Chronology of disc degeneration and facet joint arthritis in lumbar spine is variable - A CT based cross-sectional study.

BACKGROUND: The notion that disc degeneration (DD) always precedes facet joint arthritis (FJA) has held sway for many decades. However, it is not always the case. We hypothesized that DD is not always the first offender studied the prevalence of isolated DD and isolated FJA in the lumbar spine. METHODS: Inter-vertebral discs and bilateral facet joints of lumbar spines of 135 participants were graded. The participants were divided into one of the four categories. 'No degeneration,' 'Isolated disc degeneration without facet joint arthritis,' 'Combined disc degeneration and facet joint arthritis,' and 'Isolated facet joint arthritis without disc degeneration.' Multivariate logistic regression analysis was done to evaluate the predictive factors for spinal degeneration using FJA as a dependent variable while age, sex, BMI, smoking history, and DD as predictor variables. RESULTS: The majority of participants had isolated FJA 64 (47.4%). Combined DD and FJA were noted in 32 (23.7%), isolated DD in 8 (5.9%), while 31(23%) had no degeneration. Only age was found to be significantly contributing to the prediction model in multivariate analysis. CONCLUSION: Our study shows that spinal degeneration may begin either in the disc or in the facet joints depending upon the aetiological factors. It is a vicious circle that may be entered at any point, FJA or DD.

Plantar Fasciitis with Chronic Baxter's Neuropathy Causing Hindfoot Pain - A Case Report.

Introduction: The main differentials of non-traumatic heel pain are plantar fasciitis (PF), plantar heel fat pad atrophy, worn-out footwear, especially asymmetric wear and tear, hyperuricemia, corns, callosities, tumors of the calcaneum, osteomyelitis, calcaneal stress fractures due to overweight or unaccustomed over usage, radiating pain from S1 nerve root compression, and seronegative spondyloarthropathies. Compression of the tibial nerve or the medial calcaneal nerve at or around the flexor retinaculum is the other possibility. In this case report, we want to highlight a sparsely known pathology, caused due to the entrapment of the first branch of the lateral plantar nerve or inferior calcaneal nerve, also known as Baxter's nerve that may present independently or accompany the common PF. Non-steroidal anti-inflammatory medications or injections of local steroids are typically used for conservative management. However, hydro-dissection or surgical release may be needed in non-responsive cases. Case Report: We present the case of a 57-year-old female with complaints of chronic pain and tenderness in the middle of the heel radiating laterally. She underwent magnetic resonance imaging that revealed chronic denervation changes in the form of marked atrophy and near complete fatty replacement of abductor digiti minimi muscle suggesting chronic Baxter neuropathy. A mildly thickened and hyperintense plantar fascia adjacent to the calcaneal spur and significant heel fat pad edema were seen too. The patient responded well to a local steroid injection and remains pain-free at the 1-year follow-up. Conclusion: When heel pain is present, Baxter's nerve impingement presents as a challenging clinical diagnosis that may accompany the common PF and is often overlooked. MRI can be used to assess the denervation effects of both the acute and chronic stages of Baxter's nerve impingement by identifying abnormalities of the abductor digiti minimi muscle belly.

Complete Ankle Joint that is Tibiotalar and Distal Tibiofibular Coalition Presenting with Foot and Ankle Pain - A Case Report.

Introduction: Coalition is an abnormal, usually congenital, or developmental connection in between or the complete fusion of two bones that are otherwise separate. It is of three types, i.e., synostosis (bony connection), synchondrosis (cartilaginous connection), or syndesmosis (fibrous tissue). Its typical cause is the failure of mesenchymal segmentation and differentiation. Usually, it is seen in tarsal or carpal bones and very rarely in between other bones. Only a single case of a tibiotalar coalition has been reported previously in literature. Herein, we are reporting a case of the talocrural coalition, which is the first one from the Indian sub-continent. Case Report: A 16-year-old moderately built female patient of Indian origin presented with chronic pain of 1-year duration in the right foot and ankle region on weight bearing. The pain was dull aching type, mild-to-moderate in severity and worsened with activity or prolonged walking, and relieved on taking non-steroidal anti-inflammatory drugs. No relevant history was present. On local examination, diffuse tenderness was present in the ankle and the tarsal bones. Almost negligible dorsiflexion and about 15° plantar flexion of the foot were possible. An initial radiograph of the right ankle revealed osseous fusion between the distal tibia and fibula, as well as between the tibia, fibula, and the dome of the talus. Magnetic resonance imaging (MRI) revealed osseous fusion involving the distal tibia, fibula, and the dome of the talus (both medially and laterally), indicative of talocrural fusion. No edema or inflammation was appreciable in the adjacent tendons or synovium. The patient was explained regarding the pathology and the prognosis. She was managed conservatively and was satisfied. Conclusion: Radiographs play a crucial role in evaluating patients suspected of having a coalition or ankylosis. Complementary tools such as computed tomography and MRI are valuable for a more in-depth assessment of the fusion and aid in surgical planning.

Synthesis of ciprofloxacin-linked 1,2,3-triazole conjugates as potent antibacterial agents using click chemistry: exploring their function as DNA gyrase inhibitors via in silico- and in vitro-based studies.

The antibacterial efficacy of some newly developed C-3 carboxylic group-containing ciprofloxacin-linked 1,2,3-triazole conjugates was studied. Twenty-one compounds from three different series of triazoles were synthesized using click chemistry and evaluated for their antibacterial activity against nine different pathogenic strains, including three Gram-positive strains, i.e. Enterococcus faecalis (ATCC29212), Staphylococcus aureus (ATCC25923), Staphylococcus epidermidis (clinical isolate), and six Gram-negative bacterial strains, i.e. Escherichia coli (ATCC25922), Pseudomonas aeruginosa (ATCC27853), Salmonella typhi (clinical isolate), Proteus mirabilis (clinical isolate), Acinetobacter baumannii (clinical isolate) and Klebsiella pneumonia (clinical isolate). Among the compounds, 10, 10a, 10b, 10c, 10d, 11a, 11f, 12c, 12e and 12f showed excellent activity with MIC values upto 12.5 µg mL-1, whereas the control ciprofloxacin showed MIC values of 0.781-25 µg mL-1 towards various strains. In addition, the low toxicity profile of the synthesized molecules revealed that they are potent antibiotics. Molecular docking and MD analysis were performed using the protein structure of E. coli DNA gyrase B, which was further corroborated with an in vitro assay to evaluate the inhibition of DNA gyrase. The analysis revealed that compound 10b was the most potent inhibitor of DNA gyrase compared to ciprofloxacin, which was employed as the positive control. Furthermore, the structure of two title compounds (11a and 12d) was characterized using single-crystal analysis.

Fabrication of gelatin coated polycaprolactone nanofiber scaffolds co-loaded with luliconazole and naringenin for treatment of Candida infected diabetic wounds.

The current study focuses on the development of gelatin-coated polycaprolactone (PCL) nanofibers co-loaded with luliconazole and naringenin for accelerated healing of infected diabetic wounds. Inherently, PCL nanofibers have excellent biocompatibility and biodegradation profiles but lack bioadhesion characteristics, which limits their use as dressing materials. So, coating them with a biocompatible and hydrophilic material like gelatin can improve bioadhesion. The preparation of nanofibers was done with the electrospinning technique. The solid state characterization and in-vitro performance assessment of nanofibers indicate the formation of uniformly interconnected nanofibers of 200-400 nm in diameter with smooth surface topography, excellent drug entrapment, and a surface pH of 5.6-6.8. The antifungal study showed that the nanofiber matrix exhibits excellent biofilm inhibition activity against several strains of Candida. Further, in-vivo assessment of nanofiber performance on C. albicans infected wounds in diabetic rats indicated accelerated wound healing efficacy in comparison to gauge-treated groups. Additionally, a higher blood flow and rapid re-epithelialization of wound tissue in the treatment group corroborated with the results obtained in the wound closure study. Overall, the developed dual-drug-loaded electrospun nanofiber mats have good compatibility, surface properties, and excellent wound healing potential, which can provide an extra edge in the management of complex diabetic wounds.

Nanofibers of N,N,N-trimethyl chitosan capped bimetallic nanoparticles: Preparation, characterization, wound dressing and in vivo treatment of MDR microbial infection and tracking by optical and photoacoustic imaging.

Recent advancements in wound care have led to the development of interactive wound dressings utilizing nanotechnology, aimed at enhancing healing and combating bacterial infections while adhering to established protocols. Our novel wound dressings consist of N,N,N-trimethyl chitosan capped gold­silver nanoparticles (Au-Ag-TMC-NPs), with a mean size of 108.3 ± 8.4 nm and a zeta potential of +54.4 ± 1.8 mV. These optimized nanoparticles exhibit potent antibacterial and antifungal properties, with minimum inhibitory concentrations ranging from 0.390 µg ml-1 to 3.125 µg ml-1 and also exhibited promising zones of inhibition against multi-drug resistant strains of S. aureus, E. coli, P. aeruginosa, and C. albicans. Microbial transmission electron microscopy reveals substantial damage to cell walls and DNA condensation post-treatment. Furthermore, the nanoparticles demonstrate remarkable inhibition of microbial efflux pumps and are non-hemolytic in human blood. Incorporated into polyvinyl alcohol/chitosan nanofibers, they form Au-Ag-TMC-NPs-NFs with diameters of 100-350 nm, facilitating efficient antimicrobial wound dressing. In vivo studies on MDR microbial-infected wounds in mice showed 99.34 % wound healing rate within 12 days, corroborated by analyses of wound marker protein expression levels and advanced imaging techniques such as ultrasound/photoacoustic imaging, providing real-time visualization and blood flow assessment for a comprehensive understanding of the dynamic wound healing processes.

Formulation and characterization of polyvinyl alcohol/chitosan composite nanofiber co-loaded with silver nanoparticle & luliconazole encapsulated poly lactic-co-glycolic acid nanoparticle for treatment of diabetic foot ulcer.

Chronic wounds are prone to fungal infections, possess a significant challenge, and result in substantial mortality. Diabetic wounds infected with Candida strains are extremely common. It can create biofilm at the wound site, which can lead to antibiotic resistance. As a result, developing innovative dressing materials that combat fungal infections while also providing wound healing is a viable strategy to treat infected wounds and address the issue of antibiotic resistance. Present work proposed anti-infective dressing material for the treatment of fungal strains Candida-infected diabetic foot ulcer (DFU). The nanofiber was fabricated using polyvinyl Alcohol/chitosan as hydrogel base and co-loaded with silver nanoparticles (AgNP) and luliconazole-nanoparticles (LZNP) nanoparticles, prepared using PLGA. Fabricated nanofibers had pH close to target area and exhibited hydrophilic surface suitable for adhesion to wound area. The nanofibers showed strong antifungal and antibiofilm properties against different strains of Candida; mainly C. albicans, C. auris, C. krusei, C. parapsilosis and C. tropicalis. Nanofibers exhibited excellent water retention potential and water vapour transmission rate. The nanofibers had sufficient payload capacity towards AgNP and LZNP, and provided controlled release of payload, which was also confirmed by in-vivo imaging. In-vitro studies confirmed the biocompatibility and enhanced proliferation of Human keratinocytes cells (HaCaT). In-vivo studies showed accelerated wound closure by providing ant-infective action, supporting cellular proliferation and improving blood flow, all collectively contributing in expedited wound healing.

Broken Intraluminal Needle in an Intravenous Drug User - A Case Report and Review.

Introduction: Intravenous injections are an everyday practice in the health-care sector and are also frequently abused by drug abusers. One rare complication of intravenous injections is venous intraluminal breakage of the needle, which is a matter of concern due to the possible embolization of needle fragments in the body. Case Report: We report our case of an intravenous drug abuser with an intraluminal breakage of a needle presenting within 2 h of the incidence. The broken needle fragment was retrieved successfully at the local injection site. Conclusion: Intraluminal intravenous needle breakage should be treated as an emergency, and a tourniquet should be applied as soon as possible.

Double Trouble of "Double Segmental" Fractures - A Report of Two Cases.

Introduction: A "double segmental" fracture is an injury pattern that has three fracture sites and four fracture segments in a single bone. It is extremely rare, with only three "Double segmental femoral fracture" and only four "double segmental tibia fracture" cases reported in the literature. These fractures are associated with difficulty in deciding the implant for fixation, segment reduction, maintenance of reduction, maintaining blood supply of segment during fixation, and the high risk of post-operative complications. Case Report: We present two unique cases, one of "double segmental femur fracture" and the other of "double segmental tibia fracture," fixed with intramedullary nailing. When Schanz screw or Steinman pins were used to reduce the intermediate fragments and hold them in place, they interfered with the reaming due to the protruding part in the narrow canal. This problem could be solved using weber clamps to hold reduction as they do not obscure the canal. All the fractures united uneventfully at 9 months follow-up. Conclusion: A "single intramedullary device" to fix "all the segments" can help provide stabilization without compromising soft-tissue attachments and viability of the intermediate fracture segments in "double segmental" fractures.

Symptomatic Coracoclavicular Joint - A Case Report of an Important but Lesser known Differential Diagnosis of Shoulder Pain.

Introduction: Actual coracoclavicular (CC) joint is a rare finding and usually incidental. It is mostly asymptomatic, but few cases have been reported in which there was associated shoulder pain and even brachial plexus neuralgia. It is not to be confused with CC ligament which is a well-known anatomical entity. Case Report: Here, we present a case of symptomatic CC joint treated at our hospital. A 50-year-old man presented to the outdoor patient department of our hospital with a history of acute on chronic pain in the left shoulder. The pain used to be dull/aching, occurring after some activity and usually relieved on rest. On local examination, mild tenderness was present around the coracoid process. The pain was aggravated on flexion and external rotation of the shoulder. X-ray of the shoulder revealed the presence of a CC joint. It was confirmed by non-contrast computed tomography of the shoulder. Ultrasound-guided injection of local anesthetic and steroid was given in the CC joint, providing instant pain relief to the patient. At 1-year follow-up, the patient is asymptomatic and continuing his daily routine activities. Conclusion: Although CC Joint is a rare entity, its role in causing symptoms is unrefutable. Conservative treatment should be tried before surgical excision. More awareness regarding this joint and its pathology is required for identification and diagnosis.

Rheumatoid or tubercular: Flexor tenosynovitis of the wrist with rice bodies.

Rice bodies are formed mainly in tenosynovitis and bursitis of rheumatoid or tubercular origin. It rarely presents with compressive ulnar neuropathy. A 35-year-old female presented with painful swelling in the volar aspect of the left wrist and incomplete flexion of the little finger. The laboratory tests revealed ESR 10 mm/1st hr and C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide tests were negative. Thickened and distended ulnar bursa with rice bodies was seen on magnetic resonance imaging (MRI). Thorough drainage, debridement, and synovectomy were done. Epithelioid cell granulomas with multinucleated giant cells on microscopy and the strongly positive Mantoux test prompted us to start anti-tubercular treatment. The wound healed uneventfully with good recovery of range of motion of the little finger at one-year follow up. Rice bodies can be a diagnostic dilemma in the absence of classical signs of their rheumatoid or tubercular origin.

Necrotic mediastinal lymphadenopathy: Tuberculosis or Sarcoidosis, a diagnostic conundrum - A case report and review of the literature.

Sarcoidosis is an uncommon disease involving pulmonary parenchyma and lymph nodes. Non-necrotizing, bilaterally symmetric hilar, and right paratracheal lymph nodes are the pathognomonic imaging features of sarcoidosis. Rarely, atypical radiological findings of sarcoidosis may mimic mycobacterial infections, posing a diagnostic dilemma, especially in tuberculosis endemic countries. In this report, we have discussed the case of a 61-year-old female presenting with multiple conglomerated necrotic mediastinal lymph nodes on computed tomography that looked tubercular but eventually turned out to be sarcoidosis. It is important for primary care physicians, who are the first point of contact for patients, to keep in mind the atypical radiologic manifestations of sarcoidosis, in order to reach a timely diagnosis and help reduce the associated morbidity and mortality.

The humble wrist pain could be "early" tuberculosis and a high index of suspicion may help nip it in the bud: A case report.

Osteoarticular tuberculosis of the wrist is a very rare subset of skeletal Tuberculosis. Diagnosing the tuberculosis wrist in its early stage poses a major challenge to the clinicians because of its atypical and vague presentations and a close resemblance to many relatively benign pathologies. Clinicians from developed parts of the world having less exposure to the myriad forms of osteoarticular tuberculosis are more likely to miss it. We hereby report one such case who presented with wrist pain of short duration, which after thorough examination and investigations, turned out to be tuberculous. It was successfully managed with anti-tuberculosis drugs alone without any debridement or synovectomy. Familiarity with the clinical profile of this entity, in its early stages, is valuable for primary care physicians, rheumatologists, internal medicine specialists, and orthopaedicians alike, who may confuse it with one of the many more common inflammatory, degenerative, or traumatic causes of wrist pain. Within normal range or near normal erythrocyte sedimentation rate and C-reactive protein, and normal looking X-ray does not preclude the diagnosis of tuberculosis wrist. The role of a high index of suspicion and a low threshold for getting higher radiological investigation like MRI in non-responding cases of wrist joint pain cannot be overstated.

A case report of drone injury and its relevance in India.

Drones are being used globally for varied purposes, including recreational, surveillance, and military. This ever-expanding usage has led to an increase in drone-related injuries. Blunt trauma to the head, eye globe injuries, and skin laceration being the commonest. We present a case of drone injury to the hands caused by its propeller blades.

The Flood of COVID-19 Publications: a Word of Caution.

The entire world is currently experiencing difficult times with respect to physical, mental, and socio-economic health. The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since early 2020 caught the world by surprise. While there are promising developments, to date, there is no available drug or vaccine, and researchers are working around the clock to develop a solution. Sadly, all these crucial efforts are being affected and, at times, misguided and derailed by the publication of fake articles by so-called researchers and perhaps the mismanagement by authentic and predatory journals. The problem is that genuine and good quality articles are getting lost in the crowd. More than ever, it is now the time to bring in stricter controls and to follow due diligence before allowing articles into the public domain. At the same time, it has become life-saving to separate the wheat from the chaff so that the genuine studies of first-hand experience of handling and management of COVID-19 patients, and authentic research is not submerged in this flood of unreliable publications.

Is thoracic facet joint arthritis over-reported? It's time to review CT grading parameters - An analytical cross-sectional study.

BACKGROUND: In the absence of any exclusive classification for dorsal FJA, there is a lot of confusion while labelling grade 1 FJA in thoracic spine based on decreased FJ space. PURPOSE: The purpose of this study was to know the facet joint space measurements in thoracic spine of asymptomatic and symptomatic participants and to comment whether the lower cut-off of 2 mm used in lumbar FJA classification can be safely applied in thoracic spine too. MATERIALS AND METHODS: This cross-sectional study was done from December 1, 2018 to November 30, 2019. Patients above 18 years of age in this study who underwent CT thorax for causes unrelated to dorsal spinal pain were included. IBM SPSS Statistics v 26 was used for statistical analysis. RESULTS: We measured and analysed 1512 thoracic facet joints in 63 patients (30 females and 33 males) in both axial and sagittal plane on CT scan. Mean age of the entire sample was 59.19 ± 15.19 years, ranging from 33 to 97 years and a standard error of mean 1.365 years. Overall mean thoracic facet joint space was measured to be 1.270 mm ± 0.3416 mm, ranging from 0 to 3.1 mm and a standard error of mean 0.0088 mm and a variance of 0.117 mm. The median was 1.300 mm while mode was 1.1 mm. CONCLUSION: The popular lumbar FJA classification by Weishupt et al. cannot be applied in its present form in thoracic spine, without the modification in parameters of grade 1 FJA. The lower cut-off of normal thoracic facet joint space probably lies around 1 mm.

Prevalence of facet joint arthritis and its association with spinal pain in mountain population - A cross-sectional study.

INTRODUCTION: People living in the mountains are subject to tough terrain and climbing biomechanics which lead to degeneration of the spine and Facet joint arthritis (FJA). AIMS: The goal of present study was (1) to know the prevalence of facet joint arthritis on CT scans in mountain population in regard to (a) different levels in spine (b) age (c) sex (2) to know if there is any significant association between FJA and spinal pain at that corresponding level. MATERIALS AND METHODS: Bilateral Facet joints of 210 participants (age range, 18 to 97 years) who underwent MDCT imaging for reasons other than spinal pain, were graded and statistically analysed with SPSS software in this study. FJA was defined as at least one joint affected by facet joint disease (grade 2). RESULTS: In our study, Seventy two men (68.5%) and eighty four women (80%) had Facet Joint arthritis. The difference between men and women in the prevalence of FJA was not statistically significant (P = 0.058). The increasing age demonstrated a higher prevalence of facet joint arthritis with statistical significance (P = 0.000). In dorsal and lumbar spine region, there was a statistically significant difference in prevalence of FJA according to spinal level. The prevalence of FJA grade 2 in cervical and dorsal spine region was associated with spinal pain in both men (P = 0.000) and women (P = 0.000). However, no statistically significant association was found between FJA grade 2 and spinal pain in lumbar spine region in both males (P = 0.680) and females (P = 0.680) as well as in total population (P = 0.513). CONCLUSIONS: People residing and actually ambulating in the mountain regions and exposed to the terrain have higher prevalence of Facet joint arthritis as compared to general population and this may be an independent risk factor for development of facet joint arthritis. However, a statistically significant relation between FJA and spinal pain exists only in cervical and dorsal spine.

Cleidocranial dysplasia: Radiological mimic of pyknodysostosis - A case report.

Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal disorder with predominant membranous bone involvement. It may also occur as a sporadic mutation. The diagnosis of this condition is based on the clinical, radiological and genetic findings. It is characterised by hypoplasia or aplasia of the lateral thirds of the clavicles; craniofacial and dental anomalies; and hypoplastic iliac bones. Pyknodysostosis is a close radiological mimic of this entity. Definite diagnosis is based on the genetic analysis. A 36-year-old short-statured female was referred for computed tomography of the paranasal regions for complaints of a deviated nasal septum and midline depression in her forehead. Skeletal screening demonstrated an open metopic suture, wormian bones, maxillary hypoplasia, maldentition and aplastic lateral thirds of both clavicles. In this article, we report a case of CCD, discuss various overlapping features between CCD and pyknodysostosis and attempt to differentiate them radiologically.

Takayasu arteritis presenting with malignant hypertension; a rare manifestation of a rare disease: a case report and review of the literature.

Takayasu arteritis (TA) is a chronic inflammatory and obliterative disease of large vessels, which mainly affects the aorta and its major branches. TA can lead to renal failure and renovascular hypertension in 60% of patients; it is rare in children aged <10 years and, more rarely, it presents with malignant hypertension in the paediatric age group. Here we present a case of 9-year-old boy with TA who presented with malignant hypertension and required surgical intervention to control the blood pressure. Subsequently, his medications were titrated using 24 h ambulatory blood pressure monitoring (ABPM) and is doing well on follow-up.

Renal cell carcinoma in children and adolescence: our experience.

BACKGROUND: Literature on renal cell carcinoma (RCC) in children is lacking. Occasional case report has been mentioned. Aims and objective of our study are to evaluate the clinical presentation and outcome in children with RCC. PATIENTS AND METHODS: Records of 11 children and adolescence, from January 2007 to June 2011, who were treated for RCC were retrospectively analysed. Age, clinical presentation, any paraneoplastic symptom or sign, haematological, bio-chemical investigations, radiological imaging's, operative details, pathological reports and treatment details were taken from hospital records and results were analysed. All patients were followed-up with complete haemogram, biochemical investigations, ultrasonography - whole abdomen and chest X-ray at 6 months interval and patients with stages 2 and 3 were also followed-up with contrast enhanced computed tomography - whole abdomen. They were followed-up for 2-5 years. RESULTS: All had undergone open radical nephrectomy with eight hilar lymph node dissection and three formal lymphadenectomy. None had received adjuvant therapy. Four patients with stage 1 were well at 5, 4, 2.5 and 2 years. One patient with stage 1 was lost to follow-up. Three patients with stage 2 were well at 4, 3 and 2 years of follow-up while three with stage 3 were well at 5, 4 and 2 years of follow-up. CONCLUSIONS: Lymph node dissection not only improves the survival, but it guides one the exact pathological staging and one can adopt the more aggressive follow-up in advanced pathological staging and strict follow-up is mandatory.