What has changed in total hip arthroplasty in patients of juvenile idiopathic arthritis since 2000? A systematic review and pooled data analysis.

PURPOSE: The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16-150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA. METHODS: Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included. RESULTS: The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10-33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8-25%) as compared to 4% (95% CI 1-6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared. CONCLUSION: JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival. LEVEL OF EVIDENCE: IV.

Plate osteosynthesis in patellar fractures: a systematic review and meta-analysis.

INTRODUCTION: To perform a systematic review and assess the indications, outcomes, complications, and union rates associated with plate osteosynthesis in patellar fractures compared to tension band wiring. METHODS: The systematic search was conducted for articles in PubMed, Embase Biomedical, Cochrane central, and LILACS databases (date of inception to July 30, 2020). Articles were included if they were randomized control trials, cohort studies, case-control studies, and case series (with more than five cases), which focused on the clinical outcomes of patients with plate osteosynthesis as a treatment for fracture of the patella and had a minimum follow-up of 3 months. All studies were assessed according to their level of evidence, the number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Meta-analysis could only be done for two parameters (complications and reoperations) due to the paucity of data and heterogeneity of studies' limited statistical analysis. The data are presented as a review table with the key points summarized. RESULTS: Twenty studies (seven prospective and 13 retrospective articles) identified 533 patients with 534 fractures who had undergone plate osteosynthesis for fracture of the patella. The most common fracture treated with plate osteosynthesis was 34C. CONCLUSION: Basket plate was most commonly used for inferior pole fractures, while mesh plates were for intra-articular patella fractures. Overall plating was associated with better clinical outcomes, fewer complication rates, and high union rates compared to tension band wiring for patella fractures.

GC-MS based lemon grass metabolite analysis involved in the synthesis of silver nanoparticles and evaluation of photo-catalytic degradation of methylene blue.

Silver nanoparticles (AgNPs) is of great importance to scientific community due to their plethora of applications. Several plant extracts have been reported for synthesis of AgNPs. In this study, lemon grass was used as a reducing and capping agent to prepare AgNPs. The formation of AgNPs was confirmed by using UV-Vis spectra as AgNPs show a characteristic peak around 400 nm. Effect of pH, temperature and lemon grass extract to silver nitrate ratio was optimized using response surface methodology (RSM). Characterization of AgNPs was done using X-Ray Diffraction (XRD), Energy Dispersive X-Ray spectroscopy (EDX), Trasmission Electron Microscopy (TEM) and Dynamic Light Scattering (DLS). Gas Chromatography-Mass spectrometry (GC-MS), Energy Dispersive X-Ray spectroscopy and Fourier Transform-Infrared (FT-IR) spectroscopic analysis showed involvement of metabolites of lemon grass in the formation of AgNPs. Photo-catalytic activity of synthesized AgNPs was evaluated through degradation of organic pollutant methylene blue dye.

Spontaneous intratumoral infarction--an unusual evolution of a falcine meningioma.

OBJECTIVE: We report the incidence of spontaneous infarction of a falcine meningioma without preceding hemorrhage and shed light on the relation between intratumoral necrosis and hemorrhage. CLINICAL PRESENTATION: A 50 year-old woman presented with recurrent headaches and was found to harbor a falcine meningioma. The patient elected to observe the mass and 13 months later she developed new neurological deficits. Prior to scheduled resection, she presented with abdominal pain and underwent emergent laparoscopic cholecystectomy. Two days after the procedure, she developed sudden right hemiparesis associated with severe headache. MRI of the brain showed an intratumoral wedge-shaped hypointense area with significant peritumoral edema. The patient was started on high-dose corticosteroids with considerable improvement in strength. INTERVENTION: The patient underwent a complete resection of the tumor with no new neurological deficits post-operatively. Histopathological analysis confirmed a WHO grade II atypical meningioma with extensive necrosis without hemorrhage. CONCLUSION: This case highlights that tumor infarction, although rare, should be in the differential diagnosis of patients with meningiomas presenting with new neurological deficits. When this condition is recognized and treated in timely manner with high-dose corticosteroids and surgical resection, patients can have favorable long-term outcomes.

Healing Assessment of Spinal Tuberculosis: A Systematic Review.

OBJECTIVE: Deciding the healing end point in spinal tuberculosis (STB) remains a controversial topic. The current systematic review aims to address the controversy existing in the literature to find a comprehensive method to assess healing in STB. METHODS: A thorough literature search was carried out for studies with the assessment of healing parameters in STB. Data extraction was carried out manually, which included study characteristics and healing criteria evaluated in each study. RESULTS: Qualitative analysis of 8 included studies showed that healing parameters were described in 3 domains: clinical, hematologic, and radiologic response of the patient to antitubercular chemotherapy. Each domain included various individual parameters, with clinical and radiologic assessment criteria being used in most of the studies. Improvement in terms of pain, constitutional symptoms, weight gain, neurology; variation in erythrocyte sedimentation rate and C-reactive protein; and changes in radiography, magnetic resonance imaging, and positron emission tomography/computed tomography were found to be promising predictors in the assessment of healing. CONCLUSIONS: Radiologic response parameters emerged as the maximally used criteria to assess healing in STB. However, in the absence of any statistical analysis and an observed lag in radiologic response, the cumulative effect of all the parameters in 3 domains (clinical, hematologic, and radiologic) can be used to declare a spinal tubercular lesion nonhealing, healing, or healed.

False-Positive Phencyclidine (PCP) Result on 11-Panel Urine Drug Screen (UDS) in a 17-Year-Old Adolescent with Long-Term Venlafaxine Use.

Venlafaxine is an antidepressant belonging to the class of serotonin-norepinephrine reuptake inhibitors that are US Food and Drug Administration-approved to treat and manage symptoms of depression, anxiety, and other mood disorders in adults. We describe an adolescent patient who likely had a false-positive phencyclidine result detected with an 11-panel urine drug screen in an outpatient setting of long-term use of therapeutic venlafaxine extended release for the treatment of recurrent major depressive disorder and generalized anxiety disorder. We believe that this may be the first published case report to characterize this phenomenon in a young patient in the absence of an acute overdose.

Assessment of the factors that affect the selection of a dentifrice among a population of 18-24-year-old students in Mangalore: A questionnaire survey.

Introduction: Bacterial plaque accumulation is the primary etiological factor for periodontal disease; hence, prevention of its accumulation is the cornerstone to any oral hygiene practice. Mechanical tooth cleaning by means of toothbrush and a dentifrice remains the most reliable and common method for controlling supragingival plaque. The objective of the study was to evaluate the factors considered while choosing a dentifrice and also to assess the role of socioeconomic status in determining these factors. Materials and Methods: This was a questionnaire study carried out among undergraduate students from the business and mass communication background of two private degree colleges in Dakshina Kannada, India. Two hundred and fifty-five students were included in the study. The questionnaire consisted of 24 close-ended questions. Results and Conclusion: The parameters of brand name, availability, and the flavor of the dentifrice are among the most accepted factors that a consumer takes into consideration in selecting a dentifrice. Parameters of influence (parents, colleagues, and celebrities), advertisement, and dentist recommendations of a dentifrice were also found to have a major influence on the consumer in selecting a dentifrice.

Imaging Parameters of Hip Dysplasia in Cerebral Palsy: A Systematic Review.

Background: Cerebral Palsy is the leading cause of childhood physical disability globally. The motor disorders of CP are often associated with musculoskeletal anomalies, of which hip displacement is the second most common abnormality after abnormalities of foot and ankle. Various radiological parameters have been described in the literature which detects and quantifies hip dysplasia, with MP being the current gold standard. This study aims to review these radiological indicators of hip dysplasia in children with cerebral palsy from the published literature. Methods: A literature search using PubMed, Embase, and Google Scholar was done on 15th June 2021 focusing on surveillance of hip dysplasia in cerebral palsy. The studies to be included were to have used anyone or more radiological parameter for detection of hip dysplasia with the use of any of the radiological methods. Results: The initial search yielded 1184 results. After the screening of the abstracts and full texts, a final of 30 studies was included for this systematic review. The majority of the studies were graded as Level 3 evidence (16/30), followed by Level 2 studies (14/30). X-ray was the most common modality of detection of dysplasia followed by CT scan, ultrasonography, and arthrogram. The reproducibility of the various parameters shows good to excellent intraclass coefficients. Conclusions: Parameters other than MP can be used to screen hips in CP. This would be useful in patients in whom either the lateral acetabular edge is not discernible on a plain anteroposterior radiograph or there are issues in the positioning of the patient. Additional views and structures can be visualized which can lead to improved screening and planning. Further investigations are required to appreciate the full potential of these parameters and how they can be better utilized.

Parametrization of Backbone Flexibility in a Coarse-Grained Force Field for Proteins (COFFDROP) Derived from All-Atom Explicit-Solvent Molecular Dynamics Simulations of All Possible Two-Residue Peptides.

Recently, we reported the parametrization of a set of coarse-grained (CG) nonbonded potential functions, derived from all-atom explicit-solvent molecular dynamics (MD) simulations of amino acid pairs and designed for use in (implicit-solvent) Brownian dynamics (BD) simulations of proteins; this force field was named COFFDROP (COarse-grained Force Field for Dynamic Representations Of Proteins). Here, we describe the extension of COFFDROP to include bonded backbone terms derived from fitting to results of explicit-solvent MD simulations of all possible two-residue peptides containing the 20 standard amino acids, with histidine modeled in both its protonated and neutral forms. The iterative Boltzmann inversion (IBI) method was used to optimize new CG potential functions for backbone-related terms by attempting to reproduce angle, dihedral, and distance probability distributions generated by the MD simulations. In a simple test of the transferability of the extended force field, the angle, dihedral, and distance probability distributions obtained from BD simulations of 56 three-residue peptides were compared to results from corresponding explicit-solvent MD simulations. In a more challenging test of the COFFDROP force field, it was used to simulate eight intrinsically disordered proteins and was shown to quite accurately reproduce the experimental hydrodynamic radii (Rhydro), provided that the favorable nonbonded interactions of the force field were uniformly scaled downward in magnitude. Overall, the results indicate that the COFFDROP force field is likely to find use in modeling the conformational behavior of intrinsically disordered proteins and multidomain proteins connected by flexible linkers.