Bi-portal Endoscopic Calcaneoplasty for Haglund's Deformity.

Introduction Haglund's deformity is an abnormal bony postero-superior calcaneal prominence which causes the posterior heel pain. Surgery is the choice of treatment after failed conservative management. Both open and endoscopic techniques are used to treat this condition. In this article, we discuss endoscopic calcaneoplasty for the management of such cases. Methods All included patients underwent bi-portal endoscopic calcaneoplasty. Clinical outcomes were assessed by using the visual analog scale (VAS) score and the American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological outcome was assessed by a change in the Fowler-Philip angle (FPA). All patients were followed at one month, three months, and six months postoperatively. Results A total of 22 patients were included in this prospective study. Patients were followed up to six months postoperatively. The mean VAS score was 6.32 ± 0.65 which was significantly reduced to 0.91 ± 0.68 (p < 0.001) at six months. Similarly, AOFAS Score was improved to 90.01 ± 2.67 (p < 0.001) from 64.36 ± 7.07 preoperatively. The mean Fowler Philip Angle was reduced from 72.45° ± 3.74° to 65.77° ± 2.25° at six months (p < 0.001). Conclusion Bi-portal endoscopic calcaneoplasty significantly improves clinical outcomes in Haglund's deformity. Compared to open procedures, bi-portal endoscopic calcaneoplasty offers several advantages, including shorter recovery times, smaller incisions, and better clinical results for Haglund's deformity.

A systematic analyses of different bioinformatics pipelines for genomic data and its impact on deep learning models for chromatin loop prediction.

Genomic data analysis has witnessed a surge in complexity and volume, primarily driven by the advent of high-throughput technologies. In particular, studying chromatin loops and structures has become pivotal in understanding gene regulation and genome organization. This systematic investigation explores the realm of specialized bioinformatics pipelines designed specifically for the analysis of chromatin loops and structures. Our investigation incorporates two protein (CTCF and Cohesin) factor-specific loop interaction datasets from six distinct pipelines, amassing a comprehensive collection of 36 diverse datasets. Through a meticulous review of existing literature, we offer a holistic perspective on the methodologies, tools and algorithms underpinning the analysis of this multifaceted genomic feature. We illuminate the vast array of approaches deployed, encompassing pivotal aspects such as data preparation pipeline, preprocessing, statistical features and modelling techniques. Beyond this, we rigorously assess the strengths and limitations inherent in these bioinformatics pipelines, shedding light on the interplay between data quality and the performance of deep learning models, ultimately advancing our comprehension of genomic intricacies.

Evaluation of the analytical performance of the 15-minute point-of-care DASH™ SARS-CoV-2 RT-qPCR test.

Accurate and timely diagnosis for COVID-19 diagnosis allows highly effective antiviral medications to be prescribed. The DASH™ Rapid PCR System is a sample-to-answer point-of-care platform combining state-of-the-art PCR kinetics with sequence specific hybridization. The platform's first assay, the DASH™ SARS-CoV-2/S test for anterior nares direct swab specimens, received FDA Emergency Use Authorization in March 2022 for point-of-care use. Here we report the analytical characteristics of the assay including limit of detection, dynamic range, and robustness of SARS-CoV-2 variant detection. The limit of detection was determined by testing swabs contrived with one hundred copies of wild type or Omicron BA.5 virus and detecting 20/20 and 19/20, respectively. The dynamic range was assessed with contrived swabs containing 102-106 copies; the log-linear relationship between Cq and copy input was plotted, and the qPCR efficiency calculated from the slope of the line was 101.4%. Detection of seven SARS-CoV-2 variants was demonstrated.

Design of high bulk moduli high entropy alloys using machine learning.

In this work, the authors have demonstrated the use of machine learning (ML) models in the prediction of bulk modulus for High Entropy Alloys (HEA). For the first time, ML has been used for optimizing the composition of HEA to achieve enhanced bulk modulus values. A total of 12 ML algorithms were trained to classify the elemental composition as HEA or non-HEA. Among these models, Gradient Boosting Classifier (GBC) was found to be the most accurate, with a test accuracy of 78%. Further, six regression models were trained to predict the bulk modulus of HEAs, and the best results were obtained by LASSO Regression model with an R-square value of 0.98 and an adjusted R-Square value of 0.97 for the test data set. This work effectively bridges the gap in the discovery and property analysis of HEAs. By accelerating material discovery via providing alternate means for designing virtual alloy compositions having favourable bulk modulus for respective applications, this work opens new avenues of applications of HEAs.

Epidemiology of Pediatric Musculoskeletal Trauma Patients Admitted to a Trauma Center in Northern India: A Prospective Cohort Study.

Background Pediatric injuries are the leading cause of death and disability worldwide and place a considerable burden on nations with limited resources. A careful investigation of the epidemiology of pediatric musculoskeletal trauma can provide insight into its causation and the demography of the affected children and help us devise preventive strategies to reduce the burden of pediatric musculoskeletal trauma. Methodology Musculoskeletal trauma patients up to the age of 18 years were included in this prospective cohort study. Information about age, sex, time since the injury to presentation to a trauma center, mode of injury, the site where the injury was suffered, and the exact injury were recorded. Age was further recorded as 0 to 3 years, >3 to 6 years, >6 to 12 years, and >12 to 18 years. A subgroup analysis of the mode of injury was done using age group and sex.  Results A total of 201 patients were enrolled in the study. The age (mean ± standard deviation [SD]) of the enrolled patients was 12.48 ± 4.71 years. Of the 201 patients enrolled, 146 (72.63%) were males. The mean time since the injury to the reception in the emergency department of the King George's Medical University trauma center (a tertiary care center) was 19.13 ± 33.86 hours. The common mechanisms of injury observed were road traffic accidents (RTAs, 55.22%), falls from height (29.35%), and falls at ground level. There was a significant difference in the mode of injury in the age groups (P = 0.0297) and among males and females (P = 0.0034). Injuries to the lower limbs were most common in all age groups. Conclusions Our study presents the baseline epidemiological data on pediatric musculoskeletal injuries distributed by age groups, gender, mode of injury, site of injury, and region-wise distribution of injuries. The data may be used by policymakers in planning a pediatric trauma care system in India.

Glycopyrrolate-induced polyuria: An unexpected side effect.

Polyuria is urine output exceeding 3 L/d in adults, primarily due to solute and water diuresis. In a hospital setting, mannitol and diuretics commonly lead to polyuria. We have found an interesting association of polyuria with glycopyrrolate; to the best of our knowledge, no case is reported in the literature. Here, we are describing a case of Guillain-Barre Syndrome, which developed polyuria during the hospital stay, which was secondary to glycopyrrolate.

The dynamic role of cohesin in maintaining human genome architecture.

Recent advances in genomic and imaging techniques have revealed the complex manner of organizing billions of base pairs of DNA necessary for maintaining their functionality and ensuring the proper expression of genetic information. The SMC proteins and cohesin complex primarily contribute to forming higher-order chromatin structures, such as chromosomal territories, compartments, topologically associating domains (TADs) and chromatin loops anchored by CCCTC-binding factor (CTCF) protein or other genome organizers. Cohesin plays a fundamental role in chromatin organization, gene expression and regulation. This review aims to describe the current understanding of the dynamic nature of the cohesin-DNA complex and its dependence on cohesin for genome maintenance. We discuss the current 3C technique and numerous bioinformatics pipelines used to comprehend structural genomics and epigenetics focusing on the analysis of Cohesin-centred interactions. We also incorporate our present comprehension of Loop Extrusion (LE) and insights from stochastic modelling.

Enhanced performance of gene expression predictive models with protein-mediated spatial chromatin interactions.

There have been multiple attempts to predict the expression of the genes based on the sequence, epigenetics, and various other factors. To improve those predictions, we have decided to investigate adding protein-specific 3D interactions that play a significant role in the condensation of the chromatin structure in the cell nucleus. To achieve this, we have used the architecture of one of the state-of-the-art algorithms, ExPecto, and investigated the changes in the model metrics upon adding the spatially relevant data. We have used ChIA-PET interactions that are mediated by cohesin (24 cell lines), CTCF (4 cell lines), and RNAPOL2 (4 cell lines). As the output of the study, we have developed the Spatial Gene Expression (SpEx) algorithm that shows statistically significant improvements in most cell lines. We have compared ourselves to the baseline ExPecto model, which obtained a 0.82 Spearman's rank correlation coefficient (SCC) score, and 0.85, which is reported by newer Enformer were able to obtain the average correlation score of 0.83. However, in some cases (e.g. RNAPOL2 on GM12878), our improvement reached 0.04, and in some cases (e.g. RNAPOL2 on H1), we reached an SCC of 0.86.

Comparison of Functional Outcomes of an Anterior Cruciate Ligament (ACL) Reconstruction Using a Peroneus Longus Graft as an Alternative to the Hamstring Tendon Graft.

Background Ever since the arthroscopic reconstruction of the anterior cruciate ligament (ACL) has begun, the use of the peroneus longus (PL) graft for primary ACL reconstruction (ACLR) has never been thought of. There is very little literature on it. Hence, our study aims to compare the functional outcomes, knee stability, donor site morbidity, and assessment of thigh muscle wasting in patients with ACL injury managed by arthroscopic single bundle reconstruction with peroneus longus tendon (PLT) and hamstring tendons (HT), respectively. Methods All adults aged 16-50 years of either gender presenting with symptoms of symptomatic ACL deficiency were admitted for arthroscopic single-bundle ACLR and allocated into two groups (peroneus longus and hamstring tendon). Functional scores (International Knee Documentation Committee (IKDC), Lysholm score), clinical knee evaluation (anterior drawer, Lachman, and pivot shift test), donor site morbidity (American Orthopedic Foot and Ankle Society ankle hindfoot score (AOFAS)), and thigh circumference were recorded preoperatively and at six months and one year postoperatively. The same post-op rehabilitation protocol was followed in both groups. Results One hundred and ninety-four patients (hamstring n = 96, peroneus n = 98) met the inclusion criteria. There were no significant differences between the preoperative, six-month postoperative, and one-year postoperative scores between the hamstring and peroneus longus groups in the IKDC (p=0.356) and Lysholm knee score (p=0.289). The mean for the AOFAS was 99.05 ± 3.56 and 99.80 ± 0.70 in the PLT and HT groups, respectively, showing no statistical difference, with a significant improvement in thigh muscle wasting among the PLT group at final follow-up (p < 0.001). Conclusion We observed similar knee stability and functional outcomes and no obvious donor site morbidity among both groups. These patients also had better responses to physiotherapy in recovering from their thigh muscle wasting. So, we can recommend that a PL graft can be a safe, viable, and effective option for usual arthroscopic single-bundle ACL reconstruction.

Enhanced performance of gene expression predictive models with protein-mediated spatial chromatin interactions.

There have been multiple attempts to predict the expression of the genes based on the sequence, epigenetics, and various other factors. To improve those predictions, we have decided to investigate adding protein-specific 3D interactions that play a major role in the compensation of the chromatin structure in the cell nucleus. To achieve this, we have used the architecture of one of the state-of-the-art algorithms, ExPecto (J. Zhou et al., 2018), and investigated the changes in the model metrics upon adding the spatially relevant data. We have used ChIA-PET interactions that are mediated by cohesin (24 cell lines), CTCF (4 cell lines), and RNAPOL2 (4 cell lines). As the output of the study, we have developed the Spatial Gene Expression (SpEx) algorithm that shows statistically significant improvements in most cell lines.

Early-Stage Liquid Infiltration in Nanoconfinements.

Liquid infiltration is one of the commonly adapted flow mechanisms in microscale/nanoscale heat-transfer applications. The theoretical modeling of dynamic infiltration profile in the microscale/nanoscale requires a deep study, because the acting forces are entirely different from those of a large-scale system. Herein, a model equation is developed from the fundamental force balance at the microscale/nanoscale level, to capture the dynamic infiltration flow profile. Molecular kinetic theory (MKT) is used to predict the dynamic contact angle. Molecular dynamics (MD) simulations are performed to study the capillary infiltration in two different geometries. The infiltration length is computed from the simulation results. The model is also evaluated over surfaces having different surface wettability. The generated model provides a better estimation of the infiltration length, compared to the well-established models. The developed model is expected to aid in the designing of microscale/nanoscale devices where liquid infiltration plays a key role.

Normative cutoffs of muscle mass, muscle strength, and frailty for healthy Indian population.

BACKGROUND: Population-derived cutoffs for low skeletal muscle mass, skeletal muscle strength, and frailty among Indians are lacking. Studies describing sarcopenia and frailty among patients with chronic liver diseases have used cutoffs derived from Caucasian populations giving erroneous results. AIMS: We aimed to derive gender-specific cutoffs for low skeletal muscle mass and skeletal muscle strength from healthy Indians. METHODS: Healthy Indian population consisted of two groups. Group 1 (Gp I) included 242 healthy liver donors and group 2 (Gp II) 272 healthy health care workers. Skeletal muscle index (SMI) was calculated from computed tomography (CT) abdomen performed prior to donor hepatectomy only in Gp I. Liver frailty index (LFI) was computed using the online calculator, after recording hand grip strength (HGS), chair stand-up test (CSUT), and balance test in both groups. HGS was measured using the Smedley handgrip dynamometer. CSUT was noted as time to complete 5 chair stand-ups with subjects' arms folded across the chest. Gender-specific cutoffs of SMI and HGS were derived as <5th percentile of the distribution values and as >95th percentile for CSUT and LFI values. RESULTS: The SMI was measured from Gp I subjects (n=242; 120 males [mean age 31.13] and 122 females [mean age 36.60]). The HGS, CSUT, and LFI were measured in Gp I and Gp II subjects (n=514; 272 males [mean age 34.30] and 242 females [mean age 37.52]). The cutoffs for SMI, HGS, CSUT, and LFI were <27.72 cm2/m2, <25.63 kg, >10 s, and >3.49, respectively for healthy males. The corresponding cutoffs for healthy females were <24.4 cm2/m2, <16.7 kg, > 10 s, and >3.68, respectively. CONCLUSIONS: We derived gender-specific cutoffs for SMI, HGS, CSUT, and LFI from healthy adult Indian population, which can be used to detect sarcopenia and frailty among patients with liver diseases, as well as other conditions.

An echocardiographic evaluation to determine the immediate and short-term changes in biventricular systolic and diastolic functions after PDA device closure-an observational analytical prospective study (echo- PDA study).

OBJECTIVES: -This prospective study with a sizable cohort was undertaken to assess changes in left and right ventricle systolic and diastolic functions after percutaneous patent ductus arteriosus device closure with appropriate follow up evaluation. METHODS: - It is an observational analytical prospective study. Ninety-eight patients were recruited out of which sixty-eight patients underwent percutaneous PDA device closure and were taken for final analysis. The primary objective was to study the left and right ventricular systolic and diastolic functions pre- and post-procedure at 48 h with follow up analysis at six months. RESULTS: - The mean age of the patients was 7.88 ± 5.05 years with the female to male ratio was 3.85:1. Thirty-three (48.52%) of the patients had immediate post PDA device closure LV systolic dysfunction. It was more common in those having pre-procedure mean low LVEF and those having a significant reduction in mitral A velocity. It became normal at six months follow up. The study reported immediate decrease in mea/n LVEF from 63.55 ± 8.11% to 48.19 ± 7.9%. The changes in LVEDD, LVEF, LVFS and LVEDV were statistically significant (p < 0.0001). In diastolic functions, there were significant reductions in peak early and late diastolic velocities. There was no statistically significant difference in right chamber functional assessment. CONCLUSION: Asymptomatic LV systolic and diastolic dysfunction in immediate post PDA closure period is a common complication and reported in around 48.5% cases. It was more common in those having pre-procedure mean low LVEF and those having a significant reduction in mitral A velocity.

Drotaverine-induced priapism.

Drug-induced priapism is well known and papaverine is the most common drug known to cause priapism. Drotaverine, an analog of papaverine, is used extensively to treat Colicky pain. We report the first case of drotaverine.induced priapism.

Intra-operative control of positive vitreous pressure in a graded manner by pars plana sutureless, small gauge trocar-cannula.

BACKGROUND: The purpose of this paper is to delineate a technique of using a 23G, single, sutureless transconjunctival pars plana sclerotomy to facilitate anterior segment surgery in eyes with increased positive vitreous pressure (PVP) ascribe to predisposing or intraoperative factors. METHODS: We have implemented this technique in five eyes when PVP was anticipated before the surgery because of risk factors or it was encountered during anterior segment surgery. Different case scenarios in which PVP occurs during the surgery comprising phacolytic glaucoma, corneal tear repair combined with cataract surgery with IOL in a case with traumatic corneal injury, anterior capsule rupture and secondary glaucoma, Trabeculectomy in case of uveitic glaucoma, routine phacoemulsification cataract surgery with PVP encountered during surgery were addressed by using this technique. RESULTS: The new technique outlined by the authors consists of passing sutureless 23 G trocar cannula which enables controlled and gradual efflux of clear watery fluid, resulting in passive vitreous decompression with minimal risk of vitreous traction and retinal breaks. Once PVP is reduced, anterior segment surgery can be safely completed without risk of developing devastating complications. CONCLUSIONS: This sutureless single port pars plana trocar cannula technique is minimally invasive, safe, effective and fast technique which can cause reduction of PVP intraoperatively in a controlled and graded manner, thereby minimizing complication rates in difficult case scenarios.

Intravitreal moxifloxacin injections in acute post-cataract surgery endophthalmitis: Efficacy and safety.

Purpose: The aim of this study was to evaluate the efficacy and safety of intravitreal moxifloxacin injections in the treatment of acute post-cataract surgery endophthalmitis with visual acuity equal to or greater than hand movements. Methods: Fifty two patients with post-cataract surgery endophthalmitis who presented within 6 weeks with visual acuity equal to or greater than hand movements received two intravitreal moxifloxacin injections 48 h apart. Patients with prior history of ocular disease or treatment were excluded. Patients were followed up to 3 months either for resolution of endophthalmitis or worsening of disease. Number of patients who achieved visual acuity equal to or better than 20/40 and 20/200 at the third-month follow-up visit were compared with the number of patients at presentation, using Chi-square test. In addition, pretreatment LogMAR visual acuity at the time of presentation was compared with posttreatment visual acuity at end of third month using paired t test. Results: Fifty (96.15%) patients showed complete resolution of endophthalmitis while three patients required vitrectomy. Forty-one (78.85%) and 49 (94.23%) patients achieved visual acuity equal to or better than 20/40 and 20/200, respectively, at the third-month follow-up visit as compared to eight (15.38%) and 13 (25%) patients, respectively, at presentation (P < 0.05). In addition, mean LogMAR visual acuity at the time of presentation was 0.755 which improved to 0.307 at the third-month follow-up visit (P < 0.05). None of the patients developed hypersensitivity reactions to intravitreal moxifloxacin. Conclusion: Intravitreal moxifloxacin injections showed promising results in acute post-cataract surgery endophthalmitis.

Point-of-care p24 antigen detection for early infant diagnosis of HIV infection: cross-sectional and longitudinal studies in Zambia.

BACKGROUND: Early infant diagnosis of HIV infection is challenging in sub-Saharan Africa, particularly in rural areas, leading to delays in diagnosis and treatment. Use of a point-of-care test would overcome many challenges. This study evaluated the validity of a novel point-of-care p24 antigen detection test (LYNX) in rural and urban settings in southern Zambia. METHODS: Two studies were conducted: a cross-sectional study from 2014 to 2015 at Macha Hospital (LYNX Hospital study) and a longitudinal study from 2016 to 2018 at 12 health facilities in Southern Province, Zambia (NSEBA study). In both studies, children attending the facilities for early infant diagnosis were enrolled and a blood sample was collected for routine testing at the central lab and immediate on-site testing with the LYNX test. The performance of the LYNX test was measured in comparison to nucleic acid-based testing at the central lab. RESULTS: In the LYNX Hospital study, 210 tests were performed at a median age of 23.5 weeks (IQR: 8.9, 29.0). The sensitivity and specificity of the test were 70.0 and 100.0%, respectively. In the NSEBA study, 2608 tests were performed, including 1305 at birth and 1222 on children ≥4 weeks of age. For samples tested at birth, sensitivity was 13.6% (95% CI: 2.9, 34.9) and specificity was 99.6% (95% CI: 99.1, 99.9). While specificity was high for all ages, sensitivity increased with age and was higher for participants tested at ≥4 weeks of age (80.6%; 95% CI: 67.4, 93.7). Children with positive nucleic acid tests were more likely to be negative by the LYNX test if their mother received antiretroviral therapy during pregnancy (60.7% vs. 24.2%; p = 004). CONCLUSIONS: Considering the high specificity and moderate sensitivity that increased with age, the LYNX test could be of value for early infant diagnosis for infants ≥4 weeks of age, particularly in rural areas where centralized testing leads to long delays. Point-of-care tests with moderate sensitivity and high specificity that are affordable, easy-to-use, and easily implemented and maintained should be developed to expand access to testing and deliver same-day results to infants in areas where it is not feasible to implement nucleic acid-based point-of-care assays.