Comparison of the Analgesic Duration Using Ultrasound-guided Popliteal Sciatic Nerve Block between Diabetics with Neuropathy and Nondiabetics without Neuropathy.

INTRODUCTION: In India, the prevalence of diabetes mellitus neuropathy was reported to be as high as 30%. Eight percentage of the diabetic population suffer from foot ulceration and 1.8% have amputations. Popliteal nerve block can be potentially used for foot and ankle surgery with several advantages. AIM: To compare analgesic duration of an ultrasound (US)-guided popliteal sciatic nerve block between diabetics with neuropathy and nondiabetics without neuropathy. PATIENTS AND METHODS: Participants were allocated into two groups for popliteal sciatic nerve blocks under US guidance. The primary outcome was the duration to onset of sensory and motor blockade. The secondary outcome was the duration to rescue analgesic and the visual analog scale scoring within 24 h. Hemodynamic outcomes were also monitored along with the above variables. RESULTS: It was observed that the onset of sensory blockade was faster in participants with diabetes mellitus with peripheral neuropathy as compared to the nondiabetic participants and the duration for onset of motor blockade in dorsiflexion was faster in diabetic patients as compared to the nondiabetic patients (17.48 ± 3.21 min). However, there was no significant changes when comparing the onset of duration to loss of plantar flexion, in diabetics (17.86 ± 2.29 min) versus in nondiabetics (18.51 ± 3.32 min). The duration for rescue analgesics was found to be longer in diabetic participants (13.19 ± 2.14 h) as compared to the nondiabetic participants (11.44 ± 1.86 h). No differences were observed in the hemodynamic changes and the complications associated with local anesthetics in either group. CONCLUSION: Diabetic patients with neuropathy have faster onset of blockade when compared to nondiabetic patients without neuropathy which may be due to the degenerative condition of the peripheral nerves in them. The hemodynamic parameters do not play a role in defining the outcome of the block.

Résumé Introduction:En Inde, la prévalence de la neuropathie liée au diabète sucré atteignait 30 %. Huit pour cent de la population diabétique souffrent d'ulcères du pied et 1,8 % sont amputés. Le bloc du nerf poplité peut être potentiellement utilisé pour la chirurgie du pied et de la cheville avec plusieurs avantages.Objectif:Comparer la durée analgésique d'un bloc du nerf sciatique poplité guidé par échographie (É.-U.) entre des diabétiques atteints de neuropathie et des non diabétiques sans neuropathie.Patients et méthodes:Les participants ont été répartis en deux groupes pour les blocs du nerf sciatique poplité sous la direction des États-Unis. Le critère de jugement principal était la durée jusqu'à l'apparition du blocus sensoriel et moteur. Le résultat secondaire était la durée nécessaire pour sauver l'analgésique et l'échelle visuelle analogique après 24 h. Les résultats hémodynamiques ont également été surveillés avec les variables ci-dessus.Résultats:Il a été observé que l'apparition du blocage sensoriel était plus rapide chez les participants atteints de diabète sucré avec neuropathie périphérique que chez les participants non diabétiques et (la durée d'apparition du blocage moteur en dorsiflexion était plus rapide chez les patients diabétiques que chez les patients non diabétiques (Cependant, il n'y a eu aucun changement significatif en comparant le début de la durée à la perte de flexion plantaire, chez les diabétiques (17,86 ± 2,29 min) versus chez les non diabétiques (18,51 ± 3,32 min). La durée des analgésiques de secours a été trouvée être plus longue chez les participants diabétiques (13,19 ± 2,14 h) par rapport aux participants non diabétiques (11,44 ± 1,86 h). Aucune différence n'a été observée dans les changements hémodynamiques et les complications associées aux anesthésiques locaux dans les deux groupes.Conclusion:Patients diabétiques atteints de neuropathie ont un début de blocage plus rapide que les patients non diabétiques sans neuropathie, ce qui peut être dû à l'état dégénératif des nerfs périphériques chez eux. Les paramètres hémodynamiques ne jouent aucun rôle dans la définition de l'issue du bloc.

An In Vitro Study Demonstrating the Significance of Acromioclavicular Ligament Repair in Restoring Horizontal and Rotational Acromioclavicular Joint Stability.

BACKGROUND: The principle of joint reconstruction surgery is to try to recreate the native joint biomechanics and stability. With respect to acromioclavicular joint (ACJ) surgery, much focus to date has been on restoring the superoinferior stability. There is concern that persistent horizontal instability following ACJ reconstruction could lead to poorer patient outcomes; therefore, we evaluated whether acromioclavicular (AC) ligament repair offers improved horizontal stability in conjunction with ACJ reconstruction. METHODS: A whole-body human cadaver was used. The ACJ was exposed and subjected to a constant 70N load on the lateral end of the clavicle to test the anteroposterior (AP), superoinferior (SI), and horizontal pivot angle (HPA) around the ACJ. The AC and coracoclavicular (CC) ligaments were subsequently divided, and the above three parameters were re-tested. Ligament augmentation and reconstruction system (Corin Group, Cirencester, UK), LockDown (LockDown Medical Limited, Redditch, UK), Endobutton (Smith and Nephew Inc., London, UK), and Neoligament implant (Xiros Ltd., Leeds, UK) were used to reconstruct the CC ligaments and tested with and without AC repair. RESULTS: The native ACJ allowed an average 2.48 mm AP and 3.88 mm SI translation with a 27° HPA. All synthetic implants significantly improved the vertical stability of the ACJ but allowed up to a four-fold increase in AP translation. Coupled with ACJ repair, all the reconstructions were far superior, especially in restoring horizontal stability. CONCLUSION: The implants varied in their approach to fixation and concentrated primarily on the reconstruction of CC ligaments. Our study was able to demonstrate that AC repair significantly improves the stability of the construct and significantly reduces vertical and horizontal instability.

Measurement of radon concentration in soil gas and radon exhalation rate from soil samples along and across the Main Central Thrust of Garhwal Himalaya, India.

The present study focuses on measuring radon concentrations in soil gas at various depths, radon exhalation rate (surface and mass) from soil samples, and gamma dose rate along and across the Main Central Thrust of Garhwal Himalaya, India. Radon concentration in soil gas, surface, and mass exhalation rates was measured using a portable SMART radon monitor (RnDuo). Furthermore, the gamma dose rate was measured using a pocket radiation monitor. The soil gas radon concentration varied from 15 ± 4 to 579 ± 82 Bq m-3 at a depth of 25 cm, 10 ± 2 to 533 ± 75 Bq m-3 at a depth of 30 cm, and 9 ± 1 to 680 ± 95 Bq m-3 at a depth of 35 cm. The surface and mass exhalation rates were found 3 ± 0.7 to 98 ± 3 Bq m-2 h-1 (with AM ± SD = 36 ± 28 Bq m-2 h-1) and 1 ± 0.2 to 95 ± 2 mBq kg-1 h-1 (with AM ± SD = 30 ± 22 mBq kg-1 h-1), respectively. The gamma dose rate for the present study area varies from 0.11 ± 0.05 to 0.28 ± 0.05 µSv h-1 with a mean value of 0.17 ± 0.05 µSv h-1. The correlation analysis between the exhalation rates (mass and surface) and radon concentration of soil gas at various depths was carried out in the current study.

Harnessing Social Media to Enhance Nephrology Academia.

The process of learning has been confined to the realms of educational institutions. Over the last ten years, the semantics of social media networks have evolved with the use of mobile gadgets. Consequently, nephrologists have realised the potential benefits of using these platforms for their educational and career development. Social media can change the horizon of nephrology education. The concept of bedside examination, teaching and sharing experiences have changed with the advent of Facebook, YouTube, Instagram and X (former Twitter). Other networking portals, such as WhatsApp, Telegram, X (former Twitter), and Pinterest, have also amassed the attention of selected users. Despite split opinions on the utility of social media, it is undeniable that it has influenced interaction between students and mentors. Resources ranging from online networks, blogs, visual aids, podcasts, online journal clubs, videos, live conference coverages, and tutorials have made it possible for nephrologists to stay informed and educated with recent updates. In this review, we discuss how social media can enrich nephrology academia, facilitate the sharing of research and access to fellowships and mentorship programs, provide career prospects to trainees, and broadcast scientific conferences while bringing nephrology societies together. Keywords: education; nephrology; social media.

Vitamin D status in Psoriasis: impact and clinical correlations.

Psoriasis is a continuing, periodic, immune­mediated, fiery skin disease branded by hyper proliferation of epidermal keratinocytes and accompanying with inflammatory cellular infiltrate in both dermis and epidermis. Immunomodulation could be an important effect of vitamin D in Psoriasis. This case-control study was designed to measure serum 25-hydroxy vitamin D levels in patients with psoriasis and healthy controls and to find out clinical correlation, if any. Six hundred two (n = 602) subjects (285 cases and 317 controls) were taken for the study. Cases and controls were frequency matched with respect to age and gender. Various demographic and clinical details were taken using a questionnaire. Chemiluminescence Micro Particle Immunoassay was used to estimate serum 25-hydroxy vitamin D levels. The vitamin D deficiency in psoriasis patients was 60.0% vs. 17.5% in controls (P < 0.001) with mean vitamin D levels of 28.3 ± 13.9 ng/ml in psoriasis patient's vs. 37.9 ± 9.7 ng/ml in controls. Vitamin D deficiency was found to be associated with psoriasis independently of gender, age, smoking status, family history, hypertension, chronic medication, nail changes, duration of symptoms and severity of disease. Vitamin D levels were seven times lower in patients with Psoriasis as compared to controls. Reduced vitamin D levels are related to duration and clinical severity of the disease. Early detection of vitamin D deficiency and timely intervention could lead to better clinical outcome and improved quality of life in psoriasis patients.

Immediate effect of cold mud pack therapy on autonomic variables in primary hypertensive individuals: a randomized trial.

OBJECTIVES: Mud pack or compress is an easily accessible, cost-effective, efficient treatment modality used in naturopathy to manage and prevent various chronic illnesses. This study sought to elucidate the effectiveness of cold spinal mud packs on improving neuro-cardiac parameters among hypertensive individuals. METHODS: A total of 100 hypertensive subjects aged 30-50 years were randomly allocated into two groups: Cold spinal mud pack (CSMP) and prone rest. Blood Pressure (BP) and Heart Rate Variability (HRV) were assessed at three-time points: Baseline, After 20 min (T1), After 60 min (T2). This single-blinded randomized controlled trial was registered in the Clinical Trials Registry-India (CTRI/2019/12/022492). RESULTS: After 20 min of CSMP showed a statistically significant reduction (p<0.01) in mean values of Systolic BP, Diastolic BP, and in HRV attained statistically significant change (p<0.01) in mean score in the frequency domain except for Very low-frequency power (VLF) and a significant difference found in the mean score of time-domain values (p<0.01) when compared to control group and 95% confidence interval (CI) will be provided for each effect. CONCLUSIONS: CSMP reduces the sympathetic tone and shifts the sympathovagal balance in favor of parasympathetic dominance, contributing to a decrease in BP and effective changes in components of HRV.

Mid- to long-term survivorship of the cemented, semiconstrained Discovery total elbow arthroplasty.

BACKGROUND: The incidence of total elbow arthroplasty (TEA) is increasing, and an improved understanding of elbow kinematics and biomaterials has driven advances in implant design. In modern practice, cemented, semiconstrained devices are most frequently used. The Discovery TEA has demonstrated promising early results, although there are a paucity of follow-up studies and no dedicated mid- to long-term series. We therefore present the longest, most complete such study to date. METHODS: A prospectively maintained local joint registry was interrogated to yield a consecutive series of Discovery TEAs performed at a single non-design center. The minimum follow-up period was set at 5 years. Revision procedures and TEAs performed for acute trauma were excluded. The primary outcome was survivorship of the implant. The secondary outcomes included clinical, radiographic, and patient-reported outcomes. RESULTS: We identified 67 TEAs in 58 patients for inclusion at a mean of 98.5 ± 20.4 months from surgery. Four cases (6%) were lost to follow-up, and implant survival was censored accordingly. The implant was revised in 14 cases (20.9%). The Kaplan-Meier method showed an implant survivorship rate of 76.8% at 119 months. A significant difference in survival was found between dominant and nondominant elbows (P = .012, Breslow test), with elbow dominance conferring a 4.5-fold increased risk of revision (relative risk, 4.5; 95% confidence interval, 1.1-18.5). Pooled clinical outcomes (70.9% follow-up at minimum of 60 months and median of 77.8 months) were also determined. CONCLUSIONS: We present the longest-term and most complete single-center follow-up study of the Discovery TEA to date. Further long-term survival studies are required to elucidate the performance of this implant compared with more established designs. We have also demonstrated differences in implant survivorship owing to hand dominance for the first time.

Assessing wrist pain: a simple guide.

Wrist pain is a common presenting symptom, affecting any age group. Assessment of wrist pain can be very challenging for junior clinicians and non-specialists, especially in patients with a chronic condition. This article looks at the bony and neurovascular anatomy of the wrist joint and describes a simple guide to clinical assessment of wrist pathology, highlighting the awareness of red flag signs, which would warrant an immediate referral for secondary care input.

Long-term measurements of residential radon, thoron, and thoron progeny concentrations around the Chhatrapur placer deposit, a high background radiation area in Odisha, India.

The Chhatrapur placer deposit is found in a high background radiation area which has been recently identified on the southeastern coast of India. Previously, some geochemical studies of this area were carried out to assess external dose from radionuclides-bearing heavy mineral sands. In this study, radon, thoron and thoron progeny concentrations were measured in about 100 dwellings during three seasons (autumn-winter, summer, and rainy) in a 10- to 12-month period and annual doses due to inhalation of them were evaluated. The measurements were made by passive-type radon-thoron discriminative detectors and thoron progeny detectors in which solid state nuclear track detectors were deployed. The results show that radon and thoron concentrations differ by one order of magnitude depending on exposure periods, while thoron progeny concentration is nearly constant throughout the year. Since thorium-rich sand is distributed in the studied area, exposure to thoron is equal to, or exceeds, exposure to radon and is not negligible for dose evaluation. Based on the measurements, doses due to inhalation of radon and thoron are evaluated as 0.1-1.6 mSv y-1 and 0.2-3.8 mSv y-1, respectively. The total dose is 0.8-4.6 mSv y-1, which is the same order of magnitude as the worldwide value.

STUDY OF RADIATION EXPOSURE DUE TO RADON, THORON AND PROGENY IN THE INDOOR ENVIRONMENT OF YAMUNA AND TONS VALLEYS OF GARHWAL HIMALAYA.

Long-term measurements of indoor radon, thoron and their progeny concentrations have been carried out in dwellings of Yamuna and Tons Valleys of Uttarkashi, Garhwal Himalaya to investigate the health risk associated with inhalation of radon, thoron and progeny. The experimentally determined values of radon, thoron and progeny concentrations were used to estimate the annual inhalation doses and annual effective doses. The annual inhalation dose has been found to vary from 0.8 to 3.9 mSv y-1 with an average of 1.8 mSv y-1 The annual effective dose from the exposure to radon and its progeny in the study area has been found to vary from 0.1 to 2.4 mSv with an average of 1.2±0.6 mSv. Similarly, the annual effective dose due to thoron and its progeny has been found to vary from 0.2 to 1.5 mSv with an average of 0.6±0.4. The measurement techniques and results obtained are discussed in detail.

Estimation of radon diffusion coefficients in soil using an updated experimental system.

Radon diffusion through soil is strongly affected by the degree of water saturation of the soil pores. Methods have been developed by many researchers to measure radon diffusion coefficient. We developed an updated experimental system to estimate radon diffusion coefficients for typical types of soil in Japan and applied it to a typical loam with different water saturation levels (0-0.82). The system consists of a passive-type scintillation cell, soil column, accumulation tank, and radon source. The radon concentration in the accumulation tank is kept stable, and radon diffused through the soil column is continuously measured with the passive-type scintillation cell. We found the radon diffusion coefficients vary from 9.60 × 10(-6) m(2) s(-1) to 1.27 × 10(-7) m(2) s(-1) for the loam samples. Generally, the diffusion coefficients are almost constant for a water saturation range of 0-0.4 and decrease with increasing water saturation from 0.4 to 0.82.

Medial tibial hemi-condylar elevation osteotomy as an operative technique to treat varus mal-united tibial plateau fracture.

Hemi-condylar tibial osteotomy was first reported as a corrective surgical option for neglected Blount's disease by Langenskiold in 1964. The indication for this procedure is largely reserved for the rare cases of excessive ligament laxity. To the best of our knowledge, literature search reveals only 6 cases, all of which were of Blount's disease and there has been no report of this procedure being used in Trauma. We present a case of failed osteosynthesis of Type V tibial plateau fracture, which resulted in genu varum deformity secondary to collapse of only the medial tibial condyle. We successfully realigned the mechanical axis by elevation osteotomy of the medial tibial hemicondyle.

Association between early childhood caries, streptococcus mutans level and genetic sensitivity levels to the bitter taste of, 6-N propylthiouracil among the children below 71 months of age.

BACKGROUND: Oral health is an integral component of pre-school health and well-being. Unfortunately, many children are afflicted with dental caries at an early age, even those as young as 12 months of age. The purpose of this study is to determine the association between Early Childhood Caries (ECC), Streptococcus mutans and genetic sensitivity levels to the bitter taste of, PROP among the children below 71 months of age. MATERIALS AND METHODS: Total of 119 children belonging to the age group of 36 to 71 months of both sexes, were recruited from A. J. Institute of Dental Sciences, Mangalore (Karnataka). PROP sensitivity test was carried out to determine the inherent genetic ability to taste a bitter or sweet substance. One who tasted bitter as taster and one who was not able to differentiate/tasted like paper as non-tasters. Facial expression was observed during the tasting to support the verbal response. Estimation of S. mutans level and caries experience was recorded. The results were statistically analyzed using Mann'Whiteney-U Test and Kruskal value test. RESULTS: In the total of 119 children, the mean DMFS was definitely higher in non-taster children compared to tasters and also had a high S. mutans level. Tasters had low ECC experience, low S. mutans level. The tasters had a mean DMFS value of 9.5120 (S.D. 7.0543) and non-tasters had a value of 7.7250 (S.D. 8.33147), which was statistically significant. CONCLUSION: Children who had higher level S. mutans had ECC and were non tasters. The PROP sensitivity test (filter paper test) proved to be a useful diagnostic tool in determining the genetic sensitivity levels of bitter taste. Age and low socio-economic status of pre-school children suggest a complex multifactorial relationship between S. mutans colonization, ECC and taste perception.

Estimation of indoor radon concentration based on radon flux from soil and groundwater.

The indoor radon concentration was estimated based on the radon flux in soil and groundwater. The indoor radon concentration in Budhakedar area of Garhwal Himalaya, India is estimated to be 3.0-131.4 Bq/m(3) in summer and 4.6-92.4 Bq/m(3) in winter. Based on the available data from study area, the calculated value of diffusion coefficient for the soil ranges from 0.1×10(-2) to 3.0×10(-2)cm(2) s(-1) in the summer season and 0.1×10(-2) to 0.4×10(-2)cm(2) s(-1) in the winter season. The calculated value of diffusion flux in the study area is found to vary from 0.1×10(-2) to 16.1×10(-2)Bq m(-2) s(-1) in summer season and 0.1×10(-2)-12.2×10(-2)Bq m(-2) s(-1) in winter season. The formulation was tested by comparing the results of radon values from two different seasons of a year.

Spontaneous resolution of discal cyst around L5 nerve root: case report and review of literature.

The treatment of discal cysts is controversial, with different surgical options described in the literature. We present an interesting case of spontaneous resolution of a symptomatic discal cyst. Based on our case report, we recommend non-operative management in the first instance and an up-to-date MRI scan before contemplating surgery.

Salivary C-Reactive Protein in Hashimoto's Thyroiditis and Subacute Thyroiditis.

C-reactive protein (CRP), an acute-phase reactant, has been identified as a saliva-based biomarker of inflammation. The objective of the study was to estimate and compare salivary CRP levels in Hashimoto's thyroiditis (HT) and Subacute thyroiditis (SAT). The study included 30 HT patients who presented with clinical features of hypothyroidism, 15 SAT patients who presented with clinical features of hyperthyroidism, and 20 healthy age- and sex-matched euthyroid controls. CRP levels in saliva were estimated using an Enzyme-Linked Immunosorbent Assay method with enhanced sensitivity. In HT, the mean salivary CRP levels did not differ significantly from controls. SAT patients had significantly elevated salivary CRP levels compared to HT patients and controls. The rise in salivary CRP levels in SAT patients conceivably reflects the presence of an inflammatory process. Saliva CRP levels appear to serve as inflammatory markers in SAT patients and may aid their clinical evaluation.

Scapulothoracic dissociation: level of vascular insult, an indirect prognostic indicator for the final outcome?

Scapulothoracic dissociation is the result of severe blunt trauma or sudden forceful traction applied to the shoulder, simulating a traumatic forequarter amputation but with sparing of the skin. This grievous injury results in injury at three levels: neural, vascular and musculoskeletal. Since the neural damage cannot be ascertained in the acute stage of this injury, wheras the vascular injury can be defined, this study aimed to find out any correlation of the eventual neural damage with the level of vascular injury. It became evident, after compilation of the authors' 8 cases and the 37 relevant cases reported in literature, that the patients with subclavian artery injury had more frequently a complete brachial plexus involvement, whereas those with axillary artery involvement sustained more often a partial plexus injury. This correlation was found to be statistically significant (p < 0.05). It is thus concluded that the more proximal the level of vascular injury, the more grave is the neurological damage. This fact can be utilized to prognosticate the eventual outcome of the limb concerned.

(226)Ra, (232)Th and (40)K contents in soil samples from Garhwal Himalaya, India, and its radiological implications.

The exposure of human beings to ionising radiation from natural sources is a continuing and inescapable feature of life on earth. Natural radionuclides are widely distributed in various geological formations and ecosystems such as rocks, soil groundwater and foodstuffs. In the present study, the distribution of (226)Ra, (232)Th and (40)K was measured in soil samples collected from different lithological units of the Thauldhar and Budhakedar regions of Garhwal Himalaya, India. The collected soil samples were analysed using gamma ray spectrometry. The activity concentrations of the naturally occurring radionuclides (226)Ra, (232)Th and (40)K in these soil samples were found to vary from below detection level (BDL) to 131 +/- 18 Bq kg(-1), 9 +/- 6 to 384 +/- 53 Bq kg(-1) and 471 +/- 96 to 1406 +/- 175 Bq kg(-1), respectively. The distribution of radionuclides depends upon the rock formation and chemical properties within the earth. The activity concentrations vary widely depending on the sample origin. The external absorbed gamma dose rates due to (226)Ra, (232)Th and (40)K were found to vary from 49 to 306 nGy h(-1). The average radium equivalent activity from these soil samples was 300 Bq kg(-1).

Soil-gas radon as seismotectonic indicator in Garhwal Himalaya.

Research on earthquake-related radon monitoring has received enormous attention recently. Anomalous behaviour of radon in soil and groundwater can be used as a reliable precursor for an impending earthquake. While earthquake prediction may not yet be possible, earthquake prediction research has greatly increased our understanding of earthquake source mechanisms, the structural complexities of fault zones, and the earthquake recurrence interval, expected at a given location. This paper presents some results of continuous monitoring of radon in soil-gas in Garhwal Himalaya, India. Daily soil-gas radon monitoring with seismic activity and meteorological parameters were performed in the same laboratory system, located at H.N.B. Garhwal University Campus, Tehri Garhwal, India. Radon anomalies along with meteorological parameters were found to be statistically significant for the seismic events within the magnitudes M2.0-M6.0 and epicentral distances of 16-250 km from the monitoring station. The frequent positive and negative anomalies with constant environmental perturbation indicate the opening and closing of micro cracks within the volume of dilatancy by strain energy. The spike-like and sharp peak anomalies were recorded before, during and after earthquakes occurred in the area. The variations in radon concentrations in soil-gas are found to be correlated with seismic activities in the Garhwal Himalaya. The correlation between radon level and meteorological parameters is also discussed.