A prospective study of neglected and resistant clubfoot cases treated using Joshi’s external stabilization system

Background: Clubfoot is a common congenital deformity occurring in 1 to 2 per thousand live births. In relapsed or neglected clubfoot the deformities become fixed and treatment using conservative methods often fails. JESS (Joshi’s external stabilizing system) is a simple construct for the correction of deformity in these patients. The present study was taken up to assess the results of JESS fixator in correction of deformities in neglected, resistant or relapsed cases of clubfoot and deformities in the late presented patients.Methods: The present study was conducted on randomly selected patients of clubfoot in the department of Orthopaedics, ESI Hospital, Basaidarapur, New Delhi between June 2014 and December 2017. A total of 22 feet (of 16 patients) suffering from neglected, resistant or relapsed clubfoot under the age of 7 years, were included in the study.Results: Excellent results were obtained in 52% of cases, while 19% had good, 14.5% had fair and 14.5% had poor results. Complications encountered were temporary oedema in 10 feet, superficial pin tract infection in 5 feet, pin loosening in 3 feet, skin necrosis 2 feet and flexion contracture of toes in 2.Conclusions: JESS application is an excellent technique for treatment of recurrent and neglected clubfoot. This procedure is ideally suited for children in whom the clubfoot deformities remain uncorrected by POP casts and manipulation, as well as for recurrent clubfoot cases

Outcome of staged injection of autologous platelet rich plasma in treatment of mild to moderate knee osteoarthritis

Background: Autologous platelet-rich plasma (PRP) offers an easy solution for delivering multiple growth factors needed for tissue repair. Intra-articular injections of PRP have been proposed as a simple low cost minimally invasive way to obtain the concentration of growth factors and biologically active molecules to promote cartilage healing in osteoarthritic (OA) knee joint. The objective of the present study was designed to evaluate the clinical efficacy of autologous platelet rich plasma injection in mild to moderate osteoarthritic knee and to assess the role of serial staged autologous platelet rich plasma injection.Methods: 50 patients with mild to moderate osteoarthritis of knee were divided into two groups. Group A was given staged injection of freshly prepared autologous PRP in the affected knee. Group B was given single injection of PRP. The Results were evaluated on the basis of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire and visual analog scale (VAS) before treatment and 3 weeks, 8 weeks, 16 weeks and 24 weeks after treatment.Results: At 24-weeks follow up the following observations were made; the MeanVAS in Group A decreased to 3.30 whereas in Group B it increased to 4.54. The Mean WOMAC score in Group A was reduced to a mere28.64 in Group A and in Group B it was 39.76.Conclusions: It is concluded from our study that concomitant use of serial staged injection (two) of PRP over four months is more effective than single injection in patients with mild to moderate OA of knee

Acute Oxalate Nephropathy Due to Bilimbi Poisoning: A Case Report

Background: The concentrated juice made from Averrhoa bilimbi is rich in oxalic acid. It can cause acute oxalate nephropathy by blocking the tubules with calcium oxalate crystals. Case: An elderly woman was admitted to the hospital with a history of swelling of the legs, facial puffiness, and abdominal distention. Her biochemical study revealed features of acute renal failure. She gave history of taking half liter of bilimbi juice. Renal biopsy confirmed it was a case of acute oxalic nephropathy, which made it the second case of acute oxalic nephropathy due to ingestion of bilimbi juice ever reported from Bangladesh.Conclusion: It is not safe to consume high oxalate-containing fruits in large quantities

Usual interstitial pneumonia - secondary vs idiopathic pulmonary fibrosis

Background: Interstitial Lung Diseases is a group of disorders where the pulmonary interstitium, alveolar structures and the small airways are affected. Identification of a specific pattern on HRCT, with a thorough clinical evaluation can help a physician in narrowing down the differential diagnosis for the underlying cause. Usual Interstitial Pneumonia (UIP) is a frequently identified pattern. Differentiating patients with definite UIP pattern, into IPF and non-IPF spectrums is important. Aim of this study is to compare UIP patients with a secondary cause vs Idiopathic Pulmonary Fibrosis.Methods: Statistically 33 patients having UIP pattern on HRCT were evaluated based on the history of extrapulmonary symptoms, environmental exposure, drugs and subsequent serology testing. Patients were divided into two groups - IPF and UIP with a secondary cause. Both groups were compared on various clinical parameters. Inferences were drawn from the same.Results: Total 66.6% patients were identified to have Idiopathic Pulmonary Fibrosis, 33.3% had UIP with a secondary cause. Majority of patients with a secondary cause had Connective Tissue Disorder (90.9%) and one patient of Chronic Hypersensitivity Pneumonitis (HP).Conclusions: Absence of extrapulmonary symptoms in UIP patients need no further investigations and can be diagnosed as a case of IPF. However, presence of extrapulmonary symptoms needs further evaluation to diagnose the underlying disease and start treatment for the same

Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions

Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared to mobilized peripheral blood stem cells (PBSC). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita (GNI) and region/countries into four groups. Groups analyzed were high income countries (HIC), which were further divided into US-Canada (N=486) and other HIC (N=1264), upper middle-income (UMIC) (N=482), and combined lower middle, low income countries (LM-LIC) (N=142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared to PBSC in all countries or BM in UMIC or LM-LIC (p<0.001). There was no significant difference in OS between BM and PBSC in UMIC (p=0.32) or LM-LIC (p=0.23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSC compared to BM (97% vs. 77%, p<0.001). Chronic GVHD was significantly higher with PBSC in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSC may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI