Functional outcome following arthroscopic ACL reconstruction using semitendinosus graft: a prospective observational study

Background: Anterior cruciate ligament (ACL) injuries remain a common orthopaedic disease, particularly in young adults. The treatment of choice for ACL injuries is ACL reconstruction (ligamentoplasty). The present study was conducted to observe and evaluate the outcome results of arthroscopic ACL reconstruction by hamstring grafts using Endobutton-CL technique for femoral fixation and Bioabsorbable Intrafix Screw technique for tibial fixation in ACL injury.Methods: This prospective comparative observational study related data were captured between January 2014 to December 2015 in a tertiary care teaching hospital, Haldia. About 36 patients with arthroscopic anatomic ACL reconstruction using hamstring tendon graft were evaluated and followed up for functional outcome. Patients were evaluated for pain, functioning and stability of knee using validated knee scoring systems which included tegner activity scale and IKDC score.Results: Out of 36 patients 31 patients (86.11%) were male and 5 patients (13.88%) were females. About 25 patients (69.44%) had right sided ACL injury and remaining 11 patients (30.55%) had left sided ACL injury. The mean of the pre-op IKDC scoring was 42.45 with SD of 9.68 and the mean of the post-operative IKDC scoring was 81.87 with SD of 13.40, so improvement was statistically significant. Conclusions: The technique of arthroscopic ACL reconstruction offers an excellent knee function, knee stability and restoration of preoperative functional status with minimal complications

Placental damages from ultrasonic changes to histopathological findings in maturing placenta in pregnancy complicated with hypertension: an observational clinical study

Background: The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. Obstetric ultrasound provides a cornerstone to other modalities used for assessing hypertensive disorders of pregnancy. Placental architecture is modified in PE and eclampsia. This study was designed to detect the placental changes in hypertensive disorders of pregnancy and correlation with ultrasonic and histopathological changes.Methods: The study group comprised of 42 patients with pregnancy complicated with hypertension with period of gestation above 20 weeks and B.P. more than 140/90 mm of Hg measured on two occasions 6 hours or more apart. The control group consists of 42 normotensive patients matched with age and parity. One ultrasonic examination was performed between 28 weeks and 34 weeks and another after 34 weeks till term. Apart from routine parameters i.e. BPD, AC, FL, Amniotic fluid index, EBW and gestational age routine placental grading were performed according to the classification proposed by Grannum and associates. To evaluate perinatal outcome following measurement were studied birth weight immediately after delivery, mode of delivery, perinatal morbidity and mortality, APGAR score, presence of fetal distress.Results: In 97.62% cases (41 out of 42) of control group showed Grade–II changes as opposed to 57.14% of cases (24 out of 42) in study group before 34 weeks. All 21 cases in study group showing Grade ‘III’ changes before 34 weeks had infarction, calcification, increased syncytial knots, fibrinoid necrosis from 95.23 to 100% of these cases showed all these changes. Only 2 cases (9.52%) showed perivascular hemorrhage having Grade ‘III’ before 34 weeks.Conclusions: Accelerated maturation of placenta in pregnancy complicated with hypertension are more common in the hypertensive group. Increased histopathological degenerative changes e.g. calcification, fibrinoid necrosis etc., are more marked even before 34 weeks of gestation in hypertensive group

Photocatalytic degradation of ciprofloxacin·HCl using Aeroxide® P-25 TiO2 photocatalyst: Comparative evaluation of solar and artificial radiation

The photocatalytic degradation of ciprofloxacin (CFX) has been investigated using Aeroxide® P-25 TiO2 photocatalyst in the presence of solar as well as artificial radiation. The effects of different operating parameters like initial concentration of CFX, catalyst loading, pH of solution and effect of co-existing ions on photocatalytic degradation of CFX have been investigated with a view to establish the optimum operating conditions. It is observed that as the initial concentration of CFX increases, the rate of photocatalytic degradation decreases. Optimum catalyst loading is observed at 1 g L-1 for CFX concentration of 100 mg L-1. Over the pH range 3-11, maximum degradation rate occurs at pH 9. The mechanism and intermediates formed during the photocatalytic degradation of CFX are discussed based on UPLC-MS/MS analysis. From kinetic studies, it is found that the photocatalytic degradation obeys pseudo-first order kinetics. The degradation rate constant using solar radiation is about 1.7 times higher than that under artificial radiation

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

This online publication has been corrected. The corrected version first appeared at thelancet.com on September 28, 2023BACKGROUND : Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS : Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS : In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world’s highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION : Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.Bill & Melinda Gates Foundation.http://www.thelancet.comam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Converting a conventional wired-halogen illuminated indirect ophthalmoscope to a wireless-light emitting diode illuminated indirect ophthalmoscope in less than 1000/- rupees

Aim: To report the "do it yourself" method of converting an existing wired-halogen indirect ophthalmoscope (IO) to a wireless-light emitting diode (LED) IO and report the preferences of the patients and the ophthalmologists. Subjects and Methods: In this prospective observational study, a conventional IO was converted to wireless-LED IO using easily available, affordable electrical components. Conventional and the converted IO were then used to perform photo-stress test and take the feedback of subjects and the ophthalmologists regarding its handling and illumination characteristics. Results: The cost of conversion to wireless-LED was 815/- rupees. Twenty-nine subjects, mean age 34.3 ΁ 10 years with normal eyes were recruited in the study. Between the two illumination systems, there was no statistical difference in the magnitude of the visual acuity loss and the time to recovery of acuity and the bleached vision on photo-stress test, although the visual recovery was clinically faster with LED illumination. The heat sensation was more with halogen illumination than the LED (P = 0.009). The ophthalmologists rated wireless-LED IO higher than wired-halogen IO on the handling, examination comfort, patient′s visual comfort and quality of the image. Twenty-two (81%) ophthalmologists wanted to change over to wireless-LED IO. Conclusions: Converting to wireless-LED IO is easy, cost-effective and preferred over a wired-halogen indirect ophthalmoscope

Anti-proliferative and apoptotic potential of Ferula asafoetida’s essential oil on Colon Cancer via inhibiting NF-kB and TNF-alpha receptors pathway

Purpose: The current investigation was conducted with the aim to elucidate and determine the anti-cancer efficacy in vitro on colon carcinoma human cell lines and to determine its probable mode of action. Method: Anti-proliferative and apoptotic effect of various doses of essential oil from Ferula asafoetida was investigated on colon cancer cell lines i.e. CW620 and CT26. WT. The percentage cytotoxicity was determined by MTT assay. In addition, expression studies were carried out to determine the mode of action by determining the levels of NF-kB, TNF-alpha, TGF-beta and Caspases. Result: The potent anti-proliferative activity has been observed in both the cell lines. The percentage cytotoxicity is directly proportional to the increasing concentration of the essential oil. The same was also confirmed in the expression studies which shows significant upregulation of the antiapoptotic characteristics and down regulation of pro-carcinogenic factors. Conclusion: The essential oil shows potent anti-cancer activity and shows the role in gene regulation to attenuate the colon cancer

Posterior scleritis presenting as unilateral secondary angle-closure glaucoma.

The following is a case report of a 19-year-old male who presented with unilateral acute angle-closure glaucoma. Posterior scleritis was diagnosed based on clinical features and ultrasound B-scan. The acute angle closure attack and exudative retinal detachment completely resolved with use of oral corticosteroids

Supplementary Videos: Anthelmintic activity of Ferula asafoetida against the model worm Caenorhabditis elegans

We investigated the anthelmintic activity of a Ferula asafoetida variety (Pinaxi) against the model worm Caenorhabditis elegans. As positive controls, we employed two commonly used anthelmintic agents, benzimidazole and ivermectin. The following video clips illustrate the anthelmintic effect of F. asafoetida and the positive control compounds. These videos were captured at 24 h time point after challenging the worms with DMSO-soluble fraction of F. asafoetida