Robotic-assisted Total Knee Arthroplasty Technology Provides a Repeatable and Reproducible Method of Assessing Soft Tissue Balance.

Soft-tissue balancing is an important factor in primary total knee arthroplasty (TKA), with 30 to 50% of TKA revisions attributed to technical operative factors including soft-tissue balancing. Robotic-assisted TKA (RATKA) offers opportunities for improved soft-tissue balancing methods. This study aimed to evaluate the repeatability and reproducibility of ligamentous laxity assessments during RATKA using a digital tensioner.Three experienced RATKA surgeons assessed preresection and trialing phases of 12 human cadaveric knees with varying degrees of arthritis. Ligamentous laxity was assessed with manual varus and valgus stresses in extension and flexion, with a digital tensioner providing feedback on the change of laxity displacement. Intraclass correlation coefficient (ICC) analyses were used to determine the repeatability within a single surgeon and reproducibility between the three surgeons.The results showed excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA. Surgeons had excellent repeatability for preresection and trialing assessments, with median ICC values representing excellent reproducibility between surgeons. Surgeons were repeatable within 1 or 1.5 mm for preresection and trialing assessments. On average, the variation within a surgeon was 0.33 ± 0.26 mm during preresection and 0.29 ± 0.28 mm during trialing. When comparing surgeons to each other, they were reproducible within an average of 0.69 ± 0.33 mm for preresection and 0.65 ± 0.31 mm for trialing.This study demonstrated the reliability of robotic-assisted soft-tissue balancing techniques, providing control over ligamentous laxity assessments, and potentially leading to better patient outcomes. The digital tensioner used in this study provided excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA, highlighting the potential benefits of incorporating robotics in TKA procedures.

In Silico and In Vivo Evaluation of Synthesized SCP-2 Inhibiting Compounds on Life Table Parameters of Helicoverpa armigera (Hübner).

For environment-friendly, safe and nonpersistent chemical control of a significant polyphagous insect pest, Helicoverpa armigera, discovery of growth-regulating xenobiotics can offer a sustainable alternative to conventional insecticides. For this purpose, chemically synthesized compounds to inhibit sterol carrier protein (SCP-2) function using in silico and in vivo assays were evaluated to estimate their impact on the survivals and lifetable indices of H. armigera. From nine chemically synthesized compounds, OA-02, OA-06 and OA-09 were selected for this study based on binding poses mimicking cholesterol, a natural substrate of sterol carrier protein and molecular dynamics simulations. In vivo bioassays revealed that all compounds significantly reduced the larval and pupal weight accumulations and stadia lengths. Subsequently, the pupal periods were prolonged upon treatment with higher doses of the selected compounds. Moreover, OA-09 significantly reduced pupation and adult emergence rates as well as the fertility of female moths; however, fecundity remained unaffected, in general. The life table parameters of H. armigera were significantly reduced when treated with OA-09 at higher doses. The population treated with 450 µM of OA-09 had the least net reproductive rates (Ro) and gross reproductive rate (GRR) compared to the control population. The same compound resulted in a declining survival during the early stages of development coupled with reduced larval and pupal durations, and fertility. These results have a significant implication for developing an effective and sustainable chemical treatment against H. armigera infestation.

Atypical haemolytic uraemic syndrome and its treatment: A case report.

Atypical Haemolytic Uraemic Syndrome (aHUS) is considered an uncommon pathology that usually affects young adults and causes acute kidney injury which can further lead to End Stage Renal Disease (ESRD). Here we present the case of a previously healthy young boy who was diagnosed as a case of atypical HUS on renal biopsy in Sheikh Zayed Hospital Lahore. His C3 was low, while ANA and C-ANCA P-ANCA were in normal range; multiple sessions of plasmapheresis were conducted, whereas IV Methylprednisolone was also given during both admissions (the patient had to be readmitted six months later after having been discharged on improvement). After that, his GFR improved along with other laboratory parameters. Rituximab was also offered but the family refused due to affordability issue.

Frequency Of Non-Diabetic Renal Disease In Type 2 Diabetes Mellitus Patients Undergoing Renal Biopsy.

BACKGROUND: Diabetes mellitus has become a major emerging health concern. Its burden, estimated to be 451 million in 2017, has been projected to rise to 693 million by 2045. This will bring a rise in the prevalence of its associated complications. There is a wide spectrum of non-diabetic renal disease (NDRD) known to be present in diabetic patients with variable prevalence. However, the majority of diabetes mellitus (DM) patients with renal disease are yet not biopsied and the diagnosis of diabetic nephropathy (DN) is presumed on clinical grounds. METHODS: It is a retrospective cross-sectional study. We selected a total of 126 cases of renal biopsies with a history of type 2 diabetes mellitus. Demographic data was collected from the medical records and pathology reports while all cases were evaluated by reviewing the archived slides. RESULTS: Patients were categorized into group 1 with isolated NDRD, group 2 showing NDRD mixed with DN and group 3 with isolated DN. Thirty-four (27%) cases had isolated NDRD (group 1), 14 (11%) had NDRD mixed with DN and 78 (62%) patients had isolated DN. NDRD, either alone or in combination with DN, was found to be present in 48 patients with an overall prevalence of 38%. CONCLUSION: Our study concludes that NDRD is frequent in type 2 diabetes mellitus patients. Renal biopsy remains the key diagnostic tool in such cases, providing crucial information for proper management of the underlying pathology.

Bi-allelic Variants in DYNC1I2 Cause Syndromic Microcephaly with Intellectual Disability, Cerebral Malformations, and Dysmorphic Facial Features.

Cargo transport along the cytoplasmic microtubular network is essential for neuronal function, and cytoplasmic dynein-1 is an established molecular motor that is critical for neurogenesis and homeostasis. We performed whole-exome sequencing, homozygosity mapping, and chromosomal microarray studies in five individuals from three independent pedigrees and identified likely-pathogenic variants in DYNC1I2 (Dynein Cytoplasmic 1 Intermediate Chain 2), encoding a component of the cytoplasmic dynein 1 complex. In a consanguineous Pakistani family with three affected individuals presenting with microcephaly, severe intellectual disability, simplification of cerebral gyration, corpus callosum hypoplasia, and dysmorphic facial features, we identified a homozygous splice donor site variant (GenBank: NM_001378.2:c.607+1G>A). We report two additional individuals who have similar neurodevelopmental deficits and craniofacial features and harbor deleterious variants; one individual bears a c.740A>G (p.Tyr247Cys) change in trans with a 374 kb deletion encompassing DYNC1I2, and an unrelated individual harbors the compound-heterozygous variants c.868C>T (p.Gln290∗) and c.740A>G (p.Tyr247Cys). Zebrafish larvae subjected to CRISPR-Cas9 gene disruption or transient suppression of dync1i2a displayed significantly altered craniofacial patterning with concomitant reduction in head size. We monitored cell death and cell cycle progression in dync1i2a zebrafish models and observed significantly increased apoptosis, likely due to prolonged mitosis caused by abnormal spindle morphology, and this finding offers initial insights into the cellular basis of microcephaly. Additionally, complementation studies in zebrafish demonstrate that p.Tyr247Cys attenuates gene function, consistent with protein structural analysis. Our genetic and functional data indicate that DYNC1I2 dysfunction probably causes an autosomal-recessive microcephaly syndrome and highlight further the critical roles of the dynein-1 complex in neurodevelopment.

Colonoscopy Findings: A Single Institution Study from Pakistan.

Introduction Colonoscopy is a diagnostic procedure used not only for screening and assessment but also for therapeutic management of various diseases such as removal of polyps, flat lesions, etc. In this study, we determine various outcomes of colonoscopy done in the gastroenterology unit of Ghulam Muhammad Mahar Medical College and Teaching Hospital in Pakistan. Methods and Materials This retrospective cross-sectional review was carried out at the colonoscopy unit of Ghulam Muhammad Mahar Medical College and Teaching Hospital in Sukkur, Pakistan. Data was gathered from medical records of patients and by calling their physicians if necessary from July 1 to December 31, 2018.  Results In our study, the most common site for colonoscopy was a rectosigmoid colon (37.85%, n=134), almost parallel to the anal canal (37.57%, n=133). Normal colonoscopy was reported in 25.42% (n=90). The most common pathology was hemorrhoids (32.48%, n=115), followed by ulcers (17.79%, n=63). Conclusion Colonoscopic detection of hemorrhoids was the most common finding in colonoscopy. Normal colonoscopy was less compared to other literature, suggesting physicians are carefully screening patients in advising colonoscopies.

Canine Retraction Using a Closed Nickel Titanium Coil Spring and an Elastic Module.

OBJECTIVE: To compare the mean change of tooth movement in canine retraction between elastic module and Ni Ti coil spring. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Orthodontics Department, Armed Forces Institute of Dentistry, Rawalpindi, from May 2015 to January 2016. METHODOLOGY: Thirty-two patients were inducted. After alignment and extraction of maxillary first premolars, canine retraction was started with closed Ni Ti coil spring on one side of the maxillary arch and with active tie back on the other side. The distance between the lateral incisor and the canine was measured on both sides before starting canine retraction. The same measurements were recorded after four weeks of retraction. The difference between pre and post retraction measurements was recorded. The difference in the rate of canine retraction between both modalities was compared using independent sample t-test. RESULTS: The study included 56% females and 43% males. The mean rate of tooth movement in Ni Ti coil group and in the elastomeric module group was 1.1 mm and 0.7 mm in one month, respectively (p=0.05). CONCLUSION: The rate of tooth movement is more rapid with Ni Ti coil spring than with the elastomeric module.

Giant intraabdominal endometrial cyst.

Endometriosis is the condition where endometrium gets implanted and flourishes outside the uterine cavity, most commonly in ovary and on the peritoneum which lines the abdominal cavity and viscera. Endometrial cells in areas outside the uterus are influenced by hormonal changes and respond in a way similar to the endometrium inside the uterus. Symptoms often worsen with the menstrual cycle. We present a case of 50 years old female who presented with gross abdominal distension and abdominal pain over years. CT scan showed a huge intraabdominal cyst of unknown origin which was compressing adjacent structures. Patient underwent a high risk operation and whole cyst weighing 214 kg (471 lbs) was removed along with both ovaries and uterus. Histopathologically, it was reported as endometrial cyst.

Paraganglioma of urinary bladder.

Paraganglioma of the urinary bladder is extremely rare. In this report of a young man, hypertensive crisis and ventricular arrhythmia was provoked during cystoscopic evaluation of a bladder mass. A diagnosis of pheochromocytoma was considered following detection of high serum and urinary catecholamine levels. A preoperative meta-iodobenzylguanidine scan was, however, negative. The bladder mass was surgically removed following initiation of antihypertensive therapy. Pathological confirmation of extraadrenal pheochromocytoma was established. During a serial follow-up, serum and urine catecholamine levels were persistently elevated. This was explained by abnormalities on fluorodeoxyglucose positron emission tomography scan, which were considered to represent a metastatic malignant neuroendocrine tumour. The patient is on palliative chemotherapy for malignant paraganglioma. This case highlights variable presentation of pheochromocytoma, importance of having a high index of clinical suspicion for early recognition and prompt management and serious adverse consequence of a delayed diagnosis.

Falciparum--the masquerader.

The case of a 23-year-old male presenting with a rash on the chest and lower limbs is presented. Work up revealed bicytopenia and plasmodium falciparum on bone marrow biopsy. Treatment with antimalarial drugs resulted in resolution of haematological abnormalities and rash.

Immunoglobulin and T-cell receptor gene-gene rearrangement in pleural cavity-based T-cell rich B-cell lymphoma in an immunocompetent patient.

Body cavity-based lymphomas are fluid-based lymphomas that are not associated with a tumor mass or adenopathy which could explain the origin of the lymphomatous effusion. A distinct lymphoma that grows in the body cavity as a lymphomatous effusion in the absence of a tumor mass has been identified as a primary effusion lymphoma. This almost exclusively occurs in patients with acquired immunodeficiency syndrome (AIDS), who invariably have a history of Kaposi sarcoma. We report a rare case of a recurrent pleural effusion in an immunocompetent patient. There was no evidence of lymphadenopathy or an associated mass on computerized tomography of the chest, abdomen and pelvis. Serology for HIV, HHS-8, EBV and HTLV-1 were negative. Cytologic examination of the pleural fluid showed an elevated white cell count with 97% lymphocytes, mostly with T-cell markers. Bone marrow aspirate and biopsy were negative and bronchoscopy was unrevealing. Pleural biopsy was significant for >70% T-lymphocytes and some large atypical cells. Which had CD19, CD20 and weak bcl-2 positivity. Kappa and lambda light chains did not show distinct clonality. A preliminary diagnosis of T-cell rich B-cell lymphoma (TCRBCL) of the pleural cavity was made. The diagnosis was confirmed with DNA studies done on the pleural biopsy specimen using PCR and southern blot. Dual rearrangement of Ig heavy chain region and TCR-beta genes were identified. The patient responded to combination chemotherapy with cyclophosphamide, adriamycin, vincristine and prednisone. Our case is the first known case of pleural cavity-based TCRBCL and illustrates the role of gene rearrangement studies in such patients.

The recurrent neurotrophic buttock ulcer in the meningomyelocele paraplegic: a sensate flap solution.

A large percentage of meningomyelocele paraplegic patients have a distal zone of sensation-bearing skin on their thighs. This sensate skin can be used as a fasciocutaneous flap to resurface a recidivistic ulcer after excision. In this study, because the transposition distance was significant, the flap length-width ratio was greater than normal and, therefore, required a 3-week elevation delay. This also permitted appraisal of the sensate flap after the first stage. The wound-healing was excellent after both stages. This reconstructive procedure was completed in four patients, with an average follow-up period of 13 years. These patients remain chronic sitters in administrative jobs and have been pressure sore-free after flap repair.