Development of duplex real-time PCR for quick detection of cryptosporidiosis in goats.

Cryptosporidium spp. is the most important foodborne and waterborne pathogens and a leading cause of mortality from foodborne and waterborne gastrointestinal diseases. In neonates of domestic animals, it is associated with consistent diarrhea and dehydration. Cryptosporidium infection begins with the ingestion of sporulated oocytes disseminated by carrier animals that consistently contaminate the environment. Many diagnostic tests are available including microscopy and antigen trap-ELISA, but none of the diagnostic tests available currently cannot differentiate between active and passive infection in the host. In the current study, to address this challenge an mRNA-based duplex TaqMan® probe PCR was developed to target the Cryptosporidium oocyst wall protein gene and 18SSU rRNA gene in a single tube that can detect metabolically active cryptosporidial oocysts. The mRNA transcripts are the direct indicator of any actively replicating cell and they will help decipher the active stages of its lifecycle in a host. This diagnostic assay was standardized by computing transcript copy number-based limit of detection (LOD). For COWP and 18SSU rRNA genes, the LOD was 7.08 × 1004 and 5.95 × 1005 , respectively. During active infections, the oocyst wall protein will be active and so its COWP gene transcripts will act as a marker for active infection. While transcripts for 18SSU rRNA are constitutively expressed in cryptosporidial life cycle. This current diagnostic assay will be a quantitative marker that will help assess the active stages of Cryptosporidium infection in neonates. The disease dynamics will help better understand to formulate the control strategies and contain infection among healthy animals.

Development of multiplex PCR assay for simultaneous detection of African swine fever, porcine circo and porcine parvo viral infection from clinical samples.

A diagnostic method for simultaneously detecting and distinguishing African Swine Fever (ASF), porcine circovirus type 2 (PCV2), and porcine parvovirus (PPV) in clinical specimens is critical for differential diagnosis, monitoring, and control in the field. Three primer pairs were designed and used to create a multiplex PCR assay. In addition, 356 porcine post mortem tissue samples from various parts of India's North Eastern region were tested by the developed multiplex PCR assay to demonstrate its accuracy. Using the designed primers, each of the ASF, PCV2 and PPV target genes was amplified, but no other porcine virus genes were detected. The assay's limit of detection was 102 copies/µl of PCV2, PPV, or ASFV. The detection of PCV2, PPV, and ASF in postmortem tissue samples revealed that they are co-circulating in India's North-Eastern region. The percentage positivity (PP) for PCV2, PPV and ASF single infection were 7.02% (25/356), 3.93% (14/356), and 3.37% (12/356), respectively, while the PP for PCV2& PPV co-infection was 2.80% (10/356), ASF & PCV2 co infection was 1.4% (5/356) and the ASF, PPV& PCV2 co-infection was1.40% (5/356). The results also indicate that the ASF can infect pigs alongside PCV and PPV.

Modern implants in total knee arthroplasty are more patellofemoral joint friendly compared to their traditional design: a systematic review and meta-analysis.

BACKGROUND: Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and meta-analysis aimed to explore the evidence in the literature regarding the outcomes of the Attune knee system over the PFC Sigma knee design and investigate the advantage of one over the other. METHODS: A systematic review and meta-analysis of published studies till August 2021 was performed using the defined eligibility criteria. This was a systematic review of the literature published in the Cochrane Central Register of Controlled Trials (CENTRAL) Library, PUBMED, and EMBASE. The analysis included prospective and retrospective comparative trials comparing TKA by PFC sigma or Attune posterior stabilized (PS) or cruciate-retaining (CR), fixed bearing, or rotating platform systems. Patient-reported outcome measures (PROM) and postoperative patellar complications were analysed in the studies utilizing attune knee system (modern implants) to its counterpart PFC sigma (traditional implants) for TKA. Quality assessment was conducted using NIH Quality Assessment Tool for controlled intervention studies (RCTs and case-control studies). RESULTS: This review included 3 RCTs and the rest, 10 of which were non-RCT, including 5852 patients. ATTUNE designs suggested a statistically significant improvement in KSS over PFC Sigma designs. Other PROMs such as OKS and WOMAC scores yielded comparable results between the two groups. ATTUNE knee prosthesis did not result in better knee range of motion, patient satisfaction, or radiological outcomes than the PFC design. Regarding the complications, attune knee prosthesis demonstrated favourable results over PFC Sigma for anterior knee pain and patellofemoral (PF) crepitus. CONCLUSIONS: The present systematic review highlights better KSS and lesser chances of PF complications favouring a modern implant design over its traditional counterpart. Other patient-reported outcome analyses at a short-term follow-up period were comparable among patients undergoing total knee replacements with two different implant designs. Radiological outcomes for component positioning also suggested similar results among the two groups.

Full-thickness peroneus longus tendon autograft for anterior cruciate reconstruction in multi-ligament injury and revision cases: outcomes and donor site morbidity.

PURPOSE: Peroneus longus tendon (PLT) autograft has been successfully used for isolated anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction cases. Being a powerful evertor and flexor of great toe, there might be associated ankle morbidity with this autograft option. However, there are only a few studies exploring whether the ankle morbidity is significant or not. This study aims to assess the functional outcomes, donor site morbidity, and ankle strength after harvesting ipsilateral peroneus longus autograft for ACL reconstruction in revision ACL and multi-ligament injury cases. METHODS: This was a prospective case series. All of the patients were evaluated by clinical examination for knee for laxity, ankle joint stability, and using visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, and Lysholm score, preoperatively and postoperatively at two-year follow-up. Morbidity of donor ankle was assessed using American Orthopedic Foot and Ankle Society (AOFAS) score, bilateral evertors, and first ray plantarflexion strength measurement using an isometer (Innovative Design Orthopedics) at two-year follow-up. RESULTS: Ipsilateral PLT graft was used in ten patients of revision ACL reconstruction and 27 patients of the multi-ligament knee injury. The mean length of PLT harvested (cm) was 26.2 (standard deviation 2.6, range 22-31), and mean diameter of the doubled graft (mm) was 7.9 (standard deviation 0.68, range 7.5-8.5). There was a significant improvement in VAS score for pain, Lysholm, and IKDC scores (p = < 0.001) at two -year follow-up. There were no cases of graft failure, superficial, or deep infection. Ankle dorsiflexion(p = 0.32), ankle plantarflexion (p = 0.19), eversion strength(p = 0.6), first ray plantarflexion strength(p = 0.52), and AOFAS score(p = 0.29) were found to be comparable to the normal side in all patients. CONCLUSIONS: Peroneus longus autograft can be considered as a potential autograft option for ACL reconstruction in multi-ligament knee injuries and revision ACL reconstruction. No significant donor site morbidity was noted at follow-up. LEVEL OF EVIDENCE: Level IV.

Combined femoral-obturator-sciatic nerve block has superior postoperative pain score and earlier ambulation as compared to spinal anaesthesia for arthroscopic anterior cruciate ligament reconstruction.

PURPOSE: Peripheral nerve blocks can be a suitable alternative to central neuraxial blockage, as the sole anaesthetic agent for better early postoperative outcomes, decreased hospital stay and earlier mobilisation after anterior cruciate ligament reconstruction (ACLR) surgery. The purpose of this study was to compare consciousness during the procedure, pain during early postoperative period (< 7 days), and perioperative outcomes following ACLR using combined sciatic, femoral, and obturator nerve blocks compared to the spinal anaesthesia. METHODS: This was a prospective case-control study including patients between 18 and 55 years of age, with anterior cruciate ligament (ACL) injury confirmed clinically and radiologically and undergoing ACLR. Patients were allocated in the two groups alternatively, group 1 included patients who received combined nerve blocks, and group 2 included patients who received spinal anaesthesia for the surgery. The sensory effect, motor effect, adequacy of anaesthesia, perioperative analgesic use, duration of stay, postoperative pain (visual analogue scale 0-10 cm) and functional outcomes were noted. RESULTS: There were 60 patients in each group. A total of seven patients in group 1 (11%) and two patients in group 2 (3%) needed conversion to general anaesthesia (n.s.). In group 1, out of 53 patients who underwent surgery, 26 patients had no perception of surgery in the joint, 17 patients had perception of manipulation of the knee joint, 4 patients had sense of touch, and 6 patients had sensation of pain in the knee (VAS scale less than 3). In group 2, out of 58 patients, 42 patients had no perception of surgery, 12 had a perception of manipulation of the knee joint, 2 had sense of touch, and 2 had sensation of pain in the knee. Blockage of sensory effect was significantly better in group 2 (p = 0.0001). However, the motor effect was comparable between the two groups (n.s.). Group 1 had significantly better pain scores 6, 12, and 18 h after the surgery. Moreover, patients in group 1 also had faster ambulation (mean difference of 5.5 h, p = 0.0001) and reduced hospital stay (mean difference of 8.4 h, p = 0.0001). CONCLUSION: Combined sciatic, femoral, and adductor canal block is an effective sole anaesthetic modality for ACLR. The sensory effect was inferior when compared to spinal anaesthesia but sufficient for the procedure without the need for supplementation with any other anaesthetic modality. Patients receiving this combined nerve block had lesser early postoperative pain scores, earlier ambulation, and shorter hospital stay as compared to the spinal anaesthesia. LEVEL OF EVIDENCE: Level 3.

No Additional Benefits of Tissue Adhesives for Skin Closure in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: This systematic review is aimed to compare the performance of tissue adhesives (TA) as an adjunct or closure method with traditional wound closure methods for cutaneous closure in arthroplasty and evaluate whether they have any added benefits in terms of decreasing wound complications and increasing postoperative patient satisfaction. METHODS: Cochrane Library, PubMed, and EMBASE were searched until February 2021. Randomized controlled trials (RCTs) comparing outcomes of TA with emphasis on skin closure time, in-hospital stay, complication rates, cosmetic scoring systems, and patient satisfaction scores (PSS) compared to subcuticular sutures (SCS) and skin staples (ST) in arthroplasty. The quality of RCTs was assessed using the National Institutes of Health quality assessment tool. RESULTS: Ten RCTs were included. The pooled and the subgroup analysis revealed no significant difference in the wound infection rates, discharge rates, dehiscence rates, and PSS between TA (as an adjunct or closure method) and SCS or ST. TA (as an adjunct or closure method) was significantly (P < .00001) associated with a longer time to closure compared to ST and a shorter time compared to SCS as a closure method. Length of stay was comparable in all groups. CONCLUSION: Using TA in combination with subcuticular sutures or ST or as a cutaneous method of closure does not provide additional benefits in terms of decreased hospital stay, decreased infection rates, or wound discharge rates. The PSS and pain scores of the scars also appear to be comparable to standard wound closure methods. No clear conclusion could be drawn regarding cosmetic scoring systems, because of the paucity of data. LEVEL OF EVIDENCE: Level I (Meta-analysis of RCTs).

Use of contralateral lateral meniscus for medial meniscal allograft transplantation: a cadaveric study.

PURPOSE: Meniscal allografts are a preferred alternative to menisectomy in cases of irrepairable meniscal tears in young patients. Biological meniscal allograft transplantation requires a cadaveric donor, limiting its availability for transplantation. We are exploring the possibility of using contralateral lateral meniscus for medial meniscal allograft transplantation, as it can be easily procured from proximal tibial cuts from total knee replacement. METHODS: Ten paired knees from five formalin-fixed Indian male cadavers were dissected. Outer and inner circumferences of the medial and meniscus, area of the articular surface of the medial tibial plateau covered by the native medial meniscus and transplanted lateral meniscus were noted. Measurements were taken using software ImageJ (National Institute of Health). The mean of the recordings from two independent observers was taken as the final value. Inter-observer and intra-observer reliability were also calculated. RESULTS: The mean inner circumference of the medial meniscus was significantly larger than the lateral meniscus (p < 0.0001). However, outer circumferences were not significantly different from each other (p = 0.1). Area of the tibial plateau covered by the native medial meniscus was smaller than the area covered by the transplanted lateral meniscus, though the difference was not statistically significant. Inter-observer reliability and intra-observer reliability were good (ICC 0.904 and 0.927, respectively). CONCLUSION: Based on measurements of the outer circumference of medial and lateral menisci, lateral meniscal allograft can be matched for transplantation on the contralateral medial side from the donor with same dimensions of the tibial plateau. Further clinical studies are necessary to prove the clinical significance of this cadaveric study. LEVEL OF EVIDENCE: Diagnostic study.

Association between functional outcome scores and MRI-based structural integrity after rotator cuff repair: a prospective cohort study.

PURPOSE: Natural history of rotator cuff tears is poorly understood. Repair of rotator cuff tears has shown to improve functional outcomes in full-thickness tears. However, high re-tear rates have been reported in literature, which does not correlate with poorer outcomes. Primary aim of this study was to explore association between functional outcome scores and structural integrity of rotator cuff, using magnetic resonance imaging (MRI)-based grading. METHODS: Patients with MRI-proven full-thickness rotator cuff tears, undergoing mini-open rotator cuff repair, were assessed for shoulder abduction strength and functional outcome scores before the surgery and 2 years after the procedure. Association between functional outcome scores and MRI grading for rotator cuff healing (Sugaya grading) was analyzed. RESULTS: A total of 38 patients (18 females and 20 males), with a mean age of 50.6 years (SD: 10.9), were included in the study. Mean duration of symptoms was 6.05 months (SD: 4.2). On postoperative MRI, healing of the cuff was categorized as Sugaya grade 1 in 12 patients, grade 2 in 20 patients and grade 3 in 6 patients. Higher Sugaya grades (T: 13.48, p: 0.001) and grades of fatty degeneration (T: 14.05, p: 0.001) were found to be associated with longer duration of symptoms. Improvement in shoulder abduction strength correlated negatively with the duration of symptoms (r: -0.39, p: 0.01). There was a significant improvement in functional outcome scores after the surgery. There was no association between postoperative structural integrity of the repaired tendon (Sugaya grading) and functional outcome scores. CONCLUSION: Early repair of rotator cuff results in better functional outcomes and shoulder strength. The findings from this study suggest there is a dissociation between MRI-based grades of healing of repaired rotator cuff and function of the shoulder. STUDY DESIGN: Level II, Prospective cohort study.

Total knee arthroplasty after a prior knee arthroscopy has higher complication rates: a systematic review.

PURPOSE: This article aimed to study in a systematic manner outcomes and complication rates after total knee arthroplasty (TKA) in patients who have undergone a prior knee arthroscopy for osteoarthritis. Our hypothesis was that a prior knee arthroscopy may be detrimental to the outcomes of knee arthroplasty in the future. METHODS: Electronic searches were performed for all studies published before June 2020. We included studies in which at least one group had a non-ligament knee arthroscopy surgery prior to primary knee arthroplasty. MINORS (Methodological index for non-randomized studies) criteria was used to assess the methodological quality of all the studies. RESULTS: Seven retrospective studies were included in the systematic review. The total number of TKA without prior arthroscopies was 138,630, and the total TKA after a prior arthroscopy was 4372. Of the five studies that reported functional outcomes, three studies reported no difference, whereas two studies reported worse outcomes in patients with a prior knee arthroscopy. Higher rates of prosthetic joint infection and overall complications were seen in patients with a prior knee arthroscopy. CONCLUSION: Total knee arthroplasty, when preceded by knee arthroscopy for osteoarthritis may lead to an increase in complication rates like prosthetic joint infections, revision, and re-operations. However, no significant differences were observed in patient-reported functional outcomes and range of joint motion. An association with postoperative complications after subsequent TKA should be a deterrent in advocating this procedure in an arthritic knee. LEVEL OF EVIDENCE: III.

Enhanced recovery protocol after single-stage bilateral primary total knee arthroplasty decreases duration of hospital stay without increasing complication rates.

PURPOSE: With an increasing number of total knee arthroplasty (TKA), protocols for better standard of patient care and shorter duration of hospital stay are necessary. Enhanced recovery (ER) protocols are becoming popular to meet these objectives. The current study aims to evaluate the clinical outcome of fast-track TKA using ER protocol in terms of length of hospital stay, perioperative complications and functional outcomes. METHODS: Patients undergoing single-stage bilateral primary TKA were prospectively included in the study. All patients went through a pre-defined ER protocol of TKA. Length of hospital stay, readmission rates, pain scores and functional scores of patients operated under ER protocol were compared with another matched historical control-group. Factors delaying the discharge of the patients by 48 h after the surgery were noted. RESULTS: We compared 275 patients undergoing single-stage bilateral primary TKA through ER protocol (Group 1) with 190 patients who had undergone bilateral primary TKA before the ER protocol was initiated (Group 2). The length of hospital stay (3.9 ± 2.1 days in group 1 and 7.5 ± 3.2 days in group 2, p 0.0001) and post-operative pain scores at 12 h (5.2 ± 2.9 in group 1 and 5.7 ± 2.1 in group 2, p 0.03) and 24 h (4.1 ± 1.6 in group 1 and 4.6 ± 1.4 in group 2, p 0.0005) were found to be significantly better with ER protocol. There was no difference in Oxford knee scores, infection rates, readmissions or mortality between the two groups. CONCLUSION: ER protocol in single-stage bilateral primary TKA resulted in decreased length of hospital stay without increasing complications and compromising the clinical outcome. It requires an integrated approach and adherence to clinical pathways. LEVEL OF EVIDENCE: Level II, Prospective comparative study.

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.

Outcomes of retro-drilled all-inside tibial tunnel vs complete tibial tunnel techniques in anterior cruciate ligament reconstruction-a comparative study.

PURPOSE: The all-inside tibial tunnel preparation technique of arthroscopic anterior cruciate ligament (ACL) reconstruction differs from traditional complete tibial tunnel technique in using closed tibial sockets, dual-cortical suspensory graft-fixation, quadrupled semitendinosus tendon graft and lesser bone removal. The study aims to find out if all-inside technique differs from complete tibial tunnel technique of single bundle ACL reconstruction in terms of graft dimensions, functional and clinical outcomes. METHODS: A prospective comparative study was conducted including 80 patients with isolated ACL tears, divided into 2 groups of 40 patients each without any randomization. The two techniques differed in tibial tunnel preparation. Group 1 underwent ACL reconstruction with a complete tibial tunnel drilled from the anteromedial tibial cortex and group 2 underwent all-inside tibial socket preparation. Duration of the surgery, perioperative and midterm complications were noted. All patients had 24 month follow-up. Functional outcome scores (Tegner-Lysholm knee scoring scale and IKDC score) were assessed preoperatively and postoperatively at 6 months and 24 months. Hamstring and quadriceps muscle strength was assessed preoperatively and postoperatively at 6 months, 9 months and 24 months. Visual analogue score (VAS) for knee pain was assessed preoperatively and postoperatively at day 2, 2 weeks, 6 weeks, 6 months and 24 months. RESULTS: Quadrupled semitendinosus tendon graft was significantly thicker than doubled semitendinosus and gracilis tendons graft (8.17 ± 0.58 vs 8.71 ± 0.4, p < 0.0001). The VAS score for knee pain at 2 and 6 weeks were lower in group 2 (5.75 ± 0.6 and 1.78 ± 1.0) as compared to group 1 (6.50 ± 0.5 and 2.5 ± 0.8) and the difference was statistically significant (P = 0.0007 and p = 0.002 respectively). There were no statistically significant differences in functional outcome scores and quadriceps muscle strength between the two groups. However, there were significant difference in hamstring power in two groups. CONCLUSION: The all-inside technique has the advantages of using a single tendon graft, lesser early postoperative pain with similar clinical and functional outcomes compared to the complete tibial tunnel technique. Level of Evidence IIProspective comparative study.

Good validity and reliability of forgotten joint score-12 in total knee arthroplasty in Hindi language for Indian population.

PURPOSE: Commonly used patient-reported outcome measurement (PROM) tools for knee joint have a ceiling effect and may not be able to differentiate between patients achieving outcomes better than the upper limit of the score. Forgotten joint score-12 (FJS-12) is said to be free of this limitation. FJS-12 has been translated and validated in different languages. This study aims to translate and validate FJS-12 in Hindi (Hindi FJS-12). METHODS: Hindi FJS-12 was tested for comprehensibility in a pilot study in 20 patients. This was followed by a prospective cohort study including 140 patients of bilateral total knee arthroplasty, with a minimum follow-up of 12 months. The mean age of the patients was 62.0 ± 14.5 years. There were 77 (55.2%) males and remaining were females. All patients were asked to fill up questionnaires of Hindi FJS-12, WOMAC, KSS and OKS. Hindi FJS-12 was tested for validity, reliability, responsiveness, floor effect and ceiling effect. Construct validity was expressed as the Pearson correlation coefficient. Internal consistency was expressed as Cronbach's alpha and test-retest reliability as the intra-class correlation coefficient (ICC). RESULTS: In the pilot study, it was seen that all the questions were well answered by most of the participants. The main study showed good construct validity with Hindi FJS-12 showing moderate correlation with WOMAC, KSS and OKS (Pearson coefficients 0.45, 0.32, 0.37, respectively). Hindi FJS-12 had excellent internal consistency with Cronbach's alpha of 0.93 (95% CI 0.90, 0.97). ICC was 0.95 (95% CI 0.90, 0.99). No floor or ceiling effect was observed. CONCLUSION: Hindi FJS-12 has high validity, reliability and reproducibility for knee function after TKA. It is devoid of floor or ceiling effect. Thus, it can be successfully used for studying knee function in the Indian population. LEVEL OF EVIDENCE: Prospective cohort study, Level II.

Online educational resources for orthopaedic residency-a narrative review.

PURPOSE: Residency programs in the medical education field are considered the keystone in the development of aptitude and skills required for practice. With the worldwide current scenario of the COVID-19 pandemic, there has been a shift in the paradigm especially in the teaching of the residents from face-to-face classes to more and more online sessions. The purpose of this study is to present a compendium of knowledge-providing sites, smartphone applications (apps), YouTube channels, and podcasts that can provide better online resource management for students in the field of orthopaedics. METHODS: Search terms were used for making a list of various online resources which can be of help during orthopaedic residency. An initial list of the selected websites, smartphone apps, podcasts, and YouTube channels was made. The corresponding author with years of teaching experience and faculty for post-graduate and fellowship training programs then selected the final list. RESULTS: A list of 16 websites with brief points on their content and online address along with the availability of free or paid content was identified as being appropriate. A total of 39 apps available for android/apple smartphones, nine podcasts, and 11 YouTube channels were also identified as being extremely useful and have been discussed elaborately in this article. CONCLUSION: Online educational tools are of immense importance in imparting adequate knowledge to an orthopaedic resident and act as an adjunct to conventional teaching methods. This article focuses on presenting various online educational resources in a simple yet concise way, which may be beneficial for the current generation of residents especially in this current time of unprecedented COVID-19 pandemic.

Pie-crusting of proximal medial collateral ligament for correcting varus deformity in total knee arthroplasty.

PURPOSE: Aim of this study was to compare outcomes of a newer technique of pie-crusting of the femoral origin of medial collateral ligament (MCL) with the conventional medial release, for correcting varus deformity during total knee arthroplasty. Null hypothesis was that there is no difference in clinical outcomes between these two techniques. METHODS: All patients requiring an additional medial release after excision of osteophytes and release of deep MCL during total knee arthroplasty were allocated into two groups, alternately. Each group composed of 40 patients. Pie-crusting with a needle was done near the femoral attachment of superficial MCL in group-1, whereas the group-2 underwent classic sub-periosteal release of the tibial insertion of superficial MCL. All the patients were assessed for any laxity (more than 3 mm opening) intraoperatively or at one-year follow-up, pain score at 12 and 24 h after the surgery, Knee Society Score, Western Ontario and McMaster Universities Arthritis Index and range of motion 12 months after the surgery. RESULTS: None of the patients showed any signs of laxity or failure at one-year follow-up. Pain scores were slightly better (not statistically significant) in the group-1. However, no differences were noted in functional outcomes scores. CONCLUSION: Pie-crusting of superficial MCL is a safe, controlled and less invasive approach for medial soft tissue release. When knee deformity is not correctable with initial soft tissue release, this is an appropriate next surgical step. There does not appear to be a risk of over-release during the surgery or afterward. STUDY DESIGN: Non-randomized controlled trial, Level II.

Insight into the changing patterns in clinical and academic activities of the orthopedic residents during COVID-19 pandemic: a cross-sectional survey.

PURPOSE: The COVID-19 pandemic has presented an unprecedented challenge to the orthopedic residency training programs to adapt to a form of a web-based learning process and simulation-based training. This study focusses on the viewpoint of the orthopedic residents to the paradigm shift in clinical care as well as the academic activities. METHODS: An anonymous questionnaire was created in an online survey generator and was sent through e-mail to 227 orthopedic residents of seven tertiary care centres in North India. The questionnaire was divided into three sections, academic activity section, mental health section, and clinical activity section. There were a total of 44 single answer questions with answers according to the increasing difficulty at present situation compared to a previous time before the COVID-19 pandemic. RESULTS: A total of 158 questionnaires were filled by 107 junior residents (67.7%) and 51 senior residents (32.3%). 49 residents (31%) were quarantined and three became positive for COVID-19. Although all of them knew about necessary precautions, personal protective equipment was difficult to avail at times. Increased difficulty in recruiting new patients for research (48.9%) and conducting prospective research (48.7%) was observed. The online-based learning process was reported to be easier (44.2%) by most of the residents. Routine clinical work in the operating room, out-patient department, and inpatient department was found to be difficult according to the majority of the residents along with the anxiety of contracting the infection. CONCLUSION: There are unique opportunities for improvement of residency programs during these times of uncertainty and the findings of this study can help the universities as well as program chairs to develop a robust program that can outlive this pandemic. The web-based learning process might prove to be useful and can be incorporated into the resident training program in the long term. LEVEL OF EVIDENCE: Level V.

Simultaneous single-stage versus two-staged bilateral total knee arthroplasty: a prospective comparative study.

PURPOSE: The study aims to prospectively compare peri-operative morbidity and mortality of simultaneous single-stage bilateral total knee arthroplasty (SS BLTKA) with two-staged bilateral total knee arthroplasty (TS BLTKA) performed within 12 months of the first surgery. We hypothesized that SS BLTKA is as safe as TS BLTKA. METHODS: Patients with a minimum follow-up of 12 months were included in this study. Oxford knee score and quality of life index SF12 was compared between the 2 groups at six weeks and six month follow-up. RESULTS: SS BLTKA included 250 patients and TS BLTKA included 210 patients. The minimum time interval between two operations was three weeks (mean 1.6 months, range 3 weeks-12 months). There was no significant difference between the 2 groups in peri-operative mortality, surgical site infection, major peri-operative complications. There was no difference between the 2 groups in the Oxford knee score and quality of life index SF12 at 6-month follow-up. There was no difference in the range of knee flexion between the 2 groups at six months. Post-operative haemoglobin drop was significantly more in SS BLTKA patients and consequently, blood transfusion requirement was significantly higher in SS BLTKA. There was a significantly higher length of hospital stay and duration of surgery in TS BLTKA group. CONCLUSION: There does not appear to be a difference in complication rates between the 2 groups. SS BLTKA seems to be a logical choice if both knees have severe osteoarthritis. Patients with severe cardiopulmonary compromise were excluded, and a unilateral procedure may be preferred in them.

Characterization and establishment of a reference deltamethrin and cypermethrin resistant tick line (IVRI-IV) of Rhipicephalus (Boophilus) microplus.

The problem of ticks and tick borne diseases is a global threat and growing reports of resistance to commonly used insecticides further aggravated the condition and demands for country specific resistance monitoring tools and possible solutions of the problem. Establishment of standard reference is prerequisite for development of monitoring tools. For studying possible role of different mechanisms involved in development of resistance in Rhipicephalus (Boophilus) microplus population and to develop newer drug to manage the problem of resistance, a deltamethrin exposed and selected tick colony, referred to as IVRI-IV, was characterized using reference susceptible IVRI-I tick line as control. The RF values of IVRI-IV ticks against deltamethrin, cypermethrin and diazinon were determined as 194.0, 26.6, 2.86, respectively, against adults. The esterase enzyme ratios of 2.60 and 5.83 was observed using α-naphthyl and ß-naphthyl acetate while glutathione S-transferase (GST) ratio was 3.77. Comparative analysis of IVRI-I and IVRI-IV carboxylesterase gene sequences revealed 13 synonymous and 5 non synonymous mutations, reported for the first time. The C190A mutation in the domain II S4-5 linker region of sodium channel gene leading to leucine to isoleucine (L64I) amino acid substitution was also detected in the IVRI-IV population. In the present study, monitorable indicators for the maintenance of the reference IVRI-IV colony, the first established deltamethrin and cypermethrin resistant tick line of India, were identified.

A novel experimental approach for the catalytic conversion of lignocellulosic Bambusa bambos to bioethanol.

Bambusa bambos (B.B) biomass is cellulose rich lignocellulosic material, containing 47.49% cellulose, 17.49% hemicellulose, 23.56% lignin was used as a potential substrate for bioethanol production. The research paper investigates the use of B.B biomass as a substrate for bio-ethanol production through a two-phase catalytic conversion process. Four water-regulated regimes were identified to optimize the conversion of lignocellulosic biomass to biofuel precursors. The catalytic hydrolysis of B.B using CuCl2 was conducted for 10 hours at 110˚C, in aprotic ionic liquid (1-Butyl-3-methylimidazolium chloride) medium. The concentrations of glucose and 5-hydroxymethylfurfural (5-HMF) were measured while varying the amount of water addition. Water played a crucial role in the conversion of cellulose to glucose and 5-HMF by influencing product yields through the interplay of transport properties like heat conduction and viscosity. The highest glucose yield was achieved at 60.82% when operating at a water inclusion rate of 115.72 µL water/h for a duration of 6 hours at 110˚C. On the other hand, the maximum HMF yield was observed as 5.84% at water inclusion rate of 77.15 µL water/h for 5 hours at 110˚C. Yeast mediated glucose fermentation resulted in a bioethanol concentration of 5.5 mg/mL utilizing 15 mg/mL of catalytically produced glucose at a temperature of 30°C. After catalytic hydrolysis, the ionic liquid was also efficiently recycled for a sustainable economy.

Comparative analysis of free vascularized fibula grafting and Ilizarov bone transport in management of segmental long bone defect of the lower limb: A systematic review and meta-analysis.

Introduction: Reconstruction of segmental defects of long bones is a daunting task for surgeons. Bone transport with the help of Illizarov external fixator and vascularized free fibula flap are some of the most discussed and valid options for the same. Both techniques have their limitations and overlapping indications. However, there has been no objective evidence in the manner of a systematic review supporting one treatment method over the other. Aim: This systemic review is aimed to compare the bony union, functional outcomes, and complications of Illizarov bone lengthening and free fibula flap performed for segmental bone defects of long bones of the leg. Methods: A comprehensive search was done for all studies published before May 2023. Any observational study comparing bone transport based on Illizarov external fixator and free vascularized fibula grafting techniques for treating lower limb long bone segmental defects was entailed in this study. Results: This systematic review comprised of five retrospective studies. A total of 96 patients were treated by the Illizarov-based bone transport technique and 72 patients were treated by the free vascularized fibula grafting technique. The free vascularized fibula grafting technique yielded a shorter mean time to union (average difference 9.3 months), relatively shorter external fixator time (average difference 5.32 months), and external fixator index (average difference 0.57 months/cm). However, there was no difference in terms of bony and functional outcomes between both techniques when used for the reconstruction of bony defects in the lower limb. Total number of complications was 68 % higher in bone transport with Illizarov external fixator. However, the rates of non-union didn't differ between the groups. Conclusion: The free vascularized fibula grafting technique had a lesser time to bony union, shorter time for external fixator application, and lower incidence of complications. However, the functional and bony outcomes didn't differ between both techniques. Level of evidence: Level 4.