solid dispersion (SD) in HPMC capsules. The combinational approach was used to reduce the lag time in drug release and improvise its dissolution. SDs of TLMS was prepared using hot fusion method by varying the combinations of Pluronic-F68, Gelucire 50/13 and Plasdone S630. A total of nine batches (SD1-SD9) were characterized for micromeritic properties, in vitro dissolution behavior and surface characterization. SD4 with 52.43% cumulative drug release (CDR) in phosphate buffer, pH 7.4, in 120 min, t50% 44.2 min and DE30min 96.76% was selected for the development of semi-solid capsules. Differential scanning calorimetry of SD4 revealed molecular dispersion of TLMS in Pluronic-F68. SD4 was formulated into SSCs using Gelucire 44/14 and PEG 400 as semi-solid components and PEG 6000 as a suspending agent to achieve reduction in lag time for effective drug dissolution. SSC6 showed maximum in vitro drug dissolution 97.49 % in phosphate buffer, pH 7.4 with in 20 min that was almost a three folds reduction in the time required to achieve similar dissolution by SD. Thus, SSCs present an excellent approach to enhance in vitro dissolution as well as to reduce the lag time of dissolution for poorly water soluble drugs especially to those therapeutic classes that are intended for faster onset of action. Developed approach based on HPMC capsules provided a better alternative to target delivery of telmisartan to the vegetarian population.

It has been observed that most of the chemical entities have high lipophilicity and poor aqueous solubility, which result in poor bioavailability. In order to improve the bioavailability, the release behavior of such drugs should be improved. Although there are numerous techniques to handle solubility related issue, but they are expensive due to involvement of complicated equipments, advanced manufacturing operations that includes multiple and tedious steps. The liquisolid technology or powder solution technology is a promising technique for modifying the release characteristics of active pharmaceutical ingredients. As the liquisolid technology uses similar production processes as followed to develop a conventional tablet, but this technology to improve the release rate of poorly water soluble drugs is simple and cost effective The core concept of the technique involves, liquids such as solution/dispersion of poorly soluble drugs in a non-volatile solvent that is transformed into free flowing and desirable compression characteristics. To develop a fast-release liquisolid formulation, high amount of liquid vehicle is required while more effective tableting excipients with high liquid adsorption are needed to reduce the weight of the tablet. Simultaneously, this technology also has the capability to sustain the drug release and allow the development of sustained release formulation with desirable release kinetics. The present work deals with the chronological compilation and briefing of all the reported researches which involved the concept of underlined technology by the use of common as well as novel excipients to modify the release behavior of therapeutically active compounds.

The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a) the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b) the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c) a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d) nearly all synthetic grafts have been recalled from the market; and (e) bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the published reviews on the ACL focus largely on animal ACL than human ACL. Further, this review article summarizes the issues with autografts and synthetic grafts used so far. Autografts (patellar tendon and hamstring tendon) remains the gold standard as nearly all synthetic grafts introduced for clinical use have been withdrawn from the market. The mechanical strength during the ligamentization of autografts is also highlighted in this work.

Curcumin suffers from the limitation of poor solubility and low dissolution that can lead to limited applications. The investigation was aimed to substantiate the potentiality of melt sonocrystallized gastroretentive tablets of curcumin. Melt sonocrystallized curcumin (MSC CMN) was developed and its therapeutic potential was validated by in vitro cytotoxicity studies against Human oral cancer cell line KB. MSC curcumin was then formulated as floating tablet and evaluated. MSC form of CMN exhibited 2.36-fold and 2.40-fold solubility enhancement in distilled water and phosphate buffer, pH 4.5, respectively, better flow properties and intrinsic dissolution rate (0.242 ± 1.42 and 0.195 ± 1.26 mg/cm2/min) in comparison to its original form. The GI50 value of MSC CMN was found to be less than 10, specifying inhibition of growth more effectively at its least concentration by 50%. The gastroretentive-floating tablet (Formulation F4) displayed controlled drug release (96.22% ± 1.43%) for over 12 h. The present study revealed melt sonocrystallization can be used to produce particles with superior biopharmaceutical properties without the use of organic solvents or the addition of other excipients, and amenable to formulation in to a pharmaceutical dosage form.

Background and Aims: Arthroscopic knee surgery is a common procedure and may cause enough pain to delay rehabilitation. Intra-articular (IA) morphine is a known modality for post-operative pain relief. However, the optimal dose of IA morphine has not been studied. The current study has been conducted to find out the optimal dosage of IA morphine when administered with 0.25% bupivacaine. Methods: Sixty adult patients of either sex, aged between 18 and 60 years, undergoing diagnostic/therapeutic knee arthroscopic surgery were included in the study and randomised into three groups. All patients underwent surgery under subarachnoid block. After the surgical closure, 20 ml of 0.25% bupivacaine with 1 mg, 3 mg and 5 mg of morphine as additive was injected intra-articularly in Group A, B and C patients, respectively. Post-operative pain assessment was performed with visual analogue scale score in the 1st, 2nd, 6th, 12th and 24th post-operative hour. The common complications were also recorded. Results: There was statistically significant analgesia in Group B and C than Group A in the 1st and 2nd post-operative hour; while at the 24th post-operative hour, Group C had statistically significant analgesia than the other two groups. Time to first rescue analgesia was statistically significantly less and consumption of supplemental analgesia was significantly higher in Group A than the other two groups. Conclusion: IA dose of 3 mg and 5 mg morphine with 20 ml of 0.25% bupivacaine provided adequate analgesia. However, 3 mg morphine group patients had fewer side effects than 5 mg group patients although the difference was not statistically significant.

Background: Displaced proximal humeral fractures, which used to be treated conservatively in the past, often had compromised functional results. With the advancement of technology, these fractures are now more often managed operatively, fulfilling the demands of an active and productive life style by the patients. The aim of this study was to assess the functional outcome of management of proximal humeral fractures with Philos (Synthes; Johnson and Johnson, West Chester, Pennsylvania, USA) plate fixation. Methods: In this prospective study, 40 patients aged 18–80 years (mean age 52.4 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients were functionally evaluated based on subjective (35 points) and objective (65 points) parameters as per the constant scoring system. Results: All these operated patients were followed up for 18–36 months (average 27.3 months). Functional outcome based on the constant scoring system showed excellent results in 20 (50%), good in eight (20%), and moderate in eight (20%) patients. Four (10%) patients had poor functional results. Out of six cases of four-part fracture dislocations, avascular necrosis of the humeral head was observed in two patients. One of these two patients had avascular necrosis of the head along with nonunion of the fragment to the shaft. Conclusion: Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and minimal complications.

Aims: To compare conventional magnetic resonance imaging (MRI) and direct magnetic resonance (MR) arthrography in the evaluation of triangular fibrocartilage complex (TFCC) and intrinsic wrist ligament tears. Materials and Methods: T1-weighted, fat suppressed (FS) proton density plus T2-weighted (FS PD/T2), 3D multiple-echo data image combination (MEDIC) sequences and direct MR arthrography were performed in 53 patients with wrist pain. Images were evaluated for the presence and location of TFCC, scapholunate ligament (SLL) and lunatotriquetral ligament (LTL) tears, and imaging findings were compared with operative findings in 16 patients who underwent arthroscopy or open surgery (gold standard). Results: Sixteen patients underwent arthroscopy/open surgery: 12 TFCC tears were detected arthroscopically out of which 9 were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in the detection of TFCC tears were 75%, 83.3%, and 100%, respectively. Out of the eight arthroscopically confirmed SLL tears, three tears were detected on FS PD/T2 sequence, five on MEDIC sequence, and all eight were visualized on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in detecting SLL tears were 37.5%, 62.5%, and 100%, respectively. One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography. The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively. Conclusions: MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears.

Augmentation cystoplasty is a procedure to increase the anatomical as well as functional capacity of the urinary bladder using a segment of bowel or ureter. Upto half of these patients develop complications but most of them are minor and managed easily. Urolithiasis, especially bladder calculi are seen in upto half of the cases and are removed endoscopically or by open approach. Hysterectomy is an uncommon procedure in patients with augmentation cystoplasty and is complicated by the altered anatomy of the pelvis. We describe a rare case of simultaneous abdominal hysterectomy and cystolithotomy in a patient with augmentation cystoplasty and discuss the relevant surgical anatomy.

Renal hydatid disease accounts for 2% of all cases of hydatid cysts. With the majority of isolated renal hydatid disease patients being asymptomatic, hydatid cysts grow slowly for several years. They may be associated with pressure symptoms or flank pain, depending on their size and location. Hydatiduria occurs in less than one-fifth of the patients. In the absence of hydatiduria, diagnosis is usually radiological. Surgery is the mainstay of treatment which is usually renal sparing surgery as most cysts are non-communicating. In cases of cyst communicating with the collecting system, nephrectomy remains the mainstay of treatment. We report a case of hydatiduria due to a communicating hydatid cyst diagnosed on CT urography, where a renal sparing approach was followed and the patient was managed with cystopericystectomy, closure of Pelvicalyceal System (PCS) and double J (DJ) stenting with an excellent result.

Bilateral clavicle fractures are uncommonly reported in the literature with the incidence being less than 0.5% of all the clavicle fractures. Bilateral clavicle fractures are caused either by high-energy transfer of compression forces across both shoulder girdles or by a direct trauma to one clavicle followed by that to the other clavicle. These fractures could be missed due to their association with more severe chest injuries or a more symptomatically displaced fracture on one side or due to inadequate chest radiographs. We report three cases of traumatic bilateral clavicle fractures with three modes of injuries in different age groups. All the fractures were treated conservatively with good functional outcomes without any sequelae. Bilateral clavicle fractures should be actively sought by every trauma team with proper clinical examination and chest radiographs including both shoulder joints in high-energy trauma cases or with bilateral shoulder compression injuries.

Context: Monitor 100® (Electa Lab, Italy) is a newly developed automated method for measurement of erythrocyte sedimentation rate (ESR). Aims: The aim of our study was to compare the ESR values by Monitor 100® against the standard Westergren method. Patients and Methods: This cross-sectional study was conducted at a Level I trauma care center on 200 patients. The samples taken were as per the recommendations charted out by International Council for Standardization in Hematology (ICSH) for comparing automated and manual Westergrens method. Statistical Analysis Used: Bland and Altman statistical analysis was applied for evaluating Monitor 100® against the conventional Westergren method. Results: The analysis revealed a low degree of agreement between the manual and automated methods especially for higher ESR values, mean difference -11.2 (95% limits of agreement, -46.3 to 23.9) and mean difference -13.4 (95% limits of agreement-58.9 to 32.1) for 1 and 2 hours, respectively. This discrepancy which is of clinical significance was less evident for ESR values in the normal range