Juxta articular osteoid osteoma of the calcaneum: a rare case report

Osteoid osteoma of calcaneum in a juxta-articular position is a rare finding, it is most often misdiagnosed. It mimics as arthritis. Osteoid osteoma is benign bone neoplasia mostly in male in 2nd - 3rd decade of life. It has typical features of night pain relieved with salicylates. 35 years old female present with right heel pain. Mother has positive history of rheumatoid arthritis. X-ray and computer tomography were done for diagnosis. Diagnosis was made of juxta –articular position of osteoid psteoma in the calcaneum. Lesion was excised after pre-anesthesia checkup and sent for histopathology. Once investigation was done diagnosis was made as an osteoid osteoma in juxta articular position of calcaneum. Treated by excision of the lesion surgically and specimen sent for biopsy which confirm osteoid osteoma

Arthroscopic remplissage: a valuable adjunct to arthroscopic Bankart’s repair in shoulder instability

Current study present results of arthroscopic shoulder stabilisation surgery. 46 consecutive patients with recurrent anterior shoulder dislocations and less than 25% Glenoid bone loss were treated with arthroscopic surgery in 2017-2020. Arthroscopic repair of Bankart’s lesion with capsular shift was performed in each. In 8 patients, where the Hill sach’s lesion was “off track” or “engaging”, arthroscopic remplissage was performed along with arthroscopic Bankart’s repair. There was no recurrence of shoulder instability after a mean follow up of 1 year. This included the non-engaging Hill sach’s group (treated with Bankart’s repair) as well as the engaging or off track Hill sach’s group (treated with Bankart’s repair and remplissage). All patients went on to obtain full forward flexion, full abduction and internal rotation. The Bankart’s and remplissage group had a mean of 8 degrees restriction of external rotation. SST scores and oxford scores had improved considerably on follow up in both groups Arthroscopic shoulder surgery provides a safe and reliable option in the management of recurrent shoulder dislocations. Arthroscopic remplissage is a useful adjunct to Bankart’s repair when treating the difficult problem of a large engaging Hill Sachs lesion.

Evaluation of fine needle aspiration cytology as the initial diagnostic test in cases of cervical lymphadenopathy

Background: Cervical lymph node enlargement is common amongst the various causes of neck swelling. Proper diagnosis and early treatment is necessary for cervical lymph node disease and it is also necessary to rule out potentially curable causes as against malignancy in which the treatment is generally palliative. Fine needle aspiration cytology (FNAC) is now a day the initial investigation in most of the cases of cervical lymph node enlargement. Aims and Objectives of the study were to evaluate the sensitivity and specificity of FNAC in the diagnosis of cervical lymph node disease with an emphasis on discordant cases between the cytology and the histopathology.Methods: Patients admitted with cervical lymph node enlargement in a tertiary hospital of western India (attached with a medical college) from October 2014 to September 2016 were prospectively studied. Detailed history, clinical examination and necessary investigations of all patients were done especially fine needle aspiration cytology and histopathology examination and inference was obtained after the diagnosis was confirmed.Results: The cytological diagnoses were found to be malignant in 48 cases (30.6%) and benign in 109 cases (69.4%). The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. The overall diagnostic accuracy was 82.2%, while the overall discordance rate was 17.8%.Conclusions: FNAC is the initial investigation of choice in the diagnostic approach to most of the cases of cervical lymphadenopathy and it has good diagnostic sensitivity and specificity

Comparative study between choices of preoperative and post operative dress wear among orthopedics patients

Background: Clothes are identity of an individual. A monk, a priest, a doctor, a lawyer etc. all can be identified by clothing. But can we identify preoperative and postoperative orthopedics patient simply by difference in clothing? Can we evaluate the reasons for this difference in clothing mainly due to hide surgical scar or may be due to comfort fit or may be due to compensation of gait abnormalities etc. Methods: The study was conducted at Maharaja Agrasen medical college, India with a population of 1000 OPD and indoor patient for a period of 6 months from January 2022 to June 2022, with data collection and compilation for another 3 months. Our study is an observational retrospective study which discovers where pre trauma preference is for skin tight clothing like jeans, t shirt for men and skirt for girls, post trauma post operative preference shifts to loose and formal clothes like full sleeves shirt, formal pant, pajama, lungi, dhoti for men and full length skirt for girl and saree for women. Results: Causes enlisted for such clothing was hiding surgical scar (80%), comfortable fitting (10%), to hide gait abnormalities (7%), limb length discrepancies (2%), miscellaneous (1%). Conclusions: We claim to be first in literature to have thought and research on this wonderful topic. We claim to devise new system of surgical and non-surgical wear in post operative patients with our research. We also bring out reason for such difference in clothing and work closely with our in-house patient for preference in clothing

Profile of patients of spontaneous pneumothorax of North Gujarat region, India: a prospective study at GMERS medical college, Dharpur-Patan

Background: Spontaneous pneumothorax is a respiratory emergency, which we come across in clinical practice. It needs quick diagnosis and prompt treatment. Its immediate and prompt management can save a life of the patient. Delayed management can produce serious implication on respiratory function. The objective was aimed to study profile of patients of spontaneous pneumothorax.Methods: This was a prospective descriptive study conducted among purposively selected 100 patients of pneumothorax at a GMERS Medical College and Hospital, Dharpur-Patan of North Gujarat region, India between February 2013 and January 2015 after taking written informed consent. A predesigned semi-structured performa was used. Detailed demographic and clinical data were recorded. Patients were treated with simple needle aspiration or Intercostal drainage tube (ICDT) as per the standard practice at our institute. Data was statistically analyzed using SPSS software (trial version).Results:Based on the total number of admissions to our hospital during the study period, the annual incidence of SP was calculated as 99.9 per 100,000 hospital admissions. Out of 100 patients 84 patients were above the age of 40 years. 96 % of the patients were male. Dyspnea was the most common symptom at the onset and was present in all patients. History of smoking was present in 88% of the patients. Past history of COPD and tuberculosis were found in 58% and 34% of the patients respectively. Radiological evidence showed right sided pneumothorax in 50% of the patients whereas 48% had left sided pneumothorax. 86% of the patients were treated with Intercostal drainage tube. Among all patients treated with ICDT, 6% of the patients had surgical emphysema while 10% of the patients had secondary infection of pleural space leading to hydro pneumothorax.Conclusion: Spontaneous pneumothorax in India is more often secondary to an underlying lung disease. COPD and pulmonary tuberculosis remains the common causes of SP. Smoking is an important risk factor for the development of pneumothorax. X-Ray chest is one of the most important investigations for diagnosis of pneumothorax & underlying etiological factors.

Headband technique of reimplantation of a partially amputed finger: a first reported in literature

Background: Reimplantation of a partially amputee finger is a challenging task especially in resource limited country like India. In most of the scenario it lands in total amputation either due to delay in arrival at operative set up or due to lack of plastic surgery facility. Methods: We developed an innovative approach (1st reported in literature) of “headband technique “of reimplantation of such partially amputee fingers and toes. Partially amputee fingers and toes with viability were selected for the operative treatment and for the study. The study was conducted from January 2020 to 2021 with a follow up period for 6 months at our institution. The innovative suturing technique involved a single stitch at the tip of the pulp and rest on adjacent to nail bed securing the neurovascular structures. The patient was in age group of 9 months to 94 years, mostly traumatic injury, with 40 male and 15 female patients. Patients who reported with fully amputee fingers, black escharotic finger were excluded from the study. Results: To our accomplishment out of 55 operated patients, more than 50 have fully recovered. Conclusions: With this simple technique of reimplantation even doctor at PHC’S can save fingers from getting amputed. Our study is with small number of patients; hence we advocate a larger study for to have conclusive evidence for the same

Comparative study between Blair’s procedure of ankle fusion and arthroscopic ankle arthrodesis

Background: Our objective was to perform a comparative study in terms of functional outcome of Blair’s procedure of ankle fusion versus arthroscopic methods of ankle fusion.Methods: 25 patients that underwent arthroscopic ankle arthrodesis versus Blair’s procedure of ankle fusion were taken for study at government medical college, Srinagar (VCSGGIMS and R) from the duration 2015-2021. Clinical assessment was done foot and ankle disability index and visual analog scale score for pain. Radiological assessment was done by serial X-rays. Regular follow-ups were taken till one year.Results: Both modalities proved to be equally effective in terms of patient’s functional outcome. Our analysis showed that Blair’s procedure ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, p=0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, p<0.00001), and longer length of stay (MD 1.60,95% CI 1.10-2.10, p<0.00001) compared to arthroscopic ankle fusion; however, there was no significant difference between two groups in terms of infection rate (OR 2.41, 95% CI 0.76-7.64, p=0.14), overall complication rate (OR: 1.54, 95% CI 0.80-2.96, p=0.20), and operation time (MD 4.09, 95% CI 2.4910.66, p=0.22).Conclusions: We found no significant difference between two groups in terms of infection rate, overall complication rate, and operation time. Further high quality randomized controlled trials that are adequately powered are required

Phosphorylation of Mycobacterium tuberculosis Ser/Thr Phosphatase by PknA and PknB

Background: The integrated functions of 11 Ser/Thr protein kinases (STPKs) and one phosphatase manipulate the phosphorylation levels of critical proteins in mycobacterium tuberculosis. In this study, we show that the lone Ser/Thr phosphatase (PstP) is regulated through phosphorylation by STPKs. Principal Findings: PstP is phosphorylated by PknA and PknB and phosphorylation is influenced by the presence of Zn2+-ions and inorganic phosphate (Pi). PstP is differentially phosphorylated on the cytosolic domain with Thr137, Thr141, Thr174 and Thr290 being the target residues of PknB while Thr137 and Thr174 are phosphorylated by PknA. The Mn2+-ion binding residues Asp38 and Asp229 are critical for the optimal activity of PstP and substitution of these residues affects its phosphorylation status. Native PstP and its phosphatase deficient mutant PstPcD38G are phosphorylated by PknA and PknB in E. coli and addition of Zn2+/Pi in the culture conditions affect the phosphorylation level of PstP. Interestingly, the phosphorylated phosphatase is more active than its unphosphorylated equivalent. Conclusions and Significance: This study establishes the novel mechanisms for regulation of mycobacterial Ser/Thr phosphatase. The results indicate that STPKs and PstP may regulate the signaling through mutually dependent mechanisms. Consequently, PstP phosphorylation may play a critical role in regulating its own activity. Since, the equilibrium between phosphorylated and non-phosphorylated states of mycobacterial proteins is still unexplained, understanding the regulation of PstP may help in deciphering the signal transduction pathways mediated by STPKs and the reversibility of the phenomena

Causality assessment, severity and preventability of adverse drug reactions due to first-line antitubercular agents

TB (Tuberculosis) is a common infectious disease affecting humans since very long time. Multidrug therapy with its associated adverse drug reactions is one of the major concerns for the management of TB. The current study has been conducted for identifying causality assessment, severity as well as preventability of first-line anti-tubercular agents. All the diagnosed patients of tuberculosis attending TB and chest department of tertiary care hospital of western India and received Anti-TB drugs over 6 months enrolled in the study. Demographic details, suspected drugs/groups, causality assessment, severity assessment, and preventability assessment were analyzed from reported suspected ADR (adverse drug reaction) forms. Throughout the research period of 6 months, 500 patients received Anti- TB drugs. Among them, (10%) 50 patients developed 121 adverse drug reactions. According to the WHO causality scale, 66 (54.54%) ADRs were classified as ‘probable’ and 53 (43.8%) ADR were ‘possible’. More than half of the reactions (31, 62%) were mild on the severity scale while most of the ADRs were definitely (34, 68%) preventable as per the preventability scale. Gastrointestinal system is the most common affected system (54, 47.62%) followed by dermatological disorders (26, 23.01%) and Liver and biliary system (20, 16.52%). Isoniazid (46, 38%) and Rifampicin (40, 33%) were the common cause of first-line antitubercular agents for ADRs. ADRs to antitubercular agents are a major concern for patient compliance. Patient education, intensive reporting, and management can be helpful to improve the outcome of antitubercular therapy

A Novel Approach for Room-Temperature Intersubband Transition in GaN HEMT for Terahertz Applications

Terahertz (THz) technology has attracted tremendous attention recently due to its promising applications in various domains such as medical, biological, industrial imaging, broadband, safety, communication, radar, space science, and so on. Due to non-availability of powerful sources and highly sensitive and efficient detectors, the so-called THz gap remains largely unfilled. Despite seamless efforts from electronics and photonics technology researchers, the desired level of technology development to fill the THz gap still remains a challenge. GaN-based HEMT structures have been investigated as potential THz sources and detectors by a number of researchers. This chapter presents a very new and versatile mechanism for electrical tuning of intersubband transitions (ISBT) GaN high electron mobility transition (HEMT) devices. ISBT phenomena are usually demonstrated in photonic devices like a quantum cascade laser (QCL). Here we explore ISBT in an electronic GaN HEMT device. Conventional photonic devices like a QCL are operated at cryogenic temperature to minimize thermal effect. Tuning the conduction band through external gate bias is an advantage of an HEMT device for room temperature (RT) THz applications. This chapter demonstrates the theoretical and experimental novel ISBT phenomenon in GaN HEMT is for potential ambient applications in the THz range