Management of Flexion Contracture in Total Knee Arthroplasty

Fixed flexion deformity at knee is common in osteoarthritic knee and is a combination of bony deformity, capsular and ligamentous deformity. It affects knee biomechanics in terms of increased forces at the patellofemoral and tibiofemoral joint. This in turn makes carrying out of routine daily activities like walking or use of staircase very difficult. Therefore, it is essential to correct this deformity at the time of operative intervention. Major interventions like posterior capsular release and removal of osteophytes and adequate bony resection helps in correcting the deformity. Post operatively, use of extension night splints and adequate physiotherapy can help in correcting the residual deformity left over at the time of knee arthroplasty

Single-Bundle Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed in orthopedics. The research has focused extensively on surgical technique factors like tunnel position, graft choices, fixation methods, and rehabilitation protocols following surgery. The advantages and disadvantages of each graft option shall help in deciding the correct graft in an individual case. A thorough understanding of anatomy and biomechanics of normal ACL has improved the understanding of complexities of knee joint stabilization over the preceding decades. The chapter shall discuss in detail about the anatomy, biomechanics, and surgical techniques along with postoperative rehabilitation protocol in current perspective

Glycemic control in smokers and risk of type 2 diabetes

Chronic cigarette smoking seems to markedly aggravate insulin resistance that could be due to the increase in counter-regulatory hormones such as GH, cortisol and catecholamine's that elevates blood glucose, Weight gain usually follows the cessation of smoking and increasingly, fear of weight gain discourages many smokers from attempting to quit Yet, weight gain after quitting smoking has proved so unresponsive  to preventive attempt  as to suggest that weight control  might even be incompatible with successful smoking cessation . Innovative treatments that can prevent or minimize weight gain are badly needed to encourage quitting smoking. However recently featured review and research on smoking and diabetes concluded the evidence that smoking is associated with the preparation for development of type 2 diabetes in men and women Therefore, this review focuses in the possible features of smoking cessation on the glycemic control and risk of type 2 diabetes.key words: Hyperglycemia,Smokers, types 2 diabete

The down-regulation of pank2 gene in zebrafish as a model of Pantothenate Kinase Associated Neurodegeneration.

open9siThe increased iron deposition is a hallmark of many neurodegenerative diseases, but its pathogenic role is still unclear. A strong link between iron and neurodegeneration is evident in a set of heterogeneous neurological disorders, known as Neurodegeneration with Brain Iron Accumulation (NBIA). The most common form of inherited NBIA is associated with mutations in hPank2 gene (PKAN). Pank2 is the rate limiting enzyme in CoA biosynthesis and its downregulation in mammalian cells leads to perturbation of cellular iron homeostasis. Here we explore Pank2 biological function in Danio rerio, and propose this system as an important new tool for the study of PKAN disease.openZizioli, Daniela; Tiso, Natascia; Busolin, Giorgia; Khatri, Deepak; Giuliani, Roberta; Borsani, Giuseppe; Monti, Eugenio; Argenton, Francesco; Finazzi, DarioZizioli, Daniela; Tiso, Natascia; Busolin, Giorgia; Khatri, Deepak; Giuliani, Roberta; Borsani, Giuseppe; Monti, Eugenio; Argenton, Francesco; Finazzi, Dari

Zika virus (ZIKV) disease: past, present and future

The mosquito-borne arbovirus Zika virus (positive-stranded RNA virus, ZIKV, Flavivirus, Flaviviridae), has caused an outbreak imposing by its extent and quick spread. This became the focus of a current pandemic and public health crisis all around the world because of the incessant geographic growth of both the virus and its mosquito vectors; it is often misdiagnosed with other disease like yellow fever, west nile, dengue and chikungunya because of same clinical manifestation. After unprecedented huge scale outbreak of ZIKV in Pacific, Micronesian island of Yap in 2007, though ZIKV infections are in general sporadic cases or causing mild self-limiting illness, harsh symptoms have been explained including neurological disorders, autoimmune disorder, fetal anomalies, impaired central nervous system of the fetus, microcephaly in newborns, meningoencephalitis, myelitis and Guillain Barre´Syndrome supposed to be linked with ZIKV. The virus is transmitted mainly by a mosquito Aedes aegypti, whereas, other routes of viral broadcast includes monkey bite, coitus and body fluids such as semen, blood and saliva which needs further corroboration. The relationship between these conditions with ZIKV infection is still not established and is under assessment. Till now there is no vaccine or specific antiviral against ZIKV, therefore the public health authority focuses on preventing infection, mainly in pregnant women and virus transmitted area. WHO and other health officials are working on the expansion of new projects and mosquito control techniques to manage up with infection as there is very fewer literature present on the pathogenesis of the ZIKV to help understand the clinical disease spectrum and target treatments to decrease or stop infection. The future status of ZIKV dispersal to other parts of the world is still unknown. The present review emphasizes various features of ZIKV and its history, epidemiology, transmission, clinical manifestations, progress  and advances in developing effective diagnostics, vaccines and drugs/therapeutics along with accepting suitable avoidance and control strategies to undertake this deadly emerging disease. Keywords: Zika virus, Flavivirus, Aedes aegypti, Pregnancy, Transmission, Microcephaly, Afric

Dental management of a patient with down syndrome: a case report and review of literature

Down syndrome (DS) is the most common chromosomal abnormality which affects numerous organs, including the orofacial region. Patients with DS may not be cooperative during dental treatment, and in cases of complex treatment, it is necessary to use oral or inhaled sedation and/or general anesthesia, which represents safe and efficient treatment resources. This article reports a management of DS in a 7-year-old male patient who came to the Hospital of New Delhi with the chief complaint of pain in lower right back tooth region. Due to the uncooperative nature of the patient, dental treatment was done under general anesthesia in which multiple dental restoration and extraction were done

Epidemiological pattern of corneal foreign bodies and utilization of protective eye devices: a hospital-based cross-sectional study

Introduction: A corneal foreign body is the most common occupational ocular injury that can cause secondary infection or scars on the visual axis, decreasing vision. The study aimed to find out practices of wearing protective eye devices in the workplace and the factors influencing the utilization of such devices among patients with corneal foreign body (CFB) injury. Methods: This cross-sectional study was conducted in a tertiary eye hospital in Bhaktapur from April 2021 to August 2021. All patients with CFB attending the hospital were included in the study. CFB was removed with ocular examination under a slit lamp biomicroscope, and face-to-face interview was conducted. Results: Among 142 patients, only one was female, and 41.5% had a previous history of CFB. The most common CFB particle was metallic (n=124, 87.3%),. Three-fourths (75.1%) of patients were not using eye-protective devices at the time of injury, and 45.1% tried physically removing the CFB in a harmful way. Nearly two in five (19.7%) had used topical antibiotics eye drops before presenting for CFB removal. Sixty-six (46.5%) reported never wearing any protective eye devices, and the main reason for not-wearing was the unavailability (48.4%) of such devices in their workplace. The awareness of the need for protective eye devices (p<0.001) was significantly associated with using protective eye devices during work. Conclusion: The workers should be made aware of the consequences of harmful practices following CFB injury. The workers should wear protective eye devices to minimize the risk of ocular injury and consequent visual impairment

EFFICACY AND SAFETY OF KNOTLESS BARBED SUTURES IN CAPSULAR CLOSURE FOLLOWING DISTAL FEMUR FRACTURE FIXATION

ABSTRACT Introduction: Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. Material and methods: A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. Results: The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant Conclusion: Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial

Knock-down of pantothenate kinase 2 severely affects the development of the nervous and vascular system in zebrafish, providing new insights into PKAN disease

Pantothenate Kinase Associated Neurodegeneration (PKAN) is an autosomal recessive disorder with mutations in the pantothenate kinase 2 gene (PANK2), encoding an essential enzyme for Coenzyme A (CoA) biosynthesis. The molecular connection between defects in this enzyme and the neurodegenerative phenotype observed in PKAN patients is still poorly understood. We exploited the zebrafish model to study the role played by the pank2 gene during embryonic development and get new insight into PKAN pathogenesis. The zebrafish orthologue of hPANK2 lies on chromosome 13, is a maternal gene expressed in all development stages and, in adult animals, is highly abundant in CNS, dorsal aorta and caudal vein. The injection of a splice-inhibiting morpholino induced a clear phenotype with perturbed brain morphology and hydrocephalus; edema was present in the heart region and caudal plexus, where hemorrhages with reduction of blood circulation velocity were detected. We characterized the CNS phenotype by studying the expression pattern of wnt1 and neurog1 neural markers and by use of the Tg(neurod:EGFP/sox10:dsRed) transgenic line. The results evidenced that downregulation of pank2 severely impairs neuronal development, particularly in the anterior part of CNS (telencephalon). Whole-mount in situ hybridization analysis of the endothelial markers cadherin-5 and fli1a, and use of Tg(fli1a:EGFP/gata1a:dsRed) transgenic line, confirmed the essential role of pank2 in the formation of the vascular system. The specificity of the morpholino-induced phenotype was proved by the restoration of a normal development in a high percentage of embryos co-injected with pank2 mRNA. Also, addition of pantethine or CoA, but not of vitamin B5, to pank2 morpholino-injected embryos rescued the phenotype with high efficiency. The zebrafish model indicates the relevance of pank2 activity and CoA homeostasis for normal neuronal development and functioning and provides evidence of an unsuspected role for this enzyme and its product in vascular development

Analysis of cardiac autonomic modulation in normotensive obese and eutrophic adults of Nepal

Background: Obese people have a higher prevalence of cardiovascular disease, though unknown mechanism, supposed to be due to autonomic dysfunction which is still in controversy. This study aimed to assess and compare heart rate variability (HRV) between normotensive obese and adults.Methods: The study was conducted on 30 normotensive obese adults (mean age 32.07±7.25 years) with BMI>30 and 29 age- and sex-matched normal weight controls (mean age 30.48±8.01 years) with BMI: 18-24 Kg/m2. Short-term HRV variables were assessed using standard protocol. The data were compared between the groups using Mann Whitney ‘U’ test.Results: In obese group, there was significant increase in the mean heart rate [79.17±8.80 Vs 71.48±8.41 beats/min, p=0.001], systolic blood pressure [121.20±9.89 Vs 113.24±11.07, mmHg, p=0.004] and diastolic blood pressure [84.97±7.87 Vs 74.83±10.31 mmHg, p=0.000]. The HRV parasympathetic indicators were less [RMSSD {28.75(16.72-38.35) Vs 41.55(30.6-56.75) ms, p=0.018}, NN50 {15.5(2-39) Vs 83.5(32.75-116.25), p=0.010}], and sympathetic indicator LF/HF ratio [1.2(0.65-2.20) Vs 0.79(0.5-1.02), p=0.004] was more in obese group.Conclusions: Obese persons have increased sympathetic activity with a reduction in parasympathetic (vagal) tone indicating poor autonomic cardiac rhythm control. Moreover, the altered autonomic activity could be the reason for increased mean heart rate and blood pressures in normotensive obese persons