Bromocriptine therapy: Review of mechanism of action, safety and tolerability.

Bromocriptine is a sympatholytic dopamine D2 receptor agonist with remarkable bioactivities. It has been used clinically as a prescription drug for more than 30 years to treat hyperprolactinemia associated conditions, Parkinson's disease, acromegaly, prolactinomas and other pituitary hormone dependent adenomas and recently, diabetes mellitus as well as various other disorders. Long-term treatment with bromocriptine has minimal or no harmful effects on renal, hepatic, cardiac or hematologic functions. This review article was planned to study the hypothetical and proposed mechanism of action as well as provide a brief discussion about its safety issues and tolerability. Bromocriptine represents an attractive option with high efficacy and safety profile for hyperprolactinemia-associated conditions, acromegaly, parkinsonism, type 2 diabetes mellitus and various other diseases in a variety of dosage forms for best possible beneficial effects. It appeared to be an effective and safe addition to the pharmacopoeia of drugs for the treatment of a vast variety of diseases as monotherapy or in combination with other drugs.

Inter-Parental Conflict's Persistent Effects on Adolescent Psychological Distress, Adjustment Issues, and Suicidal Ideation During the COVID-19 Lockdown.

The current study sought to ascertain the impact of inter-parent conflicts on teenage psychological distress, social and academic adjustment and examine the suicide ideation during the COVID-19. The results found to be alarming as 22% of the individuals displayed suicidal tendencies, with 9% having attempted suicide once, 4.6% having tried suicide twice, and 11% stating that they were likely to do so again. Therefore, the media and the government might host awareness programs and counseling initiatives to promote mental health and prevent suicidal behavior. Moreover, parents may be educated on community level, about the effect of inter-parental arguments on the mental health of their children.

Thermo-catalytic decomposition of polystyrene waste: Comparative analysis using different kinetic models.

Due to a huge increase in polymer production, a tremendous increase in municipal solid waste is observed. Every year the existing landfills for disposal of waste polymers decrease and the effective recycling techniques for waste polymers are getting more and more important. In this work pyrolysis of waste polystyrene was performed in the presence of a laboratory synthesized copper oxide. The samples were pyrolyzed at different heating rates that is, 5°Cmin-1, 10°Cmin-1, 15°Cmin-1 and 20°Cmin-1 in a thermogravimetric analyzer in inert atmosphere using nitrogen. Thermogravimetric data were interpreted using various model fitting (Coats-Redfern) and model free methods (Ozawa-Flynn-Wall, Kissinger-Akahira-Sunose and Friedman). Thermodynamic parameters for the reaction were also determined. The activation energy calculated applying Coats-Redfern, Ozawa-Flynn-Wall, Kissinger-Akahira-Sunose and Friedman models were found in the ranges 105-148.48 kJmol-1, 99.41-140.52 kJmol-1, 103.67-149.15 kJmol-1 and 99.93-141.25 kJmol-1, respectively. The lowest activation energy for polystyrene degradation in the presence of copper oxide indicates the suitability of catalyst for the decomposition reaction to take place at lower temperature. Moreover, the obtained kinetics and thermodynamic parameters would be very helpful in determining the reaction mechanism of the solid waste in a real system.

Detoxification of photo-catalytically treated 2-chlorophenol: optimization through response surface methodology.

The present study was conducted to degrade and detoxify 2-chlorophenol (2-CP) under UV irradiation in the presence of titanium dioxide (TiO2) and hydrogen peroxide (H2O2). The treatment efficiency was evaluated on the basis of degradation and cytotoxicity reduction as well as biochemical oxygen demand (BOD), chemical oxygen demand (COD) and total organic carbon (TOC) removal. The process variables such as TiO2, pH, UV irradiation time and H2O2 were optimized. Central composite design in combination with response surface methodology was employed to optimize the process variables. A quadratic model was proposed to predict the treatment efficiency and analysis of variance was used to determine the significance of the variables. The correlation between the experimental and predicted degradation was confirmed by the F and P values (<0.05). The coefficient of determination (R2 = 0.99) were high enough to support the validity of developed model. At optimized conditions, up to 92% degradation of 2-CP was achieved with 3.5 × 10-4 s-1 rate constant. Significant reductions in BOD, COD and TOC values were also achieved. Cytotoxicity was evaluated using bioassays and it was observed that UV/TiO2/H2O2 reduced the cytotoxicity considerably. It is concluded that UV/TiO2/H2O2 could possibly be used to detoxify 2-CP in industrial wastewater.

Nickel adsorption onto polyurethane ethylene and vinyl acetate sorbents.

The present study was conducted to appraise the efficiencies of polyurethane ethylene sorbent (PES) and vinyl acetate sorbent (VAS) for nickel (Ni) adsorption. Process variables, i.e. Ni(II) ions initial concentration, pH, contact time and adsorbent dosage were optimized by response surface methodology (RSM) approach. The Ni(II) adsorption was fitted to the kinetic models (pseudo-first-order and pseudo-second-order) and adsorption isotherms (Freundlich and Langmuir). At optimum conditions of process variables, 171.99 mg/g (64.7%) and 388.08 mg/g (92.7%) Ni(II) was adsorbed onto PES and VAS, respectively. The RSM analysis revealed that maximum Ni(II) adsorption can be achieved at 299 mg/L Ni(II) ions initial concentration, 4.5 pH, 934 min contact time and 1.3 g adsorbent dosage levels for PES, whereas the optimum values for VAS were found to be 402 mg/L Ni(II) ions initial concentration, 4.6 pH, 881 min contact time and 1.2 g adsorbent dosage, respectively. The -OH and -C = O- were involved in the Ni(II) adsorption onto PES and VAS adsorbents. At optimum levels, up to 53.67% and 80.0% Ni(II) was removed from chemical industry wastewater using PES and VAS, respectively, which suggest that PES and VAS could possibly be used for Ni(II) adsorption from industrial wastewater.

Isolated Talonavicular Joint Tuberculosis in a Child - Rare Location of Koch's Bacillus: A Case Report.

Tuberculosis of the foot is an uncommon entity and the reported incidence is 0.1% to 0.3%. The isolated tuberculosis of talonavicular joint is exceptionally rare. In tuberculosis of the foot and ankle, the presentation is usually nonspecific. The diagnosis of tuberculosis affecting foot is difficult, especially when it is isolated. In doubtful cases, diagnosis should be confirmed by histopathological examination. Unlike pulmonary Kochs, osteoarticular tuberculosis should be treated with antituberculous drugs for a longer duration, preferably for 18 months. We are reporting a case of a 9-year-old boy with tuberculosis of the isolated talonavicular joint and the diagnosis was suggested on plain radiography, which was further confirmed by histopathological examination. He was treated with first-line antitubercular drugs. A good recovery was seen following the commencement of anti-tuberculosis treatment. After two years of follow-up, he was pain-free and doing all of his routine activities. In tuberculosis of the foot, diagnosis is usually delayed or missed due to vague presentation.

Inferior glenohumeral joint dislocation with greater tuberosity avulsion.

Inferior glenohumeral dislocation is the least common type of glenohumeral dislocations. It may be associated with fractures of the adjacent bones and neurovascular compromise. It should be treated immediately by close reduction. The associated neuropraxia usually recovers with time. Traction-counter traction method is commonly used for reduction followed by immobilization of the shoulder for three weeks. Here, we report a case of inferior glenohumeral joint dislocation with greater tuberosity fracture with transient neurovascular compromise and present a brief review of the literature.

Management of Idiopathic Clubfoot by Ponseti Technique in Children Presenting After One Year of Age.

We conducted a study to determine the effectiveness of the Ponseti technique in the management of idiopathic congenital clubfoot in patients older than 1 year of age. A total of 19 patients with 28 clubfeet (16 males [84.2%], 3 females [15.8%]) were included in the present study. The mean age at presentation was 2.7 (range 1 to 3.5) years. The results of treatment using the Ponseti technique were evaluated using the Pirani and Dimeglio scoring systems. The mean precorrection total Pirani score was 4.84 (range 3.5 to 5.5) and the mean precorrection Dimeglio score was 12.96 (range 10 to 14). The mean postcorrection total Pirani score was 0.55 (range 0 to 1), and the mean postcorrection Dimeglio score was 2.32 (range 2 to 3). These differences were statistically significant (p < .001 and p < .001, respectively). In 92.8% of the feet, satisfactory correction of the deformity was achieved. The mean number of casts applied was 8 (range 5 to 12). All but 1 (3.6%) of the clubfeet required tenotomy to achieve correction. The mean follow-up duration was 2.7 (range 1.5 to 3.5) years. We have concluded that the Ponseti technique is an effective method for the management of idiopathic congenital clubfoot, even in toddlers.

Multiple volar dislocations of the carpometacarpal joints with an associated fracture of the first metacarpal base.

Multiple volar dislocations of carpometacarpal (CMC) joints are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clinical examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His radiographs of the hand showed volar dislocation of the second, third and fourth CMC joints in association with an extra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up.

Does early stable fixation reduce complications in paediatric femoral neck fractures?

The primary objective of this study was to juxtapose the union rate and incidence of complications in paediatric patients presenting early (≤ 7 days) following injury with children presenting later (> 7 days) with femoral neck fractures. This critical appraisal evaluated 15 patients according to their timing of presentation and surgery from the initial day of injury (Group A: operated ≤ 7 days or Group B: > 7 days of injury). Patients with traumatic femoral neck fractures with Delbet 1 to 4 subtypes who were skeletally immature (age ≤ 16 years) were included in the study. Pathological fractures and post-infective fractures were not included. Each patient's secondary loss of reduction was calculated by measuring the Neck shaft angle (NSA) on the immediate post-operative radiograph and at the union. A change in NSA of ≥ 5 degrees was considered a significant loss of reduction. Ratliff's Criteria was used to analyze the final result, and a thorough record of complications was kept. There were no significant variations in the two groups' with respect to distributions of age, sex, injury mechanism, or fracture pattern. The most frequent injury culprit in both groups was falling from a height. Type II fracture pattern (54.54%) was more common in group A, while Type III and Type II fracture pattern was equally distributed in group B. In group A, the mean operation time was 55 ± 8.25 minutes, whereas in group B, it was 65 ± 15 minutes (p-value > 0.05). In group A, 90.9% of patients underwent CCS fixation, and in group B, 75% underwent fixation by CCS. The quality of reduction in post-operative radiographs was anatomical in 10 (90.9%) patients and unacceptable in 1 (9.1%) patient. In group B, 2 (50%) patients had an anatomical reduction, while 2 (50%) patients had an unacceptable reduction. Timing of reduction and its association with complications showed that early stable reduction and fixation decrease the occurrence of complications in femoral neck fractures (p-value = 0.033). Fracture union was seen in all our patients in both groups and none of our patients underwent non-union. The mean union time was 11.11 ± 7.06 weeks in group A and 16.5 ± 2.59 weeks in group B (p-value = 0.0189). In group A, only 1 (9.1%) patient developed coxa vara. In group B, out of 4 patients, the femoral head of one patient underwent avascular necrosis, one patient exhibited coxa vara, and 1 patient developed premature physeal closure with limb length inequality. Management of femoral neck fractures in children is challenging because of the paediatric bone's peculiar anatomic and physiological considerations. In our study, patients operated within 7 days developed fewer complications as compared to patients who were operated after 7 days, which was statistically significant. Although AVN is a frequent adverse consequence of pediatric femoral neck fractures, early reduction and stable fixation lowers AVN rates, as observed in our study. Our short-term functional and radiological results using the Ratliff scoring system were comparable to previous studies owing to stable anatomic reduction. Based on our findings and the existing literature, we emphasize long-term follow-up and recommend an early stable anatomic reduction in the treatment of paediatric femoral neck fractures.

Fabrication of CMC/PVA/Dextrin-Based Polymeric Membrane for Controlled Release of Cefixime With Enhanced Antibacterial Activity.

This study focuses on the investigation of the significance of polymers in drug delivery approaches. The carboxymethyl cellulose (CMC), polyvinyl alcohol (PVA) and dextrin-based hydrogel membrane were prepared and employed for the sustained release of third-generation oral antibiotic (cefixime). Different proportions of CMC, PVA and dextrin were blended and hydrogel membranes were fabricated via solvent casting method. The prepared membrane was characterized by FTIR, SEM, UV-visible, TGA and swelling analysis. Cefixime drug was incorporated in the CMC/PVA/dextrin matrix and drug release was investigated. The sustained release of the tested drug (cefixime) was investigated and the drug was released in 120 min in the phosphate-buffered saline (PBS) solution. The antibacterial activity of the prepared membrane was promising against Proteus vulgaris, salmonella typhi, Escherichia coli and Bacillus subtilis strains. The swelling capabilities, thermal stability and non-toxic nature of the prepared CMC/PVA/dextrin membrane could have potential applications for cefixime drug in delivery in a controlled way for the treatment of infectious diseases.

Tibial Tuberosity Avulsion Fracture with Epiphyseal Injury in a Soccer Player: Treatment Options and Challenges.

Introduction: Acute avulsion of the tibial tubercle is an uncommon fracture, with reported incidence rates of 0.4-2.7% of all epiphyseal injuries and <1% of all physeal injuries. Typically, these fractures present with marked displacement of the entire proximal apophysis, with or without intra-articular extension, and variable associated soft-tissue injury. The Ogden classification has historically directed both non-operative and operative treatment of this injury. The overarching objective of several fracture fixation techniques has been outlined as being to restore the joint surface and the extensor mechanism. Case Report: This case report describes the management of a 14-year-old male who sustained a rare avulsion fracture of the left tibial tuberosity with epiphyseal injury during a soccer game. The fracture was classified as Ogden Type III-B, indicating an intra-articular extension. The patient underwent open reduction and internal fixation with three cannulated screws and tension band wiring. Conclusion: The fracture united with no residual deformity and return of full range of motion. Tension band wiring provides stable reduction; hence, prompt diagnosis and appropriate surgical intervention in similar cases is important to optimize outcomes.

Management of post-traumatic ankle deformities in children.

The objective of this clinical appraisal was to assess the clinical-radiological results of ankle deformity correction secondary to physeal injury, utilizing the methods based on the age of the child, site & severity of the deformity, remaining growth potential, condition of the soft tissue envelop and integrity of neurovascular status. Fifteen subjects ≤ 16 years of age, with angular deformities of the ankle secondary to physeal injury, were included. Deformities secondary to infection and pathological fractures were excluded. Demographic data, type of injury, treatment method, and follow-up were recorded from the case files. Treatment categories included osteotomies for acute correction (> 10 years) and growth modulation (≤ 10 years). Male to female ratio was 7:8, with an average age of 11.8 ± 2.31 years (range 9-16 years). The right and left ratio was 7:8. Mean duration of follow-up was 1 year and 4 months. Gradual deformity correction was done in 2 cases utilizing the principle of growth modulation, while acute correction by osteotomy was done in 13 cases. The average pre-operative ankle deformity was 20.8 ± 3.11 degrees (Range -25 to 24 degrees). Radiological union was attained at a mean of 11 weeks (8-24). Nine patients achieved neutral ankle alignment. The mean residual varus was 2.3°, and the valgus was 4°. There was a statistically significant improvement of the AOFAS score by 17 points from a mean pre-operative score of 57 (44-84) to 74 (56-100) points at the final follow-up (p-value < 0.001). The average pre-operative shortening was 2.36 ± 0.21 cm, which was completely corrected in 9 individuals. Management of angular deformities around the ankle calls attention to correcting the resultant angular deformity and/or limb length disparity, utilizing acute or gradual correction. A successful outcome depends on early recognition and patient-specific treatment of paediatric ankle fracture patterns. Correlating the results of our study with the available literature, we feel that both acute or gradual correction for angular deformities around the ankle is a feasible solution as long as principles of deformity correction are adhered to. Techniques for salvaging and restoring the viability of injured physeal plate warrant additional research.

Efficient drug delivery potential and antimicrobial activity of biocompatible hydrogels of dextrin/Na-alginate/PVA.

Ceftriaxone sodium belongs to the third-generation cephalosporin group and is used intramuscular and intravenous route as a broad-spectrum antibiotic. This research aims to prepare biocompatible hydrogels for targeted delivery of ceftriaxone sodium by parental route. Different proportions of polymers (natural and synthetic) in the presence of cross-linker were synthesized by solvent casting method. Ceftriaxone sodium was loaded in hydrogels in different concentrations and its drug release behavior was evaluated along with swelling and biodegradation analysis. The characterization of hydrogel was done by scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) to analyze surface morphology and functional groups involved in the formation of dextrin/Na-alginate/PVA hydrogels loaded with the drug. Thermogravimetric analysis (TGA) was confirmed by thermal stability and degradation pattern of loaded and unloaded hydrogels. The drug-loaded samples presented promising antimicrobial activity against S. aureus and P. multocida and their cytotoxic nature was also studied. Drug release analysis using simulated intestinal fluid (SIF) and phosphate buffer saline(PBS) for the circulatory system shows the consistent release of the drug. The findings unveiled the development of a biocompatible and innovative hydrogel, which has potential advantages for biomedical application, particularly in enhancing the therapeutic efficacy of ceftriaxone sodium drug.

Volar dislocation of second, third, and fourth carpometacarpal joints: a rare and easily missed diagnosis.

Volar carpometacarpal dislocation is a rare form of hand injury that can be easily missed without applying a high level of suspicion and performing a meticulous examination. In this case report, we present a rare case of compound volar dislocation of the second, third, and fourth carpometacarpal joints in a 40-year-old male. This was managed by closed reduction and the use of a mini external fixator. The patient regained a good range of motion in 6 weeks with no pain. It is important to diagnose and treat this injury in order to avoid the considerable morbidity associated with this condition.

Outcomes of BDSF technique for osteosynthesis of femoral neck fractures.

INTRODUCTION: Femoral neck fractures present a significant challenge for orthopedic surgeons, especially in young patients who want to preserve their natural femoral head. Conventional methods for fixing these fractures often lead to poor outcomes and high complication rates. The Biplane Double-supported Screw Fixation (BDSF) technique is a novel approach that involves placing screws in two planes simultaneously, creating a two-point support for the screws in the neck and head of the femur. METHODS: This study aimed to evaluate the effectiveness of the BDSF technique in treating femoral neck fractures in patients aged 20-60 years. A total of 28 patients with fresh femoral neck fractures (less than three weeks old) were treated with closed reduction and internal fixation using the BDSF method. The patients' functional outcomes were evaluated using the Harris hip score, and the radiographic outcomes of union, femoral neck shortening, screw back-out, and femoral head avascular necrosis (AVN) were also evaluated. RESULTS: The results showed that the BDSF technique is a safe and effective method for treating femoral neck fractures in young adults. Out of the 25 patients who were followed up for a mean time of 18 months (range 6-24 months), 20 (80%) achieved fracture union in a mean time of 5.2 months. Non-union occurred in five patients (20%), and AVN of the femoral head was observed in three patients (12%). Two patients experienced varus collapse, but their fractures united successfully. CONCLUSION: The BDSF technique offers several advantages over conventional methods, including increased stability and improved fixation strength. It can be considered as an alternative to conventional methods for managing femoral neck fractures in young adults, with a low incidence of non-union and avascular necrosis and no cases of fixation failure or varus collapse.

Bilateral Distal Humeral Physeal Separation-From Birth Trauma to Family Trauma.

Introduction: Chondro-epiphyseal separation of the distal humerus is a rare injury, which can occur as a consequence of excessive traction on the upper extremity accompanying a dystocic birth or one complicated by cephalopelvic disproportion. Such fracture patterns can also result from a combination of rotatory and shear forces, also typically seen following child abuse. It can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. Since unossified cartilage cannot be seen radiographically, these injuries are better appreciated by ultrasound or magnetic resonance imaging. Case Report: We present a case of an 8-day-old neonate who presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow joint was identified on the radiograph. On ultrasound, a trans-physical supracondylar distal humerus fracture was identified. This was presumed as trauma secondary to a difficult delivery. At the 11th week of follow-up, the patient presented with a fracture of the right proximal tibia, followed by a fracture shaft left femur at 5 months of follow-up. Chest X-ray at this time revealed uniting rib fractures with callus formation. After ruling out any congenital collagen disorder (osteogenesis imperfecta), the patient was diagnosed with a case of battered baby syndrome. The case was reported to child protection services and parents were questioned and counseled for the same. Conclusion: This case report highlights the importance of a high degree of suspicion of child abuse in any child with a rare fracture pattern, uncommon serial fracture occurrence, and unconventional clinic-radiological presentation.

Chondrosarcoma of Great Toe: A Case Report.

Introduction: Chondrosarcoma (CHS) of the toes is very rare and the involvement of phalanges is extremely rare. The osteolytic destruction of this tumor severely affects limb function and carries the risk of distant metastasis. These tumors are removed surgically to minimize local recurrence and distant metastases, maximize limb function with better prognosis. The main objective of this report is to present the case of a CHS that invaded the phalanx of the left great toe and formed a large phalangeal mass with osteolytic destruction of the distal bone. Case Report: This case report includes a 60-year-old man suffering from swelling of his left great toe for 2 years, with pain and swelling for 6 months. Serial hematological, radiological and tumor investigations were done. Magnetic resonance imaging revealed a well-defined peripherally enhancing multilobulated soft-tissue mass with central necrotic component involving the entire proximal phalanx of left great toe extending to distal phalanx and head of first metatarsal. The patient was planned for operative intervention due to the possibility of invasion into the adjacent bones. The tumor was excised and sent for histopathological examination, which was reported as Grade 2 CHS (PT, Nx, and Mx) and was S100 positive. The patient has been followed-up for 5 months. Results: There were no signs of local recurrence or distant metastasis on radiological investigations or clinical assessment during follow-ups. Conclusion: CHS occurring in toes is extremely rare. In this case, extensive surgical resection of the large low-grade CHS was safe and effective.

Short versus long proximal femoral nail in the management of intertrochanteric fractures - a comparative study.

INTRODUCTION: Intertrochanteric fractures are those that occur in the region spanning from the extracapsular basilar neck region to the region along the lesser trochanter proximal to the development of medullary canal. Low-energy falls account for 90% of fractures in people over the age of 50, with females having a higher prevalence. Intertrochanteric fractures in children and teenagers are caused by high-energy trauma. The aim of this study was to compare the functional and radiological outcomes as well as complications of intertrochanteric fractures treated with long proximal femoral nail (PFN) versus short proximal femoral nails. METHODS: The study was a clinical randomized prospective comparative study which included 30 (2 groups of 15 patients each, being treated with short and long PFNs respectively) skeletally mature patients with fresh (less than 3 weeks old) intertrochanteric fractures of femur AO/OTA 31-A1, AO/OTA 31-A2 or AO/OTA 31-A3 as per AO/OTA classification. Harris Hip score was used to compare the functional outcomes. RESULTS: The average age of patients in short PFN group (Group A) was 62.1 ± 15.77 years and in long PFN group (Group B), it was 54.1 ± 10.8 years. Male-female ratio in the study was 1.7:1. AO31A2 of AO fracture classification was the most common type of fracture in both the groups. The mean injury to surgery interval in Group A was 9.6 ± 4.45 days and in Group B, it was 6 ± 4.12 days. The mean operative duration in Group A was 68.6 ± 6.62 minutes and in Group B, it was 78.6 ± 7.35 minutes. The average time of union in Group A was 15.69 ± 2.72 weeks while that of Group B was 15.77 ± 2.05 weeks. The average Harris Hip score at final follow up in Group A was 81.0 ± 11.62 and in Group B, it was 80.3 ± 10.83. There was 1 case of implant failure in each group, which were re-operated. One case of screw back-out in Group A led to a varus collapse and had to be reoperated. One case of non-union was reported in Group B. One case of superficial wound infection was reported in each group. CONCLUSION: The Proximal Femur Nail can be used as an efficient implant to manage per trochanteric fractures regardless of the length of the implant. However, the mean operative time was found to be lower when a short nail is used.