Swin Transformer and the Unet Architecture to Correct Motion Artifacts in Magnetic Resonance Image Reconstruction.

We present a deep learning-based method that corrects motion artifacts and thus accelerates data acquisition and reconstruction of magnetic resonance images. The novel model, the Motion Artifact Correction by Swin Network (MACS-Net), uses a Swin transformer layer as the fundamental block and the Unet architecture as the neural network backbone. We employ a hierarchical transformer with shifted windows to extract multiscale contextual features during encoding. A new dual upsampling technique is employed to enhance the spatial resolutions of feature maps in the Swin transformer-based decoder layer. A raw magnetic resonance imaging dataset is used for network training and testing; the data contain various motion artifacts with ground truth images of the same subjects. The results were compared to six state-of-the-art MRI image motion correction methods using two types of motions. When motions were brief (within 5 s), the method reduced the average normalized root mean square error (NRMSE) from 45.25% to 17.51%, increased the mean structural similarity index measure (SSIM) from 79.43% to 91.72%, and increased the peak signal-to-noise ratio (PSNR) from 18.24 to 26.57 dB. Similarly, when motions were extended from 5 to 10 s, our approach decreased the average NRMSE from 60.30% to 21.04%, improved the mean SSIM from 33.86% to 90.33%, and increased the PSNR from 15.64 to 24.99 dB. The anatomical structures of the corrected images and the motion-free brain data were similar.

Generation of two iPSC lines (MHHi001-A-12 and MHHi001-A-13) carrying biallelic truncating mutations at the 3'-end of SRCAP using CRISPR/Cas9.

Non-Floating Harbour Syndrome (FLHS) neurodevelopmental disorder (NDD) is a recently described disorder caused by mutations in certain regions of the SRCAP gene. We generated two iPSC lines that contain truncating mutation on both alleles at the 3'-end of SRCAP using CRISPR/Cas9 technology. Both cell lines are pluripotent, differentiate into the 3 germ layers and contain no genomic aberrations or off-target modifications. The cell lines form part of a human disease model to investigate the effects of truncating mutations in different regions of SRCAP.

The effect of smoking on union rates following corrective osteotomies around the knee: A systematic review and meta-analysis.

BACKGROUND: Distal femur osteotomies (DFO) and high tibial osteotomies (HTO), are well-established treatment options for joint preservation in active patients with uni-compartmental osteoarthritis. Optimal outcomes are contingent on adequate preoperative evaluation of patient-specific factors. This systematic review and meta-analysis aims to explore the difference in union rates between smokers and non-smokers following corrective osteotomies around the knee. METHODS: A systematic search of the MEDLINE and EMBASE databases was performed in accordance with the PRISMA guidelines to identify studies reporting smoking status in adults who developed delayed and/or non-union following HTO or DFO. Studies were pooled using a random effect model [Review Manager (RevMan) software, V.5.4] and heterogeneity was estimated using I2. RESULTS: Data for meta-analysis was available for 1,406 osteotomies from 10 studies, performed in patients with mean age ranging from 38-54 years, and 65% were male. The union rate among non-smokers was 97.3% (1100/1131) compared with 89.5% (246/275) among smokers; OR 4.59 [95% CI 1.99 to 10.62], p-value < 0.001. Subgroup analysis revealed that the risk of non-union in smokers after opening wedge osteotomy was almost double (OR 4.8) that of closing wedge osteotomies (OR 2.9). CONCLUSION: Smoking increases the risk of non-union during elective knee osteotomy surgery. Our findings also suggest that smokers have a better chance of achieving union with closing wedge osteotomy compared to open wedge osteotomy.

TB treatment using family members, treatment supporters and self-administered therapies in rural Papua New Guinea.

SETTING: Papua New Guinea (PNG) has one of the world's highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary. OBJECTIVE: To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context. DESIGN: A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019-2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model. RESULTS: Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7-19.3), as were PEC sessions (OR 4.3, 95% CI 2.5-7.2). CONCLUSION: By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals' needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.

LIEU: La Papouasie-Nouvelle-Guinée (PNG) présente l'un des taux d'incidence de TB les plus élevés au monde. Il est difficile pour les patients d'accéder aux soins contre la TB dans les provinces éloignées en raison d'une infrastructure insuffisante et d'un terrain difficile, rendant nécessaire l'utilisation de modèles de prestation variés et ciblés pour le traitement de la tuberculose. OBJECTIF: Évaluer les résultats du traitement en utilisant l'autotraitement, le traitement soutenu par la famille et la thérapie directement observée (DOT) basée sur la communauté avec un accompagnateur de traitement, dans le contexte de la PNG. MÉTHODES: Une analyse rétrospective et descriptive des données collectées de manière routinière auprès de 360 patients dans deux sites entre 2019 et 2020. Tous les patients ont été assignés à un modèle de traitement en fonction des facteurs de risque (adhésion ou abandon) et ont bénéficié d'une éducation et d'un accompagnement des patients, de conseils aux familles et de frais de transport. Les résultats en fin de traitement ont été évalués pour chaque modèle. RÉSULTATS: Les taux de réussite du traitement de la TB sensible aux médicaments (DS-TB) étaient globalement bons: 91,1% pour l'autotraitement, 81,4% pour le traitement soutenu par la famille et 77% pour les patients en DOT. L'autotraitement était fortement associé à des résultats favorables (OR 5,7; IC 95% 1,7­19,3), tout comme les séances d'éducation et d'accompagnement des patients (OR 4,3; IC 95% 2,5­7,2). CONCLUSION: En tenant compte des facteurs de risque lors de la détermination du modèle de prestation de traitement, de bons résultats ont été observés dans les trois groupes. Plusieurs modes d'administration du traitement, adaptés aux besoins et aux facteurs de risque individuels, constituent un modèle de soins réalisable, efficace et centré sur le patient pour les contextes difficiles d'accès et aux ressources limitées.

Procalcitonin versus C-Reactive Protein as a Biomarker for Prediction of Bacterial Infection in Children with Febrile Neutropenia in Acute Leukemia.

Febrile neutropenia (FN) is a frequently occurring treatment-related complication with significant morbidity and mortality for childhood acute leukemia. Early diagnosis and assessment of severity are essential steps for early comprehensive treatment to reduce FN-related morbidity and mortality. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) can be used to assess and predict the bacterial infection in children with febrile neutropenia. The objective of the study was to determine the role of procalcitonin and CRP as a biomarker for prediction of bacterial infection in children with FN in acute leukemia. This prospective observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2020 to July 2021. Total 58 Children with acute leukemia aged 1 to <18 years with FN were analyzed in this study. A proper history and thorough physical examination were carried out. The blood sample was sent for biomarkers (Procalcitonin and CRP) within 24 hours of the onset of FN and other investigations, such as Complete blood count, Blood C/S, Urine R/E and C/S. Metabolic workup (SGPT, Serum Creatinine, Serum Electrolytes, Serum Ca+) was also done in every patient. Stool R/E & C/S, Chest X-ray, Wound swab for C/S were done when the patient presented with diarrhoea, cough, respiratory distress and focal sepsis respectively. In this study, the mean age of the patients was 6.62±4.07 years (1.10-16.0 years) and 34 patients (58.6%) were male. In 65.5% of patients, localizing signs of infection were not identified. Of the 58 patients, 12 patients (20.7%) showed positive blood culture and 2 patients (3.4%) showed positive urine culture. Klebsiella spp (41.0%) was the most frequent organism isolated followed by Acinetobacter (17.0%), Pseudomonas (17.0%) and E. coli (17.0%). The median PCT levels were significantly higher in patients with bacterial infection than patients without bacteremia (26.10µg/l versus 0.78µg/l, p=0.002) and PCT level >2µg/l was significantly associated with bacteremia. The median CRP levels in the bacteremia and without-bacteremia patients were 137.4mg/L and 54.17mg/L, respectively (p=0.036). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.797 (95% CI 0.651-0.943) for PCT and 0.697 (95% CI 0.54-0.855) for CRP in predicting the bacterial infection. PCT and CRP both are useful biomarkers for the prediction of bacteremia, but PCT may be a superior early biomarker as compared to CRP to predict bacterial infection in children with febrile neutropenia in acute leukemia.

Evidence-based review of safe theatre practice during the COVID-19 pandemic beyond personal protective equipment.

INTRODUCTION: COVID-19 remains a threat for a fear of a second pandemic. Emergency orthopaedic operations are still among the most commonly performed procedures with increased risk of transmission of SARS CoV-2 to the patients and the healthcare workers. The aim of this study was to present the evidence available into best practices limiting the spread of COVID-19 in healthcare setting during current and future pandemics. METHODS: A review of the literature was performed in multiple databases (PubMed, the Cochrane Library, Google Scholar, World Health Organization and Centers for Disease Control), using 'COVID-19' with other relevant keywords in different combinations. Owing to the limited and heterogenous evidence available, data were presented in a narrative manner. FINDINGS: From the evidence gathered it was noted that a multimodal approach to minimising pathogen transmission is required. This primarily comprises the wider engineering and administrative controls to reduce the concentration of the pathogen and to separate staff and patients from it. Theatre isolation and traffic control bundling, theatre flow and logistics, ventilation and waste management form a pivotal role in the environmental/engineering controls. Administrative measures include policies for both patients and staff. For patients, isolation and preoperative screening are of utmost value. For staff, testing for COVID-19, risk assessment, redeployment and provision of persona; protective equipment, together with the necessary training are important administrative controls. CONCLUSION: We believe these measures are likely to improve the sustainability of resources and can be carried to elective settings in order to return to some form of normality and help to mitigate the effects of future pandemics.

New TB drugs for the treatment of children and adolescents with rifampicin-resistant TB in Mumbai, India.

SETTING: Médecins Sans Frontières (MSF) clinic in Mumbai, India.OBJECTIVE: To determine the final treatment outcomes, culture conversion and adverse events (AEs) during treatment among children and adolescents (0-19 years) with rifampicin-resistant tuberculosis (RR-TB) who received ambulatory injectable-free treatment, including bedaquiline (BDQ) and/or delamanid (DLM) during September 2014-January 2020.DESIGN: This was a retrospective cohort study based on review of routinely collected programme data.RESULTS: Twenty-four patients were included; the median age was 15.5 years (min-max 3-19) and 15 (63%) were females. None were HIV-coinfected. All had fluoroquinolone resistance. Twelve received treatment, including BDQ and DLM, 11 received DLM and one BDQ. The median exposure to BDQ (n = 13) and DLM (n = 23) was 82 (IQR 80-93) and 82 (IQR 77-96) weeks, respectively. Seventeen (94%) patients with positive culture at baseline (n = 18) had negative culture during treatment; median time for culture-conversion was 7 weeks (IQR 5-11). Twenty-three (96%) had successful treatment outcomes: cured (n = 16) or completed treatment (n = 7); one died. Eleven (46%) had 17 episodes of AEs. Two of 12 serious AEs were associated with new drugs (QTcF >500 ms).CONCLUSION: Based on one of the largest global cohorts of children and adolescents to receive new TB drugs, this study has shown that injectable-free regimens containing BDQ and/or DLM on ambulatory basis were effective and well-tolerated among children and adolescents and should be made routinely accessible to these vulnerable groups.

Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays.

BACKGROUND: Hip fractures remain a major health concern owing to the increasing elderly population and their association with significant morbidity and mortality. The effects of weekend admission on mortality have been studied since the late 1970s. Despite most studies showing that mortality rates are higher for patients admitted on a weekend, the characteristics of the admitted patients have remained unclear. We aim to investigate this 'weekend effect' at our hospital in patients presenting with a hip fracture. METHODS: Patients undergoing acute hip fracture surgery were identified from the local National Hip Fracture Database. Patient demographics, fracture type, co-morbidities and admission blood parameters were examined. The outcome analysed was 30-day mortality. The data were analysed with regard to day of admission, i.e. weekday (Monday to Friday) or weekend (Saturday and Sunday). RESULTS: A total of 894 patients were included. Results demonstrated that 30-day mortality was similar on the weekend compared with the weekday (6.96% versus 10.39%, OR 0.65, 95% CI 0.36-1.14, p = 0.128) for patients who sustained an acute hip fracture. The total number of deaths within 30 days was 85 (69 weekday versus 16 weekend). This remained non-significant after adjusting for several variables: age and sex only (OR = 0.65, 95% CI 0.37-1.16, p = 0.146), age, sex, and care variables (OR = 0.59, 95% CI 0.33-1.06, p = 0.080), age, sex, and blood test results (OR = 0.62, 95% CI 0.35-1.12, p = 0.111), and all covariates (OR = 0.69, 95% CI 0.29-1.62, p = 0.392). In the fully adjusted model, the following variables were independent predictors of mortality: sex (male) (OR = 1.93, 95% CI 1.11-3.35, p = 0.019) and ASA > 2 (OR = 2.6, 95% CI 1.11-6.11, p = 0.028) and age (1.08, 95% CI 1.04-1.13, p < 0.001). CONCLUSION: The evidence for a 'weekend effect' in patients with a hip fracture is absent in this study. However, we have shown other factors that are associated with increased mortality such as increased age, male sex and higher ASA grade. LEVEL OF EVIDENCE: Level 3.

Frequency and Risk Factors of Erectile Dysfunction among Bangladeshi Adult Men with Type 2 Diabetes Mellitus.

Various forms of sexual dysfunction occur in men with diabetes mellitus (DM) including disorders of libido, ejaculatory problems, and erectile dysfunction (ED). This cross sectional study was conducted in a tertiary hospital of Bangladesh from December 2017 to May 2018 to find out the frequency and risk factors of ED in subjects with type 2 DM (T2DM). One hundred fifty (150) consecutive male patients with T2DM attending the Endocrinology outpatient department (OPD) of the hospital during the study period were evaluated for the presence of ED by using the International Index of Erectile Function-5 (IIEF-5) questionnaire; their socio-demographic, anthropometric, and clinical data were also recorded. Glycemic status was assessed by measurement of fasting plasma glucose (FPG) and HbA1c. Morning serum testosterone was measured in all. Among 150 subjects 68(45.3%) had ED; ED was mild in 14.7%, mild to moderate in 18.0%, moderate in 6.0% whereas severe ED was present in 6.7% of the subjects. The subjects with ED had higher mean age, longer duration of DM, higher body mass index (BMI), higher HbA1c, higher FPG, higher serum creatinine, and lower serum testosterone level than those without ED. Study subjects in the higher age group and higher duration of DM had higher frequencies of ED. IIEF-5 score showed significant negative correlation with age, duration of DM, HbA1c, fasting plasma glucose, serum creatinine and significant positive correlation with serum testosterone. In logistic regression analysis, duration of DM and serum testosterone were found be independent predictors of ED. Frequency of ED among Bangladeshi type 2 diabetic males is high; duration of DM and serum testosterone are independent predictors of ED in them.

Synthesis of glycoimmunogen Tn-Thr-PS A1 via hydrazone bond and stability optimization of PS A1 monosaccharide mimics under vaccine development conditions.

Previously, our group constructed several immunogens utilizing oxime linkage to conjugate a T-cell stimulatory zwitterionic polysaccharide PS A1 and tumor associated carbohydrate antigens (TACAs) in acetate buffer. Here, a semi-synthetic immunogen was synthesized using hydrazone conjugation between PS A1 and a glycopeptide hydrazide (α-d-GalNAc-l-Thr-NH-NH2) with an excellent loading in PBS buffer. To get robust immune response, the retention of zwitterionic character of PS A1 under vaccine construction conditions is essential. In this regard, the stability of embedded pyruvate acetal moiety in tetrasaccharide repeating unit of PS A1 can validate the retention of the dual charges. Therefore, rather than utilizing this highly immunogenic PS A1 fully, stability studies were performed with synthetic 1-thiophenyl-4,6-O-pyruvate acetal-d-galactopyranose in varying acetate buffer pHs and time intervals. Furthermore, 1-propyl-d-galactofuranose was synthesized to mimick the d-Galf of PS A1 to examine regioselective hydrazone and oxime formation with α-d-GalNAc-l-Thr-NH-NH2 and α-d-GalNAc-ONH2 moieties respectively.

Contamination and ecological risk assessment of trace elements in sediments of the rivers of Sundarban mangrove forest, Bangladesh.

In this study, total concentrations of 16 trace elements (Al, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Cd, Sb, Hg, Pb, Th and U) in sediments of the rivers of the Sundarban mangrove forest, after the catastrophic oil spill accident in the Sela river of Sundarban, were determined. The overall mean concentrations of V, Cr, Fe and Cd in surface sediments of the Sundarban are remarkably higher than available literature data of those elements. Trace element contamination assessment, using different environmental contamination indices, reveals that As, Sb, Th and U are low to moderately contaminated while Cd is moderately to severely contaminated in the sediments of this area. The multivariate statistical analyses were applied to reveal the origin and behavior of the elements during their transport in the mangrove ecosystem. High Cr, Ni, Cu and As concentrations suggest the risk of potentially adverse biological effects in the ecosystem.

Early performance-based and patient-reported outcomes of a contemporary taper fit bone-conserving short stem femoral component in total hip arthroplasty.

AIMS: The aim of this study was to compare early functional and health related quality of life outcomes (HRQoL) in patients who have undergone total hip arthroplasty (THA) using a bone conserving short stem femoral component and those in whom a conventional length uncemented component was used. Outcome was assessed using a validated performance based outcome instrument as well as patient reported outcome measures (PROMs). PATIENTS AND METHODS: We prospectively analysed 33 patients whose THA involved a contemporary proximally porous coated tapered short stem femoral component and 53 patients with a standard conventional femoral component, at a minimum follow-up of two years. The mean follow-up was 31.4 months (24 to 39). Patients with poor proximal femoral bone quality were excluded. The mean age of the patients was 66.6 years (59 to 77) and the mean body mass index was 30.2 kg/m2 (24.1 to 41.0). Outcome was assessed using the Oxford Hip Score (OHS) and the University College Hospital (UCH) hip score which is a validated performance based instrument. HRQoL was assessed using the EuroQol 5D (EQ-5D). RESULTS: There were no major peri-operative complications. There was no difference in the mean post-operative OHS, EQ-5D or function subscale of the UCH hip scores between the two groups. The mean pre-operative OHS and EQ-5D scores improved significantly (all p < 0.001). The mean functional component of the UCH hip score at final follow-up was 42.5 and 40.6 in the short stem and conventional stem groups, respectively. There was no statistically significant difference between the groups (p = 0.42). A total of seven patients (21.2%) in the short stem group and nine (16.98%) in the conventional group achieved a ceiling effect using the OHS; none did using the function subscale of the UCH hip score. CONCLUSION: The proximally porous coated tapered short stem femoral component achieves comparable short-term functional outcomes when compared with a conventional longer stem uncemented femoral component when THA is undertaken in patients with good bone quality. Cite this article: Bone Joint J 2017;99-B(4 Supple B):49-55.

The assessment of outcome after total knee arthroplasty: are we there yet?

The routine use of patient reported outcome measures (PROMs) in evaluating the outcome after arthroplasty by healthcare organisations reflects a growing recognition of the importance of patients' perspectives in improving treatment. Although widely embraced in the NHS, there are concerns that PROMs are being used beyond their means due to a poor understanding of their limitations. This paper reviews some of the current challenges in using PROMs to evaluate total knee arthroplasty. It highlights alternative methods that have been used to improve the assessment of outcome.

Measuring function after hip and knee surgery: the evidence to support performance-based functional outcome tasks.

Accurate, reproducible outcome measures are essential for the evaluation of any orthopaedic procedure, in both clinical practice and research. Commonly used patient-reported outcome measures (PROMs) have drawbacks such as 'floor' and 'ceiling' effects, limitations of worldwide adaptability and an inability to distinguish pain from function. They are also unable to measure the true outcome of an intervention rather than a patient's perception of that outcome. Performance-based functional outcome tools may address these problems. It is important that both clinicians and researchers are aware of these measures when dealing with high-demand patients, using a new intervention or implant, or testing a new rehabilitation protocol. This article provides an overview of some of the clinically-validated performance-based functional outcome tools used in the assessment of patients undergoing hip and knee surgery.

Does the DVR(®) plate restore bony anatomy following distal radius fractures?

INTRODUCTION: Fractures of the distal radius are common. Malreduced fractures are associated with residual functional deficiency. There has been a trend over the last few years for using fixed angle volar locking plates to surgically stabilise this injury. Our unit uses the DVR(®) plate (DePuy, Warsaw, IN, US). Nevertheless, it is unknown whether the normal bony anatomy is recreated or merely restored to acceptable limits with its usage. The aim of this study was to evaluate the reduction achieved compared with an uninjured population and pre-existing quoted 'normal' values. Furthermore, we wanted to identify the percentage of cases that were reduced to acceptable limits, and determine whether the grade of the surgeon and fracture type was a confounding influence on this reduction. METHODS: A retrospective review of the 3-month postoperative radiography of 48 eligible patients who underwent open reduction and internal fixation of a distal radius fracture with a DVR(®) plate was undertaken. RESULTS: Volar tilt, radial length and inclination were different to quoted normal values (p<0.01). Despite this, these parameters fell within acceptable limits in 46 cases; this was not influenced by fracture type or grade of operating surgeon. CONCLUSIONS: The DVR(®) plate restores the bony anatomy to within acceptable limits in the majority of patients who have sustained a fracture of the distal radius although of all parameters investigated, the widest variability is seen in volar tilt.

Ultrasound guided fine needle aspiration cytology: a sensitive diagnostic tool for diagnosis of intra-abdominal lesions.

Ultrasound guided fine needle aspiration cytology is widely accepted as a safe diagnostic procedure in various neoplastic and non-plastic disorders. This study was conducted to determine the usefulness and diagnostic accuracy of ultrasound guided fine needle aspiration cytology in the diagnosis of intraabdominal lesions. This cross sectional study was conducted in the Department of Radiology and Imaging, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh during the period of June 2007 to June 2009. A total 78 patients with intra abdominal lesions were included in this study. Fifty nine (75.6%) were males and 19 (24.4%) were females. Out of total aspirates 29 (37.2%) were categorized as benign, 41 (52.6%) were malignant and 8 (10.3%) were non-representative, as it contained only blood. Most of the benign lesions were liver abscess 19 (24.4%). A diagnosis of primary malignancy was established in 26 (33.3%) and that of secondary in 15 (19.2%). The results showed a sensitivity of 89.7%. Ultrasound guided fine needle aspiration cytology is a sensitive diagnostic tool in a wide spectrum of intra-abdominal neoplastic and non-neoplastic disorders. It is a simple, safe, rapidand inexpensive technique.

A performance based patient outcome score for active patients following total knee arthroplasty.

OBJECTIVE: The aim of this study was to develop and validate a user friendly performance based knee outcome score for use in active patients undergoing TKA surgery. DESIGN: We prospectively studied a cohort of 50 subjects without any knee symptoms, and 50 patients who underwent TKA for osteoarthritis (OA). The patients were assessed pre- and postoperatively. SF-36 and WOMAC were concurrently administered for comparison. Patients completed seven physical tasks of the finalised outcome instrument which were objectively assessed and scored. RESULTS: The mean functional score was 31.7 in the normal subjects. The mean functional score improved postoperatively from 10.0 to 17.7 (P < 0.001) in the TKA group. Our results confirm that the performance based score has a high test-retest reliability (intra-class correlation coefficient (ICC) of 0.89), internal consistency (Cronbach's alpha 0.84) and construct validity showing expected correlations with relevant components of the WOMAC and SF-36 scores. The responsiveness as measured by the effect size compared favourably with the same relevant components of the SF-36 and WOMAC. CONCLUSIONS: Our performance based knee function score is a reliable dimension specific tool to detect change in musculoskeletal function after TKA. It complements existing self-reported outcome tools in facilitating a comprehensive assessment of patients following TKA.

The radiological assessment of total and unicompartmental knee replacements.

Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure. The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.

Proteinuria is an independent risk factor for ischemic stroke among diabetic patients.

This study was done to assess the relationship between proteinuria and ischemic stroke in subjects with diabetes mellitus, and to determine whether proteinuria is an independent risk factor for stroke. This comparative study was conducted in Mymensingh Medical College Hospital from January 2009 to June 2010. It was done to establish the relationship between proteinuria (Microalbuminuria) and ischemic stroke among diabetic patients. Other risk factors were also assessed. Patients were divided in Group A - diabetic patients with ischemic stroke (n=50) and Group B diabetic patients without stroke (n=50). Mean age of the Group A & B were 60.16±8.33 and 57.19±7.73 years (p=0.068). Mean Blood sugar (2 hours after Break Fast) was 14.68±4.32mmol/L in Group A and 14.75±4.02mmol/L in Group B (p>0.05). Albumin Creatinine ratio was abnormal in 84.0% in Group A and 22.0% in Group A (p=0.001) [Odds ratio (95%CI) = 18.61 (6.78-51.09)]. Logistic regression analysis has also shown that microalbuminuria (ACR) is an independent risk factor for ischemic stroke (p=0.001), [Odds ratio (95%CI) = 19.811(5.915-66.348)]. In diabetic patients increased urinary protein is a risk factor for stroke. Estimation of urinary protein (Microalbuminuria) may be used as a predictor for ischemic stroke in patients with diabetes.

True hermaphrodite - a rare case for hysterectomy.

One apparently healthy male patient reported at the Urology outpatient department, Bangabandhu Sheikh Mujib Medical University, Bangladesh, with the history of cyclical bleeding per urethra. He started bleeding from the age of 10. The bleeding lasted for 2-3 days. He also had cyclical lower abdominal pain, which remained unexplained. Menstruation occurred every 3-4 months. Left testis was normal but there was a separate soft palpable mass from its lower pole. Chromosomal analysis showed translocation of X and Y chromosome 45(t X/Y). Ultrasonography revealed normal kidneys with well-filled urinary bladder that appeared regular in outline. Left testis was normal in size, measuring about 2.73 × 1.72 cm. Its echotexture was finely homogenous with no evidence of collection or mass. There was a multiloculated cystic mass in the right half of scrotum. Right testis was not visualised along the line of descent. Surprisingly, uterus was found to be present and normal in size and anteverted in position. Fluid collection was noted in the uterine cavity. No ovarian outline was noted. FSH level was almost four times the normal level for males (31.74 IU). The LH level was slightly raised (16.17 IU). The testosterone, Estradiol and Prolactin level were within normal male range, being 3.5 microgram/L, 24 pg/L, and 13.54 microgram/L respectively. Semen analysis revealed azoospermia but the amount of semen was normal. After discussion with the patient, a total abdominal hysterectomy with right-sided salpingo-oophorectomy and left salpingectomy was performed under general anaesthesia. True hermaphrodites must be distinguished from a false one, they have both male and female gonadal tissue, false hermaphrodites are unisexual, but their sex organs resemble those of the opposite sex. This particular patient raised great interest because true hermaphrodites are rare. Attempts were made to make his life normal as a male. If he had the opportunity to have easy access to medical treatment, would he be raised as a female? Controversies are paramount. In this patient, subsequent surgery was done by urologists to correct the chordee and the hypospadias. The overall life of this patient is still a dilemma to us. It was a rare case of hysterectomy done, from the gynaecologist's point of view.