Single-stage revision in the management of prosthetic joint infections after total knee arthroplasty - A review of current concepts

© 2024 The AuthorsProsthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA); and the gold standard surgical approach involves a two-staged, revision TKA (TSR). Owing to the newer, emerging evidence on this subject, there has been gradual shift towards a single-stage revision approach (SSR), with the purported benefits of mitigated patient morbidity, decreased complications and reduced costs. However, there is still substantial lacuna in the evidence regarding the safety and outcome of the two approaches in chronic PJI. This study aimed to comprehensively review of the literature on SSR; and evaluate its role within Revision TKA post PJI. The narrative review involved a comprehensive search of the databases (Embase, Medline and Pubmed), conducted on 20th of January 2024 using specific key words. All the manuscripts discussing the use of SSR for the management of PJI after TKA were considered for the review. Among the screened manuscripts, opinion articles, letters to the editor and non-English manuscripts were excluded. The literature search yielded a total 232 studies. Following a detailed scrutiny of these manuscripts, 26 articles were finally selected. The overall success rate following SSR is reported to range from 73 % to 100 % (and is comparable to TSR). SSR is performed in PJI patients with bacteriologically-proven infection, adequate soft tissue cover, immuno-competent host and excellent tolerance to antibiotics. The main difference between SSR and TSR is that the interval between the 2 stages is only a few minutes instead of 6 weeks. Appropriate topical, intraoperative antibiotic therapy, followed by adequate postoperative systemic antibiotic cover are necessary to ascertain good outcome. Some of the major benefits of SSR over TSR include reduced morbidity, decreased complications (such as arthrofibrosis or anesthesia-associated adverse events), meliorated extremity function, earlier return to activities, mitigated mechanical (prosthesis-associated) complications and enhanced patient satisfaction. SSR is a reliable approach for the management of chronic PJI. Based on our comprehensive review of the literature, it may be concluded that the right selection of patients, extensive debridement, sophisticated reconstruction strategy, identification of the pathogenic organism, initiation of appropriate antibiotic therapy and ensuring adequate follow-up are the key determinants of successful outcome. To achieve this will undoubtedly require an MDT approach to be taken on a case-by-case basis. [Abstract copyright: © 2024 The Authors.]Unfunde

Comparison of body mass index and intraocular pressure

Background: Raised intaocular pressure is considered as a major risk factor for developing optic neuropathy. Intraocular pressure (IOP) depends on various systemic and local factors and it has been postulated that IOP increases proportionately with increase in systolic blood pressure and increase in degree of obesity. The aim of this study was to compare the Body Mass Index (BMI) and Intraocular Pressure (IOP) in adult population.Methods: Four hundred ninety nine participants (284 male, 215 female) aged between 20 to 70 years were included in the cross-sectional study. On the basis of BMI subjects were divided into four categories i.e. underweight, normal weight, overweight and obese as per revised body type classification for Indian population recommended by Ministry of Health and Diabetes foundation of India. The mean IOP difference was 14.6±1.8 as compared amongst the four categories.Results: The participants were divided into six categories according to age and the mean IOP of different age groups was calculated. The changes in the mean IOP of males was 15.8±2.5 mm of Hg and the mean IOP of females was 14.7±2.2 mm of Hg. The results of the current study were statistically significant p<0.01.Conclusions: By concluding the current study as well as in the previous published literature, the findings of the current study were statistically significant. IOP was positively correlated with BMI. However, the clinical significance cannot be confirmed by the minor deviation in the IOP as well as BMI of the participants

Malignant transformation of ovarian dermoid: a rare case

Mature cystic teratoma also known as the dermoid cyst is the most common benign tumor of the ovary (10 – 20%) in women of reproductive age. Malignant transformation in a dermoid is very rare (<2%) with squamous cell carcinoma being the most common malignancy. A total of 36 ovarian cysts have been operated in our hospital from the year February 2007 to April 2012 of which about 90% were dermoid but no case of ovarian dermoid turned malignant have been reported till date in our state, Sikkim, India. We report a rare case of dermoid cyst of ovary in a 47 yr old woman which had malignant transformation. Surgeons should keep the chance of malignant transformation in mind when faced with a dermoid cyst especially in older patients or in larger than usual so that the best can be done for the patient regarding the staging of the disease and its further management

Estimation of Correlation Matrices from Limited time series Data using Machine Learning

Prediction of correlation matrices from given time series data has several applications for a range of problems, such as inferring neuronal connections from spiking data, deducing causal dependencies between genes from expression data, and discovering long spatial range influences in climate variations. Traditional methods of predicting correlation matrices utilize time series data of all the nodes of the underlying networks. Here, we use a supervised machine learning technique to predict the correlation matrix of entire systems from finite time series information of a few randomly selected nodes. The accuracy of the prediction from the model confirms that only a limited time series of a subset of the entire system is enough to make good correlation matrix predictions. Furthermore, using an unsupervised learning algorithm, we provide insights into the success of the predictions from our model. Finally, we apply the machine learning model developed here to real-world data sets.Comment: 13 pages, 5 figure

Comparative study of interval versus postpartum Cu-T insertion in a central referral hospital of North East India

Background: Aim of current study was to compare interval and postpartum Cu-T (380A) insertion in terms of safety and immediate outcome.Methods: This was a retrospective cohort study where retrospective analysis of prospectively collected data in the department of OBG, SMIMS, Gangtok, from April 2011 to April 2012 were taken for evaluation. 164 women who were inserted Cu-T after delivery and in the interval period were studied. 80 were inserted Cu-T at post-partum period (36 after vaginal delivery and 44 intra caesarean) while 84 were inserted at interval period. Follow up was done at 6 weeks and 3 months. Outcome was measured by tail visibility at 6 weeks and 3 months, spontaneous expulsion rate, removal rate and perception of insertion using visual analog scale (0-5).Results: Tail visibility at 6 weeks and 3 months was less in post-partum than that of interval insertion. Spontaneous expulsion rate was nil in post-partum while 5/84 (5.95%) in interval insertion. Perception of insertion for doctor and client was easiest in intra Caesarean (0) while difficult in interval (4). Removal rate was 1/80(1 %) in post-partum and 9/84 (10.7%) in interval.Conclusions: Study suggested that post-partum insertion is more effective than interval Cu-T insertion with low expulsion rate and complications compared to interval insertion.

Supervision of a self-driving vehicle unmasks latent sleepiness relative to manually controlled driving

Human error has been implicated as a causal factor in a large proportion of road accidents. Automated driving systems purport to mitigate this risk, but self-driving systems that allow a driver to entirely disengage from the driving task also require the driver to monitor the environment and take control when necessary. Given that sleep loss impairs monitoring performance and there is a high prevalence of sleep deficiency in modern society, we hypothesized that supervising a self-driving vehicle would unmask latent sleepiness compared to manually controlled driving among individuals following their typical sleep schedules. We found that participants felt sleepier, had more involuntary transitions to sleep, had slower reaction times and more attentional failures, and showed substantial modifications in brain synchronization during and following an autonomous drive compared to a manually controlled drive. Our findings suggest that the introduction of partial self-driving capabilities in vehicles has the potential to paradoxically increase accident risk

Common Variants in CRP and LEPR Influence High Sensitivity C-Reactive Protein Levels in North Indians

BACKGROUND: High sensitivity C-reactive protein (hsCRP) levels are shown to be influenced by genetic variants in Europeans; however, little is explored in Indian population. METHODS: Herein, we comprehensively evaluated association of all previously reported genetic determinants of hsCRP levels, including 18 cis (proximal to CRP gene) and 73 trans-acting (distal to CRP gene) variants in 4,200 North Indians of Indo-European ethnicity. First, we evaluated association of 91 variants from 12 candidate loci with hsCRP levels in 2,115 North Indians (1,042 non-diabetic subjects and 1,073 patients with type 2 diabetes). Then, cis and trans-acting variants contributing maximally to hsCRP level variation were further replicated in an independent 2,085 North Indians (1,047 patients with type 2 diabetes and 1,038 non-diabetic subjects). RESULTS: We found association of 12 variants from CRP, LEPR, IL1A, IL6, and IL6R with hsCRP levels in non-diabetic subjects. However, only rs3093059-CRP [β = 0.33, P = 9.6×10⁻⁵] and the haplotype harboring rs3093059 risk allele [β = 0.32 µg/mL, P = 1.4×10⁻⁴/P(perm) = 9.0×10⁻⁴] retained significance after correcting for multiple testing. The cis-acting variant rs3093059-CRP had maximum contribution to the variance in hsCRP levels (1.14%). Among, trans-acting variants, rs1892534-LEPR was observed to contribute maximally to hsCRP level variance (0.59%). Associations of rs3093059-CRP and rs1892534-LEPR were confirmed by replication and attained higher significance after meta-analysis [β(meta) = 0.26/0.22; P(meta) = 4.3×10⁻⁷/7.4×10⁻³ and β(meta) = -0.15/-0.12; P(meta) = 2.0×10⁻⁶/1.6×10⁻⁶ for rs3093059 and rs1892534, respectively in non-diabetic subjects and all subjects taken together]. CONCLUSION: In conclusion, we identified rs3093059 in CRP and rs1892534 in LEPR as major cis and trans-acting contributor respectively, to the variance in hsCRP levels in North Indian population

Cohort for Tuberculosis Research by the Indo-US Medical Partnership (CTRIUMPH): protocol for a multicentric prospective observational study

INTRODUCTION: Tuberculosis disease (TB) remains an important global health threat. An evidence-based response, tailored to local disease epidemiology in high-burden countries, is key to controlling the global TB epidemic. Reliable surrogate biomarkers that predict key active disease and latent TB infection outcomes are vital to advancing clinical research necessary to ‘End TB’. Well executed longitudinal studies strengthening local research capacity for addressing TB research priorities and advancing biomarker discovery are urgently needed. METHODS AND ANALYSIS: The Cohort for Tuberculosis Research by the Indo-US Medical Partnership (CTRIUMPH) study conducted in Byramjee Jeejeebhoy Government Medical College (BJGMC), Pune and National Institute for Research in Tuberculosis (NIRT), Chennai, India, will establish and maintain three prospective cohorts: (1) an Active TB Cohort comprising 800 adults with pulmonary TB, 200 adults with extrapulmonary TB and 200 children with TB; (2) a Household Contact Cohort of 3200 adults and children at risk of developing active disease; and (3) a Control Cohort consisting of 300 adults and 200 children with no known exposure to TB. Relevant clinical, sociodemographic and psychosocial data will be collected and a strategic specimen repository established at multiple time points over 24 months of follow-up to measure host and microbial factors associated with (1) TB treatment outcomes; (2) progression from infection to active TB disease; and (3) Mycobacterium tuberculosis transmission among Indian adults and children. We anticipate CTRIUMPH to serve as a research platform necessary to characterise some relevant aspects of the TB epidemic in India, generate evidence to inform local and global TB control strategies and support novel TB biomarker discovery. ETHICS AND DISSEMINATION: This study is approved by the Institutional Review Boards of NIRT, BJGMC and Johns Hopkins University, USA. Study results will be disseminated through peer-reviewed journals and research conferences. FUNDING: NIH/DBT Indo-US Vaccine Action Programme and the Indian Council of Medical Research

Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored

BackgroundMore than 20% of tuberculosis (TB) disease worldwide may be attributable to smoking and alcohol abuse. India is the second largest consumer of tobacco products, a major consumer of alcohol particularly among males, and has the highest burden of TB globally. The impact of increasing tobacco dose, relevance of alcohol misuse and past versus current or never smoking status on TB treatment outcomes remain inadequately defined.MethodsWe conducted a multi-centric prospective cohort study of newly diagnosed adult pulmonary TB patients initiated on TB treatment and followed for a minimum of 6 months to assess the impact of smoking status with or without alcohol abuse on treatment outcomes. Smokers were defined as never smokers, past smokers or current smokers. Alcohol Use Disorder Identification Test (AUDIT) scores were used to assess alcohol misuse. The association between smoking status and treatment outcomes was assessed in univariate and multivariate random effects poisson regression models.ResultsOf 455 enrolled, 129 (28%) had a history of smoking with 94 (20%) current smokers and 35 (8%) past smokers. Unfavourable treatment outcomes were significantly higher among past and current smokers as compared to never smokers. Specifically, the risk of treatment failure was significantly higher among past smokers (aIRR = 2.66, 95% CI: 1.41-4.90, p = 0.002), recurrent TB among current smokers (aIRR = 2.94, 95% CI: 1.30-6.67, p = 0.010) and death among both past (2.63, 95% CI: 1.11-6.24, p = 0.028) and current (aIRR = 2.59, 95% CI: 1.29-5.18, p = 0.007) smokers. Furthermore, the combined effect of alcohol misuse and smoking on unfavorable treatment outcomes was significantly higher among past smokers (aIRR: 4.67, 95% CI: 2.17-10.02, pConclusionPast and current smoking along with alcohol misuse have combined effects on increasing the risk of unfavourable TB treatment outcomes. Innovative interventions that can readily address both co-morbidities are urgently needed