Mesenchymal stromal cell therapy for patients with rheumatoid arthritis.

Management of relapses and refractory rheumatoid arthritis (RA) patients is complex and difficult. Even after the administration of new biological disease-modifying anti-rheumatic drugs (DMARDs), only a few patients achieve the complete remission phase. DMARDs help only in modifying the disease activity, which sooner or later fails. They do not manage the disease at the patho-etiological level. There are some serious side effects as well as drug interaction with DMARDs. There are few subsets of RA patients who do not respond to DMARDs, reasons unknown. Mesenchymal stem cells (MSCs) provide a promising alternative, especially in such cases. This review elaborates on the studies pertaining to the application of MSCs in rheumatoid arthritis over the last two decades. A total of 14 studies (one review article) including 447 patients were included in the study. Most of the studies administered MSCs in refractory RA patients through the intravenous route with varied dosages and frequency of administration. MSCs help in RA treatment via various mechanisms including paracrine effects. All the studies depicted a better clinical outcome with minimal adverse events. The functional scores including the VAS scores improved significantly in all studies irrespective of dosage and source of MSCs. The majority of the studies depicted no complications. Although the use of MSCs in RA is still in the early stages requiring further refinement in the source of MSCs, dosage, and frequency. The role of MSCs in the management of RA has a promising prospect. MSCs target the RA at the molecular level and has the potential to manage refractory RA cases not responding to conventional treatment. Multicentric, large sample populations, and long-term studies are required to ascertain efficacy and safety.

Whole-body cryotherapy in orthopaedics: current concepts.

The use of whole-body cryotherapy (WBC) for musculoskeletal ailments is growing. WBC, involving brief exposure to extremely low temperatures, is increasingly used for its analgesic, anti-inflammatory, and antioxidant effects. The paper examines the physiological impacts of WBC on cardiovascular, musculoskeletal, hematologic, hormonal, and metabolic systems. Specific orthopaedic applications discussed include its role in the management of fractures, osteoarthritis, osteonecrosis of the femoral head, osteomyelitis, adhesive capsulitis, tendinopathies, rheumatic pathologies, chronic pain syndromes, and fibromyalgia. The study also highlights the benefits and drawbacks of WBC, including its potential to improve athletic performance, recovery, mood, and well-being, while noting risks like frostbite and impaired muscle strength. Clinical evidence from various studies is evaluated, revealing a spectrum of outcomes. For instance, WBC shows promise in enhancing bone health in athletes and providing relief in osteoarthritis and fibromyalgia patients. However, evidence for its efficacy in conditions like chronic pain syndromes and osteomyelitis is less robust. The paper underscores the need for further research to establish standardised protocols and understand long-term effects. While WBC offers significant benefits in orthopaedics, understanding its limitations and potential risks is crucial for its safe and effective clinical application.

Current understanding of MSC-derived exosomes in the management of knee osteoarthritis.

Mesenchymal stem cell-derived exosomes (MSC-Exos) have been utilized as medicinal agents or as delivery vehicles in cartilage injuries and cartilage-based diseases. Given the ongoing emergence of evidence on the effector mechanisms and methods of the utility of the MSC-Exos in knee osteoarthritis, a comprehensive review of the current evidence is the need of the hour. Hence, in this article, we review the current understanding of the role of MSC-Exos in the management of knee osteoarthritis in view of their classification, characterization, biogenesis, mechanism of action, pathways involved in their therapeutic action, in-vitro evidence on cartilage regeneration, in-vivo evidence in OA knee models and recent advances in using MSC-Exos to better streamline future research from bench to bedside for OA knee.

Advancements in Tuberculosis Diagnostics: A Comprehensive Review of the Critical Role and Future Prospects of Xpert MTB/RIF Ultra Technology.

Tuberculosis remains a persistent global health challenge, demanding swift and accurate diagnostic methods for effective treatment. The emergence of the Xpert MTB/RIF Ultra system marks a significant milestone in combating tuberculosis, streamlining the identification of Mycobacterium tuberculosis, and advancing our pursuit of eradicating the disease. Delving into the therapeutic landscape of tuberculosis and rifampicin resistance, this scientific narrative review offers a comprehensive exploration. It begins by delving into the historical backdrop and the hurdles encountered with traditional tuberculosis diagnostics. From there, it traces the journey of the Xpert MTB/RIF technology, underscoring its molecular underpinnings. In this narrative review, the performance of the Xpert MTB/RIF Ultra system undergoes thorough scrutiny, encompassing investigations into sensitivity, specificity, and comparisons with alternative diagnostic methods. The spotlight shines on its clinical applications across diverse scenarios, from diagnosing pulmonary and extrapulmonary tuberculosis to its pivotal role in identifying rifampicin resistance. The study also evaluates its clinical efficacy in enhancing patient outcomes and supporting global tuberculosis control initiatives. However, the review does not shy away from discussing the challenges and limitations associated with the Xpert MTB/RIF Ultra system. It meticulously addresses concerns regarding cost, infrastructure requirements, and potential diagnostic inaccuracies. Offering a panoramic view, the review assesses the system's impact in resource-constrained settings and its potential to bolster tuberculosis elimination endeavors worldwide. Peering into the future, it explores ongoing research avenues and potential enhancements in Xpert MTB/RIF Ultra technology, envisioning a landscape of improved performance, broader applications, and emerging diagnostic innovations in the realm of tuberculosis diagnostics.

The New Consumer Protection Act Controversy: Does It Apply to Doctors in India?

A new Consumer Protection Act (CPA) was introduced in 2019 and has created quite a stir in the medical fraternity. There is widespread uncertainty as to whether this new Act applies to the medical profession. However, on careful review of the original CPA of 1986, the definition of services included within the Act, and understanding the changes introduced in CPA 2019, the legal application of CPA 2019 to medical professionals becomes clear. While the term medical services has been removed from the list of services under the purview of the Act, the phrase "but not limited to" before listing the services leaves the door open for the inclusion of other services.

Tuberculosis of the Femur With Intramedullary Abscesses and No Pulmonary Foci in an Immunocompetent Male: A Rare Case.

Tuberculosis of the long bones/femur, especially in an immunocompetent person, is a challenging diagnosis. It is a rare entity, even in endemic settings. The non-specific clinical features, backed by a low suspicion about such presentations even in endemic settings, may result in delayed diagnosis and often unfavorable treatment outcomes. The situation becomes even more challenging in the absence of pulmonary foci and a contact history of tuberculosis. Here is a case of a young adult male who presented with complaints of pain over his left leg for three months. A diagnosis was achieved with magnetic resonance imaging and the isolation of the bacteria from a bone biopsy using a cartridge-based nucleic acid amplification test. Antituberculous treatment was promptly initiated.

Tuberculosis of the Parietal Bone in an Indian Boy: A Rare Entity.

Tuberculosis is a common issue in endemic regions. The disease can affect both adults and children. Tuberculosis involving the flat bones of the skull is infrequently reported. Besides, reports of parietal bone tuberculosis in children are rare and a diagnostic challenge. Often, these cases report late, and this could compromise the treatment outcomes. Herein, a case of post-traumatic tuberculosis of the left parietal bone is presented in a child. The diagnosis was achieved by radiometric investigations and the isolation of Mycobacterium tuberculosis from the pus. He was initiated on antituberculous chemotherapy.

Spina Ventosa of the Left Ring Finger With Tuberculous Pyomyositis in the Forearm Muscles in a Young Immunocompetent Indian Male With No Pulmonary Involvement: A First Report of Its Type.

Tuberculous infection of the extrapulmonary sites, especially the small bones, is a seldom reported entity even in endemic countries. Moreover, simultaneous involvement of the forearm muscles is a very rare presentation with no such case reported showing concurrent involvement of the two sites. The diagnosis is challenging due to the paucibacillary nature of the disease, a lack of awareness among primary clinicians, and ambiguity in clinical features with other musculoskeletal disorders, especially when there is no pulmonary involvement. Herein, we present a first-of-its-type case of spina ventosa of the left ring finger with a tuberculous abscess in the forearm in a 15-year-old Indian male with no pulmonary seeding. The diagnosis was achieved through a detailed diagnostic workup, which resulted in the detection of Mycobacterium tuberculosis. He was initiated on antituberculous treatment with a remarkable improvement.

Isolated Tuberculosis of the Radius in an Immunocompetent Indian Male Without Pulmonary Involvement: A Report of a Rare Case.

Extrapulmonary tuberculosis is less commonly reported, and isolated tuberculous involvement of bones such as the radius, without any pulmonary lesions, is extremely rare. Diagnosing this condition can be challenging due to ambiguous clinical features and non-specific radiological findings in the early stages. The present case describes a rare instance of isolated tuberculosis of the radius in an immunocompetent Indian male with no pulmonary involvement. The diagnosis was achieved through a high index of suspicion in an endemic region, advanced radiometric investigations, and the isolation of Mycobacterium tuberculosis using the cartridge-based nucleic acid amplification test. The patient was started on a 12-month course of appropriate chemotherapy.

Blood Money: Is it Time to Incentivize Blood Donation in India?

Blood donation, a fundamental act of altruism, has undergone significant evolution over the centuries. Despite medical progress, the persistent challenge lies in securing an adequate supply of blood and its derivatives. This article critically examines the proposal to introduce monetary incentives for blood donation, delving into ethical, legal, and pragmatic dimensions. India's current framework staunchly upholds voluntary, unpaid donations. However, global practices diverge significantly. Notably, India previously permitted monetary compensation for blood donation but later prohibited it due to concerns about infection transmission. Monetary incentives offer a potential solution to address key deterrents faced by potential donors. Health anxieties, time constraints, and fear of infection often discourage voluntary donations. By providing financial motivation, we may enhance donor participation and bolster the reliability of the blood supply. While the benefits are evident, caution is essential. Implementing monetary incentives necessitates robust safeguards. Preventing the exploitation of vulnerable populations and ensuring the safety of blood products remain paramount. Striking this delicate balance requires careful consideration. By analyzing ethical, legal, and practical facets, we navigate the intricate landscape of blood supply management.

Bilateral Subluxation of the Proximal Tibiofibular Joint: A Rare Case Report.

Introduction: Proximal tibiofibular joint (PTFJ) subluxations are rare and can occur following trauma or sporting events. Idiopathic PTFJ subluxations are more common in females and in patients with generalized ligament laxity. The proper history and clinical examination together with imaging can help in establishing the diagnosis in the majority of cases. Case Report: We report a rare case of bilateral subluxation of PTFJ and describe the detailed clinical features and magnetic resonance imaging findings. The patient was managed conservatively with good results. Conclusion: Bilateral subluxation of the PTFJ is a rare clinical entity often associated with specific demographic and physical characteristics, such as young females engaged in high-impact sports. This case underscores the importance of a thorough clinical and imaging evaluation to differentiate it from other causes of lateral knee pain and prominence. Conservative management, including physical therapy and routine follow-ups, has proven effective in managing symptoms and avoiding progression, highlighting the non-operative approach in treating this condition.

The Theatre of Surgery: The Ethical and Legal Implications of Live Surgeries.

Surgical training has long emphasized learning through direct observation, allowing young surgeons to gain practical insights from experienced surgeons. The advent of live surgical demonstrations has extended this learning method, providing real-time broadcasts of surgeries to wider audiences. Live surgery is a surgery that is broadcasted in real time to an audience. While live surgeries offer substantial educational benefits, enabling the rapid dissemination of advanced surgical techniques and reducing the learning curve for surgeons, they also raise critical ethical and legal questions. Concerns include potential compromises in surgical outcomes due to increased pressure on surgeons, the ethical implications of patient consent, privacy issues, and the ambiguity of accountability when complications arise. In India, these concerns have intensified following a patient's death during a live surgery, prompting legal scrutiny and a Supreme Court petition seeking to regulate the practice. This article delves into the multifaceted debate surrounding live surgeries, examining both their educational value and the ethical, legal, and practical challenges they pose. We aim to provide a comprehensive overview that will inform readers about the complexities of live surgeries, spread awareness, and stimulate further discussions on this evolving practice.

White Coats Under Fire: Understanding the Epidemic of Violence Against Doctors.

The doctor-patient relationship, once grounded in trust and mutual respect, is increasingly marred by incidents of violence against healthcare providers. This alarming trend not only threatens the safety of doctors but also undermines the integrity of medical care. This article delves into the multifaceted reasons behind such violence, exploring emotional, financial, societal, and systemic factors that contribute to this disturbing phenomenon. Drawing from extensive surveys and real-world incidents, we shed light on the pressures and misunderstandings that fuel hostility towards medical professionals. Our analysis identifies key stressors, including heightened emotions, lack of understanding, financial burdens, societal prejudices, and systemic frustrations, which exacerbate tensions in healthcare settings. By understanding these underlying causes, we offer practical recommendations for doctors to navigate these challenges, emphasizing empathy, clear communication, and professional boundaries. Additionally, we highlight the need for systemic reforms, such as better security measures in hospitals and effective grievance redressal systems, to protect doctors and improve the overall healthcare environment. This article aims to raise awareness, foster dialogue, and provide actionable solutions to mitigate violence against doctors, ultimately striving to restore the sanctity of the doctor-patient relationship.

Exploring New Horizons: Advancements in Cartilage Tissue Engineering Under Space Microgravity.

Novel investigations of how microgravity affects cellular and tissue development have recently been made possible by the multidisciplinary fusion of tissue engineering and space science. This review examines the intersection of cartilage tissue engineering (CTE) and space science, focusing on how microgravity affects cartilage development. Space microgravity induces distinct physiological changes in chondrocytes, including a 20-30% increase in cell diameter, a 1.5- to 2-fold increase in proliferation rates, and up to 3-fold increases in chondrogenic markers such as SOX9 and collagen type II. These cellular alterations impact extracellular matrix composition and tissue structure. Space-optimized bioreactors using dynamic culture methods replicate physiological conditions and enhance tissue growth, but the absence of gravity raises concerns about the mechanical properties of engineered cartilage. Key research areas include the role of growth factors in cartilage development under microgravity, biocompatibility and degradation of scaffold materials in space, and in situ experiments on space stations. This review highlights the opportunities and challenges in leveraging microgravity for CTE advancements, emphasizing the need for continued research to harness space environments for therapeutic applications in cartilage regeneration. The multidisciplinary fusion of tissue engineering and space science opens novel avenues for understanding and improving cartilage tissue engineering, with significant implications for the future of biomedical applications in space and on Earth.

Customizable Hyperextension Splint for Mallet Finger.

Introduction: Mallet finger is a common deformity occurring due to the traumatic detachment of the extensor tendon at its insertion in the distal phalanx. Despite several different methods of splinting being available, residual extensor lag remains one of the most common complications of conservative treatment. Technique Report: We demonstrate a novel technique to make a hyperextension splint which can be customized as per the individual. The pictorial demonstration depicts every step in the preparation, application, and maintenance of the splint. Conclusion: We believe that the use of such easily accessible materials and visual demonstration of each step, with pointers along the way to verify the correct technique, will empower any medical professional, to satisfactorily treat such injuries at the primary point of contact, without necessitating the services of a hand surgeon.

Beyond Blame: Is India Ready for No-Fault Liability in Healthcare?

In contemporary healthcare systems, the pursuit of justice intertwines with fault attribution and liability determination. The exploration of no-fault liability as a potential alternative within India's healthcare landscape delves into its feasibility and implications. Drawing from international experiences, regulatory frameworks, and societal readiness, the complexities and potential benefits of adopting a no-fault liability system are elucidated. Perspectives from patients, healthcare providers, and broader societal stakeholders are considered, highlighting both the advantages and challenges associated with such a transition. Addressing disparities in access, legal reforms, and logistical hurdles underscores the groundwork necessary for potential adoption, signaling a potential paradigm shift toward equitable compensation and accountability within India's healthcare system.

GOLD-Induced Cytokine (GOLDIC): A Critical Review of Its Properties, Synthesis, and Biomedical Applications.

This narrative review examines the intricate landscape of gold-induced cytokine responses, delving into the anti-inflammatory and immune-modulating properties of gold compounds, with a primary focus on their application in treating rheumatoid arthritis and other autoimmune conditions. Utilizing a comprehensive search strategy across major scientific databases, we identified and analyzed a diverse range of studies published within the last two decades. The aim of this review is to provide a nuanced understanding of the current state of knowledge, addressing key questions regarding the mechanisms by which gold compounds modulate cytokine responses and their clinical implications. Our review encompasses an in-depth exploration of the anti-inflammatory effects of gold compounds, emphasizing their impact on pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin 1ß (IL-1ß), and interleukin 6 (IL-6). Moreover, we investigate the lesser-explored terrain of immune modulation, shedding light on the ability of gold compounds to influence anti-inflammatory cytokines, notably interleukin 10 (IL-10). Through an extensive analysis of the literature, we unravel the multifaceted mechanisms underlying gold-induced cytokine responses, including the inhibition of nuclear factor kappa B (NF-κB) signaling and interference with janus kinase/signal transducers and activators of transcription (JAK/STAT) pathways. In exploring the clinical applications of gold-induced cytokine modulation, we synthesize findings from relevant studies, elucidating the potential of gold compounds as therapeutic agents. However, challenges such as variability in formulations and diverse cytokine assessment methods are discussed, emphasizing the need for standardization in both research and clinical settings. Looking ahead, our scoping review identifies key unanswered questions and proposes future directions for research in this domain. We discuss emerging therapeutic strategies, considering the integration of gold compounds with other modalities to optimize treatment outcomes. This comprehensive review serves as a foundational resource for researchers, clinicians, and policymakers seeking a nuanced understanding of gold-induced cytokine responses, paving the way for further advancements in this critical area of study.

Spina Ventosa of the Thumb With Valgus Deformity in a Female With No Pulmonary Involvement: A First Report of Its Type in an Immunocompetent Adult From India.

Small bone involvement caused by Mycobacterium tuberculosis infection is an uncommon clinical entity. Usually, the condition is linked to the spread of bacteria from the lungs. It is rather uncommon for people without pulmonary seeding, trauma, or a history of tuberculosis to experience isolated episodes of spina ventosa. We describe a rare case of an immunocompetent Indian woman, aged 25, who complained of swelling in her left thumb. The diagnosis of primary tubercular dactylitis of the thumb was made after a thorough clinical and laboratory workup, and she received conservative treatment.

Surgical Preparedness Index in Orthopaedics During the Coronavirus Disease 2019 (COVID-19) Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has increased the vulnerability of routine surgical procedures and elective surgery preparedness all over the world, with the suspension of most elective surgeries during the pandemic and the backlog of patients currently on waiting lists, especially in publicly funded healthcare systems. On average, at the beginning of the year 2022, about 200 million patients awaited surgery all over the world. By enhancing the strength of surgical preparedness, there is a better chance of strengthening elective surgical systems against shocks such as future pandemics or climate emergencies. We explore the implications, challenges, and strategies of the concept of surgical preparedness to maintain sustainability in the global healthcare system, especially in low- and middle-income countries (LMICs), with the experiences gained during the COVID-19 pandemic.

Disseminated Tuberculosis of the Lungs, Brain, Pleurae, Mediastinal Lymphadenopathy, and Elbow Joint in an Immunocompetent Indian Female: A First-of-Its-Type Case.

Tuberculosis is usually seen in the lungs. However, the involvement of various extrapulmonary sites is due to the spread of the bacteria via blood, lymphatic, or direct inoculation. The present case is a rare presentation of tuberculosis in an Indian female who came with complaints of swelling in her right elbow joint, headache, and cough with expectoration. A diagnostic evaluation resulted in the isolation of Mycobacterium tuberculosis from the sputum samples and elbow joints, which was further supported by an exudative picture on the cerebrospinal fluid examination. The findings were supported by advanced radiometric techniques. She was commenced on an antituberculous treatment per her weight. Disseminated tuberculosis is a challenging diagnosis as there is often a delay in clinical presentation, a lack of awareness about the possibility of multiple sites with tuberculous infection in clinicians, and a time lag in the availability of the culture results.