Genu valgum deformity - correction by a wedgeless implantless femoral "V" osteotomy

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

Diffusion of confined fluids in microporous zeolites and clay materials

Fluids exhibit remarkable variation in their structural and dynamic properties when they are confined at the nanoscopic scale. Various factors, including geometric restriction, the size and shape of the guest molecules, the topology of the host, and guest-host interactions, are responsible for the alterations in these properties. Due to their porous structures, aluminosilicates provide a suitable host system for studying the diffusion of sorbates in confinement. Zeolites and clays are two classes of the aluminosilicate family, comprising very ordered porous or layered structures. Zeolitic materials are important due to their high catalytic activity and molecular sieving properties. Guest molecules adsorbed by zeolites display many interesting features including unidimensional diffusion, non-isotropic rotation, preferred orientation and levitation effects, depending on the guest and host characteristics. These are useful for the separation of hydrocarbons which commonly exist as mixtures in nature. Similarly, clay materials have found application in catalysis, desalination, enhanced oil recovery, and isolation barriers used in radioactive waste disposal. It has been shown that the bonding interactions, level of hydration, interlayer spacing, and number of charge-balancing cations are the important factors that determine the nature of diffusion of water molecules in clays. Here, we present a review of the current status of the diffusion mechanisms of various adsorbed species in different microporous zeolites and clays, as investigated using quasielastic neutron scattering and classical molecular dynamics simulation techniques. It is impossible to write an exhaustive review of the subject matter, as it has been explored over several decades and involves many research topics. However, an effort is made to cover the relevant issues specific to the dynamics of different molecules in microporous zeolites and clay materials and to highlight a variety of interesting features that are important for both practical applications and fundamental aspects.

Impact of a Psychodermatological Education Package on the Subjective Distress, Family Burden, and Quality of Life among the Primary Caregivers of Children Affected with Epidermolysis Bullosa

Background

Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL.

Objectives

To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB.

Methods

In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied.

Results

The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI.

Conclusions

PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.

Contrasting Behaviors of FA and MA Cations in APbBr3

It is known that the organic units in hybrid halide perovskites are free to rotate, but it is not clear if this freedom is of any relevance to the structure-property relationship of these compounds. We have employed quasi-elastic neutron scattering using two different spectrometers, thus providing a wide dynamic range to investigate the cation dynamics in methylammonium lead bromide (MAPbBr₃) and formamidinium lead bromide (FAPbBr₃) over a large temperature range covering all known crystallographic phases of these two compounds. Our results establish a plastic crystal-like phase forming above 30 K within the orthorhombic phase of MAPbBr₃ related to 3-fold rotations of MA units around the C-N axis with an activation energy, E_a, of ∼27 meV, which has no counterpart in the FA compound. MA exhibits an additional 4-fold orientational motion of the whole molecule via rotation of the C-N axis itself with an E_a of ∼68 meV common for the high-temperature tetragonal and cubic phases. In contrast, the FA compound exhibits only an isotropic orientational motion of the whole FA unit with E_a ≈ 106 meV within the orthorhombic phase and a substantially reduced common E_a of ∼62 meV for the high-temperature tetragonal and cubic phases. Our results suggest that the rotational dynamics of the organic units, crystallographic phases, and physical properties of these compounds are intimately connected.

A split face randomized controlled trial comparing 1,064 nm Q-switched Nd-YAG laser and modified Kligman's formulation in patients with melasma in darker skin

BACKGROUND

No randomized studies compared the efficacy and safety of modified Kligman's triple combination (TC) with 1,064 nm Q-switched Nd-YAG laser (QSNYL) in melasma in darker skin.

OBJECTIVES

To compare the efficacy and safety of QSNYL and TC in the treatment of melasma in Fitzpatrick skin types IV and V.

METHODS

In this split face randomized controlled trial, participants' cheeks were randomized to receive either weekly QSNYL (group A) or daily TC (group B) for 12 weeks, followed by 12 weeks of follow-up.

RESULTS

Twenty-eight patients completed the intervention, and 21 of them completed follow-up. We found a significant but modest reduction in mean melanin index, modified Melasma Area Severity Index (MASI), and photographic and patient's assessment in both modalities (P < 0.01). No significant differences were detected between the groups. All patients had reappearance of pigmentation by the end of follow-up. Adverse reactions were significantly more in group B (P < 0.001).

LIMITATION

The desired sample size could not be achieved.

CONCLUSION AND RELEVENCE

No statistically significant differences were observed between QSNYL and TC as monotherapy in melasma. Reappearance of melasma is inevitable after stopping treatment.

Comparison of Platelet-Rich Plasma Prepared Using Two Methods: Manual Double Spin Method versus a Commercially Available Automated Device

Background:

In the absence of a standard protocol, several methods and devices have been used for preparing platelet-rich plasma (PRP) with varying platelet concentrations.

Methods:

Venous blood sample from 20 patients was used for preparing PRP using two methods: a manual double-spin method (1^st spin at 160 g × 10 min, 2^nd spin at 400 g × 10 min), and using a commercially available automated device (DrPRP-Kit®, REMI Laboratory Instruments). Platelet, erythrocyte, and total leukocyte counts were calculated for each PRP sample and compared.

Results:

Platelet count in the PRP prepared with the manual double-spin method (PRP_m, 12.51 ± 5.89 × 10⁵/μL) as well as with the automated device (PRP_a, 7.25 ± 4.74 × 10⁵/μL) had significantly higher mean platelet count than whole blood (2.58 ± 0.81 × 10⁵/μL, P < 0.001). The mean platelet count in PRP_m was statistically significantly higher than PRP_a (P < 0.001). The platelet capture efficiency of the manual method (mean 47.11%, median 41.75%) was statistically significantly higher than that of the automated device (mean 31.89%, 29.51%, P = 0.012). Platelet counts in both PRPs were variable, but the counts were more dispersed in PRP_a(coefficient of variation 65%) as compared to PRP_m(coefficient of variation 47%).

Conclusion:

The manual double-spin method had a higher platelet capture efficiency resulting in a higher platelet concentration as compared to the automated device. Though there was a significant interindividual variation in the platelet yield in the PRPs produced by both methods, results were more consistent with the manual method.

A split-face randomized controlled study comparing the efficacy and safety of intralesional radiofrequency-assisted subcision vs conventional subcision in postacne scars

BACKGROUND

Postacne scars have significant psychosocial distress among patients. Subcision is a well-known treatment modality specially for rolling type of acne scars, but is a crude mechanical process, which carries a risk of hematoma formation.

AIMS

To compare the efficacy and safety of radiofrequency-assisted subcision (rSubcision) with conventional subcision in postacne scars.

METHODS

In this randomized, split-face study, adult patients with postacne scars were randomized to receive either conventional subcision or rSubcision in 2 sessions, 4 weeks apart and followed up for 2 months. Outcome was measured using Goodman and Baron score (GBS), investigator global assessment (IGA) by two blinded dermatologists, and patient global assessment (PGA).

RESULTS

Seventeen out of 21 patients completed the treatment. Statistical analysis of the results was performed using SPSS 15.0 statistical software (SPSS). Patients in both the groups had significant improvement from baseline according to quantitative scoring (P = .0001), number of scars (P = .0001), IGA, and PGA. The improvement was comparable in both the groups according to GBS and IGA but better on rSubcision side in terms of PGA. Two patients developed small entry point burn during rSubcision which healed in one month and one developed persistent hematoma with conventional subcision.

CONCLUSIONS

Both modalities were comparable in terms of assessment scores and investigator assessment, but patients found improvement better on rSubcision side.

Intravenous thrombolysis for large vessel or distal occlusions presenting with mild stroke severity

BACKGROUND AND PURPOSE

We investigated the effectiveness of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS) patients with large vessel or distal occlusions and mild neurological deficits, defined as National Institutes of Health Stroke Scale scores < 6 points.

METHODS

The primary efficacy outcome was 3-month functional independence (FI) [modified Rankin Scale (mRS) scores 0-2] that was compared between patients with and without IVT treatment. Other efficacy outcomes of interest included 3-month favorable functional outcome (mRS scores 0-1) and mRS score distribution at discharge and at 3 months. The safety outcomes comprised all-cause 3-month mortality, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH and severe systemic bleeding.

RESULTS

We evaluated 336 AIS patients with large vessel or distal occlusions and mild stroke severity (mean age 63 ± 15 years, 45% women). Patients treated with IVT (n = 162) had higher FI (85.6% vs. 74.8%, P = 0.027) with lower mRS scores at hospital discharge (P = 0.034) compared with the remaining patients. No differences were detected in any of the safety outcomes including symptomatic ICH, asymptomatic ICH, severe systemic bleeding and 3-month mortality. IVT was associated with higher likelihood of 3-month FI [odds ratio (OR), 2.19; 95% confidence intervals (CI), 1.09-4.42], 3-month favorable functional outcome (OR, 1.99; 95% CI, 1.10-3.57), functional improvement at discharge [common OR (per 1-point decrease in mRS score), 2.94; 95% CI, 1.67-5.26)] and at 3 months (common OR, 1.72; 95% CI, 1.06-2.86) on multivariable logistic regression models adjusting for potential confounders, including mechanical thrombectomy.

CONCLUSIONS

Intravenous thrombolysis is independently associated with higher odds of improved discharge and 3-month functional outcomes in AIS patients with large vessel or distal occlusions and mild stroke severity. IVT appears not to increase the risk of systemic or symptomatic intracranial bleeding.

Effect of Q-switched Nd-YAG laser on the clinical, pigmentary, and immunological markers in patients with lichen planus pigmentosus: A pilot study

The persistent discoloration in lichen planus pigmentosus (LPP) is secondary to persistent melanophages in the superficial dermis in these patients. We evaluated the effect of Q-switched Nd-YAG laser on the clinical, pigmentary, and immunological markers in patients with LPP. Nine females with a clinical diagnosis of LPP were included in the study. After six sessions of laser with toning protocol, performed over a representative area of 5 × 5 cm² at 2-weekly intervals, the mean clinical improvement as per the physician assessment was 25.7% (10-40%). There was no significant reduction in melanin and erythema index. On expression analysis using quantitative-polymerase chain reaction, the reduction in tyrosinase (p = 0.03) was statistically significant, though, the reduction in other pigment and immunological markers was not significant. The immunohistochemistry quantification data of corresponding proteins also did not show any significant difference. Post inflammatory hypopigmentation was noted in one patient. Q-switched Nd-YAG laser toning protocol resulted in modest clinical and histological improvement in patients of LPP.

Rituximab as an adjuvant therapy for pemphigus: experience in 61 patients from a single center with long-term follow-up

BACKGROUND

Rituximab is increasingly being used as an adjuvant treatment for recalcitrant or relapsed pemphigus, but information on its use as a first-line agent is limited. We describe the long-term effectiveness and safety of rituximab in the treatment of pemphigus and compare the treatment outcomes when rituximab is used as first-line treatment vis-à-vis after treatment failure or relapse.

METHODS

This was a retrospective review of 61 patients with pemphigus treated with rituximab at our center from March 2012 to October 2018.

RESULTS

Of the 61 patients, 51 achieved complete remission (on or off treatment) and 10 had partial remission. Forty-nine (80.33%) patients achieved complete remission off prednisolone over a mean period of 8.08 ± 4.45 (range 3-20) months. Seventeen (27.9%) patients relapsed after a mean period of 23.94 ± 13.15 months after first rituximab cycle and 15.97 + 13.7 months after stopping prednisolone. Treatment-related serious adverse effects were noted in six (9.8%) patients. Eighteen (29.5%) patients were administered rituximab as the first-line adjuvant, while 43 (70.5%) patients received it after treatment failure or relapse. In both groups, remission rates on prednisolone (88.9%, 81.4%) and off prednisolone (88.9%, 76.7%) were comparable (P > 0.05). Relapse rates in the group which received rituximab as first-line treatment were about half of those who received rituximab after relapse or treatment failure (16.7% vs. 32.6%, P = 0.348). No statistically significant difference was seen in the times to different treatment endpoints (disease control, complete remission on and off prednisolone, and relapse) between the two groups.

CONCLUSIONS

Rituximab is a safe and effective adjuvant in the treatment of pemphigus. Treatment outcomes were better for patients who received rituximab as first-line treatment, but the difference was not statistically significant.

Membrane softening by nonsteroidal anti-inflammatory drugs investigated by neutron spin echo

In spite of their well-known side effects, the nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications for their antipyretic and anti-inflammatory actions. Interaction of NSAIDs with the plasma membrane plays a vital role in their therapeutic actions and defines many of their side effects. In the present study, we investigate the effects of three NSAIDs, aspirin, ibuprofen, and indomethacin, on the structure and dynamics of a model plasma membrane using a combination of small angle neutron scattering (SANS) and neutron spin echo (NSE) techniques. The SANS and NSE measurements were carried out on a 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) membrane, with and without NSAIDs, at two different temperatures, 11 °C and 37 °C, where the DMPC membrane is in the gel and fluid phase, respectively. SANS data analysis shows that incorporation of NSAIDs leads to bilayer thinning of the membrane in both the phases. The dynamic properties of the membrane are represented by the intermediate scattering functions for NSE data, which are successfully described by the Zilman and Granek model. NSE data analysis shows that in both gel and fluid phases, addition of NSAIDs results in a decrease in the bending rigidity and compressibility modulus of the membrane, which is more prominent when the membrane is in the gel phase. The magnitude of the effect of NSAIDs on the bending rigidity and compressibility modulus of the membrane in the gel phase follows an order of ibuprofen > aspirin > indomethacin, whereas in the fluid phase, it is in the order of aspirin > ibuprofen > indomethacin. We find that the interaction between NSAIDs and phospholipid membranes is strongly dependent on the chemical structure of the drugs and physical state of the membrane. Mechanical properties of the membrane can be quantified by the membrane's bending rigidity. Hence, the present study reveals that incorporation of NSAIDs modulates the mechanical properties of the membrane, which may affect several physiological processes, particularly those linked to the membrane curvature.

Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: a prospective study

Temporomandibular joint (TMJ) ankylosis significantly impacts both physical and psychosocial patient wellbeing. A complete evaluation of treatment outcomes necessitates knowing the extent to which a patient's quality of life (QoL) is impacted. This study was performed to evaluate the impact of TMJ ankylosis on QoL in 25 TMJ ankylosis patients treated by interpositional arthroplasty. The patients completed OHIP-14 and UWQoL questionnaires once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. With the exception of functional limitation, all OHIP domains showed significant improvement. Preoperatively, the worst scores were found in the psychological distress domain, followed by the social handicap, physical pain and physical disability domains. More than half of the subjects (56%) reported having suicidal thoughts. Amongst the individual UWQoL domains, appearance, chewing, anxiety (P <  0.01), recreation and mood (P <  0.05) showed improved scores. Appearance and chewing were the top ranked priority domains before and after surgery. No significant change was found in speech, taste, sleep, or breathing. Psychosocial factors were found to play a much bigger role than previously thought. The physical, psychological, and social factors were intricately related and dynamically interacted with each other. Surgical treatment produced a definitive QoL improvement in the patients.

DRD2 methylation and regional grey matter volumes in young adult offspring from families at ultra-high risk for alcohol dependence

Dopaminergic alteration is a prominent feature in those with AD and may influence brain development in those with a family history of AD. MRI scans (3T) from 43 HR offspring (27.4 ± 3.6 years) and 45 controls (24.5 ± 4.1 years) provided whole brain (WB) and region of interest (ROI) analyses. The VBM8 toolbox was used for WB analysis (threshold p < 0.005; cluster = 100 voxels); the MarsBaR ROI toolbox provided region of interest data. Pyrosequencing of CpG sites within the DRD2 gene was performed. DRD2 methylation was significantly increased in association with familial high-risk status. Significant familial risk group differences were seen with HR individuals showing reduced volume of the Left Inferior Temporal, Left Fusiform and Left Insula regions relative to LR controls. These regions have previously been linked to social cognition. DRD2 methylation was negatively related to grey matter volumes in these regions. Because these regions, have been previously linked to facial affect perception and social cognition, lesser grey matter volumes in individuals at high-risk for developing AD suggests that neural underpinnings of social cognitive impairment may be a premorbid risk factors for AD.

Safety and efficacy of autologous noncultured dermal cell suspension transplantation in the treatment of localized facial volume loss: A pilot study

Background

Available options for correction of facial volume loss, such as synthetic fillers, autologous fat and cultured fibroblasts, have limitations viz. temporary effect and high cost.

Aim

To assess the use of a novel technique, autologous non-cultured dermal cell suspension transplantation, for correction of localized facial volume loss due to inflammatory pathologies.

Methods

It was a pilot study conducted in the Dermatology Outpatient Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Autologous non-cultured dermal cell suspension was transplanted in a total of 10 patients, out of which 5 had predominantly dermal loss and the rest had predominantly lipoatrophy. The donor tissue from the gluteal region was digested into a single cell suspension using collagenase-1 and injected into the recipient area. The outcome was assessed subjectively by patients and investigators and objectively using ultrasonography. Cell count, viability testing and measurement of mesenchymal stem cells were also done.

Results

On assessment of patients, the median improvement in the predominantly dermal atrophy group at 3 and 6 months was 70% (range: 10-90%) and 80% (range: 0-90%), respectively, and in the predominantly lipoatrophy group, 0% (range: 0-40) and 0% (range: 0-50), respectively. Mean thickness of dermis + subcutis at the baseline was 1.835 mm (range: 0.89-6.04 mm), which increased to 2.912 mm (range: 0.88-7.07 mm, P = 0.03) at 6 months.

Limitations

Our pilot study has some limitations such as small sample size and heterogeneity of the recruited patients.

Conclusions

Autologous non-cultured dermal cell suspension transplantation appears to be safe and effective in localized facial dermal defects because of inflammatory pathologies, but not effective in deeper defects.

In vitro assessment of gentamicin and azithromycin-based combination therapy against Neisseria gonorrhoeae isolates in India

PURPOSE

The public health burden of infections caused by Neisseria gonorrhoeae is magnified due to high rates of resistance to traditional antimicrobials. The aim of this study was to evaluate the in vitro efficacy of an alternative dual therapy comprising gentamicin and azithromycin.

METHODOLOGY

The E-test method was used to determine the minimum inhibitory concentrations (MICs) of gentamicin and azithromycin individually prior to testing in combination using the cross or 90^o angle formation method. A total of 70 clinical isolates of N.gonorrhoeae displaying varying ceftriaxone MICs along with 2 reference strains (WHO K and P) and 1 ceftriaxone-resistant QA isolate were examined. The fractional inhibitory concentration index (FICI) was calculated and the results were interpreted using the following criteria: synergy, FICI ≤0.5; indifference or additive, FICI >0.5 to ≤4.0; and antagonism, FICI >4.0.

RESULTS

A total of 54 (77.1 %) isolates displayed indifference, while 16 (22.9 %) demonstrated synergy. When azithromycin was tested alone, the MICs ranged from 0.016 to 2 µg ml^-1 . However, in combination with gentamicin, the mean MIC value of all isolates decreased from 0.275 µg ml^-1 to 0.090 µg ml^-1 (P=0.05).When gentamicin was tested alone, the MICs ranged from 0.25 to 8 µg ml^-1, with a mean MIC of 4.342 µg ml^-1, whereas in combination with azithromycin it decreased significantly to 2.042 µg ml^-1 (P=0.04).

CONCLUSION

No antagonism was observed in this combination, suggesting that it could be a future treatment option as we prepare for a post-cephalosporin era. However, comprehensive in vivo evaluations are warranted and recommendations should be made based on clinical trials.