Pre-operative fixed flexion deformity a curse to the knee arthroplasty surgeon?

Background: The aim of the study was to study the effect of preoperative flexion deformity on the postoperative knee range of motion following total knee arthroplasty.Methods: A total of 28 knees were studied out of which twenty were osteoarthritis and eight were rheumatoid arthritis. Cruciate substituting and cruciate retaining implants were used. Patients above the age of 45 years with a minimum follow up period of two years from April 2010 were studied.Results: 28 knees had an average preoperative range of motion of 87.678. Patients with preoperative flexion deformity had postoperative range of motion of 97.5 degrees. The average postoperative flexion in 8 rheumatoid patients was 96.25 and 20 osteoarthritis patients was 107.462.Conclusions: The average postoperative range of motion was 105.538. Patients with a higher pre-operative range of motion had higher postoperative range of motion. Rheumatoid patients had a significantly low range of motion when compared to osteoarthritis patients. Patients with increased fixed flexion deformity had a significantly low postoperative range of motion

DEVELOPMENT AND OPTIMIZATION OF ENZALUTAMIDE-LOADED SOLID LIPID NANOPARTICLES USING BOX–BEHNKEN DESIGN

Objective: The primary motive behind this investigation is to develop and optimize the solid lipid nanoparticles formulation of enzalutamide for the effective drug delivery. Materials and Methods: The formulation variables were optimized using design of experiments. Box–Behnken design was used for the study and the results were analyzed using response surface methodology. The prepared nanoformulation was characterized for particle size, zeta potential, surface morphology, X-ray diffractometry (XRD), in vitro drug release kinetics, and stability study. Results: The influence of formulation variables, drug-to-lipid ratio, concentration of phosphatidylcholine, and concentration of poloxamer 188 were evaluated by regression analysis. The optimized formulation (F3) was found to have the minimum particle size (253 nm) with maximum entrapment efficiency (89.72%) and drug loading (23.84%). From SEM studies, the data showed a spherical shape for enzalutamide nanoparticles with uniform and relatively narrow particle distribution. From XRD examines, it is demonstrative that the drug was not in crystalline form in nanoformulation when compared with pure drug. In vitro release studies disclosed that maximum cumulative drug release was attained by F3 (99.72%) in controlled manner. The optimized formulation of enzalutamide followed zero-order release kinetics with a strong correlation coefficient (R2 = 0.9994). Conclusion: The nanoformulation prepared under optimized conditions is in concurrence with the expected results. The SLN formulation can be used as a potential carrier for the effective delivery of enzalutamide

Climate change effects on Chickpea yield and its variability in Andhra Pradesh, India

Farmers usually do not know the precise output that is affected by climatic factors such as temperature and rainfall and are characterized by inter-annual variability, part of which is caused by global climate change. No study covers the influences of climate factors on yield and yield risk in the context of chickpea farming in Andhra Pradesh, India. In this context, this study aimed to investigate the trends in climate change variables during Rabi season (October to January, 1996-2020) and evaluated their variability on chickpea yields across different agro-climatic zones in Andhra Pradesh by employing Just and Pope production function. Four non-parametric methods-Alexandersson’s Standard Normal Homogeneity Test, Buishand’s Range Test, Pettitt’s Test and Von Neumann’s Ratio Test are applied to detect homogeneity in the data. Mann–Kendall (MK) test and Sen’s slope (SS) method were employed to analyze monthly rainfall trends and minimum and maximum temperature trends. Results of Just and Pope (panel data) quadratic and Cobb-Douglas methods revealed that monthly minimum temperature positively influenced the mean yield of chickpea (0.22% and 0.16%, respectively). However, rainfall (-0.41% and -0.31%) and maximum temperature (-0.08% and -0.04%) negatively influenced the mean yield of chickpea under quadratic and Cobb-Douglas models, respectively. Accordingly, rainfall (0.08% and 0.06%) and maximum temperature (0.83% and 0.72%) positively influenced the yield variability and minimum temperature (-0.77% and -0.67%) reduced yield variability of chickpea under quadratic and Cobb-Douglas models respectively. In view of these findings, it is imperative to advocate the farmers about the importance of cultivating drought-tolerant chickpea varieties, drought-proofing and mitigation strategies, micro-irrigation practices and improving their access to agro-meteorological information towards sustainable chickpea cultivation in Andhra Pradesh

Primary total knee replacement using dished polyethylene with resected posterior cruciate ligament

Background: The choice between preserving, sacrificing or substituting the posterior cruciate ligament (PCL) is always a controversial topic in total knee replacement (TKR). Dished polyethylene insert with PCL resection enables correction of the commonly present fixed flexion and varus deformities. Additionally, the risk of premature wear of polyethylene is less because of the confirming articular geometry between the femoral and tibial component.Methods: This is a retrospective study in which we studied 120 knees in 95 consecutive patients undergoing primary TKR by the senior author at our institute. We used TKR system with dished metal backed polyethylene tibial component. PCL resection was performed in all cases. Pre-operative and post-operative functional assessment were done using knee society clinical scores and Western Ontario and McMaster universities osteoarthritis index (WOMAC). All radiographs were assessed using the knee society Roentgenographic scoring system (KSRES). Statistical analysis was performed using paired student t tests. Survivorship was determined using Kaplan-Meier survivorship curves. Results: Mean follow-up was 8 years. Range of motion increased from 75 degrees to 110 degrees.  The knee society pain score increased from 30 to 94. The knee society function score increased from 35 to 75. WOMAC score increased in terms of pain, stiffness and physical function.Conclusions: We conclude that deep dish bearing is a viable option in presence of deficient PCL and provides adequate stability and functional outcome. We need a larger sample size, multicentre trial and longer follow-up to see for complication rate, revision rate and survival

Catastrophic chromosomal restructuring during genome elimination in plants.

Genome instability is associated with mitotic errors and cancer. This phenomenon can lead to deleterious rearrangements, but also genetic novelty, and many questions regarding its genesis, fate and evolutionary role remain unanswered. Here, we describe extreme chromosomal restructuring during genome elimination, a process resulting from hybridization of Arabidopsis plants expressing different centromere histones H3. Shattered chromosomes are formed from the genome of the haploid inducer, consistent with genomic catastrophes affecting a single, laggard chromosome compartmentalized within a micronucleus. Analysis of breakpoint junctions implicates breaks followed by repair through non-homologous end joining (NHEJ) or stalled fork repair. Furthermore, mutation of required NHEJ factor DNA Ligase 4 results in enhanced haploid recovery. Lastly, heritability and stability of a rearranged chromosome suggest a potential for enduring genomic novelty. These findings provide a tractable, natural system towards investigating the causes and mechanisms of complex genomic rearrangements similar to those associated with several human disorders

Does 3-Day Course of Oral Amoxycillin Benefit Children of Non-Severe Pneumonia with Wheeze: A Multicentric Randomised Controlled Trial

WHO-defined pneumonias, treated with antibiotics, are responsible for a significant proportion of childhood morbidity and mortality in the developing countries. Since substantial proportion pneumonias have a viral etiology, where children are more likely to present with wheeze, there is a concern that currently antibiotics are being over-prescribed for it. Hence the current trial was conducted with the objective to show the therapeutic equivalence of two treatments (placebo and amoxycillin) for children presenting with non-severe pneumonia with wheeze, who have persistent fast breathing after nebulisation with salbutamol, and have normal chest radiograph.This multi-centric, randomised placebo controlled double blind clinical trial intended to investigate equivalent efficacy of placebo and amoxicillin and was conducted in ambulatory care settings in eight government hospitals in India. Participants were children aged 2-59 months of age, who received either oral amoxycillin (31-54 mg/Kg/day, in three divided doses for three days) or placebo, and standard bronchodilator therapy. Primary outcome was clinical failure on or before day- 4.We randomized 836 cases in placebo and 835 in amoxycillin group. Clinical failures occurred in 201 (24.0%) on placebo and 166 (19.9%) on amoxycillin (risk difference 4.2% in favour of antibiotic, 95% CI: 0.2 to 8.1). Adherence for both placebo and amoxycillin was >96% and 98.9% subjects were followed up on day- 4. Clinical failure was associated with (i) placebo treatment (adjusted OR = 1.28, 95% CI: 1.01 to1.62), (ii) excess respiratory rate of >10 breaths per minute (adjusted OR = 1.51, 95% CI: 1.19, 1.92), (iii) vomiting at enrolment (adjusted OR = 1.49, 95% CI: 1.13, 1.96), (iv) history of use of broncho-dilators (adjusted OR = 1.71, 95% CI: 1.30, 2.24) and (v) non-adherence (adjusted OR = 8.06, 95% CI: 4.36, 14.92).Treating children with non-severe pneumonia and wheeze with a placebo is not equivalent to treatment with oral amoxycillin.ClinicalTrials.gov NCT00407394

Alcohol Use Disorders (AUD) among Tuberculosis Patients: A Study from Chennai, South India

BACKGROUND: Alcohol Use Disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. Studies from Tuberculosis Research Centre (TRC), Chennai have reported that alcoholism has been one of the major reasons for default and mortality in under the DOTS programme in South India. Hence, it is planned to conduct a study to estimate prevalence of alcohol use and AUDs among TB patients attending the corporation health centres in Chennai, India. METHODOLOGY: This is a cross-sectional cohort study covering 10 corporation zones at Chennai and it included situational assessment followed by screening of TB patients by a WHO developed Alcohol Use Disorders Identification Test AUDIT scale. Four zones were randomly selected and all TB patients treated during July to September 2009 were screened with AUDIT scale for alcohol consumption. RESULTS: Out of 490 patients, 66% were males, 66% were 35 years and above, 57% were married, 58% were from the low monthly income group of <Rs 5000 per month. No females reported alcohol use. Overall, out of 490 TB pts, 29% (141) were found to consume alcohol. Among 141 current drinkers 52% (73) had an AUDIT score of >8. Age (>35 years), education (less educated), income (<Rs 5000 per month), marital status (separated/divorced) and treatment category (Category 2) were statistically significant for TB patients with alcohol use than those TB patients without alcohol use. CONCLUSIONS: AUD among TB patients needs to be addressed urgently and the findings suggest the importance of integrating alcohol treatment into TB care