"Trends and beliefs in ACL reconstruction surgery: Indian perspectives".

Objectives: The survey aimed to assess trends and beliefs in the management of anterior cruciate ligament reconstruction (ACLR) amongst orthopaedic surgeons in India. Methods: A survey was created and distributed among the various orthopaedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies and the rehabilitation protocol. Results: 135 surgeons completed the survey. 35% of them were having experience of more than 12 years. A large number of surgeons were from government academic institutes (35.5%). The most common criteria for deciding about surgery was Clinical evaluation (94.8%). The most common graft choice was hamstring tendon (94%), and suspensory fixation on the femur side and interference screw on the tibial side (80%) is the most common fixation method. Almost two-thirds of surgeons in this survey use bracing to protect ACL graft in the initial phase. Conclusion: We presented the preferences amongst the group of surgeons on the management of ACL injuries. Hamstring tendon graft remains the most preferred graft for ACL reconstruction. Further, the suspensory loop on the femoral side and interference screw on the tibial side are the preferred fixation method. This group of surgeons is conservative in terms of the timing of surgeries and post-operative bracing. Level of evidence Level V, Expert Opinion.

Extent of knowledge and attitudes on plagiarism among undergraduate medical students in South India - a multicentre, cross-sectional study to determine the need for incorporating research ethics in medical undergraduate curriculum.

BACKGROUND: Undergraduate medical students in India participate in various research activities However, plagiarism is rampant, and we hypothesize that it is the lack of knowledge on how to avoid plagiarism. This study's objective was to measure the extent of knowledge and attitudes towards plagiarism among undergraduate medical students in India. METHODS: It was a multicentre, cross-sectional study conducted over a two-year period (January 2018 - December 2019). Undergraduate medical students were given a pre-tested semi-structured questionnaire which contained: (a) Demographic details; (b) A quiz developed by Indiana University, USA to assess knowledge; and (c) Attitudes towards Plagiarism (ATP) questionnaire. RESULTS: Eleven medical colleges (n = 4 government medical colleges [GMCs] and n = 7 private medical colleges [PMCs]) participated. A total of N = 4183 students consented. The mean (SD) knowledge score was 4.54 (1.78) out of 10. The factors (adjusted odds ratio [aOR]; 95% Confidence interval [CI]; p value) that emerged as significant predictors of poor knowledge score were early years of medical education (0.110; 0.063, 0.156; < 0.001) and being enrolled in a GMC (0.348; 0.233, 0.463; < 0.001).The overall mean (SD) scores of the three attitude components namely permissive, critical and submissive norms were 37.56 (5.25), 20.35 (4.20) and 31.20 (4.28) respectively, corresponding to the moderate category. CONCLUSION: The overall knowledge score was poor. A vast majority of study participants fell in the moderate category of attitude score. These findings warrant the need for incorporating formal training in the medical education curriculum.

Extent of awareness and attitudes on plagiarism among post-graduate resident doctors and junior medical faculty in India: a cross-sectional, multicentric study.

OBJECTIVES: Though dissertation is mandatory for postgraduates (PG), it is unknown if adequate knowledge on plagiarism exists at that level. Thus, we intended to study the knowledge and attitude towards plagiarism among junior doctors in India. DESIGN: Cross-sectional study SETTING: PG medical residents and Junior faculty from various teaching institutions across south India. PARTICIPANTS: A total of N=786 doctors filled the questionnaires of which approximately 42.7% were from government medical colleges (GMCs) and the rest from private institutions. METHODS: Participants were given a pretested semistructured questionnaire which contained: (1) demographic details; (2) a quiz developed by Indiana University, USA to assess knowledge and (3) Attitudes towards Plagiarism Questionnaire (ATPQ). OUTCOME MEASURES: The Primary outcome measure was knowledge about plagiarism. The secondary outcome measure was ATPQ scores. RESULTS: A total of N=786 resident doctors and junior faculty from across 11 institutions participated in this study. Of this, 42.7% were from GMCs and 60.6% were women. The mean (SD) knowledge score was 4.43 (1.99) out of 10. The factors (adjusted OR; 95% CI; p value) that emerged as significant predictors of knowledge were number of years in profession (-0.181; -0.299 to -0.062; 0.003), no previous publication (0.298; 0.099 to 0.498; 0.003) and working in a GMC (0.400; 0.106 to 0.694; 0.008). The overall mean (SD) scores of the three attitude components were: Permissive attitudes-37.33 (5.33), critical attitudes -20.32 (4.82) and subjective norms-31.05 (4.58), all of which corresponded to the moderate category. CONCLUSION: Participants lacked adequate knowledge on how to avoid plagiarism suggesting a need for a revamp in medical education curriculum in India by incorporating research and publication ethics.

Effect of Turmacin supplementation on joint discomfort and functional outcome among healthy participants - A randomized placebo-controlled trial.

OBJECTIVE: Curcuma longa has been widely used in Ayurveda for its medicinal properties and Turmacin was developed from C. longa as a standardized extract containing turmerosaccharides. In this clinical trial, the effect of Turmacin on knee joint discomfort in healthy adults subjected to strenuous physical activity was evaluated. DESIGN: Double-blind, triple-arm, parallel-group, randomized placebo-controlled trial. SETTING: Healthy participants from an urban tertiary care teaching hospital. INTERVENTION: Healthy participants were randomized in 1:1:1 ratio to receive either Turmacin 0.5 g/1 g or placebo once daily for 84 days. The participants were subjected to 10-minute strenuous exercise. OUTCOME MEASURES: Time to initial pain, final pain score on a visual analogue scale, range of movement (ROM) of knee and the force of contractions of muscles around the knee joint. RESULTS: A total of n = 90 participants were recruited. The mean final pain scores were significantly lower in the Turmacin 1 g and Turmacin 0.5 g when compared with the placebo from day-7 and day-5 onwards respectively. The survival analysis consistently showed a decreased hazard for early onset of pain in both the Turmacin groups. On day-84, the difference in mean ROM between Turmacin 0.5 g and placebo was 4.79 degrees (p = 0.008) and that for Turmacin 1 g and placebo was 2.34 degrees (p = 0.306). The difference in muscle force for isokinetic contractions of the quadriceps at angular velocities of 120 and 180 was significant between Turmacin 0.5 g and placebo (p = 0.002 and p = 0.005 respectively) while that for Turmacin 1 g & Turmacin 0.5 g (p = 0.206 and p = 0.414 respectively) and Turmacin 1 g & Placebo (p = 0.046 and p = 0.037) were not significant. However, in the within group analysis participants in Turmacin 1 g group had better preserved muscle functions than Turmacin 0.5 g group at angular velocities of 120 and 180 when compared with placebo. CONCLUSION: Turmacin (0.5 g and 1 g) was efficacious when compared to placebo in increasing the pain threshold and knee ROM in healthy participants with minor adverse events.

Conventional antidiabetic agents and bone health: A pilot case-control study.

BACKGROUND AND OBJECTIVES: The burden of noncommunicable diseases such as diabetes (type 2 diabetes mellitus [T2DM]) and osteoporosis is increasing with increasing longevity. Uncontrolled T2DM is an independent risk factor for osteoporosis explained by the insulin osteocalcin pathway. Due to limited information on the effect of various commonly used antidiabetic agents (ADA) on bone health, our study aims to analyze the association between the two. METHODOLOGY: This is a case-control study, with 100 cases of clinical osteoporosis and 100 age-, sex-, and dietary status-matched controls in whom osteoporosis was ruled out by dual-energy X-ray absorptiometry scan. Prescription details of T2DM, physical activity levels, and disease status were collected using a pretested questionnaire. Exposure to each ADA was compared using the Chi-squared test. Binary logistic regression was performed to adjust the two main confounders, namely glycemic control and physical activity levels, and adjusted risk estimates were calculated. RESULTS: There were a total of 74 T2DM patients, of whom 45 (60.8%) were cases and 29 (39.2%) were controls. Sulfonylureas (adjusted odds ratio [aOR] = 0.164, P = 0.004) and insulin (aOR = 0.248, P = 0.042) showed a significant protective effect on bone health. Biguanides (OR = 1.994, P = 0.029) and thiazolidinediones (OR: 5.444, P = 0.033), which demonstrated that an increased risk of osteoporosis in univariate analysis became insignificant after multivariate analysis. CONCLUSION: Sulfonylureas and insulin through the insulin osteocalcin pathway show favorable effect on bone health, but the probability of increased fractures secondary to hypoglycemic falls should be borne in mind. We recommend larger prospective studies to confirm this association.

Dietary calcium intake and physical activity levels among people living in Karnataka, India - An observational hospital-based study.

BACKGROUND: Calcium is the most abundant mineral in our body with varied functions, and its dietary deficiency leads to osteoporosis. Various studies have shown that adequate dietary calcium intake (DCI) and moderately increased physical activity if maintained for long term prevent osteoporosis. The data regarding DCI of people living in Karnataka, south India, are limited. Thus, we aimed to assess DCI, physical activity, and their predictors among people living in Karnataka. METHODOLOGY: A cross-sectional study was done among 250 inpatients and normal relatives of orthopedics department of a tertiary care teaching hospital. Multistage random sampling was performed. DCI and physical activity were measured using validated questionnaires. RESULTS: The mean (standard deviation) DCI was 499.94 (251.5). The prevalence [95 confidence interval (CI)] of poor intakers of DCI [DCI < Recommended Dietary Allowance (RDA)] was 76.6% (70.9, 81.7). However, only 43.52% of all participants with poor DCI were on supplements. Male gender [2.189 (1.125, 4.257)], elderly [1.988 (1.067, 3.705)], and low knowledge score [1.240 (1.093, 1.407)] were significant predictors of low DCI. The proportion (95 CI) of patients who were categorized as having low physical activity (LPA) was 44.0% (37.8, 50.4). The predictors for LPA [adjusted odds ratio (95 CI)] were marital status, being single [1.853 (1.047, 3.282)], and low socioeconomic status class [1.209 (1.002, 1.458)]. CONCLUSION: DCI was below the RDA for three-fourths of our patients with nearly half of them being physically inactive, indicating the need for better education regarding DCI and improving physical activity, all of which can prevent osteoporosis.

Neglected dorsal dislocation of the scaphoid.

Isolated dislocation of the scaphoid is very rare. A 45-year old male, industrial worker reported two and half months after injury with wrist pain and swelling on the dorsum of left wrist. He was diagnosed as neglected dorsal dislocation of scaphoid. Proximal row carpectomy with capsular interposition was done stabilizing the distal carpus on the radius using Kirschner wires. At-12 months follow-up the patient had good wrist function and was satisfied with the outcome of the treatment. We hereby report this neglected dorsal dislocation of scaphoid in view of rarity and discuss the various options for management.