Patelloplasty with and without circumpatellar denervation in reducing anterior knee pain in primary total knee arthroplasty: a comparative prospective study

Background: Anterior knee pain (AKP) following total knee arthroplasty (TKA) ­­­­­­is one of the complication which cause dissatisfaction in patients. Incidence estimated to be 4-49%. The aim of our study is to know the efficacy of patelloplasty with circumpatellar denervation with diathermy in reducing AKP in primary TKA.Methods: A total of 130 unilateral TKAs’ are divided into 2 groups. Group I (control) includes 65 patients in which only patelloplasty was done. Group II (intervention) includes 65 patients in which both patelloplasty and circumpatellar denervation with diathermy was done and analysed. Mean follow up period was 18 months. Patients were assessed both preoperatively and postoperatively at final follow up.Results: The overall incidence of AKP at follow up (18 months) was 16.9%, with 7.7% in the intervention group and 26.1% in the control group (p<0.05).  Western Ontario and McMaster Universities osteoarthritis index scores were significantly  better in intervention group when compared to control group (28.71±3.948 vs 31.40±3.860). Better results were also found in knee society scores for intervention group compared to control group (166.57±7.941 vs 161.23±11.219); Feller patellar score of  intervention group was significantly better when compared to control group (23.28±2.546 vs 20.69±3.729); the range of knee flexion was similar in both the groups (94.62±12.6 vs 93.54±10.7). In terms of pain referred by the patient at 72 hrs postoperatively, there was statistically significant difference observed according to visual analogue scale.Conclusions: There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.

A prospective comparative study between interlocking nail and locking compression plate for management of diaphyseal fractures of the humerus

Background: The aim of this study was to compare the outcomes between open reduction and internal fixation by locking compression plate (LCP) and closed reduction and internal fixation with anterograde interlocking nail (ILN) for the treatment of diaphyseal fractures of the humerus.Methods: This is a prospective comparative study, with diaphyseal fractures of the humerus treated by LCP in 30 patients and with ILN in 30 patients. Patients were followed up to 18 months. The clinical and radiographic outcomes were assessed in terms of union, complications, reoperation rate and functional outcome using the American shoulder and elbow surgeons’ score (ASES) and Stewart and Hundley’s criteria.Results: Union was achieved in 93.3% of patients in LCP group and 90% in ILN group. The mean blood loss in LCP group was 280±22.10 ml (160-400 ml) and in ILN group was 110±17.62 ml (70-150 ml) (p=0.001). The ASES score was 42.47±5.532 in LCP group and 40.93±6.330 in nailing group (p=0.320; p>0.05). Stewart Hundley criteria showed excellent and good results in 26/30 and 17/30 patients in LCP group and ILN group respectively (p=0.070; p>0.05). Complications and re-operation rate were higher in ILN group.Conclusions: Our study concludes that LCP can be considered a better surgical option for the management of diaphyseal fractures of the humerus as it had lower incidence of complications, less re-operation rate and better union rate. However, there is no difference between the two groups in terms of union time and functional outcome

Alteration of the conserved residue tyrosine-158 to histidine renders human O6-alkylguanine-DNA alkyltransferase insensitive to the inhibitor O6- benzylguanine

The DNA repair protein O6-alkylguanine-DNA alkyltransferase (AGT) protects cells from alkylation damage. O6-Benzylguanine (BG) is a potent inactivator of human AGT (ED50 of 0.1 μM) that is currently undergoing clinical trials to enhance chemotherapy by alkylating agents. In a screen of AGT mutants randomly mutated at position glycine-160, we found that the double mutant Y158H/G160A protected Escherichia coli from killing by N- methyl-N'-nitro-N-nitrosoguanidine (MNNG) even in the presence of BG and that the AGT activity of this mutant was strongly resistant to BG (ED50 of 180 μM). Because the single mutant G160A was not resistant to BG, this suggested that the presence of the charged histidine residue at position 158 was responsible. This hypothesis was confirmed by the construction of the single mutation Y158H. The Y158H-mutant AGT was slightly less active than wild-type AGT for the repair of mcthylated DNA in vitro, but it protected E. coli from killing by MNNG even in the presence of BG and had an ED50 for the inactivation by BG of 620 μM. In contrast, mutant Y158F had an ED50 of 0.2 μM. Previous studies (M. Xu-Welliver et al., Cancer Res., 58: 1936-1945, 1998) have shown that mutant P140K is highly resistant to BG (ED50 of > 1200 μM). Models of human AGT suggest that the side chain of the lysine inserted into this mutant is close to tyrosine-158 and that the positively charged lysine side-chain may interfere with BG binding. The double mutants P140K/Y158H and P140K/Y158F resembled P140K and Y158H in being highly resistant to BG, but the use of a sensitive assay for reaction of BG with AGT indicated that their abilities to react were in the order P140K/Y158H < P140K < P140K/Y158F. These results confirm that the presence of a positively charged residue close to the active site of human AGT renders it highly resistant to BG without substantially affecting activity toward methylated DNA substrates. Such mutants may limit the value of BG therapy if they arise in malignant cells during chemotherapy, but the mutant sequences may be useful for gene therapy approaches in which BG-resistant human AGTs are used to prevent hematopoietic toxicity. At least 28 AGT sequences (from 25 species) have now been described. In 25 of these, the position equivalent to 158 in the human AGT is also a tyrosine, and in the other 3, it is a phenylalanine. The importance of an aromatic ring side chain at this position is emphasized by previous studies (S. Edara et al., Carcinogenesis, 16: 1637- 1642, 1995), which show that the replacement by alanine renders human AGT inactive. Our results show that histidine can also substitute for tyrosine at this position

Factors determining the range of motion in primary total knee arthroplasty

Background: Total knee arthroplasty (TKA) ­­­­­­is one of the most successful surgical procedure with over 90% survival rate at 10 to 15 years. It provides a stable, pain free range of motion (ROM) for day to day activities. The aim of this study is to evaluate various factors determining ROM after TKA.Methods: 348 patients with 390 knees treated with TKA using cruciate retaining (CR) and posterior stabilized (PS) prosthesis were included and analysed. Mean follow up period was 18 months. Patients were analysed for factors like age, sex, diagnosis, body mass index (BMI), pre-operative exercises, ROM, deformity, posterior femoral condylar offset (PFCO), posterior tibial slope (PTS), post-operative rehabilitation and implant design (CR vs PS). Statistical analysis of above factors on knee ROM was done. Patients were assessed pre-operatively, at 6 weeks, 3, 6, 12 and 18 months post-operatively.Results: Age and sex did not affect the final ROM. The mean knee ROM improved from 86.87° to 96.95°. Factors like BMI, deformity had negative correlation and Pre-operative diagnosis, exercises, knee scores, good preoperative ROM, PFCO, PTS had positive correlation on ROM.Conclusions: Pre-operative exercises, diagnosis, ROM, deformity, BMI, PFCO and PTS were important factors which influence ROM in TKA. Patient selection and preoperative counselling are important for good clinical outcome

Influence of posterior tibial slope on knee flexion in posterior stabilized fixed bearing primary total knee arthroplasty

Background: The goal of total knee arthroplasty (TKA) is to relieve pain and maintain stable range of motion (ROM) for day to day activities. Among the various factors, posterior tibial slope slope (PTS) may play an important role in achieving good postoperative knee flexion. Our study aims to know the effectiveness of PTS on the ROM of the knee in a posterior cruciate ligament (PCL)-substituting TKA.Methods: A total of 125 unilateral PCL-substituting TKA’s were included in the study. Based on postoperative PTA which was measured on lateral radiograph, patients were divided into 3 groups, Group A (PTS of ≤2) comprise of 24 patients. Group B consists of 91 patients (PTS of 3 to 7). Group C includes 10 patients (PTS of 8 or more). Functional outcome was measured by using knee society score (KSS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) which were evaluated preoperatively and at 18months post operatively.Results: Mean postop ROM was 92.91 ± 10.632; 107.24±10.905; 107.49±13.944 in group A, B, C respectively which was significantly related to mean postop PTS (0.74; 5.62; 9.87 in group A, B, C respectively) (P&lt;0.05). Functional outcome was measured by KSS and WOMAC which showed no significant difference pre and postoperatively.Conclusions: The results of our study validate the hypothesis that a positive correlation exists between the postoperative flexion and PTS in the PCL-substituting TKA, an increase in PTS can lead to a greater degree of the knee flexion for every extra degree of PTS.

A rare association of brucellosis and pulmonary hydatid cyst in a patient with human immunodeficiency virus

Background: Hydatid disease, or cystic echinococcosis, is a parasitic infection caused by a tapeworm. Pulmonary hydatid infection is the second common manifestation of hydatid disease. We present a patient who was diagnosed with recurrent hydatid cyst in lung and later diagnosed with brucellosis, which is a highly contagious zoonotic disease. Case presentation: A 47-years-old male was diagnosed with pulmonary hydatid disease after a computed tomography (CT) chest-plain was done. As the patient had high intermittent fever for 4 months which could not be explained by an intact cyst in the followup, the patient was diagnosed with brucellosis with both IgG and IgM antibodies positive. Conclusions: Hydatid cyst present with varied symptomatology. A high degree of clinical suspicion combined with meticulous history and clinical examination supported by laboratory investigations are required for its diagnosis. This case highlights the importance of considering brucella as a differential diagnosis

Analysis of displaced acetabular fractures in adults treated with open reduction and internal fixation

Background: The incidence of acetabular fractures is increasing worldwide at a rapid rate due to increase in rail and road traffic accidents and high velocity injuries. The incidence of acetabular fractures is increasing worldwide at a rapid rate due to increase in rail and road traffic accidents and high velocity injuries.Methods: 30 patients aged between 18 to 60 years with closed displaced acetabular fractures were included into the study. A single surgical approach such as the Kocher-Langenbeck, the ilioinguinal, and the extended iliofemoral approach was selected depending on the type of fracture, with the expectation that the fracture reduction and fixation can be completely performed through the one approach.Results: Out of the 30 patients, 12 patients were between the 21-30 age group and 10 were between 31-40 age group with most of them being males involved in road traffic accidents. Predominance of right side was seen in 22 (73, 33%) and 8 (26.66%) persons had left sided fractures. Posterior wall fractures were seen in 5 cases while transverse was seen in 4 cases. Combinations of both were seen in 8 patients. The outcomes were excellent in more than 56% of the cases and good in more than 30% of them.Conclusions: Present study needs further follow up for better understanding of long term results

Gold Nanoparticles with Self-Assembled Cysteine Monolayer Coupled to Nitrate Reductase in Polypyrrole Matrix Enhanced Nitrate Biosensor

We have developed here a novel, highly sensitive and selective nitrate (NO– 3) biosensor by covalent immobilization of nitrate reductase (NaR) in self-assembled monolayer (SAM) of cysteine on gold nanoparticles (GNP)-polypyrrole (PPy) modified platinum electrode. Incorporation of GNP in highly microporous PPy matrix was confirmed by morphological scanning electron microscope (SEM) images. The electrochemical behavior of the NaR modified electrode exhibited the characteristic reversible redox peaks at the potential, –0.76 and –0.62 V versus Ag/AgCl. Further, the GNP-PPy nanocomposite enhanced the current response by 2-fold perhaps by enhancing the immobilization of NaR and also direct electron transfer between the deeply buried active site and the electrode surface. The common biological interferences like ascorbic acid, uric acid were not interfering with the NO– 3 measurement at low concentration levels. This biosensor showed a wide linear range of response over the concentration of NO– 3 from 1 μM to 1 mM, with higher sensitivity of 84.5 nA μM–1 and a detection limit of 0.5 μM. Moreover, the NO– 3 level present in the nitrate-rich beetroot juice and the NO– 3 release from the lipopolysaccharide treated human breast cancer cells were estimated

Organophosphate hydrolase is a lipoprotein and interacts with pi-specific transport system to facilitate growth of <i>brevundimonas diminuta</i> using op insecticide as source of phosphate

Organophosphate Hydrolase (OPH), encoded by the organophosphate degradation (opd) island, hydrolyzes the triester bond found in a variety of organophosphate insecticides and nerve agents. OPH is targeted to the inner membrane of Brevundimonas diminuta in a pre-folded conformation by the Twin arginine transport (Tat) pathway. The OPH signal peptide contains an invariant cysteine residue at the junction of the signal peptidase (Spase) cleavage site along with a well conserved lipobox motif. Treatment of cells producing native OPH with the signal peptidase II inhibitor globomycin resulted in accumulation of most of the pre-OPH in the cytoplasm with negligible processed OPH detected in the membrane. Substitution of the conserved lipobox cysteine to serine resulted in release of OPH into the periplasm, confirming that OPH is a lipoprotein. Analysis of purified OPH revealed that it was modified with the fatty acids palmitate and stearate. Membrane-bound OPH was shown to interact with the outer membrane efflux protein TolC and with PstS, the periplasmic component of the ABC transporter complex (PstSACB) involved in phosphate transport. Interaction of OPH with PstS appears to facilitate transport of Pigenerated from organophosphates due to the combined action of OPH and periplasmically located phosphatases. Consistent with this model, opd null mutants of B. diminuta failed to grow using the organophosphate insecticide methyl parathion as sole source of phosphate