Baker's cyst with extra- and intra-articular synovial chondromatosis of knee: A case report.

Synovial chondromatosis is a rare benign condition characterized by chondral proliferation from synovium forming loose bodies which can occur extra-articularly and intra-articularly. Surgical removal remains the mainstay of treatment for synovial chondromatosis. Due to the risk of recurrence, every case must be followed up with an MRI.

Arthroscopic management of recurrent synovial chondromatosis of the hip: a case report.

Synovial chondromatosis is a rare condition characterized by the chondral proliferation of synovium forming loose bodies which can lead to pain, swelling, and decreased range of movement of the affected joint. Case presentation: Here the authors report a case of eighteen years lady with recurrent hip synovial chondromatosis who was treated previously with hip arthrotomy and loose bodies removal and now she underwent arthroscopic loose bodies removal with partial synovectomy. Clinical discussion: In comparison to arthrotomy of the hip, arthroscopic management is a minimally invasive surgery that is associated with decreased postoperative pain, earlier improvement in range of motion, a shorter course of rehabilitation, and overall lower morbidity. Conclusion: Thus, the authors recommend arthroscopic removal of the loose bodies and partial synovectomy for the management of synovial chondromatosis of the hip.

Investigating the Efficacy and Safety of Diacerein in the Management of Knee Osteoarthritis with reference to its conventional management.

BACKGROUND: Designated as a "priority disease" by World Health Organization, Osteoarthritis is the most common chronic rheumatic disease. Providing a proper treatment for Osteoarthritis is still a major public health challenge. Diacerein has been proposed as a slow acting, symptom modifying or even disease modifying drug used in Osteoarthritis having a risk-benefit ratio far better than conventionally used drugs. However, the evidence of efficacy and safety of use of Diacerein in Osteoarthritis is yet to be explored. Hence, this study attempted to investigate the efficacy and safety of Diacerein in the management of knee osteoarthritis. METHODS: This is an analytical cohort study comparing Diacerein with Non-steroidal anti-inflammatory drugs for two months in the management of knee OA. Efficacy was assessed by scores of Lysholm Knee Scoring Scale, Knee injury and Osteoarthritis Outcome Score - Physical Function Short form and Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS: After two months of treatment, the post- treatment scores were significantly superior to the baseline scores in both the treatment groups (p<0.001). There were no significant differences among the post-treatment scores in two different treatment groups (p>0.05). Discoloration of urine and gastritis were the frequently reported adverse effects in Diacerein treatment group and Non-steroidal anti-inflammatory drugs treatment group respectively. CONCLUSIONS: Our findings have shown Diacerein is as effective as Non-steroidal anti-inflammatory drugs in treating knee OA patients. Diacerein was generally well tolerated, with a good safety profile. These findings indicate the need for further studies with experimental study design in larger scale.

Anterior Cruciate Ligament Tear Using Magnetic Resonance Imaging among Patients Undergoing Arthroscopy in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Magnetic Resonance Imaging is the preferred imaging modality in patients having anterior cruciate ligament tears. The aim of this study was to find out the prevalence of anterior cruciate ligament tears using magnetic resonance imaging among patients undergoing arthroscopy in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Orthopaedics and Traumatology of a tertiary care centre. Data from 17 November 2017 to 17 October 2022 were collected between 26 December 2022 and 30 December 2022 from the hospital records. Ethical approval was obtained from Institutinal Review Committee of the same institute (Reference number: 233/22). All patients with a knee injury who received arthroscopy were included in the study. Magnetic resonance imaging reports, arthroscopic findings and relevant data of each case were retrieved from the medical case records of patients. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among patients with arthroscopy confirmed anterior cruciate ligament tear, 138 (91.39%) (86.92 to 95.86, 95% Confidence Interval) had anterior cruciate ligament tear diagnosed with magnetic resonance imaging. The mean age of the patients who had anterior cruciate ligament tear in the magnetic resonance imaging was 32.35±11.31 years. Out of them, 87 (63%) were males and 51 (37%) were females. The mean duration of the injury was 11.60±18.47 months. Conclusions: The prevalence of anterior cruciate ligament tear using magnetic resonance imaging among patients undergoing arthroscopy in tertiary care centres was similar when compared to other similar studies when conducted in similar settings. Keywords: anterior cruciate ligament tears; arthroscopy; cross-sectional studies; MRI.

Mediating Effects of Neural Targets on Depression, Weight, and Anxiety Outcomes of an Integrated Collaborative Care Intervention: The ENGAGE-2 Mechanistic Pilot Randomized Clinical Trial.

Background: Integrated treatments for comorbid depression (often with anxiety) and obesity are lacking; mechanisms are poorly investigated. Methods: In a mechanistic pilot trial, adults with body mass index ≥30 and Patient Health Questionnaire-9 scores ≥10 were randomized to usual care (n = 35) or an integrated behavioral intervention (n = 71). Changes at 6 months in body mass index and Depression Symptom Checklist-20 scores were co-primary outcomes, and Generalized Anxiety Disorder Scale-7 score was a secondary outcome. Changes at 2 months in the activation and functional connectivity of regions of interest in the negative affect circuit were primary neural targets, and secondary targets were in the cognitive control, default mode, and positive affect circuits. Results: Participants were 47.0 years (SD = 11.9 years), 76% women, 55% Black, and 20% Latino. Depression Symptom Checklist-20 (between-group difference, -0.3 [95% CI: -0.6 to -0.1]) and Generalized Anxiety Disorder Scale-7 (-2.9 [-4.7 to -1.1]) scores, but not body mass index, decreased significantly at 6 months in the intervention versus usual care groups. Only Generalized Anxiety Disorder Scale-7 score changes at 6 months significantly correlated with neural target changes at 2 months in the negative affect (anterior insula, subgenual/pregenual anterior cingulate cortex, amygdala) and cognitive control circuits (dorsal lateral prefrontal cortex, dorsal anterior cingulate cortex). Effects were medium to large (0.41-1.18 SDs). Neural target changes at 2 months in the cognitive control circuit only differed by treatment group. Effects were medium (0.58-0.79 SDs). Conclusions: Compared with usual care, the study intervention led to significantly improved depression but not weight loss, and the results on neural targets were null for both outcomes. The significant intervention effect on anxiety might be mediated through changes in the cognitive control circuit, but this warrants replication.

Functional Outcome and Quality of Life Following Total Hip Replacement Surgery.

BACKGROUND: Total hip replacement surgeries are popular treatment modality for degenerative and traumatic hip condition which provides high degree of patient satisfaction and are mainly described in literatures among patient residing in western world. However activities of daily living of people in hilly area of developing country are different from western country but there are paucity of literature describing outcome of these people. METHODS: Retrospective observational study was carried out in a university teaching hospital in Nepal. Patients residing in hilly region of Nepal who underwent total joint replacement of hip joint between 2017 to 2019 AD were included in the study. The functional outcome was measured using Harris Hip Score and the quality of life was assessed using SF-12 Patient Questionnaire preoperatively , 3 months , 6 months and 1 year follow up. RESULTS: More than two-thirds of the patients were male. The mean age group of patients was 45.71 years. The most common indication of surgery was avascular necrosis of femoral head. There was significant improvement in Harris Hip Score upto 6 months postoperatively. Quality of life including both physical and mental component of SF-12 improved significantly upto 6 months. CONCLUSIONS: Total hip replacement surgery significantly improves functional outcome and quality of life of patients residing in hilly region of Nepal. However, long term follow up still is request to find out effect of joint replacement in activities of daily living in these group of people.

Anticoagulation failure in pulmonary thromboembolism in COVID-19 pneumonia despite prolonged anticoagulation: A case series.

Introduction: Moderate to severely ill patients diagnosed with Coronavirus disease 2019 (COVID-19) pneumonia develop a series of complications and less frequently, we might witness cases of Pulmonary Thromboembolism (PE)-refractory to the standard treatment with Low Molecular Weight Heparin (LMWH). The aim of this case series is to report the presentation and management of pulmonary thromboembolism secondary to COVID-19 pneumonia. Method: We report a case series of seven cases aged 40-70 who were presented in Dhulikhel Hospital with COVID-19 symptoms in different stages. The case details were extracted from their medical reports of the hospital. The written informed ethical consents were obtained from all the cases and their voluntary participation was assured. Outcome: The cases in the case series admitted with COVID-19 pneumonia, after diagnostic investigation (Chest x-ray, HRCT, CTPA) were suggestive of COVID-19 Pneumonia with ARDS and pulmonary thromboembolism. The cases received rivaroxaban, a newer anticoagulant-15 mg twice daily for 21 days and after discharge, they were asked to continue once daily doses for 9 weeks. Significant improvement was witnessed, with the presence of additional intervention including rehabilitative chest exercises. Conclusion: Pulmonary thromboembolism secondary to COVID-19 pneumonia is a life-threatening condition. Rivaroxaban is seen to be very effective in the management of this condition when an anticoagulation failure occurs even after the therapeutic dose of low molecular weight heparin. Future studies may require more scientific investigations to prevent complications even in the early stages of COVID-19.

Klippel-Trenaunay Syndrome: Case series from a university hospital of Nepal.

Introduction: Klippel Trenaunay Syndrome (KTS) is a rare congenital malformation with capillary and venous malformations and soft tissue/bony overgrowth with or without lymphatic malformation. Cutaneous vascular stain, varicosities and tissue hypertrophy represent its main clinical features. Besides, the patient can develop thromboembolic pathologies, recurrent bouts of infection, stasis eczema, limb length discrepancy and intolerable pain typical of intraosseous involvement. Methods: Here, we report a case series of seven patients aged 10-45 who presented to our centre with clinical features suggestive of KTS. Out of them, six patients had involvement of unilateral lower limb, while only one had involvement of bilateral lower limb. They all had typical cutaneous vascular stains and underlying venous malformation, while one patient had developed complications with multiple ulcer formation. Outcomes: An interdisciplinary team of vascular surgeons, dermatologists, interventional radiologists, orthopaedics, and physiotherapists managed the cases. We performed an individualized treatment as per the patient's presentation, which included a combination of supportive, medical, interventional radiologic, and surgical interventions. The follow-up outcomes of all the patients revealed significant resolution of symptoms. Conclusion: Patients with KTS can have diverse presentations. Therefore, clinicians should ensure an individualized treatment with the involvement of a multidisciplinary team for proper management and prevention of complications.

Validation of the Nepali versions of the Neck Disability Index and the Numerical Rating Scale for Neck Pain.

STUDY DESIGN: A cross-sectional study with a test-retest design. OBJECTIVE: To translate and culturally adapt the numerical rating scale (NRS) for neck pain intensity and the Neck Disability Index (NDI), and asses their measurement properties in a Nepalese neck pain population. SUMMARY OF BACKGROUND DATA: Neck pain is one of the most common musculoskeletal disorders in Nepal. Research on neck pain disorders has been hampered by lack of standardized patient-reported outcome measures (PROMs) in Nepali language. Therefore, we aimed at validating a Nepali version of the NDI and NRS neck pain. METHODS: At Dhulikhel hospital in Nepal, 150 patients with neck pain and/or cervical radiculopathy completed the translated self-administered questionnaires. We had made one cultural adaption of the NDI driving item in the final Nepali version. Relative reliability was analyzed with intraclass correlation coefficient (ICC 2.1) and absolute reliability with the smallest detectable change (SDC). Internal consistency was assessed by Cronbach alpha. Construct and discriminative validity was assessed by Spearman correlation for a priori hypotheses, receiver-operating characteristics curves, and analysis of variance. Time spent and assistance needed to complete the questionnaires were used to assess feasibility. RESULTS: Test-restest reliability was excellent with ICC (95% confidence intervals) of 0.87 (0.66, 0.94) for NDI and 0.97 (0.94, 0.99) for NRS neck pain. The absolute reliability was acceptable (a SDC of 1.6 for NRS and 9.3 for NDI) and a Cronbach alpha (internal consistency) of 0.70 for NDI, as well as acceptable construct validity, discriminative validity, and feasibility. CONCLUSION: The Nepali versions of the NRS neck pain and NDI can be recommended for assessing pain and disability among patients with neck pain and cervical radiculopathy, but their responsiveness to change remains to be tested.Level of Evidence: 2.

Successful Outcome of Anterior Cruciate Ligament (ACL) Reconstruction by Hamstring Tendon for Anterior Cruciate Ligament Deficit Knee at a University Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Anterior cruciate ligament is a commonly injured and reconstructed ligament in the knee. Unlike in urban areas where sports activities and road accidents are common mechanisms of injuries, the semi-urban and rural population has a different mode of injuries, needs, and expectations. This study explores the prevalence of successful outcome of anterior cruciate ligament reconstruction in by hamstring tendon for anterior cruciate ligament deficit knee at a university hospital. METHODS: A descriptive cross-sectional study was conducted at Dhulikhel Hospital, Kathmandu University Hospital from 2018 February to 2020 January among patients having anterior cruciate ligament injuries after ethical approval. Whole sampling technique was used. Functional outcome was assessed with Lysholm scale at the end of at least one year. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. RESULTS: Out of 66 anterior cruciate ligament reconstruction, 35 (59%) cases had successful outcomes. Excellent outcomes were seen in 9 (15%) cases and 26 (44%) had good outcomes. The mean Lysholm score was 84. CONCLUSIONS: Anterior cruciate ligament injuries were seen in heterogeneous populations during their activities of daily living or recreational sports activities. Anatomic anterior cruciate ligamentreconstruction with hamstring grafts provided good functional outcomes, especially among the young population. Our findings are similar to current studies on anterior cruciate ligament-reconstruction.

Weight loss effects in usual primary care: Findings from 5 behavioral weight loss RCTs.

Primary care is an important setting for obesity treatment and behavior therapy is considered the first line. However, current practice often does not meet clinical guidelines and, furthermore, effects of usual care (UC) on weight loss are unclear. This makes it difficult to design sufficiently powered weight loss trials in primary care. This study analyzed data from UC control participants across 5 primary care-based randomized clinical trials of behavioral weight loss interventions to assess UC effects for 4 weight outcomes: body mass index (BMI), weight change (kg and %), and percent of participants achieving clinically significant 5% weight loss. Results indicated modest UC effects, suggesting modest weight loss is possible in usual primary care.

Epigastric mass in a young girl: trichobezoar. Imaging diagnosis.

A 16-year old girl presented with a history of abdominal pain, lump in epigastrium since one year. The ultrasound examination showed an epigastric mass, which was delineated as a filling defect in the stomach on barium studies. Upper GI endoscopy showed a large intragastric mass composed of hair. The CT scan showed a gastric mass extending to the duodenum. She was managed by surgical removal. A large gastric trichobezoar extending upto the jejunum was found. This case highlights the characteristic radiological appearance on barium, ultrasound and computed tomography of a bezoar within the stomach and a trichobezoar with a long tail extending upto the jejunum without intestinal obstruction is unusual.

Epigastric mass in a young girl: trichobezoar. Imaging diagnosis.

A 16-year old girl presented with a history of abdominal pain, lump in epigastrium since one year. The ultrasound examination showed an epigastric mass, which was delineated as a filling defect in the stomach on barium studies. Upper GI endoscopy showed a large intragastric mass composed of hair. The CT scan showed a gastric mass extending to the duodenum. She was managed by surgical removal. A large gastric trichobezoar extending upto the jejunum was found. This case highlights the characteristic radiological appearance on barium, ultrasound and computed tomography of a bezoar within the stomach and a trichobezoar with a long tail extending upto the jejunum without intestinal obstruction is unusual.