Incidence of patella baja following patellar eversion in total knee arthroplasty

Background: Patella baja is a rare complication of total knee arthroplasty (TKA) leading to decreased mechanical advantage of the extensor mechanism, decreased knee range of motion, anterior knee pain and increased wear of the tibial and patellar polyethylene. There exists a lack of evidence on whether patellar eversion leads to shortening of the patellar tendon. The present study aims to determine if eversion of patella during TKA leads to patella baja.Methods: Between August 2014 and August 2016, 55 knees undergoing primary TKA with a standard medial parapatellar arthrotomy and eversion of patella were included in this two point cross sectional study. Preoperative X-rays were taken to assess the length of the patellar tendon and Insall Salvati ratio (ISR). Postoperatively the Blackburne Peel Index (BPI), ISR and patellar tendon lengths were assessed on lateral X-rays to look for any incidence of patella baja.Results: The postoperative change in the length of the patellar tendon was unpredictable; though most of them decreased. The pre and post op difference in the length of patellar tendon was statistically significant in females (4.43±0.20 cm vs. 4.35±0.24 cm; p value-0.005). Significant decrease in length of patellar tendon was seen in patients aged 66-70 years (p= 0.024) and patients with BMI >30 kg/m2. No case of true patella baja was found postoperatively. No significant correlation could be established between ISR and age, sex or BMI of the patients.Conclusions: The different risk factors for post TKA shortening of patellar tendon include female gender and higher BMI (>30 Kg/m²). However eversion of patella during TKA may not lead to an increased incidence of true patella baja

Management of infected non-union of lower limb long bone fractures using ilizarov technique: a study of outcomes

Background: Nonunion of long bone fractures is a common condition treated by an orthopaedic surgeon. Many nonunions can be treated effectively by internal fixation with or without bone grafting but, an infected nonunion can prove to be a tough challenge. The Ilizarov method is effective in managing infected nonunion of long bones. This study aims to assess the outcome of management of infected nonunions of long bones of lower limb with Ilizarov Ring fixator using bone and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System.Methods: We retrospectively analysed 18 patients (16 Male: 2 Female; Mean age 43.2 years) managed with Ilizarov technique for an infected tibial or femoral nonunion between 01 January 2013 and 31 December 2014. They were followed up for an average of 25.4 months after removal of fixator. They were assessed for functional and Bone (radiological) outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.Results: 17 limbs were salvaged and union could be achieved. One limb required amputation due to severe persistent intractable infection. None required any additional skeletal stabilisation after removal of fixator frame except casting in a few patients for a period of 6 weeks. Mean time to union was 211.83 days (range 136 - 320days/median 184) or 7.01 months. As per the ASAMI score, Bone results were excellent in 10, good in 5, fair in 2 and poor in 1. Functionally 7 were graded as excellent, 6 as good, 3 as fair and 1 as poor and 1 patient underwent amputation.Conclusions: The Ilizarov’s method remains one of the most versatile and successful means of achieving bone healing in infected nonunions of long bones of lower limbs with additional benefits of correcting bone defects, deformities and limb length inequalities.

Interaction of annexin A6 with alpha actinin in cardiomyocytes

<p>Abstract</p> <p>Background</p> <p>Annexins are calcium dependent phospholipid binding proteins that are expressed in a wide variety of tissues and implicated in various extra- and intracellular processes. In myocardial tissue, annexins A2, A5 and A6 are particularly abundant, of which the expression levels of annexin A6 has been found to be maximal. Conflicting reports from transgenic mice overexpressing annexin A6 or null mice lacking annexin A6 showed imbalances in intracellular calcium turnover and disturbed cardiac contractility. However, few studies have focussed on the signalling module of annexin A6 in the heart either in normal or in pathological state.</p> <p>Results</p> <p>To identify the putative binding partners of annexin A6 in the heart, ventricular extracts were subjected to glutathione S-transferase (GST)- annexin A6 pull down assay and the GST- annexin A6 bound proteins were identified by mass spectrometry. The pull down fractions of ventricular extracts with GST-full length annexin A6 as well as GST-C terminus deleted annexin A6 when immunoblotted with anti sarcomeric alpha (α)-actinin antibody showed the presence of α-actinin in the immunoblot which was absent when GST-N terminus deleted annexin A6 was used for pull down. Overexpression of green fluorescent protein (GFP) tagged full length annexin A6 showed z-line like appearance in cardiomyocytes whereas GFP-N termimus deleted annexin A6 was mostly localized to the nucleus. Overexpression of GFP-C terminus deleted annexin A6 in cardiomyocytes showed aggregate like appearance in the cytoplasm. Double immunofluorescent staining of cardiomyocytes with anti annexin A6 and anti sarcomeric α-actinin antibodies showed perfect co-localization of these two proteins with annexin A6 appearing like a component of sarcomere. Transient knockdown of annexin A6 in cardiomyocytes by shRNA significantly enhances the contractile functions but does not affect the z-band architecture, as revealed by α-actinin immunostaining in shRNA treated cells.</p> <p>Conclusions</p> <p>In overall, the present study demonstrated for the first time that annexin A6 physically interacts with sarcomeric α-actinin and alters contractility of cardiomyocytes suggesting that it might play important role in excitation and contraction process.</p

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Adenosine stimulates proliferation of human endothelial cells in culture

The effect of adenosine on proliferation of human endothelial cells was investigated by adding adenosine to the medium of cultures derived from human umbilical veins. Cell counts on cultures grown in 10 microM adenosine for 4-7 days were 41-53% greater than counts from control cultures. In contrast, 10 microM adenosine had no effect on growth of a human fibroblast cell strain (IMR-90). Neither inosine nor 2\u27,5\u27-dideoxyadenosine influenced endothelial cell growth at concentrations of 0.1 or 10 microM. Addition of adenosine deaminase abolished the proliferative effect of added adenosine and inhibited proliferation by 16% in control cultures, suggesting that endogenous adenosine may enhance proliferation in culture. The adenosine receptor antagonist, 8-phenyltheophylline, at 0.1 and 1.0 microM blocked the enhanced proliferation caused by 10 microM adenosine. Addition of 10 microM adenosine enhanced DNA synthesis in endothelial cell cultures as indicated by an increased incorporation of [3H]thymidine into acid-insoluble cell material. The results indicate that addition of physiological concentrations of adenosine to human umbilical vein endothelial cell cultures stimulates proliferation, possibly via a surface receptor, and suggest that adenosine may be a factor for human endothelial cell growth and possibly angiogenesis

<b style="">A review on Bael tree</b>

171-178Bael, Aegle marmelos (Linn.) Correa ex Roxb., a tree of Indian origin is known from pre-historic time. It has a great mythological significance for Hindus. Utilization of bael in day-to-day life has great nutritional, environmental as well as commercial importance. It has been in use from time immemorial in traditional systems of medicine for relieving constipation, diarrhoea, dysentery, peptic ulcer and respiratory infections. Important medicinal properties of bael are antidiabetic, antimicrobial, anti-inflammatory, antipyretic, analgesic, cardioprotective, antispermatogenic, anticancer and radioprotective. The present review deals with general and chemical profile and its economic importance including medicinal and other uses

To Compare the Severity of Hearing Loss in Two Modalities of Treatment for Head and Neck Cancer Cases

Background: Ototoxicity is the cellular degeneration of cochlear and/or vestibular tissues leading to its functional deterioration, due to the usage of certain therapeutic agents. The present study was undertaken to compare hearing loss in patients receiving radiotherapy alone and concurrent chemoradiation therapy was done. Materials &amp; Methods: All patients with head and neck cancers who visited the Department of Otorhinolaryngology and Head and Neck surgery and undergone treatment, after histological confirmation, at the Department of Radiation Oncology at Sardar Patel Medical College, Bikaner, Rajasthan from November 2019 to October 2020 were taken up for the study. 80 patients who fulfilled the inclusion and exclusion criteria and given informed, written consent were divided into 2 groups, A and B of 40 each. Group A were treated with radiotherapy only and group B with concurrent chemoradiotherapy. Data was entered in Microsoft Excel and was subsequently imported to Statistical package for the social sciences (SPSS) free version 21.0 and Epi info version 3.0 for analysis. Results: Our study consisted of 80 subjects out of which 52 (65%) were male and 28 (35%) females. The age of the subjects ranged from 30 to 60 years, with highest number of patients belonged to the age group of 51-60 (57.5%) years. In our study, majority of the patients had carcinoma oral cavity (35%) followed by Larynx (28.75%), Hypopharynx (16.25%), Oropharynx (8.75%), Nose &amp; PNS (6.25%), Nasopharynx and Occult primary with secondary neck (each 2.5%). In group A (RT), 50% had conductive hearing loss after completion of treatment which declined to 37.5% after 3 months follow up. Similarly, 45% developed conductive hearing loss after completion of treatment which also declined to 30% after 3 months follow up in group B (RT+CT). Otitis media with effusion and Eustachian tube dysfunction are temporary and reversible side effects of the irradiation of the ear. Conductive hearing loss develops as a reversible side effect of radiation of the ear. The impact of radiation dose on hearing loss was studied and was found that patients with radiation dose less than 60 Gy showed no hearing loss. Dose of the radiation is proportional to development of ototoxicity. Total radiation dose of minimum 60 Gy is required to produce noticeable ototoxic effects. On comparing the hearing loss, after completion of treatment with radiotherapy 30% developed significant hearing loss whereas in RT+CT group 45% had significant hearing loss while after 3 months follow up, 37.5% and 62.5% developed significant hearing loss in RT and RT+CT group respectively. The hearing loss was persistent. Statistical analysis was done, and it was found that there was significant difference in proportions of hearing loss due to RT and RT+CT (p&lt;0.05) after completion of treatment and 3 months follow up. Conclusion: Thus, we conclude that patients who received concomitant chemoradiation experienced greater hearing loss as compared with patients treated with radiotherapy alone and hearing loss was predominately of sensorineural type. In our study, cobalt 60 teletherapy was used as a method of radiation administration and radiation induced such ototoxicity can be reduced by newer techniques of radiation administration that can limit the dose of radiation to cochlea and preventing hearing loss

To Investigate the Incidence and Severity of Hearing Loss Caused By Chemoradiotherapy in Head and Neck Cancer Cases

Background: In head and neck oncology, treatment-induced hearing loss has been reported in patients treated with high-dose cisplatin chemoradiotherapy (CRT). The present study was conducted to investigate the incidence and severity of hearing loss caused by chemoradiotherapy in Head and Neck cancer cases. Materials &amp; Methods: All patients with head and neck cancers who visited the Department of Otorhinolaryngology and Head and Neck surgery and undergone treatment, after histological confirmation, at the Department of Radiation Oncology at Sardar Patel Medical College, Bikaner, Rajasthan from November 2019 to October 2020 were taken up for the study. 80 patients were included in the study out of which 40 undergone concurrent chemoradiation. Patients with concurrent chemoradiotherapy were selected for the study. Data was entered in Microsoft Excel and was subsequently imported to Statistical package for the social sciences (SPSS) free version 21.0 and Epi info version 3.0 for analysis. Results: 80 patients were included in the study out of which 40 undergone concurrent chemoradiation. Hearing levels were documented before starting of treatment, after completion of treatment and 3 months of follow up. Our study consisted of 80 subjects out of which 52 (65%) were male and 28 (35%) females. The age of the subjects ranged from 30 to 60 years, with highest number of patients belonged to the age group of 51-60 (57.5%) years. In our study, majority of the patients had carcinoma oral cavity (35%) followed by Larynx (28.75%), Hypopharynx (16.25%), Oropharynx (8.75%), Nose &amp; PNS (6.25%), Nasopharynx and Occult primary with secondary neck (each 2.5%). In patients having RT+CT , 45% had conductive hearing loss after completion of treatment which declined to 30% after 3 months follow up. Otitis media with effusion and Eustachian tube dysfunction are temporary and reversible side effects of the irradiation of the ear. Conductive hearing loss develops as a reversible side effect of radiation of the ear. The impact of radiation dose on hearing loss was studied and was found that patients with radiation dose less than 60 Gy showed no hearing loss. Dose of the radiation is proportional to development of ototoxicity. Total radiation dose of minimum 60 Gy is required to produce noticeable ototoxic effects.Conclusion: Thus, we conclude that patients who received concomitant chemoradiation experienced greater hearing loss. Hearing loss was evident after 1 month of therapy and was persistent. The incidence and severity of hearing loss increased with time and higher frequencies were affected predominately. High-frequency hearing loss can have a significant impact on quality of life because it affects speech discrimination. It is recommended to perform a pre-treatment and post- treatment audiological evaluation with special emphasis on high frequencies