Bisphosphonate-induced periprosthetic fracture: a cause of painful total hip arthroplasty

Background. Cases have been reported in the literature of periprosthetic fractures associated with the use of bisphosphonates occurring in the long term following a Total Hip Replacement (THR). We report an interesting case of periprosthetic fracture secondary to bisphosphonate use only a few months after a THR. Case Report. A 72-year-old lady (on bisphosphonates for 10 years) underwent a THR for osteoarthritis. She was pain-free in the first four months postoperatively. Thereafter, she developed spontaneous onset of pain in the lateral aspect of her thigh and groin and found it difficult to weight-bear. X-rays and blood tests were unremarkable. An ultrasound and MRI scan showed no evidence of effusion/collection or periprosthetic fracture. A radionuclide bone scan showed an abnormal appearance of the right femoral shaft. A subsequent CT scan showed an oblique vertical split on the anterior surface of the upper right femoral shaft. This stress fracture was managed nonoperatively with protected weight bearing. She has progressed well with good clinical and radiological signs of fracture healing. Conclusion. This case is an important addition to our knowledge that bisphosphonate-induced periprosthetic stress fractures can be a cause of hip pain only a few months following a THR.</p

Ergonomic Design of Noseless Bicycle Saddle using UPVC/Silica-Aerogel

Introduction: During cycling most of the people suffer from perineal pain due to the pressure acting on the perineal area by the nose of the seat. Also Unsupported sitting on the saddle in a forward bending posture for longer time induce low back pain (LBP) among cyclists. So this paper presents the design of noseless bicycle seat with backrest using UPVC/Silica-Aerogel. Methods: This seat is designed as per the anthropometric dimensions of human body. Various parameters such as Lumbar position, seat tilt angle, seat position, backrest angle, seat height, backrest height, seat and backrest width are considered and the optimal value is determined while designing. The material chosen for the base of seat is UPVC/Silica- Aerogel composite and the cushioning material is chosen as polyurethene foam.  The design is executed in 3D modelling software and validated using FEA package. Results: The maximum stresses induced in the newly proposed material UPVC/Silica-Aerogel (4.41MPa) is lesser than its yield strength (59 MPa). The maximum anterior stress of noseless seat is found out to be 24.5 kPa which is lower than that of the saddle with nose (41 kPa). Conclusion: As the anterior stress of noseless seat is lesser, the perineal pressure of cyclists is greatly reduced and this decreases the health problems associated with the perineal pressure. Also the backrest of the seatpan enhances the supporting of back muscles and reduces LBP among cyclists

Metastases to the craniovertebral junction: illustrative case report and review of literature

Metastases at the craniovertebral junction represent 0.5-1% of spinal metastatic lesions. Common primary sites include breast, lung and prostate carcinoma. Initial presenting features include neck pain and occipital neuralgia. High index of suspicion is required to recognize this entity in patients presenting with neck pain. If left unrecognized, these metastatic lesions have the propensity to cause catastrophic collapse leading to significant morbidity and mortality due to fracture subluxation and spinal cord compression. Here we discuss such a patient who presented with acute onset quadriparesis and lower cranial nerve palsies due to metastatic lesion involving the C1 and C2 vertebra causing medullary and cervical cord compression. Early detection and timely intervention are key to improving outcomes in such patients

Posterior dislocation of the elbow as an unusual presentation after a total hip replacement: a case report

<p>Abstract</p> <p>Introduction</p> <p>Posterior dislocation of the elbow is usually associated with trauma to the joint with a reported incidence of 3%to 6%. Chronic instability is usually symptomatic following the initial injury.</p> <p>Case presentation</p> <p>We report a case of posterior dislocation of the elbow occurring in a patient while using her arm to lift herself using a monkey pole on the second day following a total hip replacement. The dislocation was reduced under sedation in the ward. There were no signs or symptoms suggesting any joint hypermobility syndrome in the patient. Follow up 4 months following the injury revealed a complete recovery in the range of motion and a pain free elbow. There were no signs and symptoms of any instability.</p> <p>Conclusion</p> <p>This is the first time such a case is reported in the literature. It certainly demonstrates that even in the absence of instability a patient can be predisposed to low energy dislocation of the elbow.</p

Efficacy of an Extract of Ocimum tenuiflorum (OciBest) in the Management of General Stress: A Double-Blind, Placebo-Controlled Study

A randomized, double-blind, placebo-controlled study was conducted to evaluate the efficacy of OciBest, an extract of Ocimum tenuiflorum Linn. in symptomatic control of general stress. The participants received either placebo (n = 79) or OciBest (n = 71; 1200 mg of actives per day) for six weeks. The severity of stress-related symptoms was self-evaluated by patients at weeks 0, 2, 4 and 6 of the trial period using a symptom rating scale. After six weeks of intervention, scores of symptoms such as forgetfulness, sexual problems of recent origin, frequent feeling of exhaustion, and frequent sleep problems of recent origin decreased significantly (P ≤ 0.05) in OciBest group as compared with placebo group. Also, the total symptom scores of OciBest group revealed significant reduction (P ≤ 0.05) as compared to placebo group. The overall improvement in OciBest group was found to be 1.6 times or 39% more in the control of general stress symptoms with respect to placebo. No adverse events were reported during the study. The findings revealed that OciBest was found to be effective and well tolerated by all the patients over the six weeks of study period