Extra-articular Lateral Talar Dome Osteochondral Fracture: A Case Report and a Review of Literature.

The lateral talar dome osteochondral fracture has been described as shallow or wafer-shaped and is more likely to have an associated flake fracture than medial injuries. Displacement into the extracurricular space, however, is a rare occurrence. We present a case of ankle trauma with persistent pain and edema. A CT scan revealed a displaced osteochondral fracture of the lateral dome of the talus and an avulsion fracture of the tip of the medial malleolus. After appropriate dissection and exposure, the fragment was found below the skin, outside the ankle joint capsule. The fragment was fixed to the neck of the talus, and the deltoid ligament and anterior inferior tibiofibular ligament were repaired. After a one-year follow-up, full recovery was achieved without pain, stiffness, or osteonecrosis of the displaced fragment. Although the extra-articular displacement of lateral talar dome osteochondral fractures is rare, it should be considered when assessing ankle trauma.

Patient reported outcomes following revision neurectomy through a dorsal approach for recurrent interdigital neuroma.

Interdigital neuroma is one of the commonest causes of metatarsalgia. The reported success rate after excision of a primary neuroma is 74%. Recurrent symptoms after neurectomy can be due to a recurrent interdigital neuroma. Recurrent interdigital neuromas can be diagnosed using sound clinical examination and ultrasonography. Surgical excision is the best treatment modality with varying success reported in the literature. We report on the clinical outcome following surgical excision of recurrent interdigital neuromas through a dorsal approach. All patients who had undergone excision of a recurrent interdigital neuroma by a single surgeon between 01/2010 and 12/2019 were identified. Inclusion criteria included patients having a preoperative ultrasound and postoperative histology report. The exclusion criteria were preexisting neuropathy or tarsal tunnel syndrome. Demographic data was collected, and a self-reported foot and ankle score questionnaire (SEFAS) was completed by the patient at their most recent follow-up. Twenty-three patients (25 feet) were included in the study. Mean time of follow-up was 75 (range 14-189) months. The mean age was 49 (range 15-71) years. Eleven (44%) recurrent neuromas were excised from the second webspace and 14 (56%) were excised from the third webspace. All excised masses were confirmed as recurrent neuromas histologically. Regarding the SEFAS score, 17 (73.93%) patients scored as excellent, one (4.34%) as good, three (13.04%) as fair, and two (8.69%) as poor. This long term follow-up study on outcomes after surgery for recurrent interdigital neuroma suggests that excision through a dorsal approach is an effective treatment option with a high patient satisfaction.

A Rare Case of Flexor Digitorum Accessorius Longus Muscle Presenting as Tarsal Tunnel Syndrome.

Tarsal tunnel syndrome (TTS) is a relatively uncommon nerve entrapment neuropathy. Many pathologies are reported as possible causes for TTS. The diagnosis of TTS can be difficult and often missed. We present a rare case of TTS due to an accessory flexor digitorum longus muscle. Together with a high index of suspicion, MRI is the investigation of choice in making the diagnosis. These patients are best managed with excision or transposition of the flexor digitorum accessorius longus (FDAL) and neurolysis of the posterior tibial nerve and its branches.

Knee scooter related injuries and satisfaction in patients following foot and ankle surgery.

BACKGROUND: Knee scooters have become popular amongst foot and ankle surgeons for patients who are required to be non-weight bearing. Information is limited regarding falls and injuries sustained while using a knee scooter and potential contraindications to their use are ill-defined. No study has assessed patient reported injuries and satisfaction. This study aims to evaluates the patient's perspective with regards to the use of a knee scooter. As a secondary aim we assessed for risk factors associated with knee scooter related injuries to try make recommendations for the safe use of a knee scooter. METHODS: Patients who used a knee scooter during 2018-2020 were emailed a questionnaire assessing (1) demographic data, (2) medical history, (3) falls and injuries sustained, including the management of these injuries, and (4) patient satisfaction. This study is a descriptive, cross-sectional survey analysis. RESULTS: 101/196 (51,5%) responses were received, which included 32 males and 69 females. The cohort had a mean age of 56.4 years, and BMI of 28.5. Mean time spent using the scooter was 6.7 weeks. Twenty-five respondents had fallen off the scooter, with 5 reporting injuries. One patient required medical attention for a shoulder injury. Cause of falls included hitting an obstacle, making a sharp turn, moving too fast, and moving downhill. There was no correlation between falls and patient comorbidities. Ninety-six percent of respondents reported a high satisfaction and preferred the scooter to crutches. CONCLUSION: The knee scooter is a safe, and well-tolerated, mobility aid for patients requiring non-weight bearing during their recovery, with a high satisfaction rate. Educating patients on correct use and common causes for falling is important as a preventative measure. LEVEL OF EVIDENCE: IV, retrospective case series.

Development of Inactivated FAKHRAVAC® Vaccine against SARS-CoV-2 Virus: Preclinical Study in Animal Models.

The recent viral infection disease pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global public health crisis. Iran, as one of the countries that reported over five million infected cases by September 2021, has been concerned with the urgent development of effective vaccines against SARS-CoV-2. In this paper, we report the results of a study on potency and safety of an inactivated SARS-CoV-2 vaccine candidate (FAKHRAVAC) in a preclinical study so as to confirm its potential for further clinical evaluation. Here, we developed a pilot-scale production of FAKHRAVAC, a purified inactivated SARS-CoV-2 virus vaccine candidate that induces neutralizing antibodies in Balb/c mice, guinea pigs, rabbits, and non-human primates (Rhesus macaques-RM). After obtaining ethical code of IR.IUMS.REC.1399.566, immunizations of animals were conducted by using either of three different vaccine dilutions; High (H): 10 µg/dose, Medium (M): 5 µg/dose, and Low (L): 1 µg/dose, respectively. In the process of screening for viral seeds, viral strains that resulted in the most severe clinical manifestation in patients have been isolated for vaccine development. The viral seed produced the optimal immunity against SARS-CoV-2 virus, which suggests a possible broader neutralizing ability against SARS-CoV-2 strains. The seroconversion rate at the H-, M-, and L-dose groups of all tested animals reached 100% by 28 days after immunization. These data support the eligibility of FAKHRAVAC vaccine candidate for further evaluation in a clinical trial.

Development of a combined solution formulation of atropine sulfate and obidoxime chloride for autoinjector and evaluation of its stability.

Atropine (AT) and oximes, alone or in combination, have been proven greatly valuable therapeutics in the treatment of organophosphates intoxications. An injectable mixture of AT and obidoxime (OB) was formulated for the administration by automatic self-injector. The aqueous single dose solution contained 275 mg obidoxime chloride and 2.5 mg atropine sulfate per 1 mL (220 mg and 2 mg per 0.8 effective dose, respectively). The final solution was sterilized by filtration through a 0.22 µm pore size filter. This more concentrated solution allowed to use a smaller size and lighter weight cartridge. Quality control tests, including assay of the two major compounds were performed separately, using reversed-phase HPLC methods. Besides, the stability test was carried out according to ICH guideline for the accelerated test. The obtained results showed that the proposed formulation is stable over a period of 2 years after preparation.

Protective effects of fungal ß-(1→3)-D-glucan against oxidative stress cytotoxicity induced by depleted uranium in isolated rat hepatocytes.

Previous reports suggested that certain carbohydrate polymers, such as ß-(1→3)-D-glucan, may possess free radical scavenging activity. The present study examined the free radical scavenging activity of a carbohydrate polymer, ß-(1→3)-D-glucan against oxidative stress induced by depleted uranium in isolated rat hepatocytes. Addition of U (VI) (uranyl acetate) to isolated rat hepatocytes results in reactive oxygen species (ROS) formation, rapid glutathione depletion, mitochondrial membrane potential collapse and lysosomal membrane rupture before hepatocyte lysis occurred. Our results showed that quite similar to silymarin, which is a known antioxidant and radical scavenger, tiny concentration of ß-glucan (138 nM) very successfully protected the hepatocytes against cell lysis and all oxidative stress cytotoxicity endpoints caused by depleted uranium including ROS formation, glutathione depletion, decreased mitochondrial membrane potential, lysosomal membrane rupture and caspase 3 activity increase. In conclusion, our results confirmed the antioxidant and radical scavenging activity of ß-(1→3)-D-glucan and suggested this compound and silymarin as possible drug candidates for prophylaxis and treatment against depleted uranium toxic effects.

A search for cellular and molecular mechanisms involved in depleted uranium (DU) toxicity.

Addition of U(VI) (uranyl acetate) to isolated rat hepatocytes results in rapid glutathione oxidation, reactive oxygen species (ROS) formation, lipid peroxidation, decreased mitochondrial membrane potential, and lysosomal membrane rupture before hepatocyte lysis occurred. Cytotoxicity was prevented by ROS scavengers, antioxidants, and glutamine (ATP generator). Hepatocyte dichlorofluorescein oxidation was inhibited by mannitol (a hydroxyl radical scavenger) or butylated hydroxyanisole and butylated hydroxytoluene (antioxidants). Glutathione depleted hepatocytes were resistant to U(VI) toxicity and much less dichlorofluorescein oxidation occurred. Reduction of U(VI) by glutathione or cysteine in vitro was also accompanied by oxygen uptake and was inhibited by Ca(II) (a U(IV) or U(VI) reduction inhibitor). U(VI)-induced cytotoxicity and ROS formation was also inhibited by Ca(II), which suggests that U(IV) and U(IV) GSH mediate ROS formation in isolated hepatocytes. The U(VI) reductive mechanism required for toxicity has not been investigated. Cytotoxicity was also prevented by cytochrome P450 inhibitors, particularly CYP 2E1 inhibitors, but not inhibitors of DT diaphorase or glutathione reductase. This suggests that P450 reductase and reduced cytochrome P450 contributes to U(VI) reduction to U(IV). In conclusion, U(VI) cytotoxicity is associated with mitochondrial/lysosomal toxicity by the reduced biological metabolites and ROS.