Functional and radiological outcome following proximal fibular osteotomy in patients with knee osteoarthritis: a prospective study

Background: Osteoarthritis of knee is a common joint disease, with a prevalence of about 30 percent of individuals older than 60 years of age. Medial compartmental OA Knee, is by far the most prevalent variant of degenerative tibio-femoral joint disease and makes upto 90% of uni-compartment knee OA. Proximal Fibular Osteotomy (PFO), which essentially is resection of upper fibular diaphysis, had become increasingly adopted for the surgical intervention in the last decade. Aim: To Assess the functional and radiological Outcome In Patients Who Had Medial Compartment Knee Arthritis following Proximal Fibular Osteotomy. Materials and methods: The study was done in the Department of Orthopaedics, at Chettinad Hospital & Research institute, Tamil Nadu. The study population included total 22 cases with knee medial compartmental osteoarthritis and underwent Proximal Fibular Osteotomy. Results: In our study, mean age group of cases was 52.51 years. The mean post-operative VAS was 1.4 which was significantly lesser than pre-operative value. Significant improvement in the functional and clinical outcome, was observed. The post-operative medial joint space and knee joint ratio, were significantly enhanced.Conclusion: PFO is a suitable option for pain relief, as well as to achieve a painless knee ROM to benefit activities of daily life in patients with medial compartment osteoarthritis

Functional Outcome of Arthroscopic Reconstruction of Anterior Cruciate Ligament Injuries Using Semitendinosis-Gracilis Graft

To determine the functional outcome of arthroscopic ACL reconstruction using semitendinosis- gracilis graft, in patients with anterior cruciate ligament tears. Materials and Methods: This is a prospective observational study, of the patients Aged >18 years to <55 years old, who underwent, Arthroscopic reconstruction of anterior cruciate ligament injuries using semitendinosis-gracilis graft, at Chettinad Hospital and Research Institute (CH&RI), during the period, 11/3/2020 to 15/4/2021(13 months). Follow up period till 15/10/2021. Patients satisfying the inclusion criteria, alone were included, in this study. Total 36 patients were included in this study. The patients, were followed up, at the end of the 3rd, 6th month, from the date of surgery. Results: The mean age of the patients of the study was 33.03 ± 8.89 years with minimum age of 20 years and maximum age of 55 years. In present study at 3 months, 66.67% of patients had fair lysholm score followed by 22.22% had poor score and 11.11% of cases had good score. The mean lysholm score at 3 months was 74.58 ± 8.12 with minimum score of 58 and maximum score of 86. At 6 months 63.89% of patients had good lysholm score followed by 30.56% of cases had excellent score and 5.56% of cases had fair score with mean lysholm score at 6 months was 91.47 ± 5.78 with minimum score of 78 and maximum score of 100. The mean knee society score of patients at 3 months was 76.83 ± 5.71 with minimum score of 61 and maximum score of 86. The mean knee society score at 6 months was 92.97 ± 5.58 with minimum score of 77 and maximum score of 100. The mean distance in single hop test was 81.39 ± 11.05cms with minimum distance of 51cms and maximum distance of 103cms. Conclusion: ACL reconstruction with semi-tendinosis and gracilis graft gives good functional outcomes which might be due to the advancements in the surgical techniques and fixation device

Functional outcome following arthroscopic single row repair in degenerative rotator cuff tear

Background: Rotator cuff disease encompasses a wide range of pathology from minimal bursal or articular side irritation and tendonitis to severe degenerative rotator cuff arthropathy. Rotator cuff pathology affects adults of all ages and other shoulder afflictions must be ruled out by careful history and physical examination. Arthroscopic surgery allows for a shorter recovery time and predictably less pain following procedure than any open surgery. Materials and methods: We did a prospective study on 32 patients of age more than 40 years of age with degenerative rotator cuff tear, who met the inclusion criteria and were operated using single row technique of arthroscopic rotator cuff repair and were followed up at 1 month, 3 months and 6 months and pain, function, muscle power and range of movements were assessed by ASES and UCLA scoring system. Results: The mean age of the patients was found to be 54.94 years. The Male: Female ratio in our study was found to be 3:1. The average ASES score in the pre-operative and post-operative period was found to be 22.66 and 89.53 respectively. The average UCLA score in the pre-operative and post-operative period was found to be 8.97 and 29.13 respectively. Conclusion: Arthroscopic rotator cuff repair with single row repair provides early pain relief and improves mobility, strength as well as patient satisfaction post operatively

A prospective study in management of lumbar radiculopathy patients with selective nerve root block

Background: Prolapsed Intervertebral Disc (PID) was considered to be the commonest cause of sciatica among many others. Though the presentation of sciatica was paradoxical, in which, some people experienced sciatica without any disc prolapse on MRI/CT, whereas some people showed a prolapsed disc without experiencing any of the symptoms related to sciatica. This gave rise to different explanations that a disc prolapse in itself , is not enough to cause sciatica, and there might be some local chemical agents that might be the causative factor due to their insulting attitude on the nerve roots. Objectives: To study the functional outcome of patients with Posterior Lumbar Intervertebral disc prolapse (PLIVDP), Lumbar Canal Stenosis, and Lumbar radiculopathy after Selective Nerve Root Block at the corresponding level. Materials and Methods: A prospective cohort study on the functional outcome of patients with lumbar radiculopathy with Intervertebral disc prolapse or lumbar canal stenosis. Outcome measures used in this study are Owestry disability index score and Numerical rating scale. All patients had taken an MRI scan, which was classified according to the Michigan state university classification. After initial check up, pre-anaesthetic check up, selected patients were given Selective Nerve Root Block with Methyl Prednisolone and local anaesthetic Bupivacaine. Patients were scored at Immediate post Op, 3 weeks and 3 months after the injection was given and the data was collected. Results: A total of 127 patients were given Selective Nerve Root Block in the study period. Patients that were aged from 20-80 years were included. Average pre-injection ODI scores (in percent) were 75.24, at 1 month 20.52 and at 4 months 19.86, with a p value of <0.001. Mean NRS ratings pre injection were 8.73, Immediate post op were 1.89, at 4 weeks it was 1.48 and 4 months 1.27. Mean SLR (in degrees) Pre Injection was 48.3, Immediate was 80.00, at 4 weeks was 80.2 and at 4 months was 80.5. Conclusion: Selective Nerve Root Block is a good therapeutic procedure for pain management in the patients with Lumbar radiculopathy, and it can be used as a standard procedure, before advising the patient for any form of surger

An efficient approach to BAC based assembly of complex genomes

Background: There has been an exponential growth in the number of genome sequencing projects since the introduction of next generation DNA sequencing technologies. Genome projects have increasingly involved assembly of whole genome data which produces inferior assemblies compared to traditional Sanger sequencing of genomic fragments cloned into bacterial artificial chromosomes (BACs). While whole genome shotgun sequencing using next generation sequencing (NGS) is relatively fast and inexpensive, this method is extremely challenging for highly complex genomes, where polyploidy or high repeat content confounds accurate assembly, or where a highly accurate ‘gold’ reference is required. Several attempts have been made to improve genome sequencing approaches by incorporating NGS methods, to variable success. Results: We present the application of a novel BAC sequencing approach which combines indexed pools of BACs, Illumina paired read sequencing, a sequence assembler specifically designed for complex BAC assembly, and a custom bioinformatics pipeline. We demonstrate this method by sequencing and assembling BAC cloned fragments from bread wheat and sugarcane genomes. Conclusions: We demonstrate that our assembly approach is accurate, robust, cost effective and scalable, with applications for complete genome sequencing in large and complex genomes

Identification of Novel Pathogenicity Loci in Clostridium perfringens Strains That Cause Avian Necrotic Enteritis

Type A Clostridium perfringens causes poultry necrotic enteritis (NE), an enteric disease of considerable economic importance, yet can also exist as a member of the normal intestinal microbiota. A recently discovered pore-forming toxin, NetB, is associated with pathogenesis in most, but not all, NE isolates. This finding suggested that NE-causing strains may possess other virulence gene(s) not present in commensal type A isolates. We used high-throughput sequencing (HTS) technologies to generate draft genome sequences of seven unrelated C. perfringens poultry NE isolates and one isolate from a healthy bird, and identified additional novel NE-associated genes by comparison with nine publicly available reference genomes. Thirty-one open reading frames (ORFs) were unique to all NE strains and formed the basis for three highly conserved NE-associated loci that we designated NELoc-1 (42 kb), NELoc-2 (11.2 kb) and NELoc-3 (5.6 kb). The largest locus, NELoc-1, consisted of netB and 36 additional genes, including those predicted to encode two leukocidins, an internalin-like protein and a ricin-domain protein. Pulsed-field gel electrophoresis (PFGE) and Southern blotting revealed that the NE strains each carried 2 to 5 large plasmids, and that NELoc-1 and -3 were localized on distinct plasmids of sizes ∼85 and ∼70 kb, respectively. Sequencing of the regions flanking these loci revealed similarity to previously characterized conjugative plasmids of C. perfringens. These results provide significant insight into the pathogenetic basis of poultry NE and are the first to demonstrate that netB resides in a large, plasmid-encoded locus. Our findings strongly suggest that poultry NE is caused by several novel virulence factors, whose genes are clustered on discrete pathogenicity loci, some of which are plasmid-borne

Genome Sequencing Reveals Widespread Virulence Gene Exchange among Human Neisseria Species

Commensal bacteria comprise a large part of the microbial world, playing important roles in human development, health and disease. However, little is known about the genomic content of commensals or how related they are to their pathogenic counterparts. The genus Neisseria, containing both commensal and pathogenic species, provides an excellent opportunity to study these issues. We undertook a comprehensive sequencing and analysis of human commensal and pathogenic Neisseria genomes. Commensals have an extensive repertoire of virulence alleles, a large fraction of which has been exchanged among Neisseria species. Commensals also have the genetic capacity to donate DNA to, and take up DNA from, other Neisseria. Our findings strongly suggest that commensal Neisseria serve as reservoirs of virulence alleles, and that they engage extensively in genetic exchange

Cardiovascular disease and the role of oral bacteria

In terms of the pathogenesis of cardiovascular disease (CVD) the focus has traditionally been on dyslipidemia. Over the decades our understanding of the pathogenesis of CVD has increased, and infections, including those caused by oral bacteria, are more likely involved in CVD progression than previously thought. While many studies have now shown an association between periodontal disease and CVD, the mechanisms underpinning this relationship remain unclear. This review gives a brief overview of the host-bacterial interactions in periodontal disease and virulence factors of oral bacteria before discussing the proposed mechanisms by which oral bacterial may facilitate the progression of CVD

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

Background: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. Findings: Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]). Interpretation: Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. Funding: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg