Cerebrospinal fluid protein biomarkers in Parkinson's disease.

Proteomic profiling is an effective way to identify biomarkers for Parkinson's disease (PD). Cerebrospinal fluid (CSF) has direct connectivity with the brain and could be a source of finding biomarkers and their clinical implications. Comparative proteomic profiling has shown that a group of differentially displayed proteins exist. The studies performed using conventional and classical tools also supported the occurrence of these proteins. Many studies have highlighted the potential of CSF proteomic profiling for biomarker identification and their clinical applications. Some of these proteins are useful for disease diagnosis and prediction. Proteomic profiling of CSF also has immense potential to distinguish PD from similar neurodegenerative disorders. A few protein biomarkers help in fundamental knowledge generation and clinical interpretation. However, the specific biomarker of PD is not yet known. The use of proteomic approaches in clinical settings is also rare. A large-scale, multi-centric, multi-population and multi-continental study using multiple proteomic tools is warranted. Such a study can provide valuable, comprehensive and reliable information for a better understanding of PD and the development of specific biomarkers. The current article sheds light on the role of CSF proteomic profiling in identifying biomarkers of PD and their clinical implications. The article also explains the achievements, obstacles and hopes for future directions of this approach.

Type 2 diabetes mellitus augments Parkinson's disease risk or the other way around: Facts, challenges and future possibilities.

About 10% of the adult population is living with type 2 diabetes mellitus (T2DM) and 1% of the population over 60 years of age is suffering from Parkinson's disease (PD). A school of thought firmly believes that T2DM, an age-related disease, augments PD risk. Such relationship is reflected from the severity of PD symptoms in drug naive subjects possessing T2DM. Onset of Parkinsonian feature in case controls possessing T2DM corroborates the role of hyperglycemia in PD. A few cohort, meta-analysis and animal studies have shown an increased PD risk owing to insulin resistance. High fat diet and role of insulin signaling in the regulation of sugar metabolism, oxidative stress, α-synuclein aggregation and accumulation, inflammatory response and mitochondrial function in PD models and sporadic PD further connect the two. Although little is reported about the implication of PD in hyperglycemia and T2DM, a few studies have also contradicted. Ameliorative effect of anti-diabetic drugs on Parkinsonian symptoms and vague outcome of anti-PD medications in T2DM patients also suggest a link. The article reviews the literature supporting augmented risk of one by the other, analysis of proof of the concept, facts, challenges, future possibilities and standpoint on the subject.

Proximal Fibular Osteotomy: Is it Really an Option for Medial Compartmental Osteoarthritis Knee? Our Experience at Tertiary Centre.

INTRODUCTION: The medial compartment is commonly involved in age-related osteoarthritis knee because weight-bearing axis passes close to the medial condyle and its large surface area. Various treatments have been proposed ranging from conservative to total knee arthroplasty which is an expensive and complex treatment. Recently, proximal fibular osteotomy (PFO) for medial compartment knee osteoarthritis became popular as a treatment modality. Although, the mechanism of PFO is not clear. So, we conducted a prospective study to assess the clinico-radiological outcome of proximal fibular osteotomy in medial compartment osteoarthritis knee. MATERIALS AND METHODS: We conducted a prospective study from November 2017 to November 2019 on 32 (47 knees) patients with degenerative medial compartmental osteoarthritis knee, varus deformity < 15 and Kellgren and Lawrence grade II and grade III (K-L Grade). We recorded the visual analogue score (VAS) and knee society score (KSS) pre-operatively and post-operatively of all patients.  We got weight bearing anterio-posterior and lateral radiograph of knee done. We assessed joint space ratio and lateral tibio-femoral angle (FTA) pre-operatively, post-operatively and at each follow-up. RESULTS: Mean age was 48.4 (35-65) years and the mean follow-up was 18 months. Mean duration for unilateral PFO was 37 min and for bilateral, 55 min. The VAS was improved from 7.33 ± 0.72 to 7.13 ± 1.64 at 3 months and remained the same at final follow-up (p > 0.05). The mean pre-operative clinical and functional KSS was statistical insignificantly improved at 3 months and final follow-up (p > 0.05). The mean pre-operative lateral and mean pre-operative joint space ratio was also improved statistically insignificant (p > 0.05). Extensor hallucis longus (EHL) weakness was documented in five knees (10.6%) and paraesthesia was documented in seven (14.8%) knees. CONCLUSION: Although, PFO is a simple, less invasive and affordable procedure, we could not reproduce the favourable results in medial compartmental osteoarthritis knee. This procedure is also associated with reversible but noticeable complications. So, we would not consider PFO as an alternative option in the treatment of medial compartmental osteoarthritis knee.

Limb length discrepancy after total knee arthroplasty: Unilateral versus bilateral, a comparative study at tertiary centre.

INTRODUCTION: We conducted a prospective study to find out change in limb length (lengthening/shortening) after total knee arthroplsty in unilateral and bilateral total knee arthroplasty (TKA) because few literature is available regarding limb length discrepancy in TKA in comparison to total hip arthroplasty. Limb length discrepancy (LLD) may lead to low back pain and gait abnormalities. MATERIAL AND METHODS: We divided 58 patients into two groups: Group A (28 patients) includes patients who underwent unilateral TKA and Group B (30 patients) includes patients who underwent bilateral TKA. We assessed the patients clinico-radiologically in terms of limb length (supine position), deformity, Sagital-flexion deformity/extensor lag, coronal - varus/valgus, range of motion, knee stability, patellar tracking and Hip-knee-ankle angle preoperatively and postoperatively. RESULTS: In group A, mean limb length difference (operated limb gained length as compared to unoperated limb) was 1.11 cm. Out of 22 patients (78%) in whom limb length discrepancy was present, only 7 patients (31%) having limb length discrepancy perceived it. In group B, mean limb length difference was 1.03 cm. Fourteen patients (47%) in group B had LLD but none of them perceived it. Clinically 22 patients (78%) in group A and 14 patients (47%) in group B had LLD. Radiologically 25 patients (89%) in group A and 22 patients (73%) in group B had LLD. Out of the 7 patients who perceived LLD, all had LLD radiologically too. CONCLUSION: We reckoned that limb length discrepancy is more common in unilateral TKA. Limb length discrepancy of 2 cm or more is perceived by the patients operated for unilateral TKA. But in bilateral TKA, none of the patient perceived LLD because in this group LLD was less than 2 cm. Limb length discrepancy may leads to dissatisfaction of the patients and poor functional outcome.

Management of complex non union of tibia using rail external fixator.

INTRODUCTION: Management of the complex non union of tibia is a challenging task due to infection, bony gap, deformity, poor bone quality and poor soft tissue cover at fracture site. The limb reconstruction system (LRS) or Rail fixator has emerged as a viable option for the treatment of the same as it can address most of all above problems. It is more patient friendly and easier to apply in comparison to Ilizarov ring fixator. MATERIAL AND METHODS: Twenty two patients (17 males and 5 females) with complex non union of tibia underwent thorough debridement and resection of non viable bone followed by bone transport to fill the gap and then lengthening (8 patients) or acute docking & lengthening (14 patients) by the use of rail fixator. The average time to union, bone gap filled, lengthening achieved, treatment index were measured. The bone and functional outcome assessment was done by ASAMI score. The complications were classified according to Paley's classification. RESULTS: Union without residual infection was achieved in 20 (90.1%) patients while 2 patients had failure. As per ASAMI criteria bone results were excellent in 12 (54.5%), good in 5 (22.7%), fair in 3 (13.6%) and poor in 2 (9.1%). Functional results were excellent in 11 (50%), good in 5 (22.72%), fair in 4 (18.18%) and failure in 2 (9%). Mean treatment duration was 8.2 months (range 7-19 months). Mean follow up duration was 11.3 months (range - 8.3 to 22 months). Average lengthening achieved was 4 cm (0-9 cm). Treatment index was 2.1 month/cm. CONCLUSION: The monolateral rail fixator is simple, effective, easier to apply and more patient compliant with acceptable functional and radiological outcome.

Status of Vitamin D and Parathyroid Hormone in Patients Scheduled to Undergo Orthopedic Fracture Management: A Case-Control Study.

BACKGROUND: Vitamin D deficiency (VDD) is seen in all races, age groups, and ethnic backgrounds. VDD estimated to affect >1 billion people worldwide. The purpose of the present study is to characterize the extent of Vitamin D inadequacy and parathyroid hormone (PTH) levels among patients presenting to us for fracture management. MATERIALS AND METHODS: A prospective case-control study was performed whereby serum Vitamin D levels and corresponding PTH levels were measured. The study subjects included patients >45 years of age irrespective of sex who presented with fracture as a result of trivial trauma. A total of 102 cases (34 intertrochanteric fracture, 66 fracture neck of femur, and 2 Colle's fracture) and 100 controls were included in the study. RESULT: Average serum hydroxy-vitamin D and serum PTH of cases 15.8 ± 5.25 ng/mL and 91.15 ± 6.03 pg/mL, respectively. Average S.25-OH Vitamin D and serum PTH of controls was 25.49 ± 3.79 ng/mL and 23.46 ± 3.79 pg/mL, respectively. Eighty (78.4%) cases were in insufficient range (Vitamin D between 10-30 ng/mL), 16 (15.6%) were deficient (Vitamin D <10 ng/mL), and only 6 (5.8%) were sufficient (Vitamin D >30 ng/mL). While in controls, 28% had sufficient and 72% had insufficient Vitamin D levels. There was no deficient control. Serum PTH levels were significantly raised in cases when compared to controls consistent with secondary hyperparathyroidism. CONCLUSION: This study gives us very important data regarding the prevalence of VDD and rise of PTH secondary to the former and this hormonal milieu in our body is an independent risk factor for increased incidence of fracture.

Anharmonic vibrational spectra and mode-mode couplings analysis of 2-aminopyridine.

Vibrational spectra of 2-aminopyridine (2AP) have been analyzed using the vibrational self-consistence field theory (VSCF), correlated corrected vibrational self-consistence field theory (CC-VSCF) and vibrational perturbation theory (VPT2) at B3LYP/6-311G(d,p) framework. The mode-mode couplings affect the vibrational frequencies and intensities. The coupling integrals between pairs of normal modes have been obtained on the basis of quartic force field (2MR-QFF) approximation. The overtone and combination bands are also assigned in the FTIR spectrum with the help of anharmonic calculation at VPT2 method. A statistical analysis of deviations shows that estimated anharmonic frequencies are closer to the experiment over harmonic approximation. Furthermore, the anharmonic correction has also been carried out for the dimeric structure of 2AP. The fundamental vibration bands have been assigned on the basis of potential energy distribution (PED) and visual look over the animated modes. Other important molecular properties such as frontier molecular orbitals and molecular electrostatics potential mapping have also been analyzed.

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.

Cytodiagnosis of ChondromyxoidFibroma of the Metatarsal Head: A Case Report.

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor with a predilection for the bones of lower extremities and about one fourth of the tumors involve the foot. Radiologically, an eccentric lytic lesion with well-defined margins is seen in the metaphysis of the bone. We hereby, report an 18 yr old young male who presented to Orthopedic Outpatient Department, JN Medical College, Aligarh Muslim University, India diagnosed with giant cell tumor of the third metatarsal bone of right foot on radiography but on fine needle aspiration cytology (FNAC) the diagnosis of CMF was made. Preoperative diagnosis of this benign condition helped in doing minimum surgical intervention in the form of curettage along with bone grafting. Histopathology further confirmed the diagnosis of CMF. The case is being discussed to highlight the importance of FNAC to diagnose these uncommon benign bone lesions.

Chronic pain along the lateral condyle of humerus.

[No Abstract Available].

Unusual cause of anterior knee pain.

[No Abstract Available].

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.

Congenital Longitudinal Radial Deficiency in Infants: Spectrum of Isolated Cases to VACTERL Syndrome.

Congenital longitudinal radial deficiency is a rare congenital anomaly and encompasses a spectrum ranging from mild hypoplasia to complete absence of radius. Furthermore known as radial club hand or radial dysplasia, there is variable degree of deficiency along the radial side of the limb. The authors report a case series of four cases; two cases of isolated radial club hand and two associated with other anomalies, including VACTERL syndrome. The rarity of the disease and the need to exclude other associated anomalies are emphasized.