Association between nutritional scores and multilevel vertebral involvement in tubercular spine: a retrospective cohort study.

OBJECTIVE: The objective of this study is to evaluate the prognostic value of nutritional scores comprising the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI), in prediction of multilevel vertebral involvement (> 2 vertebra) in Spinal Tuberculosis (STB). METHODS: Retrospective analysis of 39 STB patients was conducted to assess nutritional indices (CONUT and PNI) and the numbers of vertebral affection. Spearman's correlation was used to examine the association between these variables. Receiver Operating Characteristic (ROC) curves were utilized to determine optimal cutoff values, with Area Under the Curve (AUROC) evaluation. Additionally, multiple logistic regression was performed as a predictive model. RESULTS: There were 24 males and 15 females, with a mean BMI of 18.88 kg/m² (± 1.37). Spearman's correlation analysis revealed negative correlations between BMI, PNI (rho - 0.68, p < 0.001) and multilevel vertebra involvement, while ESR (rho 0.83, p < 0.001), CRP (rho 0.81, p < 0.001), and CONUT score (rho 0.83, p < 0.001) positively correlated with multilevel vertebral affection (> 2 vertebra). Age and comorbidities showed no correlation with the level of vertebral affection. ROC analysis revealed a CONUT Score ≥ 3 cutoff (sensitivity-95.7%, specificity-87.5%) and PNI ≤ 38.605 (sensitivity-78.3%, specificity-93.8%) for predicting multilevel STB (> 2). PNI exhibited superior specificity and positive predictive value where as CONUT score was a better parameter for sensitivity, negative predictive value and diagnostic accuracy. Both CONUT score and PNI were significant predictors of vertebral involvement in univariate analysis, with multivariate analysis identifying CONUT score as the sole predictor of multilevel vertebral affection. CONCLUSION: Nutritional scores, including CONUT score and PNI, emerged as significant predictors of multilevel STB. CONUT score displayed superior sensitivity, negative predictive value, and overall diagnostic accuracy, while PNI served as a nutritional marker with high specificity and positive predictive value in predicting multilevel involvement in spinal tuberculosis.

Identification and characterization of two new oxidation degradation impurities in cinnarizine through LC-HRMS/MS and 1H NMR, along with in silico toxicity predictions of its degradation products.

Cinnarizine (CIN) drug substance is a US FDA and EMA approved antihistaminic drug, There is no report available on CIN for the identification of degradation products and their degradation pathway. Herein, we report a stability-indicating assay method for CIN, the formation and characterization of its major degradation products using LC-HRMS/MS and 1H-NMR techniques. CIN was subjected to oxidation, acid, base, thermal and photolytic degradation conditions. Two unknown degradation products (DP-1 and DP-2) of CIN were formed under oxidative conditions. We successfully separated these degradants using gradient elution on an Inertsil ODS 3 V column (150 × 4.6 mm, 5 µm) using mobile phase A consisting of 0.1% formic acid and the mobile phase B consisting of 0.1% formic acid/acetonitrile (20/80, v/v). CIN was labile to oxidative conditions and stable to acidic, alkaline hydrolytic, photolytic and thermal conditions. The degradation pathways were derived from the nature of the product formed under oxidative degradation conditions and available reports for confirmation of the mechanism. Since the stability-indicating assay method can be utilized for stability studies and routine quality control of CIN in both the pharmaceutical industry and research laboratories. This method has been validated in compliance with the guidelines set forth by the ICH.

Joint awareness among total hip arthroplasty patients operated through anterior approach versus posterior approach: a systematic review and meta-analysis.

PURPOSE: The aim of this systematic review and meta-analysis was to compare joint awareness in patients who underwent total hip arthroplasty (THA) via the anterior approach (AA) versus the posterior approach (PA). The hypothesis was that patients who underwent THA via AA would have better forgetfulness of the artificial joint. METHODS: A comprehensive search of major literature databases and bibliographic details was conducted to identify studies evaluating the forgotten joint score (FJS-12) in total hip arthroplasty (THA) patients operated through the anterior approach (AA) and posterior approach (PA). Out of 234 studies identified, seven studies met the inclusion criteria for review. The Newcastle-Ottawa Scale was used to evaluate the quality of evidence and the risk of bias in the included studies. The FJS-12 was evaluated at three months, one year, and beyond 2 years. RESULTS: The mean FJS-12 at > 2 years was 82.03 in the AA group and 80.32 in the PA group. The forest plot analysis (n = 819 patients) revealed no significant difference in FJS-12 score between these two approaches (MD 2.13, 95% CI [- 1.17, 5.42], p = 0.21; I2 = 60%). However, the joint awareness was significantly lesser in the AA group at 3 months (MD 12.56, 95% CI [9.58, 15.54], p < 0.00001, I2 = 0%) and 1 year (MD 9.55, 95% CI [7.85, 11.24], p < 0.0001, I2 = 0%). CONCLUSIONS: After analyzing the available literature, it was found that THA patients operated through the AA approach have significantly lower joint awareness than those operated through the PA approach in the first year of surgery. However, there is no significant difference in joint awareness between these two approaches after 2 years. LEVEL OF EVIDENCE: III.

Hallux valgus correction utilising a modified short scarf osteotomy with a magnesium biodegradable or titanium compression screws - a comparative study of clinical outcomes.

BACKGROUND: Biodegradable implants reduce the likelihood of further surgery for hardware removal and reduce the risks of associated infection and allergy. The purpose of this study is to evaluate the clinical efficacy and determine the comparability of biodegradable magnesium alloy MgYREZr (MAGNEZIX® CS) compression screw fixation compared with standard titanium screw fixation in the surgical treatment of hallux valgus deformity. METHODS: Eleven patients undergoing corrective surgery for hallux valgus utilising biodegradable magnesium screws and a control group of 25 patients undergoing corrective hallux valgus surgery with standard titanium screws were reviewed at a median of 19 months (range 12-30 months). PROM scores (Manchester-Oxford Foot Questionnaire (MOXFQ), Foot and Ankle Outcomes Instrument (FAOI) and the EQ-5D-3 L) were recorded preoperatively and at latest follow-up. RESULTS: The results between the two groups were broadly similar, with the Magnesium and Titanium patients showing similar patterns in the various domains in the MOXFQ, the FAOI and the EQ-5D-3 L. Most patients reported a near full shoe comfort score, and EQ-5D-3 L scores were significantly improved in both patient groups (with most patients reporting a full score). Foot pain and foot function improved irrespective of the scoring systems and patients in both groups demonstrated significantly improved scores following the surgery (p < 0.05). Notably, there were no significant differences when comparing the post-operative scores between the groups for any individual scoring parameter. No impairment to quality of life was recorded. There were no intra or post-operative complications. There were no problems encountered through the use of the bioabsorbable screws. CONCLUSION: Biodegradable magnesium-based compression screws appeared to be safe in this study and are an effective fixation device in the treatment of hallux valgus deformity with clinical outcomes similar to standard titanium screw fixation.

Iodine-catalyzed cross-coupling of isocyanides and thiols for the synthesis of S-thiocarbamates.

A novel and efficient metal free, redox-neutral method for the synthesis of secondary thiocarbamates by cross-coupling of readily available thiophenol and isocyanides has been developed. The present methodology exhibits a broad substrate scope with good to excellent yields without an additive/extra oxidant under mild reaction conditions catalyzed by inexpensive iodine as the catalyst.

Diversity-oriented sustainable synthesis of antimicrobial spiropyrrolidine/thiapyrrolizidine oxindole derivatives: New ligands for a metallo-ß-lactamase from Klebsiella pneumonia.

A simple, environmentally benign and highly proficient microwave assisted one-pot approach for the synthesis of antimicrobial spiropyrrolidine/thiapyrrolizidine oxindole derivatives is reported assembling two pharmacophoric moieties (1,3-indanedione and pyrrolidine/thiapyrrolizidine) in a single molecular framework via three-component 1,3-dipolar cycloaddition reaction of substituted isatin, sarcosine/1,3-thiazoles-4-carboxylic acid and Knoevenagel adduct (2-Cyano-3-phenyl-acrylic acid ethyl ester or 2-Benzylidene-malononitrile) in 2,2,2-trifluoroethanol as a reusable green solvent. Good functional group tolerance and broad scope of usable substrates are other prominent features of the present methodology with high degree of chemo-, regio- and stereoselectivity. The stereochemistry of synthesized compounds was confirmed by single crystal X-ray analysis. All the synthetic compounds were examined for their antimicrobial potential. The synthesized compounds having pyrrolothiazole moiety showed excellent activity against K. pneumoniae as compared to others and even more inhibitory activity than the mentioned drugs, i.e. compounds 6a (MIC=0.09µg/mL), 6b (MIC=0.045µg/mL), 6c (MIC=0.005µg/mL), 6d (MIC=0.19µg/mL). Additionally, compound 6c has shown better binding affinity against New Delhi Metallo-beta-Lactamase-1 (NDM-1) protein in computational docking studies.

Aminocatalytic cross-coupling approach via iminium ions to different C - C Bonds.

Given the attractive ability of iminium ions to functionalize molecules directly at ostensibly unreactive positions, the reactivity of iminium ions, in which an α CH2 group is replaced by CO was explored. Background studies on the ability of such iminium cations to promote reactions via an iminium-catalyzed or iminium-equivalent pathway are apparently unavailable. Previously, tandem cross-coupling reactions were reported, in which an iminium ion undergoes nucleophilic 1,2-addition to give a putative three-component intermediate that abstracts a proton in situ and undergoes self-deamination followed by unprecedented DMSO/aerobic oxidation to generate α-ketoamides. However, later it was observed that iminium ions can generate valuable α-ketoamides through simple aerobic oxidation. In all reactions, iminium ions were generated in situ by reaction of 2-oxoaldehydes with secondary amines.

Effect of different coagulants at varying strengths on the quality of paneer made from reconstituted milk.

A study was conducted to determine the effect of different types of acids viz., citric acid, tartaric acid and malic acid each at 2, 3 and 5% concentrations on the quality of paneer made using reconstituted milk. The moisture, total solid recovery and yield and sensory scores for flavour, body and texture and overall acceptability of paneer decreased with the increasing strength of acid. However, these parameters for paneer made using coagulants at 2 and 3% levels were statistically comparable (P > 0.05). Fat and protein per cent increased with the increase in the concentration of the acid. No difference was observed in the levels of ash and fat on dry matter basis and pH and appearance scores at all the three concentrations of the coagulants. The type of coagulant also elicited variations in most of the constituents of paneer. The paneer samples made with citric acid and tartaric acid had significantly higher (P ≤ 0.05) values for fat, protein, ash, total solids recovery, fat on dry matter basis, body and texture and overall acceptability scores than paneer made with malic acid at all concentrations. No significant difference was seen in appearance and flavour scores among all the samples. In order to produce paneer with the most desirable characteristics from reconstituted milk, it is suggested citric acid and tartaric acid at 2% concentration can be utilized as coagulants.

Reconstruction of the extensor mechanism using polypropylene mesh in a displaced pathological fracture of the patella affected by giant cell tumour.

A man in his 30s came to our clinic with a year-long history of progressive pain and swelling in his knee. Diagnostic imaging revealed a displaced patellar fracture with an osteolytic, septated lesion and thinned expanded cortex in both fracture fragments. A core needle biopsy confirmed the diagnosis of giant cell tumour. Treatment involved wide excision of the tumour and the use of polypropylene mesh and a peroneal longus tendon autograft to reconstruct the extensor mechanism of the knee joint. One year postoperatively, the patient experienced no pain, demonstrated full range of motion and showed no signs of functional impairment or local tumour recurrence. This case highlights that reconstruction of the extensor mechanism of the knee after tumour excision with synthetic mesh is an affordable, user-friendly and widely accessible method. It can address large defects effectively while minimising the risks of disease transmission and graft lengthening, resulting in satisfactory outcomes.

Botulinum toxin type A for treating chronic low back pain: A double blinded randomized control study.

BACKGROUND: Low back pain (LBP) is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting. LBP can arise from various causes, with stiffness in the paraspinal muscles being a notable contributor. The administration of Botulinum toxin type A (BoNT-A) has been found to alleviate back pain by relaxing these stiff muscles. While BoNT-A is approved for use in numerous conditions, a limited number of randomized clinical trials (RCTs) validate its efficacy specifically for treating LBP. AIM: To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP (CLBP). METHODS: In this RCT, adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled. Participants were allocated to either the Drug group, receiving 200 Ipsen Units (2 mL) of BoNT-A, or the Control group, which received a 2 mL placebo. Over a 2-month follow-up period, both groups were assessed using the Visual Analog Scale (VAS) for pain intensity and the Oswestry Disability Index (ODI) for disability at the start and conclusion of the study. A decrease in pain by 50% was deemed clinically significant. RESULTS: The study followed 40 patients for two months, with 20 in each group. A clinically significant reduction in pain was observed in 36 participants. There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months. Nonetheless, when comparing the mean score changes, only the reduction in ODI scores (15 in the placebo group vs 16.5 in the drug group, clinically insignificant) was statistically significant (P = 0.012), whereas the change in mean VAS scores was not significant (P = 0.45). CONCLUSION: The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.

Deep Learning Approaches for Medical Image Analysis and Diagnosis.

In addition to enhancing diagnostic accuracy, deep learning techniques offer the potential to streamline workflows, reduce interpretation time, and ultimately improve patient outcomes. The scalability and adaptability of deep learning algorithms enable their deployment across diverse clinical settings, ranging from radiology departments to point-of-care facilities. Furthermore, ongoing research efforts focus on addressing the challenges of data heterogeneity, model interpretability, and regulatory compliance, paving the way for seamless integration of deep learning solutions into routine clinical practice. As the field continues to evolve, collaborations between clinicians, data scientists, and industry stakeholders will be paramount in harnessing the full potential of deep learning for advancing medical image analysis and diagnosis. Furthermore, the integration of deep learning algorithms with other technologies, including natural language processing and computer vision, may foster multimodal medical data analysis and clinical decision support systems to improve patient care. The future of deep learning in medical image analysis and diagnosis is promising. With each success and advancement, this technology is getting closer to being leveraged for medical purposes. Beyond medical image analysis, patient care pathways like multimodal imaging, imaging genomics, and intelligent operating rooms or intensive care units can benefit from deep learning models.

Analysis of causes for revision in unicompartmental knee arthroplasty.

The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty (UKA) in their patients. These factors include substandard suturing of the wound, the presence of osteophytes and intra-articular loose bodies causing impingement, premature loosening of the tibial component, choosing unsuitable patients for the procedure, dislocation of the movable insert, and damage to the anterior cruciate ligament and medial collateral ligament. The findings suggest that employing the correct surgical techniques and indications is essential for successful outcomes in the UKA.

Knee Arthrodesis Using Dual-Plate Construct is Following Failed Distal Femur Megaprosthesis-A Case Report.

Introduction: Knee arthrodesis following failed total knee arthroplasty is a viable limb salvage option, and this procedure is reserved for failed two-stage revision surgery in severe comorbid patients with irreparable extensor mechanism disruption, severe instability, and extensive soft tissue loss. Knee arthrodesis using a dual-plate construct has been scarcely reported. We report a case of knee arthrodesis using a dual-plate construct in a male in his 20s who presented to us with a broken distal femur megaprosthesis. Case Report: An anterior midline incision was given. The cement mantle and broken prosthetic components were removed. The bone surfaces were freshened up and fixed using two orthogonal locking plates. After 4 months, there was a solid fusion in the knee, and the patient started walking independently with a short limb gait. The patient was advised limb lengthening for a shortening of 3 cm, but he denied it and managed with a shoe raise. After 4 years, he was pain free, and radiographs revealed a solid knee fusion. The patient was fully satisfied with the procedure, and he resumed manual work. Conclusion: This case report revealed that knee arthrodesis using a dual-plate construct is an economically viable salvage option for failed distal femur megaprosthesis.

Combined articular and ligament reconstructions in neglected fracture-dislocation of the knee.

Background: The management of neglected traumatic knee dislocations is challenging and is commonly associated with suboptimal outcomes. In this article we present two cases of neglected knee dislocations in two young trauma victims who presented late due to restrictions during the COVID-19 pandemic. Methods: Two young patients presented at our center with neglected knee fracture-dislocations after eight weeks and six months of trauma. Comprehensive evaluation was performed using radiographs, computed tomography scans, and magnetic resonance imaging. Surgical intervention included open reduction and internal fixation of the mal-aligned intra-articular fracture fragments. Additionally, articular congruency was restored and repair or reconstruction of the posterior cruciate ligament, anterior cruciate ligament, and meniscus was conducted using suitable tendinous autografts and implants. Following surgery, the knees were immobilized for six weeks, followed by aggressive physical therapy. Results: After three months of surgical intervention, fracture union and joint stability were achieved. At the >36-month follow-up appointments, both patients were pain-free at rest with a stable knee joint, achieving ≥90 degrees of knee flexion and without extensor deficits. Concurrent with radiographic evidence of osteoarthritic changes in the knee joint, there was mild pain (VAS 2) after prolonged knee movement activities and walking for long distances (>1 km). Conclusion: Open reduction and internal fixation, along with simultaneous menisco-ligamentous reconstructions in neglected fracture-dislocations of the knee result in satisfactory clinical outcomes. This approach proves to be an effective joint preservation procedure in young patients, even in delayed and neglected conditions.

Vermi-remediation impacts on growth and metals bioaccumulation in tomato irrigated with wastewater.

Due to their persistence in the environment, and their highly toxic and bioaccumulative nature, heavy metals are well known to the environment. Vermicompost has gained popularity because it improves soil properties and, most importantly, remediates and immobilizes heavy metals. The present study assessed vermicompost effects on heavy metal bioaccumulation in tomato plants irrigated with wastewater. A plastic bag experiment was carried out with 5 kg of growing media in each bag. Growing media contain garden soil with four levels of vermicompost mixed at 0%, 5%, 15%, and 25%. The pots were irrigated with wastewater from different industries and tap water, which was taken as control. Wastewater was collected from the pharmaceutical industry, plastic industry, and sewage water of Hayatabad Industrial Estate, Peshawar. Vermicompost application significantly affected all tomatoes' growth attributes and heavy metals concentration. Results revealed that minimum Cd (2.48 mg kg-1), Cr (1.27 mg kg-1), Cu (4.10 mg kg-1), and Pb (0.62 mg kg-1) concentrations were recorded in tomatoes cultivated in 25 % vermicompost amended soil, while, maximum Cd (5.23 mg kg-1), Cr (2.29 mg kg-1), Cu (8.84 mg kg-1) and Pb (2.18 mg kg-1) concentrations were reported in sewage water irrigated plants., Overall, vermicompost applied at 25% significantly enhanced plant growth and yield, reducing the bioavailability and bioaccumulation of heavy metals. From the finding of this study, it is observed that wastewater irrigation of plants should be avoided because of the high level of heavy metals; in contrast, the application of vermicompost is highly recommended as compost reduces heavy metals bioaccumulation and enhances productivity.

Acetabular fracture in India: An epidemiological study.

Introduction: Acetabular fractures, resulting from high-energy trauma, present significant orthopaedic challenges. Despite their rarity, the incidence of these fractures is rising, necessitating a comprehensive understanding of their epidemiological characteristics, especially in diverse populations like India. Methods: This retrospective study analyzed data from 3643 patients across four level-1 trauma centers in India (North 1, North 2, West, and South) from January 2001 to December 2019. Prior ethical approval was obtained from the respective institutions. Data were collected using the computerized patient record system (CPRS) and included patients with complete clinical and radiological records. Only patients with full radiological data were included, comprising standard anteroposterior radiograph, Judet views on radiographs, and computed tomography scan of the pelvis. The study evaluated the demographic characteristics, fracture patterns and surgical approaches. Results: The majority of patients were males (84.05 %) and the fractures were mostly seen in young individuals between 19 and 40 years' age group (44.9 %), followed by 41-60 years (42.3 %). Associated bony or other system injuries were seen in 53.42 % of patients, with pelvic injuries being the most common (9.8 %). Posterior wall fractures were the most frequent (20.7 %), while anterior wall fractures were the least common (0.8 %). Operative management was employed in 82 % of cases, with the Kocher-Langenbeck approach being the most commonly employed (42.5 %). Conclusion: High-velocity trauma remains the commonest cause of acetabular trauma in India, primarily affecting young male individuals. Pelvic fractures are the most commonly associated injuries. Posterior wall fractures are the commonest type of acetabular fracture, and the Kocher-Langenbeck approach is the commonly adopted surgical approach.

A natural product inspired hybrid approach towards the synthesis of novel pentamidine based scaffolds as potential anti-parasitic agents.

A natural product inspired molecular hybridization approach led us to a series of novel pentamidine based pyrimidine and chalcone scaffolds. All the hybrids were evaluated for their anti-leishmanial potential. Most of the screened compounds have showed significant in vitro anti-leishmanial activity with less cytotoxicity in comparison to the standard drugs (pentamidine, sodium stibogluconate, and miltefosine). Additionally, anti-malarial screening of these compounds was also done and four compounds have shown superior activity against chloroquine resistance strain (K1) of Plasmodium falciparum.

Simultaneous above-knee amputation and ipsilateral total hip arthroplasty in a neglected neck of femur fracture with an insensate limb.

Total hip arthroplasty (THA) in patients with ipsilateral mid-thigh amputation is surgically challenging. We report a case of same setting THA and ipsilateral above-knee amputation in a male patient. The patient had 8 months old neglected neck femur fracture and ipsilateral femur shaft fracture with 14 cm bone loss. There was an associated neurovascular (femoral artery injury and sciatic nerve palsy) deficit at the initial insult; however, the limb survived because of well-formed collaterals. The limb was insensate at the time of presentation because of complete sciatic nerve palsy. The decision to undergo amputation was taken based on insensate limb, compromised circulation and huge bone loss with healed open fracture. After 10 months follow-up, the patient was walking with prosthesis limb fitted to the amputated mid-thigh stump and there were no incidences of osteolysis, subsidence or infection in the THA site.

Molecular insights into anti-Protozoal action of natural compounds against Cryptosporidium parvum: a molecular simulation study.

The current study used the major target protein lactate dehydrogenase Cryptosporidium parvum to identify potential binders. Our approach was a comprehensive three-step screening of 2,569 natural compounds. First, we used molecular docking techniques, followed by an advanced DeepPurpose ML model for virtual screening. The final step involved meticulous re-docking and detailed interaction analysis. The known inhibitor FX11 was considered as a control that was used for comparative analysis. Our screening process led to the identification of three promising compounds: 5353794, 18475114, and 25229652. These compounds were chosen due to their exceptional ability to form hydrogen bonds and their high binding scores with the protein. Here, all three hits showed H-bonds with the functional residues (Asn122 and Thr231) of protein, while 25229652 also showed H-bond with the catalytic site residue (His177). RMSD behaviour reflected stable and consistent complex formation for all the compounds in their last 30 ns trajectories. Principal component analysis (PCA) and free energy landscape (FEL) showed a high frequency of favourable low free energy states. Using the MM/GBSA calculation, compounds 5353794 (ΔGTOTAL = -34.92 kcal/mol) and 18475114 (ΔGTOTAL = -34.66 kcal/mol) had the highest binding affinity with the protein however, 25229652 (ΔGTOTAL = -22.62 kcal/mol) had ΔGTOTAL comparable to the control FX11. These natural compounds not only show the potential for hindering C. parvum lactate dehydrogenase but also open new avenues in its drug development. Their strong binding properties and stable interactions mark them as the prime candidates for further research and experimental validation as anti-cryptosporidiosis agents.Communicated by Ramaswamy H. Sarma.

Access to Functionalized Thiazolothiadiazoles via the Chemoselective Cascade Heteroannulation of Thioamides with Hypervalent Iodine Reagents.

We describe herein a chemo- and regioselective cascade annulation between ß-ketothioamides and diazo-substituted hypervalent iodine reagents under transition-metal-free and base-free conditions at room temperature. Thus, a divergent construction of fused-heterocyclic scaffold thiazolothiadiazoles has been achieved with the advantages of operational simplicity, scalability, broad substrate compatibility, and mild reaction conditions. This one-pot strategy not only avoids potential toxicity but also broadens the arsenal of synthetic methods to obtain fused N,S-heterocyclic frameworks.