Evaluating axial alignment and knee phenotypes in a young Indian population, using X-rays converted to three-dimensional bone models, and their relevance in total knee arthroplasty.

PURPOSE: The standard principle of total knee arthroplasty (TKA) targeted by most orthopaedicians is the alignment of the lower limb in a neutral mechanical axis. However, for several patients the neutral mechanical alignment is not normal. Aligning these patients to a neutral mechanical axis may not result in desirable outcomes as it may feel unnatural. This study aimed to discover what percentage of the young healthy Indian population have a neutral hip-knee-ankle angle (HKA = 180°) and what percentage of this population have a deviation from the neutral HKA. We also studied the distribution of knee phenotypes in this non-arthritic population. SUBJECTS AND METHODS: A total of 196 lower limbs were evaluated from 100 subjects, between the ages of 20 and 35 years, without any history of lower limb pathology, of which 50 were males and 50 were females. All volunteers were subjected to full-leg standing anteroposterior and lateral digital radiographs on which various alignment parameters were analysed. Three-dimensional bone models were generated using a validated software. RESULTS: 125 limbs (63.7%) from the total population lay in the range of 180 ± 3°; 7.14% (14/196) of the total limbs had an HKA angle of 180°; 29.5% (58/196) of the total population had a varus alignment, i.e., HKA angle of ≤176° and 6.6% (13/196) had knees in valgus alignment, i.e., HKA angle of ≥184°. Thirty-four percent (33/96) of limbs in men and 25% (25/100) of limbs in women had constitutional varus knees with an alignment of ≤176°; 5.2% (5) of limbs in men and 8% (8) of limbs in women had constitutional valgus knees with an alignment of ≥184°; 67/96 knees in males and 58 knees in females were in the range of 180 ± 3°. CONCLUSIONS: A significant portion of the normal population had limbs that deviated from the neutral HKA. If these subjects were to need TKA in the future, it would not be desirable to restore their alignment to its neutral.

Fluoxetine or Venlafaxine for Early Post Stroke Depression.

Context: Post stroke depression (PSD) is an under diagnosed morbidity of stroke and can negatively affect the prognosis of the patient. Aims: We intended to study the prevalence of PSD and the commonly used anti-depressants and their outcome in patients with PSD. Settings and Design: A prospective observational study was conducted in the patients admitted to the stroke unit of a tertiary care centre. Methods and Materials: Diagnosis of post stroke depression was made by the Hamilton Depression Rating Scale (HDRS) during the two-week period after stroke or in the clinic follow up. A comparison of clinical outcome and adverse events of the two anti-depressants used, i.e. venlafaxine and fluoxetine were done by a follow up of up to 6 months. Statistical Analysis Used: Independent sample test was used for statistical purposes in the study. Results: Out of the 326 stroke patients admitted in the department, 73 had PSD and 60 patients out of this were assigned into the study. Forty patients were males, and the mean age of the sample population was found to be 62.13 ± 11.14. Major risk factors identified were hypertension, diabetes mellitus, and dyslipidemia. Venlafaxine showed better outcome and less adverse events compared to fluoxetine. Major adverse events observed were hyponatremia, headache, insomnia, and anxiety. Conclusions: PSD in the early phase affects a substantial number of the stroke patients. Venlafaxine has got a better outcome and adverse event profile compared to fluoxetine in this group of patients. However, larger multicenter studies will provide more helpful data in this area.

Acute insulin-responsive hyperglycemia and hypocalcemia in Theileria spp. infected goat.

Theileriosis can be manifested in appreciably variable clinical forms among domestic ruminants and may often become life-threatening. The present report narrates, the quick remarkable clinical recovery of a lactating goat infected with Theileria spp., exhibiting acute insulin-responsive hyperglycemia and hypocalcemia, by providing intensive therapy. A four year old doe was presented with the complaint of acute manifestation of weakness, ventroflexion of neck with flaccid muscles, recumbency, hypersalivation, severe abdominal breathing, anorexia and polyuria since last eighteen hours. The animal kidded three kids one month before, out of which one was mummified. Clinical examination revealed severe depression, dehydration, dyspnoea, congested mucous membrane, sluggish rumen motility and reduced pupillary light reflex. Laboratory investigation revealed severe granulocytopenia, thrombocytopenia, hypocalcemia, hyperglycemia and Theileria spp. infection. The animal showed significant improvement within a few minutes of initiating the evidence-based stabilization therapy to correct hydration status, cellular glucose uptake, calcium levels and Theileria spp. infection. This case indicates the significance of investigating the metabolic status of animals suffering from theileriosis for achieving better clinical responses. Also, future studies may focus on the endocrinological perspectives of metabolic impact of Theileria spp. infection in goats.

A novel composite matrix based on polymeric micelle and hydrogel as a drug carrier for the controlled release of dual drugs.

In the present work, we present a system of hydrogel/micelle composite as dual-drug release vehicle. The hydrogel is prepared from poly(ethyleneglycol) PEG and poly(vinyl alcohol) PVA. Polymeric micelles are enjoying high resurgence of interest in biomedical field as promising candidates for the stabilization and delivery of water insoluble drugs. This property was used to design and synthesize oleic acid-g-chitosan (OA-g-CS) copolymer micelles. Dual drugs, an analgesic, Tramadol (TMD) and an antibiotic, Cefixime trihydrate (CFX) were used as model drugs. The drug release behaviors of the micelle and PEG-PVA/micelle DDDS were studied as functions of pH and temperature. The release profiles were analyzed by a power law equation to reveal the release mechanism of drugs. The drug carrier vehicle was characterized and studies including swelling, effect of ionic strength, anti-oxidant, antimicrobial and in vitro drug release were carried out. The release of the two drugs was much more pronounced in the basic medium than in the acidic medium.

Extended wear therapeutic contact lens fabricated from timolol imprinted carboxymethyl chitosan-g-hydroxy ethyl methacrylate-g-poly acrylamide as a onetime medication for glaucoma.

An extended wear therapeutic contact lens (TCL) for the sustained delivery of timolol maleate (TML) was fabricated based on molecular imprinting technique. The designed TCL comprised of a TML imprinted copolymer of carboxymethyl chitosan-g-hydroxy ethyl methacrylate-g-polyacrylamide (CmCS-g-HEMA-g-pAAm) embedded onto a poly HEMA matrix (pHEMA). Successful reloading of TML onto the lens was monitored using a simple and novel UV-Visible spectrophotometric method which showed an excellent reloading capacity of 6.53µgTML/TCL. The in vitro drug release profile in lacrimal fluid after each cycle was fitted onto Higuchi model of drug release suggesting diffusion release mechanism with no polymer degradation. Also, the TML release kinetics indicated a sustained drug delivery which can effectively achieve the therapeutic index of TML leading to a onetime medication for glaucoma. Biological activity of eluted drug after each cycle and cell viability of the TCL were verified using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,3-bis(2-methoxynitro-5-sulfophenyl)-5-(phenylaminocarbonyl)-2H-tetrazolium hydroxide (XTT) assay, respectively.

Novel semi-IPN based on crosslinked carboxymethyl starch and clay for the in vitro release of theophylline.

A novel semi-interpenetrating polymer network (IPN) based on crosslinked carboxymethyl starch (CL-CMS) and montmorillonite (MMT) was prepared, where carboxymethylation occurs as a result of the reaction between native starch and monochloroacetic acid in isopropanol/water medium at 60°C. The carboxymethyl starch is further crosslinked and made into a semi-IPN with MMT for the release of theophylline. The drug carrier was characterized using FTIR, XRD and surface analysis using SEM. Studies including physio-chemical analysis, swelling behavior, encapsulation efficiency, effect of MMT content, effect of ionic strength and in vitro drug release were carried out. Theophylline encapsulation of up to 74% was achieved and drug release was monitored in SGF (pH 1.2) and SIF (pH 7.4). Results show that the matrix releases drug at a much faster rate in the basic medium than in the acidic medium, thereby holding the promise of developing the semi-IPN system as a potential candidate for the release of theophylline.