Surgical Technique for Lateral Patellofemoral Ligament Reconstruction Using Bone Tunnels: A New Method.

Medial patellar instability (lateral patellofemoral ligament tear) is a rare condition which is commonly associated with lateral release for lateral patellar instability. LPFL is a lateral stabilizer of the patellofemoral joint. Reconstruction of LPFL is necessary to provide stability to the patella-femoral joint in patients with instability. We describe a novel technique of trans-osseous reconstruction of LPFL to gain stability and have better graft incorporation. A doubled peroneus longus graft is inserted into the patellar tunnel and secured with an endo button on the anteromedial aspect of the patella; the other end is then inserted into the insertional point on the femur and secured with an interference screw. This is an easy, novel, and reproducible technique which can be used to reconstruct LPFL.

Health equity and gendered border blindness: an exploration of healthcare services at the international border in Rajasthan.

OBJECTIVES: Citizens' access to health care and the delivery of the healthcare services is significantly affected by the spatiality of the regions and the connectedness of the elements of the healthcare system. This network of healthcare system, region and delivery of services faces myriad challenges in the borderland geography, which is characterised by accentuated military presence, poor physical infrastructure, disinterest of habitation near the border, lack of adequate, necessary and allied services such as schools and industry, social seclusion, migration etc. All these factors amalgamate to create an effect of gender-blind phenomenon as well as border-blind phenomenon. This is particularly acute for women and children. STUDY DESIGN: A phenomenology research design has been used for the study. It encapsulates qualitative aspects of the views of those who experience marginalisation inclusive of gender-blind experiences. Marginalised women and frontline healthcare workers at the borderland were considered for the inquiry in this study. The study is a composite description of the phenomenon. METHODS: The border districts of Rajasthan from the Radcliffe line of Rajasthan have been identified for the purpose of the study. Using narrative ethnography along with interviews, an examination was executed from health professionals and marginalised women to comprehend health care access and equity from the service provider's perspective as well as the beneficiary's perspective. RESULTS: The study provides a range of attributions based on which it could be established that health inequities exist in bordering rural areas. CONCLUSIONS: The study realises the geopolitical influence of the Radcliffe line, where borderlands are commonly vital to the continuum struggle between the centre and state. Yet, there remains a gap towards implementing various schemes and services due to varied reasons for access from main to far-off border areas, making the situation vulnerable from a resource deficiency point of view. The Health Equity Framework cannot meet Social Determinants of Health in borderland areas of Rajasthan.

There is a Minimal Difference in Ankle Functional Outcomes After Peroneus Longus Harvest: Systematic Review and Meta-analysis.

Importance: Recently, peroneus longus (PL) autograft as a graft choice for ligament surgeries have attracted interest due to studies showing good clinical outcomes and minimal donor site morbidity. There remain concerns related to these grafts, especially the potential impact on ankle functions. Aims/Objective: The purpose of this review and meta-analysis is to summarize the available evidence for ankle functional outcomes after PL harvest. This will provide objective clinical evidence for surgical decision making. Evidence Review: Cochrane, Embase, Medline, and Google Scholar were all searched for articles published between January 2001 and May 2021. For the aim of a systematic review, certain inclusion and exclusion criteria were adopted in accordance with PRISMA recommendations. The primary outcome measure was the assessment of ankle functional outcomes using validated instruments (such as AOFAS score, FADI score etc.). Findings: A total of twelve studies representing pooled patient populations of 537 patients were included in this review. The average follow-up duration was 17 months (range; 6-32 months) across all studies. All twelve studies assessed AOFAS score and six studies also additionally assessed FADI score. The pooled mean outcomes measured showed a slight decrease in post-operative as compared to pre-operative AOFAS and FADI score (mean difference of AOFAS 1.92, 95% CI 1.021-3.123, p value < 0.05 and mean difference for FADI 1.50, 95% CI 0.561-2.445, p value < 0.05). Though statistically significant the magnitude of variance implies minimal clinical impact. Conclusion and Relevance: This review and meta-analysis found that PL autograft harvest leads to statistically significant but minimal impact on ankle functional outcomes. This, in conjunction with various studies on ankle parameters after PL harvest, shows that PL harvest leads to minimal impact on ankle outcomes and function. Level of Evidence: Systematic review Level III.

Use of skin and blood as nonlethal indicators of heavy metal contamination in northern water snakes (Nerodia sipedon).

Relatively little is known about contaminants in reptiles, particularly snakes. The concentrations of arsenic, cadmium, chromium, lead, manganese, mercury, and selenium were examined in blood and skin of 46 northern water snakes (Nerodia sipedon) in Tennessee and correlated with concentrations in internal tissues (liver, kidney, muscle) to determine if blood or skin could serve as a nonlethal indicator of internal metal exposure or body burden. Snakes were collected from the East Fork Poplar Creek (EFPC) within the United States Department of Energy's Y-12 National Security Complex (part of the Oak Ridge National Laboratory) and from a reference stretch of the Little River in East Tennessee. For blood, the only consistent positive correlations with internal organs were for mercury, and correlations were low except for muscle. Skin showed significant positive correlations with all three organs for mercury, chromium, selenium, and lead. For manganese and cadmium, skin level was positively correlated with liver level. Blood generally reflects recent exposure, not necessarily body burden, but in water snakes it correlates with body burden for mercury. Skin proved useful for more metals, although patterns were not necessarily consistent across sex and locality subgroups. The most consistent pattern was for mercury, the metal of greatest concern in many aquatic ecosystems, including EFPC.

Metals in horseshoe crabs from Delaware Bay.

We examined the concentrations of arsenic, cadmium, chromium, lead, manganese, mercury, and selenium in the eggs, leg muscle, and apodeme (carapace musculature) in horseshoe crabs ( Limulus polyphemus) from eight places on the New Jersey and Delaware sides of Delaware Bay to determine whether there were locational differences. Although there were locational differences, the differences were not great. Further, contaminant levels were generally low. The levels of contaminants found in horseshoe crabs were well below those known to cause adverse effects in the crabs themselves or in organisms that consume them or their eggs. Contaminant levels have generally declined in the eggs of horseshoe crabs from 1993 to 2001, suggesting that contaminants are not likely to be a problem for secondary consumers or a cause of their decline.

Metals in feathers of sooty tern, white tern, gray-backed tern, and brown noddy from islands in the North Pacific.

Levels of heavy metals are usually higher in adult than young birds because they eat larger, more contaminated prey, or because they have had longer to accumulate metals in their tissues. Further, levels of contaminants are usually less in birds nesting on remote, offshore islands than in birds breeding closer to mainland areas that are urbanized and industrialized. We examined the feather levels of arsenic, cadmium, chromium, lead, manganese, mercury, and selenium in adult sooty terns (Sterna fuscata), gray-backed terns (Sterna lunata), and brown noddy (Anous stolidus, and adult and young white terns (Gygis alba, from Midway Atoll, and in adult and young sooty terns and adult brown noddy from Manana Island, Hawaii (chicks of other terns were not available). We tested and rejected the null hypotheses that metal levels are not significantly different among species, ages, and locations. Despite their small size, adult white terns had the highest levels of lead, arsenic and tin. Brown noddies had the highest levels of cadmium, chromium, manganese, and selenium. Sooty and white terns had the highest levels of mercury. Sooty tern adults had significantly higher levels of cadmium, mercury, and selenium than young, while young had significantly higher levels of arsenic and manganese. White tern adults had significantly higher levels of selenium and tin than young, while young had higher levels of cadmium and mercury than adults. Except for mercury, there were significant inter-location differences within species in all heavy metals. Contrary to expectation, where the differences were great, metals generally were higher in the feathers of terns and noddies from Midway than from Manana.

Lead levels in exposed herring gulls: differences in the field and laboratory.

We compared blood lead levels for herring gull (Larus argentatus) chicks exposed at two days of age in the field and the laboratory. One randomly selected chick in each family of three was injected with lead, the second with a sterile saline solution, and the third was not injected. Field birds were then completely free-living, and were entirely cared for by their parents. Blood was drawn at 35 or 45 days of age for comparison with laboratory-reared chicks. In both the laboratory and the field, blood lead levels were positively related to dose, and concentrations were lower at 45 than at 35 days of age. However, at each dose, the field birds had lower levels than did the laboratory birds. We postulate that this relates to higher overall activity and accelerated bone development in the field, and perhaps to a move varied diet. Wild young gulls were mobile and practiced flight more often than did laboratory-reared gulls. Growth metabolic, and behavioral factors may enhance deposition of lead in the bone, reducing blood lead. Thus, both in ecological risk assessments and in using birds as bioindicators, caution is required in extrapolating from laboratory studies in field conditions.

Drug use in a rural community in bihar : some psychosocial correlates.

Drug use has been an integral part of any culture. The use depends on many factors including the availability. In the present study the drug use in a rural community of Chotanagpur Plateau in the Ranchi district of Bihar is focussed. The sample consisted of 157 inhabitants above the age of 15 yrs of the village Boreya in Kanke block. A sample of drug users was compared with nondrug users of the same community on the measures of stressful life events and locus of control. The results indicate that besides tobacco alcohol in the form of locally brewed 'handia' (rice beer) and 'mahua' (made from mahua flowers) was used by 334 (28.87%) individuals. Cannabis was frequently used (25.15%) Harder drugs were not used at all. There was an increase in stressful life events in the year prior to the use of drugs. The increase in life events was especially seen in the elderly age group (35-50yrs). There was no difference in the locus of control scores between the users and the nonusers. The results indicate the role of significant life events in the current use of drugs.

Psychiatric knowledge & orientation of non-psychiatrist doctors.

52 Non-psychiatrist doctors were evaluated in order to know their psychiatric orientation with the help of clinical case history along with questionnaire. Only one doctor subject could give all the diagnosis correctly on the basis of clinical stories; on the other hand all the doctors gave the diagnosis of epilepsy correctly. This reflects basic lack of understanding of psychiatry resulting from poor theoretical teaching and exposure at undergraduate level. Other characteristics of the sample and finding are discussed here.

Heavy metal and selenium levels in young cattle egrets from nesting colonies in the northeastern United States, Puerto Rico, and Egypt.

Colonially-nesting species of herons and egrets breed mainly in coastal areas, along rivers or near other large bodies of water. Such areas are also preferred for human development, exposing nesting birds to various pollutants. From 1989-1991, the concentrations of heavy metals and selenium were studied in the feathers of fledgling cattle egrets Bubulcus ibis, a terrestrially-feeding insectivore, from New York and Delaware in the northeastern United States, from Puerto Rico, and from Egypt. There were geographic differences in the concentrations of lead, mercury, cadmium, manganese, selenium, and chromium in the feathers of these egrets. Lead levels were 41 times higher in the feathers of cattle egrets from Cairo compared to the other sites. This difference was attributed to the continuing use of leaded gasoline and the dense automobile traffic in Cairo. However, other differences remain unexplained. Similarly, levels of chromium and manganese were also higher in Cairo than at any other sites. Cadmium levels were similar at all places except for higher levels in eastern Puerto Rico. Mercury concentrations were twelve times higher in the feathers of cattle egrets at Aswan compared to Cairo. In Puerto Rico, we also compared levels in adult cattle egrets with young and found higher concentrations of mercury and manganese, but lower concentrations of selenium in the adults. Using feathers from young cattle egrets is a potentially sensitive tool for biomonitoring for metals, especially lead, since they reflect the local area surrounding the breeding colony.

Performance on luria-nebraska neuropsychological battery in schhizophrenic patients.

The Luria Nebraska Neuropsychological Battery (LNNB) was administered on a group of 40 schizophrenic patients, 30 brain damaged subjects and 30 normal controls. The data were analysed using SPSS software. Discriminant function analysis results suggested overall hit rate of 77%. On MANOVA all the clinical scales of the LNNB were found to discriminate significantly amongst the groups. The schizophrenic patients performed better than brain-damaged but had poor performance in comparison to normal controls. The findings indicated high discriminative accuracy and clinical effectiveness of the LNNB in Indian population.

Assessment of mental retardation : need for newer approaches.

Mental retardation is a complex, multifaceted condition. It is not a simple condition based primarily on intellectual capacities. Assessment of a retarded child should not be limited to intellectual functioning alone. It should give an idea of the individual's strength and weaknesses globally. Unfortunately, in India, assessment of mental retardation is still primarily based on intelligence tests. There is a need to understand the limitations of such an approach.