Functional outcome of radial head replacement in isolated radial head fractures

Background: Proximal radial fractures are common type of fracture around the elbow joint. These commonly occur after an episode of fall on the outstretched arm. These fractures can occur in isolation or with other associated injuries. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring stability of the elbow joint and starting early mobilization. This study will assess functional outcome of radial head replacement in isolated radial head fractures using Mayo elbow performance score.Methods: Over a period of 24 months a total of 18 patients (male 12 and female 6) with isolated radial head fractures were included in the study. All of these patients had MASON type III fractures or above. Radial head replacement arthroplasty was done for irreparable radial head fractures and early mobilization was started. Functional outcome was calculated postoperatively with help of the Mayo elbow score on follow-up at 1, 3 and 6 month interval.Results: On the basis of Mayo elbow performance scores, 13 patients had excellent results; 3 had good results; and 2 had fair results. Mean Mayo elbow score was 88.33 (SD 11.11) after 6 month follow up. None of the patients had elbow instability after radial head replacement. Conclusions: Treatment of irreparable radial head fractures with radial head prosthesis along with soft-tissue reconstruction shows satisfactory results. Early mobilization of the elbow after operation is the key for restoration of elbow range of motion and function

To assess the effects of platelet rich plasma application on pain in osteoarthritis knee

Background: Platelet rich plasma (PRP) is a concentrate extract of platelets from autologous blood. It is known to increase growth factor of plasma and helps to heal the injured tissue. Platelet-rich plasma (PRP) is an autologous biologic treatment including patients own plasma, containing growth factors released from platelets. The rationale for the use of PRP is to stimulate the natural healing cascade and tissue regeneration by an increase release of platelet-derived factors directly at the site of treatment. This study is done to assess the effects of platelet rich plasma application on pain in osteoarthritis knee.Methods: Total of 40 cases was included in this study (18 male and 22 females) with mean age of 57.3 (Range 35-75). All patients received intra-articular PRP injection. This study was conducted on the patients coming to orthopaedic department at MGM medical college and hospital, Navi Mumbai.Results: In this study it was found that there is decrease in pain on vas pain score, with increasing time. We followed up the patients for period of 3 months. We found that average mean VAS score was decreased from 6.0 to 4.13 after follow up of 3 months after a single dose of intra-articular PRP injection. Conclusions: PRP is an effective treatment for pain in OA knee. It is one of the new approaches in the field of orthopaedics to solve the issues of pain management

To evaluate the efficacy of platlet rich plasma injection in chronic lateral epicondylitis (tennis elbow)

Background: Platelet-rich plasma helps in repair because of its growth factor. Platelet-rich plasma has been used in humans for its healing properties. Increased concentration of growth factors and secretory proteins at may increase the process of healing on a cellular level. The PRP increases the incorporation of cells, proliferation, and differentiation in tissue regeneration of the cell involved.  This study was done to check the effectiveness of PRP injections in patients with chronic lateral epicondylitis or tennis elbow.Methods: This study was done on the patients visiting the orthopaedic OPD at MGM medical college and hospital, kamothe, Navi Mumbai. Total number of patients for this study was 40 out of which 32 were male and 8 were females. The mean age of the patients was 48.1years (range 17-82 years).Study period was 3 months. Stastical tool used is visual analog score.Results: Successful treatment was taken as more than 20% reduction i.e.(24 out of 40 patients)  in visual analog score after 3 month. The mean VAS score was decreased from 6.98 to 4.91 after 3 months in males. While in females, mean VAS score was decreased from 6.66 to 5.22 after 3 months of PRP injection in lateral epicondylitis. Conclusions: Treatment of patients with PRP with chronic lateral epicondylitis or tennis elbow with PRP reduces pain and increases function of the affected elbow joint

Efficacy of platelet rich plasma injection in treatment of plantar fasciitis

Background: Platelet rich plasma is a recently introduced therapy for treatment of chronic painful conditions in orthopaedics, it acts mainly by promoting healing process. PRP has an increased concentration of platelets which initiate tissue repair by releasing growth factors. Increased concentrations of autologous platelets yield high concentrations of growth factors, subsequently leading to intensified healing of soft tissue on a cellular level. This study was conducted to evaluate the efficacy of platelet rich plasma injection in treatment of plantar fasciitis.Methods: This study was conducted on the patients coming to orthopaedic OPD at MGM medical college and hospital, kamothe, Navi Mumbai. Total of 40 planter fasciitis cases were taken in this study. Out these 40 patients 23 were Male and 17 were female. The mean age 45.85 (range 25-75). Patients were followed up for 3 months with regular interval and at each visit vas score was evaluated and noted.Total duration of study was 3 months from October 2016 to December 2016.Results: The mean pre injection vas score was 7.15 (Male – 7.13, Female – 6.70). The mean vas score at time of follow up after one week was 6.20 (Male – 6.22 Female – 6.18). The mean vas score at time of follow up after 6 week was 5.62 (Male – 5.66 Female – 5.70).  The mean vas score at time of follow up after 3 months was 3.20 (Male – 3.13 Female – 3.29). Conclusions: PRP in plantar fasciitis shows promising short term results providing patients with gradual sustained pain relief, improving daily function and lifestyle activity level. However long term results needs to be evaluated

Compressed Natural Gas Operated Two-Wheeler

In this paper the results obtained on a 110cc two-wheeler S.I. engine using both petrol and CNG as fuel. Tests like Acceleration test, Emission test, Mileage test and Exhaust noise test were conducted at different operating condition. The basic petrol engine is converted into a bi-fuel engine and regulated by means of an electronically controlled Solenoid Actuated Valve system. On a comparative analysis CNG fuelled engine accelerated slower compared to petrol fuelled engine, but the CO and CO2 emissions were lesser indicated that CNG when used as fuel accelerates at a faster rate, the emission of hazardous gases is comparatively far lower than petrol, fuel consumption of CNG is less and it is economical. The noise test shows that the exhaust of CNG is louder as compared to petrol

Neutrophil to lymphocyte ratio predicts short- and long-term mortality following revascularization therapy for ST elevation myocardial infarction

Background: Several inflammation biomarkers have been implicated in the pathogenesis and prognosis of acute coronary syndromes. However, the prognostic role of the neutrophil-lymphocyte white cell interactive response to myocardial injury in predicting short- and long-term mortality after ST elevation myocardial infarction (STEMI) remains poorly defined.Methods: We evaluated 250 consecutive STEMI patients presenting acutely for revascularization to our tertiary care center over 1 year. Patients with acute sepsis, trauma, recent surgery, autoimmune diseases, or underlying malignancy were excluded. Data gathered included demographics, clinical presentation, leukocyte markers, electrocardiograms, evaluations, therapy,major adverse cardiac events, and all-cause mortality.Results: Mean age was 62 ± 15 years, 70.4% of subjects were males while majority (49.4%) were Caucasians. Mean duration of follow-up was 571 ± 291 days (median 730 days). Univariate analysis of several inflammatory biomarkers including C-reactive protein, revealed white cell count (OR = 1.09, p < 0.001) and neutrophil to lymphocyte ratio (NLR) (OR = 1.05, p = 0.011) as predictors of short- and long-term mortality; but not mean neutrophil count (OR = 1.04, p = 0.055) or lymphocyte count alone (OR = 0.96, p = 0.551). Multivariate analysis using backward stepwise regression revealed NLR (OR = 2.64, p = 0.026), female gender (OR = 5.35, p < 0.001), cerebrovascular accident history (OR = 3.36, p = 0.023), low glomerular filtration rate (OR = 0.98, p = 0.012) and cardiac arrest on admission (OR = 17.43, p < 0.001) as robust independent predictors of long-term mortality. NLR was divided into two sub-groups based on an optimal cut off value of 7.4. This provided the best discriminatory cut off point for predicting adverse mortality outcome. Both short-term (≤ 30 days) and long-term (≤ 2 years) mortality were predicted with Kaplan-Meier survival curve separation best stratified by a NLR cut off value of 7.4.Conclusions: NLR based on an optimal cut off value of 7.4, was an excellent predictor of short- and long-term survival in patients with revascularized STEMI and warrants larger scale multi-center prospective evaluation, as a prognostic indicator. NLR offers improved prognostic capacity when combined with conventional clinical scoring systems, such as the Thrombolysis In Myocardial Infarction risk score.

Generating evidence on antibiotic use across human and animal health sectors using the World Health Organization’s Access, Watch, Reserve (AWaRe) classification: Exploratory pilot study in rural Pune, India

Background and Aim: Human antibiotic formulations in animal feed for therapeutic and non-therapeutic purposes have contributed to antimicrobial resistance worldwide; however, little evidence is available in low- and middle-income countries. We aimed to generate evidence of antibiotic use across the human and animal health sectors by investigating the overlap in antibiotic use in community settings in rural blocks of Pune District, India, following the World Health Organization’s (WHO) Access, Watch, Reserve (AWaRe) classification. Materials and Methods: An exploratory pilot study using a cross-sectional design in two randomly selected rural blocks of the Pune district included 138 interviews with general physicians (GPs, n = 62), pharmacists (n = 60), and veterinary practitioners (n = 16) using semi-structured interview schedules and the WHO AWaRe classification. IBM-Statistical Package for the Social Sciences, Version 21.0 software was used for descriptive statistics and to calculate the proportions of the different antibiotic groups. The WHO AWaRe classification was used to describe antibiotic use by the study participants and to assess the overlap in antibiotic use. Results: Our study provides evidence of an overlap in human and animal antibiotic use in rural community settings across the human and animal health sectors. Amoxicillin (access group), penicillin (access group), and ofloxacin (watch group) were used in both human and animal health. Amoxicillin and penicillin were used to treat common bacterial infections, ofloxacin was used to treat skin infections in humans and animals, and ofloxacin was used to treat pneumonia in animals and urinary bladder infections in humans. In contrast, azithromycin (watch group), cefixime (watch group), and amoxicillin (Access Group), with or without other antibiotics, were the most commonly used antibiotics by GPs in humans. Conclusion: We confirmed the overlap in antibiotic use across the human and animal health sectors in rural community settings, suggesting the need for interventions following the One Health approach. Further, research is required to assess the patterns of this overlap, as well as behavior, knowledge, and potential solutions to help avoid this overlap and prevent the rampant use of antibiotics in the animal and human health sectors in rural community settings

The Tpeak – Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: a systematic review and meta-analysis

Background: The Tpeak – Tend interval, an electrocardiographic marker reflecting transmural dispersion of repolarization, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD) in different clinical settings. Objective: This systematic review and meta-analysis evaluated the significance of Tpeak – Tend interval in predicting arrhythmic and/or mortality endpoints. Methods: PubMed, Embase, Cochrane Library and CINAHL Plus databases were searched through 30th November 2016.Results: Of the 854 studies identified initially, 33 observational studies involving 155856 patients were included in our meta-analysis. Tpeak – Tend interval prolongation (mean cut-off: 103.3 ± 17.4 ms) was a significant predictor of the arrhythmic or mortality outcomes (odds ratio (OR): 1.14, 95% CI: 1.11 to 1.17, p < 0.001). When different end-points were analyzed, the ORs are as follows: VT/VF (1.10, 95% CI: 1.06 to 1.13, p < 0.0001), SCD (1.27, 95% CI 1.17 to 1.39, p < 0.0001), cardiovascular death (1.40, 95% CI 1.19 to 1.64, p < 0.0001), and all-cause mortality (4.56, 95% CI 0.62 to 33.68, p < 0.0001). Subgroup analysis for each disease revealed that the risk of VT/VF or death was highest for Brugada syndrome (OR: 5.68, 95% CI: 1.57 to 20.53, p < 0.01), followed by hypertension (OR: 1.52, 95% CI: 1.26 to 1.85, p < .0001), heart failure (OR: 1.07, 95% CI: 1.04 to 1.11, p < .0001) and ischemic heart disease (OR: 1.06, 95% CI: 1.02 to 1.10, p = 0.001). In the general population, a prolonged Tpeak – Tend interval also predicted arrhythmic or mortality outcomes (OR: 1.59, 95% CI: 1.21 to 2.09, p < 0.001).Conclusion: The Tpeak – Tend interval is useful risk stratification tool in different diseases and in the general population

Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries:A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW: Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option. RECENT FINDINGS: This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle-Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38-2.86), cardiac mortality (RR 2.36 (1.97-2.84)), and major adverse cardiac event (RR 1.25 (1.03-1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe