Mid-term Results of Total Hip Arthroplasty for Posttraumatic Osteoarthritis after Acetabular Fracture.

Purpose: The prognosis of total hip replacement (THR) after open reduction and internal fixation (ORIF) versus THR following non-operative treatment of acetabular fractures is unclear. Few studies have been conducted in this regard. Therefore, the purpose of the current study was to perform an assessment and compare the functional outcomes for study subjects in the ORIF and non-ORIF groups during the follow-up period compared to baseline. Materials and Methods: This longitudinal comparative study, which included 40 patients who underwent THR for either posttraumatic arthritis after fixation of an acetabular fracture or arthritis following conservative management of a fracture, was conducted for 60 months. Twenty-four patients had undergone ORIF, and 16 patients had undergone nonoperative/conservative management for acetabular fractures. Following THR, the patients were followed up for monitoring of functional outcomes for the Harris hip score (HHS) and comparison between the ORIF and non-ORIF groups was performed. Results: The HHS showed significant improvement in both ORIF and non-ORIF groups. At the end of the mean follow-up period, no significant variation in scores was observed between the groups, i.e., ORIF group (91.61±6.64) compared to non-ORIF group (85.74±11.56). A significantly higher number of re-interventions were required for medial wall fractures and combined fractures compared to posterior fractures (P<0.05). Conclusion: THR resulted in improved functional outcome during follow-up in both the groups; however, the ORIF group was observed to have better functional outcome. Re-intervention was not required for any of the posterior fractures at the end of the mean follow-up period.

Attention-gated 3D CapsNet for robust hippocampal segmentation.

Purpose: The hippocampus is organized in subfields (HSF) involved in learning and memory processes and widely implicated in pathologies at different ages of life, from neonatal hypoxia to temporal lobe epilepsy or Alzheimer's disease. Getting a highly accurate and robust delineation of sub-millimetric regions such as HSF to investigate anatomo-functional hypotheses is a challenge. One of the main difficulties encountered by those methodologies is related to the small size and anatomical variability of HSF, resulting in the scarcity of manual data labeling. Recently introduced, capsule networks solve analogous problems in medical imaging, providing deep learning architectures with rotational equivariance. Nonetheless, capsule networks are still two-dimensional and unassessed for the segmentation of HSF. Approach: We released a public 3D Capsule Network (3D-AGSCaps, https://github.com/clementpoiret/3D-AGSCaps) and compared it to equivalent architectures using classical convolutions on the automatic segmentation of HSF on small and atypical datasets (incomplete hippocampal inversion, IHI). We tested 3D-AGSCaps on three datasets with manually labeled hippocampi. Results: Our main results were: (1) 3D-AGSCaps produced segmentations with a better Dice Coefficient compared to CNNs on rotated hippocampi (p=0.004, cohen's d=0.179); (2) on typical subjects, 3D-AGSCaps produced segmentations with a Dice coefficient similar to CNNs while having 15 times fewer parameters (2.285M versus 35.069M). This may greatly facilitate the study of atypical subjects, including healthy and pathological cases like those presenting an IHI. Conclusion: We expect our newly introduced 3D-AGSCaps to allow a more accurate and fully automated segmentation on atypical populations, small datasets, as well as on and large cohorts where manual segmentations are nearly intractable.

A fast and robust hippocampal subfields segmentation: HSF revealing lifespan volumetric dynamics.

The hippocampal subfields, pivotal to episodic memory, are distinct both in terms of cyto- and myeloarchitectony. Studying the structure of hippocampal subfields in vivo is crucial to understand volumetric trajectories across the lifespan, from the emergence of episodic memory during early childhood to memory impairments found in older adults. However, segmenting hippocampal subfields on conventional MRI sequences is challenging because of their small size. Furthermore, there is to date no unified segmentation protocol for the hippocampal subfields, which limits comparisons between studies. Therefore, we introduced a novel segmentation tool called HSF short for hippocampal segmentation factory, which leverages an end-to-end deep learning pipeline. First, we validated HSF against currently used tools (ASHS, HIPS, and HippUnfold). Then, we used HSF on 3,750 subjects from the HCP development, young adults, and aging datasets to study the effect of age and sex on hippocampal subfields volumes. Firstly, we showed HSF to be closer to manual segmentation than other currently used tools (p < 0.001), regarding the Dice Coefficient, Hausdorff Distance, and Volumetric Similarity. Then, we showed differential maturation and aging across subfields, with the dentate gyrus being the most affected by age. We also found faster growth and decay in men than in women for most hippocampal subfields. Thus, while we introduced a new, fast and robust end-to-end segmentation tool, our neuroanatomical results concerning the lifespan trajectories of the hippocampal subfields reconcile previous conflicting results.

Comparative effectiveness of adipose-derived mesenchymal stromal cells in the management of knee osteoarthritis: A meta-analysis.

BACKGROUND: Osteoarthritis (OA) is the most common joint disorder, is associated with an increasing socioeconomic impact owing to the ageing population. AIM: To analyze and compare the efficacy and safety of bone-marrow-derived mesenchymal stromal cells (BM-MSCs) and adipose tissue-derived MSCs (AD-MSCs) in knee OA management from published randomized controlled trials (RCTs). METHODS: Independent and duplicate electronic database searches were performed, including PubMed, EMBASE, Web of Science, and Cochrane Library, until August 2021 for RCTs that analyzed the efficacy and safety of AD-MSCs and BM-MSCs in the management of knee OA. The visual analog scale (VAS) score for pain, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, Tegner score, magnetic resonance observation of cartilage repair tissue score, knee osteoarthritis outcome score (KOOS), and adverse events were analyzed. Analysis was performed on the R-platform using OpenMeta (Analyst) software. Twenty-one studies, involving 936 patients, were included. Only one study compared the two MSC sources without patient randomization; hence, the results of all included studies from both sources were pooled, and a comparative critical analysis was performed. RESULTS: At six months, both AD-MSCs and BM-MSCs showed significant VAS improvement (P = 0.015, P = 0.012); this was inconsistent at 1 year for BM-MSCs (P < 0.001, P = 0.539), and AD-MSCs outperformed BM-MSCs compared to controls in measures such as WOMAC (P < 0.001, P = 0.541), Lysholm scores (P = 0.006; P = 0.933), and KOOS (P = 0.002; P = 0.012). BM-MSC-related procedures caused significant adverse events (P = 0.003) compared to AD-MSCs (P = 0.673). CONCLUSION: Adipose tissue is superior to bone marrow because of its safety and consistent efficacy in improving pain and functional outcomes. Future trials are urgently warranted to validate our findings and reach a consensus on the ideal source of MSCs for managing knee OA.

Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India.

BACKGROUND: The number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited. METHODS: We conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL). RESULTS: Among 400 participants, median age was 40 years (IQR 34-44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77-13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98-8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33-5.34). CONCLUSIONS: We found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.

Maturity of white matter tracts is associated with episodic memory recall during development.

The structure-function relationship between white matter microstructure and episodic memory (EM) has been poorly studied in the developing brain, particularly in early childhood. Previous studies in adolescents and adults have shown that episodic memory recall is associated with prefrontal-limbic white matter microstructure. It is unknown whether this association is also observed during early ontogeny. Here, we investigated the association between prefrontal-limbic tract microstructure and EM performance in a cross-sectional sample of children aged 4 to 12 years. We used a multivariate partial least squares correlation approach to extract tract-specific latent variables representing shared information between age and diffusion parameters describing tract microstructure. Individual projections onto these latent variables describe patterns of interindividual differences in tract maturation that can be interpreted as scores of white matter tract microstructural maturity. Using these estimates of microstructural maturity, we showed that maturity scores of the uncinate fasciculus and dorsal cingulum bundle correlated with distinct measures of EM recall. Furthermore, the association between tract maturity scores and EM recall was comparable between younger and older children. Our results provide new evidence on the relation between white matter maturity and EM performance during development.

Platelet-rich plasma therapy ensures pain reduction in the management of lateral epicondylitis - a PRISMA-compliant network meta-analysis of randomized controlled trials.

OBJECTIVES: Analyze the effectiveness of PRP therapy in comparison to other available treatments in the management of lateral epicondylitis (LE). MATERIALS AND METHODS: We conducted electronic database searches in PubMed, Embase, Web of Science, and Cochrane Library until June 2021 for RCTs analyzing the efficacy of PRP in the management of LE. VAS for pain, DASH score, and PRETEE score were the outcomes analyzed. The analysis was performed in R-platform using MetaInsight and interventions were ranked based on p-score approach. Cochrane's CINeMA approach was used for quality appraisal. RESULTS: Twenty-five RCTs with 2040 patients were included in the network analysis. Compared to saline control, only leukocyte-rich-PRP resulted in significant pain relief (WMD=-14.8,95% CI [-23.18,-6.39];low confidence) compared to steroid, local anesthetic, laser, and surgery. On analyzing DASH scores and PRETEE scores, none of the above-mentioned treatment methods were superior to saline control. In subgroup analysis, leucocyte-rich-PRP resulted in clinically significant improvement. Leucocyte-rich-PRP seems more promising with p-score of 0.415. CONCLUSION: PRP therapy offers significant pain relief compared to saline control in the management of LE without similar improvement in functional outcome. With available low-quality evidence, PRP was the most promising therapy that needs further exploration to explore its usefulness in lateral epicondylitis.

Pharmacokinetics and Safety of 3 Months of Weekly Rifapentine and Isoniazid for Tuberculosis Prevention in Pregnant Women.

BACKGROUND: Pregnancy increases the risk of tuberculosis and its complications. A 3-month regimen of weekly isoniazid and rifapentine (3HP) is safe and effective for tuberculosis prevention in adults and children, including those with HIV, but 3HP has not been evaluated in pregnancy. METHODS: IMPAACT 2001 was a phase I/II trial evaluating the pharmacokinetics and safety of 3HP among pregnant women with indications for tuberculosis preventative therapy in Haiti, Kenya, Malawi, Thailand, and Zimbabwe (NCT02651259). Isoniazid and rifapentine were provided at standard doses (900 mg/week). Pharmacokinetic sampling was performed with the first (second/third trimester) and twelfth (third trimester/postpartum) doses. Nonlinear mixed-effects models were used to estimate drug population pharmacokinetics. RESULTS: Of 50 participants, 20 had HIV and were taking efavirenz-based antiretroviral therapy. Among women without HIV, clearance of rifapentine was 28% lower during pregnancy than postpartum (1.20 vs 1.53 L/hour, P < .001), with area under the concentration-time curve (AUCSS) of 786 and 673 mg × hour/L, respectively. In pregnant women with HIV, clearance was 30% higher than women without HIV (P < .001), resulting in lower AUCss (522 mg × hour/L); clearance did not change significantly between pregnancy and postpartum. Pregnancy did not impact isoniazid pharmacokinetics. There were no drug-related serious adverse events, treatment discontinuations, or tuberculosis cases in women or infants. CONCLUSIONS: 3HP does not require dose adjustment in pregnancy. Rifapentine clearance is higher among women with HIV, but all women achieved exposures of rifapentine and isoniazid associated with successful tuberculosis prevention. The data support proceeding with larger safety-focused studies of 3HP in pregnancy. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov, NCT02651259.

Knowledge, Awareness, and Practices (KAP) towards COVID-19 among the marine fishers of Maharashtra State of India: An online cross-sectional Analysis.

The knowledge, awareness, and practices (KAP) about COVID-19 among the marine fishers who are engaged in the high-risk occupations and depend on the vulnerable sources of income in the Maharashtra state of India, were investigated to understand the behavioral changes and vulnerability among the respondents because of COVID-19. Data were collected through an online survey from 1st July to 30th July 2020 during the first peak of COVID-19 in the study area by using the questionnaire. Authors based on the latest recommendations by the World Health Organization (WHO) developed the questionnaire and covered the KAP aspects under study. The questionnaire was administered through Google form link and the link was disseminated through social media such as Facebook and What's App. The completed responses (n = 533) received from the eligible sample, excluding those outsides of the fisher community and duplicate entries were considered for analysis. Appropriate statistical tools were used to analyze the data. Among the respondents, 447 men (83.86%) and 86 women (16.14%), with a mean age of 45.4 years (M = 45.4, SD = 1.18). The results revealed that 70.92% of respondents perceived a low risk of infection because of COVID-19 with M = 1.77 and SD = 0.583, but authors found the perceived severity score high (M = 3.95, SD = 1.21) among the 60.97% of respondents. Around 95% of respondents were aware of the COVID-19, while almost all respondents knew the medium of infection and symptoms of COVID-19. The behavior of respondents towards COVID-19 infection was positive and was following sufficient precautionary measures suggested by WHO to protect themselves from COVID-19 infection. The results of multiple regression analysis revealed that the demographic features of respondents like age, education were significantly contributing to the KAP of the fisher community. The results confirmed the importance of KAP which is reflected in the behavioral responses of the fishers while tackling the COVID-19 pandemic situation. The results regarding the risk perception, severity, KAP about COVID-19 provide a collective understanding of the emerging infectious disease among the marine fishers of Maharashtra state of India.

Hippocampal subfield volumes and memory discrimination in the developing brain.

The ability to keep distinct memories of similar events is underpinned by a type of neural computation called pattern separation (PS). Children typically report coarse-grained memories narratives lacking specificity and detail. This lack of memory specificity is illustrative of an immature or impaired PS. Despite its importance for the ontogeny of memory, data regarding the maturation of PS during childhood is still scarce. PS is known to rely on the hippocampus, particularly on hippocampal subfields DG and CA3. In this study, we used a memory discrimination task, a behavioral proxy for PS, and manually segmented hippocampal subfields volumes in the hippocampal body in a cohort of 26 children aged from 5 to 12 years. We examined the association between subfields volumes and memory discrimination performance. The main results were: (1) we showed age-related differences of memory discrimination suggesting a continuous increase of memory performance during early to late childhood. (2) We evidenced distinct associations between age and the volumes of hippocampal subfield, suggesting distinct developmental trajectories. (3) We showed a relationship between memory discrimination performance and the volumes of CA3 and subiculum. Our results further confirm the role of CA3 in memory discrimination, and suggest to scrutinize more closely the role of the subiculum. Overall, we showed that hippocampal subfields contribute distinctively to PS during development.

Association of Maternal Viral Load and CD4 Count With Perinatal HIV-1 Transmission Risk During Breastfeeding in the PROMISE Postpartum Component.

BACKGROUND: Breastfeeding mothers with HIV infection not qualifying for antiretroviral therapy (ART) based on country-specific guidelines at the time of the Promoting Maternal-Infant Survival Everywhere trial and their uninfected neonates were randomized to maternal ART (mART) or infant nevirapine prophylaxis (iNVP) postpartum. HIV transmission proportions were similar (<1%) in the 2 arms. We assessed whether maternal viral load (MVL) and CD4 cell counts were associated with breastfeeding HIV transmission. METHODS: MVL was collected at entry (7-14 days postpartum) and at weeks 6, 14, 26, and 50 postpartum. CD4 cell counts were collected at entry and weeks 14, 26, 38, and 50 postpartum. Infant HIV-1 nucleic acid test was performed at weeks 1 and 6, every 4 weeks until week 26, and then every 12 weeks. The associations of baseline and time-varying MVL and CD4 cell counts with transmission risk were assessed using time-to-event analyses by randomized treatment arm. RESULTS: Two thousand four hundred thirty-one mother-infant pairs were enrolled in the study. Baseline MVL (P = 0.11) and CD4 cell counts (P = 0.51) were not significantly associated with infant HIV-1 infection. Time-varying MVL was significantly associated with infant HIV-1 infection {hazard ratio [95% confidence interval (CI)]: 13.96 (3.12 to 62.45)} in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 1.04 (0.20 to 5.39)]. Time-varying CD4 cell counts were also significantly associated with infant HIV-1 infection [hazard ratio (95% CI): 0.18 (0.03 to 0.93)] in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 0.38 (0.08 to 1.77)]. CONCLUSIONS: In women receiving mART, increased MVL and decreased CD4 cell counts during breastfeeding were associated with increased risk of infant HIV-1 infection.

Individual and Composite Adverse Pregnancy Outcomes in a Randomized Trial on Isoniazid Preventative Therapy Among Women Living With Human Immunodeficiency Virus.

BACKGROUND: International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1078, a randomized noninferiority study designed to compare the safety of starting isoniazid preventive therapy (IPT) in women living with human immunodeficiency virus (HIV) either during pregnancy or after delivery, showed that IPT during pregnancy increased the risk of composite adverse pregnancy outcomes, but not individual outcomes. Many known factors are associated with adverse pregnancy outcomes: these factors' associations and effect modifications with IPT and pregnancy outcomes were examined. METHODS: Pregnant women living with HIV from 8 countries with tuberculosis incidences >60/100 000 were randomly assigned to initiate 28 weeks of IPT either during pregnancy or at 12 weeks after delivery. Using univariable and multivariable logistic regression and adjusting for factors associated with pregnancy outcomes, composite and individual adverse pregnancy outcome measures were analyzed. RESULTS: This secondary analysis included 925 mother-infant pairs. All mothers were receiving antiretrovirals. The adjusted odds of fetal demise, preterm delivery (PTD), low birth weight (LBW), or a congenital anomaly (composite outcome 1) were 1.63 times higher among women on immediate compared to deferred IPT (95% confidence interval [CI], 1.15-2.31). The odds of fetal demise, PTD, LBW, or neonatal death within 28 days (composite outcome 2) were 1.62 times higher among women on immediate IPT (95% CI, 1.14-2.30). The odds of early neonatal death within 7 days, fetal demise, PTD, or LBW (composite outcome 3) were 1.74 times higher among women on immediate IPT (95% CI, 1.22-2.49). CONCLUSIONS: We confirmed higher risks of adverse pregnancy outcomes associated with the initiation of IPT during pregnancy, after adjusting for known risk factors for adverse pregnancy outcomes.

Reconstruction of Neglected Patellar Tendon Rupture using Tendoachilles' Allograft with Transosseous Tunnels: A Case Report.

INTRODUCTION: Neglected patellar tendon ruptures are uncommon. They are challenging due to the proximal migration of patella and soft-tissue contractures. They are usually managed with autografts or allografts with or without synthetic augmentation, and fixation is done using metallic implants. CASE REPORT: A 59-year-old farmer presented with an inability to straighten his knee for 6 months after sustaining a cut lacerated wound with a sickle. He was diagnosed with a patellar tendon rupture. Tendoachilles' allograft reconstruction was done by creating transosseous tunnels in the patella and tibial tuberosity with a figure of 8 con figurations of the final construct. Synthetic augmentation and metallic implants were not used. Excellent clinical and radiological results were achieved at 3 years' follow-up. CONCLUSION: Chronic patellar tendon ruptures can be managed using allograft without the need for synthetic augmentation or fixation with implants. This gives excellent clinical and radiological results.

An Evaluation of Baseline Kidney Function in the REPRIEVE Trial of Pitavastatin in Human Immunodeficiency Virus.

BACKGROUND: Chronic kidney disease is a common comorbid condition among persons living with human immunodeficiency virus (PWH). We characterized baseline kidney function in the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) trial cohort. METHODS: REPRIEVE enrolled PWH with low to moderate cardiovascular risk based on traditional risk factors to evaluate the effect of statin therapy on cardiovascular events. We determined baseline estimated glomerular filtration rate (eGFR) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease, and Cockcroft-Gault equations, and we evaluated baseline factors associated with eGFR <90 mL/min/1.73 m2 by logistic regression. We performed Bland-Altman plots and scatterplots to assess agreement between equations. RESULTS: Among 7770 participants enrolled, the median age was 50 years, 31% were female (natal sex), 43% black or African American and 15% Asian, the median body mass index (calculated as calculated as weight in kilograms divided by height in meters squared) was 25.8, and the median CD4 cell count 620/µL. The median CKD-EPI eGFR was 97 mL/min/1.73 m2, and 38% had an eGFR <90 mL/min/1.73 m2. In the adjusted model, factors associated with eGFR <90 mL/min/1.73 m2 included white race, older age, higher body mass index, high-income region of enrollment, hypertension, and tenofovir disoproxil fumarate. The CKD-EPI and Modification of Diet in Renal Disease equations demonstrated strong agreement, particularly at lower eGFR values. Overall, there was 56% concordance between the 3 equations (categories <60, 60 to <90, ≥90 mL/min), improving to 73% after accounting for individual body surface area. CONCLUSIONS: REPRIEVE enrolled a diverse cohort including a substantial number of PWH with reduced kidney function. Factors associated with reduced eGFR included traditional risk factors and tenofovir disoproxil fumarate exposure. Three commonly used equations have only fair agreement, with potential implications for both clinical care and epidemiologic studies. CLINICAL TRIALS REGISTRATION: NCT02344290.

Successful recruitment of a multi-site international randomized placebo-controlled trial in people with HIV with attention to diversity of race and ethnicity: critical role of central coordination.

Background: The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) is a multicenter, randomized, placebo-controlled trial, designed to test whether a statin medication can prevent cardiovascular disease in people with HIV. REPRIEVE recently completed enrollment of 7557 participants at over 100 clinical sites globally. Participant groups of focus were women, and racial and ethnic minorities.Objective: To describe recruitment methods and strategies developed by the REPRIEVE Clinical Coordinating Center (CCC) and share best practices learned from the recruitment process.Methods: Enrollment targets were agreed upon with the primary funder, the National Heart, Lung, and Blood Institute (NHLBI) and were milestone driven. Milestones included number of sites activated, number of participants enrolled within specific time frames, and proportion of women and minorities enrolled. Strategies to achieve these milestones included structured interviews with site-designated REPRIEVE Recruitment Champions to develop best practices, development of a multimedia campaign, and site level recruitment support.Results: Recruitment initiated March, 2015 and completed March, 2019. The final accrual target was 7500 participants over 48 months. The trial met this target within the time specified. Overall, 10,613 screens were completed, 48% of participants enrolled from sites outside of North America, 32% were female, 44% were Black or African American, and 25% were Hispanic or Latino.Conclusions: REPRIEVE met its overall projected recruitment goal by using multiple, simultaneous strategies to specifically target a diverse population including minority subgroups. REPRIEVE benefited from the development of recruitment strategies with clear targets and communication of accrual targets to study teams.

Hinged Total Knee Replacement for an Arthritic Knee Following a Neglected Knee Dislocation: A Case Report.

INTRODUCTION: Neglected knee dislocations are a rare entity. They present with gross degenerative changes and ligament laxity. There is no defined protocol for the treatment of arthritic knees in neglected knee dislocations. CASE REPORT: A 54-year-old male presented with pain and limp over his left knee after sustaining a knee dislocation 25 years back which was unsuccessfully reduced by open methods twice. Since the patient was a farmer and involved in heavy labor activities, we decided to avoid arthrodesis of his knee and help him ambulate immediately without any functional limitations. We performed a hinged total knee arthroplasty (TKA) which corrected the deformity, ligament laxity, and pain and helped him gain complete range of movements. The patient was followed-up till 30 months after the surgery with excellent clinical and radiological results. CONCLUSION: A hinged TKA is a reliable technique to correct a neglected knee dislocation in a single sitting provided thorough pre-operative assessment and post-operative physiotherapy are done.

Elevated highly sensitive C-reactive protein and d-dimer levels are associated with food insecurity among people living with HIV in Pune, India.

OBJECTIVE: To assess the prevalence and determinants of food insecurity among people living with HIV (PLWH) in Pune, India and its association with biomarkers known to confer increased risks of morbidity and mortality in this population. DESIGN: Cross-sectional analysis assessing food insecurity using the standardized Household Food Insecurity Access Scale. Participants were dichotomized into two groups: food insecure and food secure. Logistic regression models were used to assess associations between socio-economic, demographic, clinical, biochemical factors and food insecurity. SETTING: Antiretroviral therapy (ART) centre of Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals (BJGMC-SGH), Pune, a large publicly funded tertiary and teaching hospital in western India.ParticpantsAdult (≥18 years) PLWH attending the ART centre between September 2015 and May 2016 who had received ART for either ≤7d (ART-naïve) or ≥1 year (ART-experienced). RESULTS: Food insecurity was reported by 40 % of 483 participants. Independent risk factors (adjusted OR; 95 % CI) included monthly family income <INR 5000 (~70 USD; 13·2; CI 5·4, 32·2) and consuming ≥4 non-vegetarian meals per week (4·7; 1·9, 11·9). High-sensitivity C-reactive protein (hs-CRP) ≥0·33 mg/dl (1·6; 1·04, 2·6) and d-dimer levels 0·19-0·31 µg/ml (1·6; 1·01, 2·6) and ≥0·32 µg/ml (1·9; 1·2, 3·2) were also associated with food insecurity. CONCLUSIONS: More than a third of the study participants were food insecure. Furthermore, higher hs-CRP and d-dimer levels were associated with food insecurity. Prospective studies are required to understand the relationship between food insecurity, hs-CRP and d-dimer better.

Intestinal Barrier Dysfunction and Microbial Translocation in Human Immunodeficiency Virus-Infected Pregnant Women Are Associated With Preterm Birth.

Background: Preterm birth (PTB) rates are high in human immunodeficiency virus (HIV)-infected populations, even when on treatment. Still, only a subset of all births in HIV-infected pregnant women result in PTB, suggesting that risk factors other than HIV infection itself are also important. Inflammation is a known risk factor in uninfected populations, but its role in HIV-infected population have not been studied; in addition, the immune pathways involved are not clear and noninvasive immune markers with predictive value are lacking. Our objective was to determine the association of select markers of inflammation with PTB in HIV-1-infected pregnant women. Methods: Within a randomized trial of pregnant women receiving nevirapine (Six-Week Extended-Dose Nevirapine [SWEN] trial), we nested a case-control study (n = 107; 26 cases, 81 controls) to determine the association of maternal inflammation with PTB. Cases were defined as PTB (<37 weeks' gestational age). We assessed inflammation by measuring plasma levels of markers of general inflammation (C-reactive protein [CRP]), intestinal barrier dysfunction (intestinal fatty acid binding protein [I-FABP]), and microbial translocation/monocyte activation (soluble CD14 [sCD14] and CD163 [sCD163]). Multivariable logistic regression was used to determine the odds of PTB per log2 increase of each marker. Results: In multivariable models, there was increased odds of PTB per unit increase of log2 sCD14 (adjusted odds ratio [aOR], 2.45; 95% confidence interval [CI], 1.24-4.86), log2 sCD163 (aOR, 3.87; 95% CI, 1.43-10.49), and log2 I-FABP (aOR, 2.28; 95% CI, 1.18-4.41) but not log2 CRP (aOR, 0.72; 95% CI, .48-1.09). Conclusions: Our results show that select immune markers can identify women at higher risk for PTB in HIV-1-infected populations and suggest that modulating gut barrier integrity and microbial translocation may affect PTB. Clinical Trials Registration: NCT00061321.

Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial.

BACKGROUND: No randomized trial has directly compared the efficacy of prolonged infant antiretroviral prophylaxis versus maternal antiretroviral therapy (mART) for prevention of mother-to-child transmission throughout the breastfeeding period. SETTING: Fourteen sites in Sub-Saharan Africa and India. METHODS: A randomized, open-label strategy trial was conducted in HIV-1-infected women with CD4 counts ≥350 cells/mm (or ≥country-specific ART threshold if higher) and their breastfeeding HIV-1-uninfected newborns. Randomization at 6-14 days postpartum was to mART or infant nevirapine (iNVP) prophylaxis continued until 18 months after delivery or breastfeeding cessation, infant HIV-1 infection, or toxicity, whichever occurred first. The primary efficacy outcome was confirmed infant HIV-1 infection. Efficacy analyses included all randomized mother-infant pairs except those with infant HIV-1 infection at entry. RESULTS: Between June 2011 and October 2014, 2431 mother-infant pairs were enrolled; 97% of women were World Health Organization Clinical Stage I, median screening CD4 count 686 cells/mm. Median infant gestational age/birth weight was 39 weeks/2.9 kilograms. Seven of 1219 (0.57%) and 7 of 1211 (0.58%) analyzed infants in the mART and iNVP arms, respectively, were HIV-infected (hazard ratio 1.0, 96% repeated confidence interval 0.3-3.1); infant HIV-free survival was high (97.1%, mART and 97.7%, iNVP, at 24 months). There were no significant differences between arms in median time to breastfeeding cessation (16 months) or incidence of severe, life-threatening, or fatal adverse events for mothers or infants (14 and 42 per 100 person-years, respectively). CONCLUSIONS: Both mART and iNVP prophylaxis strategies were safe and associated with very low breastfeeding HIV-1 transmission and high infant HIV-1-free survival at 24 months.

Maternal Syphilis: An Independent Risk Factor for Mother to Infant Human Immunodeficiency Virus Transmission.

Syphilis is associated with increased human immunodeficiency virus acquisition and sexual transmission; we examined impact on human immunodeficiency virus mother-to-child transmission among mother-infant pairs enrolled in the India Six-Week Extended-Dose Nevirapine study. Maternal syphilis, diagnosed serologically using Venereal Disease Research Laboratory titer plus Treponema Pallidum Hemagglutination Assay, was associated with 2.5-fold greater risk.