Case Report: Neglected Locked Anterior Shoulder Dis- Location with Upper Brachial Plexus Injury

Introduction: The most severe and least common side effects of shoulder dislocations are brachial plexus injury. Patients generally approach with a shoulder in abduction and external rotation, a behavior that orthopedic surgeons are accustomed to seeing in patients with an anterior type of shoulder dislocation. There are different viewpoints on whether surgery should be attempted to treat these old injuries with BPI and, if so, at what time. Material and Method: We had a 25-year male old patient who was admitted through an outdoor clinic with a ‘neglected locked anterior dislocation’ that had been unrecognized for the last two months. After consent and fitness, he was managed with an open reduction as well as the Latarjet technique, followed by neurotization for BPI upper trunk after four months had passed with no improvement. Result: The patient achieved 90 degrees of abduction and forward flexion in the 4th month of follow-up neurotization with a stable shoulder joint. Conclusion: We advocate that old stuck shoulder dislocations along with BPI be reduced right after using an open method, stabilized by using the Laterjet intervention if still unstable, and surgically handle the wounded nerves after four months of no sign of regeneration

Friedelin Attenuates Neuronal Dysfunction and Memory Impairment by Inhibition of the Activated JNK/NF-κB Signalling Pathway in Scopolamine-Induced Mice Model of Neurodegeneration

Oxidative stress (OS) and c-Jun N-terminal kinase (JNK) are both key indicators implicated in neuro-inflammatory signalling pathways and their respective neurodegenerative diseases. Drugs targeting these factors can be considered as suitable candidates for treatment of neuronal dysfunction and memory impairment. The present study encompasses beneficial effects of a naturally occurring triterpenoid, friedelin, against scopolamine-induced oxidative stress and neurodegenerative pathologies in mice models. The treated animals were subjected to behavioural tests i.e., Y-maze and Morris water maze (MWM) for memory dysfunction. The underlying mechanism was determined via western blotting, antioxidant enzymes and lipid profile analyses. Molecular docking studies were carried out to predict the binding modes of friedelin in the binding pocket of p-JNK protein. The results reveal that scopolamine caused oxidative stress by (1) inhibiting catalase (CAT), peroxidase enzyme (POD), superoxide dismutase (SOD), and reduced glutathione enzyme (GSH); (2) the up-regulation of thiobarbituric acid reactive substances (TBARS) in mice brain; and (3) affecting the neuronal synapse (both pre- and post-synapse) followed by associated memory dysfunction. In contrast, friedelin administration not only abolished scopolamine-induced oxidative stress, glial cell activation, and neuro-inflammation but also inhibited p-JNK and NF-κB and their downstream signaling molecules. Moreover, friedelin administration improved neuronal synapse and reversed scopolamine-induced memory impairment accompanied by the inhibition of β-secretase enzyme (BACE-1) to halt amyloidogenic pathways of amyloid-β production. In summary, all of the results show that friedelin is a potent naturally isolated neuro-therapeutic agent to reverse scopolamine-induced neuropathology, which is characteristic of Alzheimer’s disease

Lipoma arborescence of knee joint in an adolescent male patient: a case report

A very uncommon benign synovial membrane tumor is called lipoma arborescens. It often affects a single articulation, the knee. Despite a conventional imaging assessment, the lesion&rsquo;s histological analysis is still required for the ultimate diagnosis. A 15-year-old boy attended the outpatient clinic of the Lahore General Hospital Lahore, Pakistan with pain and swelling in his left knee that had been steadily worsening over the previous 4 years. There were no concomitant prodromal symptoms, and the swelling was soft and non-tender while also inhibiting knee flexion. Soft tissue shadows were observed on radiographs. A large amount of subarticular erosion in the nearby tibial and femoral condyle was caused by the frond-like proliferation of fatty synovium, according to magnetic resonance imaging. Only the left knee joint showed focused areas of unusually elevated radionuclide uptake during the Technetium (Tc99m) bone scan. After an open synovectomy, the specimen underwent histological analysis, which revealed villiform fatty tissue, a hallmark of Lipoma arborescens coated by somewhat thicker synovium. Although infrequent, open synovectomy is currently the preferred course of treatment for lipoma arborescens, which should be taken into account when making a differential diagnosis of knee diseases. Approximately 3 months after surgery, the patient underwent his most recent follow-up and was asymptomatic with a small amount of joint effusion.</p