Fully Automated Measurement of the Insall-Salvati Ratio with Artificial Intelligence

Patella alta (PA) and patella baja (PB) affect 1-2% of the world population, but are often underreported, leading to potential complications like osteoarthritis. The Insall-Salvati ratio (ISR) is commonly used to diagnose patellar height abnormalities. Artificial intelligence (AI) keypoint models show promising accuracy in measuring and detecting these abnormalities.An AI keypoint model is developed and validated to study the Insall-Salvati ratio on a random population sample of lateral knee radiographs. A keypoint model was trained and internally validated with 689 lateral knee radiographs from five sites in a multi-hospital urban healthcare system after IRB approval. A total of 116 lateral knee radiographs from a sixth site were used for external validation. Distance error (mm), Pearson correlation, and Bland-Altman plots were used to evaluate model performance. On a random sample of 2647 different lateral knee radiographs, mean and standard deviation were used to calculate the normal distribution of ISR. A keypoint detection model had mean distance error of 2.57 ± 2.44 mm on internal validation data and 2.73 ± 2.86 mm on external validation data. Pearson correlation between labeled and predicted Insall-Salvati ratios was 0.82 [95% CI 0.76-0.86] on internal validation and 0.75 [0.66-0.82] on external validation. For the population sample of 2647 patients, there was mean ISR of 1.11 ± 0.21. Patellar height abnormalities were underreported in radiology reports from the population sample. AI keypoint models consistently measure ISR on knee radiographs. Future models can enable radiologists to study musculoskeletal measurements on larger population samples and enhance our understanding of normal and abnormal ranges.

Clinical outcomes in patients with complicated appendicitis

BACKGROUND

Complicated appendicitis (appendicitis with abscess, perforation, or generalized peritonitis) poses a significant burden on healthcare systems, with incidence up to 28-29%. Current management options include antibiotic therapy and up-front surgery, antibiotic therapy and percutaneous drainage, or antibiotic therapy alone. There is no consensus on treatment guidelines in current literature. This study aims to better define treatment algorithms for patients presenting with acute complicated appendicitis by evaluating clinical outcomes in those treated with or without surgery.

METHODS

We performed a single-institution, retrospective review of 220 adult patients (≥ 18 years old) treated for acute complicated appendicitis from January 2017 to June 2022. Demographic and clinicopathologic variables were collected and analyzed. We compared patients who were managed non-operatively versus operatively. Regression modeling was used to determine factors associated with non-operative management (NOM) and those predictive of failure of NOM.

RESULTS

Our analysis showed 26.3% patients with acute complicated appendicitis underwent NOM (n = 58), versus 73.6% underwent operative management at index admission (n = 162). Within the NOM group, 55.1% patients were treated with antibiotics alone (n = 32) versus 44.8% with percutaneous drainage (n = 26). Within the operative cohort, 88.7% of patients underwent appendectomy (n = 142). Age, body mass index, comorbidities, vital signs and laboratory values on admission were similar between both groups. Clinical factors predictive of initial NOM were perforation (OR 7.9, 95% CI 3.7-16.5) and phlegmon (OR 6.3, 95% CI 2.8-14.1) at presentation. Clinical factors predictive of failure of NOM requiring surgery on index admission or within 30 days was larger abscess and/or phlegmon size (OR 1.76, 95% CI 1.0-3.0).

CONCLUSION

There may be a role in identifying clinical factors in patients with complicated appendicitis that favor non operative versus operative management. Larger abscess and/or phlegmon size could be a predictor of failure of NOM.

Where have all the diseases gone during the COVID-19 pandemic?

This article focuses on a marked drop in volumes in the lockdown period during the COVID-19 pandemic across all modalities X-ray, sonography, CT scan and MRI scans and compares the volumes of data between a private and public hospital in Mumbai. This trend has been witnessed globally also. Even with easing of lockdown this has not reflected in an increase in numbers. Imaging volumes of a 1900-bed public hospital and a 220-bed private hospital in Mumbai were collated for all modalities, i.e., X-ray, sonography, CT and MRI for the months January, February 2020- Prelockdown, March 2020 Peri-lockdown, April, May 2020- Lockdown, June Unlock 1.0, July Unlock 2.0. The imaging volumes during lockdown, Unlock, were compared with prelockdown values. It was initially felt that this was due to a fear of visiting hospitals that are considered hotbeds of SARS-CoV-2. However, the same status has persisted over the 2 months of lockdown and the 2 months of unlocking. What is the cause of this huge drop in imaging volumes?

Does CT help in reducing RT-PCR false negative rate for COVID-19?

Background:

Early detection is the key to contain the ongoing pandemic. The current gold standard to detect SARS CoV2 is RT-PCR. However, it has a high false negative rate and long turnaround time.

Purpose:

In view of the high sensitivity of CT in detection of lower respiratory tract pathologies, a study of 2581 patients comparing RT-PCR status with CT findings was undertaken to see if it augments the diagnostic performance.

Materials and Methods:

A multi centre prospective study of consecutive cases was conducted. All CT studies suggestive of COVID 19 pneumonia were collated and evaluated independently by three Radiologists to confirm the imaging diagnosis of COVID-19 pneumonia. The RT-PCR values were retrospectively obtained, based on the RT-PCR values, CT studies were categorised into three subgroups, positive, negative and unknown. CT features from all three groups were compared to evaluate any communality or discordance.

Results:

Out of the 2581 patients with positive CT findings for COVID pneumonia, 825 were females and 1,756 were males in a wide age group of 28-90 years. Predominant CT features observed in all the subgroups were Ground glass densities 94.8%, in mixed distribution (peripheral and central) (59.12%), posterior segments in 92% and multilobar involvement in 70.9%. The CT features across the three subgroups were statistically significant with a P value <0.001.

Conclusion:

There was a communality of CT findings regardless of RT-PCR status. In a pandemic setting ground glass densities in a subpleural, posterior and basal distribution are indicative of COVID 19. Thus CT chest in conjunction to RT PCR augments the diagnosis of COVID 19 pneumonia; utilization of CT chest may just be the missing link in closing this pandemic.

Role of chest radiography in the management of COVID-19 pneumonia: An overview and correlation with pathophysiologic changes

Background:

Chest radiography (CXR) is a widely available baseline radiological modality in evaluating symptomatic patients with suspected or confirmed Covid-19 disease. Serial changes can help in monitoring the patients in conjunction with the clinical status of these patients in a hospital setting.

Purpose:

The purpose of this study was to analyse the patterns of radiological findings on chest radiograph (CXR) for suspected and confirmed COVID-19 patients on initial presentation to the emergency medical services (EMS) on admission and to assess the progression and resolution.

Materials and Methods:

In this study, patients who presented to EMS of a multispeciality hospital as suspected or confirmed Covid-19 on consecutive reverse transcriptase polymerase chain reaction (RT-PCR). CXR was examined for findings of haziness, patterns and distribution of opacities. Progression and regression of findings in serial CXR were studied and evaluated with the clinical and laboratory parameters. High resolution CT (HRCT) chest was performed initially for some patients.

Results:

756 RT-PCR confirmed COVID-19 patients were included in our study who had initial CXR. 510 (67.46%) of our patients with positive initial RT-PCR showed abnormal baseline CXR. The abnormal findings were described as haziness akin to ground glass opacities (GGO) on CT, peripheral opacities, patchy parenchymal opacities and consolidation. Peripheral opacities and lower zone distribution were the commonest pattern of CXR abnormalities with bilateral involvement. The severity of findings on serial CXR and radiographic regression was studied along with follow-up to assess response to treatment. Forty-six patients showed features of acute lung injury (ALI). Complications and new CXR findings were reported for patients who were given ventilator support.

Conclusion:

CXR is a valuable baseline radiological investigation on hospital admission in symptomatic patients with suspected or confirmed Covid-19 presenting to the EMS as it helps to monitor the progress and regression of the disease in conjunction with clinical findings.

Fibrotic interstitial lung disease occurring as sequelae of COVID-19 pneumonia despite concomitant steroids

A 75-year-old female with no history of lung disease developed severe pulmonary fibrosis within 1 month of acute severe COVID-19 pneumonia. She developed dry basal crackles, hypoxia needing home oxygen, and computed tomography changes which dramatically evolved from acute ground-glass opacities to honeycombing and traction bronchiectasis. Interestingly, these changes occurred despite her being on steroids through most of her hospital stay. She is being commenced on pirfenidone and her responses are carefully monitored, but the role of antifibrotic drugs are unclear and will only be established from large clinical trials.

The value of AI based CT severity scoring system in triage of patients with Covid-19 pneumonia as regards oxygen requirement and place of admission

CONTEXT

CT scan is a quick and effective method to triage patients in the Covid-19 pandemic to prevent the heathcare facilities from getting overwhelmed.

AIMS

To find whether an initial HRCT chest can help triage patient by determining their oxygen requirement, place of treatment, laboratory parameters and risk of mortality and to compare 3 CT scoring systems (0-20, 0-25 and percentage of involved lung models) to find if one is a better predictor of prognosis than the other.

SETTINGS AND DESIGN

This was a prospective observational study conducted at a Tertiary care hospital in Mumbai, Patients undergoing CT scan were included by complete enumeration method.

METHODS AND MATERIAL

Data collected included demographics, days from swab positivity to CT scan, comorbidities, place of treatment, laboratory parameters, oxygen requirement and mortality. We divided the patients into mild, moderate and severe based on 3 criteria - 20 point CT score (OS1), 25 point CT score (OS2) and opacity percentage (OP). CT scans were analysed using CT pneumonia analysis prototype software (Siemens Healthcare version 2.5.2, Erlangen, Germany).

STATISTICAL ANALYSIS

ROC curve and Youden's index were used to determine cut off points. Multinomial logistic regression used to study the relations with oxygen requirement and place of admission. Hosmer-Lemeshow test was done to test the goodness of fit of our models.

RESULTS

A total of 740 patients were included in our study. All the 3 scoring systems showed a significant positive correlation with oxygen requirement, place of admission and death. Based on ROC analysis a score of 4 for OS1, 9 for OS2 and 12.7% for OP was determined as the cut off for oxygen requirement.

CONCLUSIONS

CT severity scoring using an automated deep learning software programme is a boon for determining oxygen requirement and triage. As the score increases, the chances of requirement of higher oxygen and intubation increase. All the three scoring systems are predictive of oxygen requirement.

Augmentation of hepatitis C virus-specific immunity and sustained virologic response

Treatment for chronic hepatitis C virus (HCV) infection has rapidly evolved into interferon-free directly acting antiviral regimens (DAA) that result in high sustained virologic response. DAAs primarily work by suppressing HCV replication and rely less on the immune system than interferon-based therapies. However, it is unclear whether the immune system recovers with suppression of HCV replication and contributes to HCV clearance with DAA therapy. We previously demonstrated HCV clearance is associated with increased HCV-specific immunity in CHCV-GT-1-infected patients during treatment with sofosbuvir (SOF)+ribavirin (RBV). Here, we aimed to analyse changes in HCV-specific immunological responses associated with viral clearance with combination DAA therapy of SOF+ledipasvir (LDV) for 12 weeks in CHCV-GT1 (N=14) patients who relapsed without augmentation of HCV-specific immunity during treatment with SOF+RBV. Phenotypic and functional changes within the T-cell compartment of PBMCs pre- and post-treatment were analysed. Retreatment of relapsers with LDV/SOF resulted in all patients attaining SVR12 . Suppression of HCV was associated with a decline in T-cell exhaustion markers (CD57; Tim3; PD1) along with augmented of HCV-specific T-cell IFN-gamma responses post-treatment. Addition of LDV to SOF was associated with augmentation of HCV-specific immunity and SVR in patients who previously failed SOF+RBV therapy without increased immunity. These findings demonstrate a novel effect of DAA in inducing host immune responses to aid HCV clearance and achieve SVR.

Achieving sustained virologic response after interferon-free hepatitis C virus treatment correlates with hepatic interferon gene expression changes independent of cirrhosis

Chronic hepatitis C virus (HCV) infection can now be treated with oral directly acting antiviral agents, either with or without ribavirin (RBV). Virologic relapse after treatment can occur, and in some studies was more common in cirrhotic subjects. We previously observed changes in hepatic immunity during interferon (IFN)-free therapy that correlated with favourable outcome in subjects with early liver disease. Here, we compared changes in endogenous IFN pathways during IFN-free, RBV-free therapy between cirrhotic and noncirrhotic subjects. mRNA and microRNA (miRNA) expression analyses were performed on paired pre- and post-treatment liver biopsies from genotype-1 HCV subjects treated with sofosbuvir/ledipasvir (SOF/LDV) for 12 weeks (n = 4, 3 cirrhotics) or SOF/LDV combined with GS-9669 or GS-9451 for 6 weeks (n = 6, 0 cirrhotics). Nine of ten subjects achieved a sustained virologic response (SVR), while one noncirrhotic subject relapsed. Hepatic IFN-stimulated gene expression decreased with treatment in the liver of all subjects, with no observable impact of cirrhosis. Hepatic gene expression of type III IFNs (IFNL1, IFNL3, IFNL4-ΔG) similarly decreased with treatment, while IFNA2 expression, undetectable in all subjects pretreatment, was detected post-treatment in three subjects who achieved a SVR. Only the subject who relapsed had detectable IFNL4-ΔG expression in post-treatment liver. Other IFNs had no change in gene expression (IFNG, IFNB1, IFNA5) or could not be detected. Although expression of multiple hepatic miRNAs changed with treatment, many miRNAs previously implicated in HCV replication and IFN signalling had unchanged expression. In conclusion, favourable treatment outcome during IFN-free HCV therapy is associated with changes in the host IFN response regardless of cirrhosis.

Oral epithelial cells and their interactions with HIV-1

As the AIDS pandemic has continued, our understanding of the events that occur during the entry and infection of conventional, susceptible cells has increased dramatically, leading to the development of control therapies for HIV-infected individuals. However, an ongoing hole in our understanding is how HIV crosses the mucosal barriers to gain access to permissive cells, despite how important this information would be in developing successful vaccines and other preventative measures such as topical anti-HIV microbicides. In particular, our knowledge of the role that epithelial cells of the mucosal surfaces play in infection - both during early phases and throughout the life of an infected individual, is currently hazy at best. However, several studies in recent years suggest that HIV can bind to and traverse these mucosal epithelial cells, providing a reservoir of infection that can subsequently infect underlying permissive cells. Despite this interaction with epithelial cells, evidence suggests HIV-1 does not productively infect these cells, although they are capable of transferring surface-bound and transcytosed virus to other, permissive cells. Further, there appear to be key differences between adult and infant epithelial cells in the degree to which HIV can transcytose and infect the epithelium. Thus, it is clear that, whilst not primary targets for infection and virus replication, epithelial cells play an important role in the infection cycle and improving our understanding of their interactions with HIV could potentially provide key insights necessary to develop effective preventative therapies.

Factors Associated with Return to Work Postinjury: Can the Modified Rankin Scale Be Used to Predict Return to Work?

The ability to return to work (RTW) postinjury is one of the primary goals of rehabilitation. The modified Rankin Scale (mRS) is a validated simple scale used to assess the functional status of stroke patients during rehabilitation. We sought to determine the applicability of mRS in predicting RTW postinjury in a general trauma population. The trauma registry was queried for patients, aged 18 to 65 years, discharged from 2012 to 2013. A telephone interview for each patient included questions about employment status and physical ability to determine the mRS. Patients who had RTW postinjury were compared with those who had not (nRTW). Two hundred and thirty-four patients met the inclusion criteria. Of these, 171 (72.5%) patients RTW and 63 (26.7%) did nRTW. Patients who did nRTW were significantly older, had longer length of stay and higher rates of in-hospital complications. Multivariate analysis revealed that older patients were less likely to RTW (odds ratio = 0.961, P = 0.011) and patients with a modified Rankin score ≤2 were 15 times more likely to RTW (odds ratio = 14.932, P < 0.001). In conclusion, an mRS ≤2 was independently associated with a high likelihood of returning to work postinjury. This is the first study that shows applicability of the mRS for predicting RTW postinjury in a trauma population.

Factors Associated with Return to Work Postinjury: Can the Modified Rankin Scale be Used to Predict Return to Work?

The ability to return to work (RTW) postinjury is one of the primary goals of rehabilitation. The modified Rankin Scale (mRS) is a validated simple scale used to assess the functional status of stroke patients during rehabilitation. We sought to determine the applicability of mRS in predicting RTW postinjury in a general trauma population. The trauma registry was queried for patients, aged 18 to 65 years, discharged from 2012 to 2013. A telephone interview for each patient included questions about employment status and physical ability to determine the mRS. Patients who had RTW postinjury were compared with those who had not (nRTW). Two hundred and thirty-four patients met the inclusion criteria. Of these, 171 (72.5%) patients RTW and 63 (26.7%) did nRTW. Patients who did nRTW were significantly older, had longer length of stay and higher rates of in-hospital complications. Multivariate analysis revealed that older patients were less likely to RTW (odds ratio = 0.961, P = 0.011) and patients with a modified Rankin score ≤2 were 15 times more likely to RTW (odds ratio = 14.932, P < 0.001). In conclusion, an mRS ≤2 was independently associated with a high likelihood of returning to work postinjury. This is the first study that shows applicability of the mRS for predicting RTW postinjury in a trauma population.

Childhood exposure to ambient polycyclic aromatic hydrocarbons is linked to epigenetic modifications and impaired systemic immunity in T cells

BACKGROUND

Evidence suggests that exposure to polycyclic aromatic hydrocarbons (PAHs) increases atopy; it is unclear how PAH exposure is linked to increased severity of atopic diseases.

OBJECTIVE

We hypothesized that ambient PAH exposure is linked to impairment of immunity in atopic children (defined as children with asthma and/or allergic rhinitis) from Fresno, California, an area with elevated ambient PAHs.

METHODS

We recruited 256 subjects from Fresno, CA. Ambient PAH concentrations (ng/m(3) ) were measured using a spatial-temporal regression model over multiple time periods. Asthma diagnosis was determined by current NHLBI criteria. Phenotyping and functional immune measurements were performed from isolated cells. For epigenetic measurements, DNA was isolated and pyrosequenced.

RESULTS

We show that higher average PAH exposure was significantly associated with impaired Treg function and increased methylation in the forkhead box protein 3 (FOXP3) locus (P < 0.05), conditional on atopic status. These epigenetic modifications were significantly linked to differential protein expression of FOXP3 (P < 0.001). Methylation was associated with cellular functional changes, specifically Treg dysfunction, and an increase in total plasma IgE levels. Protein expression of IL-10 decreased and IFN-γ increased as the extent of PAH exposure increased. The strength of the associations generally increased as the time window for average PAH exposure increased from 24 hr to 1 year, suggesting more of a chronic response. Significant associations with chronic PAH exposure and immune outcomes were also observed in subjects with allergic rhinitis.

CONCLUSIONS AND CLINICAL RELEVANCE

Collectively, these results demonstrate that increased ambient PAH exposure is associated with impaired systemic immunity and epigenetic modifications in a key locus involved in atopy: FOXP3, with a higher impact on atopic children. The results suggest that increased atopic clinical symptoms in children could be linked to increased PAH exposure in air pollution.

Effect of co-morbid depression on neurocognitive functioning in patients with obsessive-compulsive disorder: a study from India

OBJECTIVE

To study neuropsychological function in subjects with obsessive-compulsive disorder (OCD) with and without co-morbid depression in comparison with healthy controls (HC).

METHODS

The 3 sample groups included subjects with OCD without depression (OCD group, n = 30); subjects with OCD and depression (OCDD group, n = 20); and HC (n = 25). All 3 groups were matched for age, gender, and years of education, and they were assessed on the following: Trail Making Tests A and B, Verbal Fluency Test, PGI Memory Scale, Stroop test, Tower of London Test, Raven's Standard Progressive Matrices, Wisconsin Card Sorting Test, and the Object Alternation Test.

RESULTS

Both OCD and OCDD groups performed more poorly than HC, whereas the OCDD group performed worse than OCD group. Besides, OCD and OCDD groups had significantly poorer performance on tests of attention, memory, executive functions, verbal fluency, and intelligence. The OCDD group performed worse than the OCD group notably on Verbal Fluency Test, PGI memory test, and Object Alternation Test.

CONCLUSION

On tests of neurocognitive functioning, the performance of the OCDD group was poorer than the OCD group, and both performed poorer than HC, suggesting that OCD is associated with neurocognitive dysfunction and that this is exacerbated in the presence of depression.

Bedside upper gastrointestinal series in critically ill low birth weight infants

BACKGROUND

The upper gastrointestinal (UGI) series is the preferred method for the diagnosis of malrotation. A bedside UGI technique was developed at our institution for use in low birth weight, critically ill neonates to minimize the risks of transportation from the neonatal intensive care unit (NICU) such as hypothermia and dislodgement of support lines and tubes.

OBJECTIVE

To determine the ability of a bedside UGI technique to identify the position of the duodenojejunal junction (DJJ) in low birth weight, critically ill infants in the NICU.

MATERIALS AND METHODS

We retrospectively reviewed bedside UGI examinations performed in premature infants weighing less than 1,500 g from 2008 to 2013 and correlated the findings with clinical data, imaging studies and surgical findings.

RESULTS

Of 27 patients identified (weight range: 633-1,495 g), 21 (78%) bedside UGI series were diagnostic. Twenty of 27 cases (74%) demonstrated normal intestinal rotation. One case demonstrated malrotation with midgut volvulus, which was confirmed at surgery. In six cases (22%), the position of the DJJ could not be accurately determined. No cases of malrotation with midgut volvulus were missed. None of the patients with normal bedside UGI studies was found to have malrotation based on clinical follow-up (mean: 20 months), surgical findings or further imaging.

CONCLUSION

The bedside UGI is a useful technique to exclude malrotation in critically ill neonates and minimizes potential risks of transportation to the radiology suite. Pitfalls that may preclude a diagnostic examination include incorrect timing of radiographs, patient rotation, suboptimal enteric tube position and bowel distention. In cases of diagnostic uncertainty, a follow-up study should be performed.

Distinct and overlapping genomic profiles and antiviral effects of Interferon-λ and -α on HCV-infected and noninfected hepatoma cells

Recently, several SNPs in the region of the IL28B (IFN-λ) gene have been associated with spontaneous clearance of hepatitis C virus (HCV) and enhanced cure rates for IFN-alfa-based therapies, suggesting a potential correlation between IFN-λ and the ability to clear HCV. To understand the mechanism of IFN-λ's as compared to IFN-α's antiviral activity, we performed a comprehensive analysis of their anti-HCV effects, whole genome transcriptome profiling with validation, and signalling of IFN-α and IFN-λ using J6/JFH-1 and Huh7.5 cells in vitro. IFN-λ and IFN-α exhibited comparable anti-HCV activity and gene expression profiles in Huh7.5 cells. While the majority of genes induced by IFN-α and IFN-λ were similar, IFN-λ exhibits profound, but delayed kinetics of IFN-stimulated genes (ISG) induction, while IFN-α induced more rapid induction of ISGs. Furthermore, the increased induction of ISG expression by IFN-λ correlated with up-regulation of IFN-λ receptor (IL-28RA) expression and more prolonged activation of the Jak-STAT signalling pathway. The findings from our comparative analysis of IFN-α and IFN-λ in HCV-infected and noninfected cells support the clinical use of IFN-λ as a potential alternative to IFN-α in the treatment of chronic hepatitis C.

Innate immunity including epithelial and nonspecific host factors: workshop 1B

The majority of HIV infections are initiated at mucosal sites. The oral mucosal tissue has been shown to be a potential route of entry in humans and primates. Whereas HIV RNA, proviral DNA, and infected cells are detected in the oral mucosa and saliva of infected individuals, it appears that the oral mucosa is not permissive for efficient HIV replication and therefore may differ in susceptibility to infection when compared to other mucosal sites. Since there is no definitive information regarding the fate of the HIV virion in mucosal epithelium, there is a pressing need to understand what occurs when the virus is in contact with this tissue, what mechanisms are in play to determine the outcome, and to what degree the mechanisms and outcomes differ between mucosal sites. Workshop 1B tackled 5 important questions to define current knowledge about epithelial cell-derived innate immune agents, commensal and endogenous pathogens, and epithelial cells and cells of the adaptive immune system and how they contribute to dissemination or resistance to HIV infection. Discovering factors that explain the differential susceptibility and resistance to HIV infection in mucosal sites will allow for the identification and development of novel protective strategies.

Dyggve melchior clausen syndrome

Dyggve Melchior Clausen syndrome is a rare autosomal recessive disorder, characterized by progressive spondylo epi metaphyseal dysplasia associated with mental retardation. The clinical and radiological findings resembles Morquio disease at the onset of condition, which may hinder its diagnosis. Two siblings with chatacteristic clinical (progressive postnatal dwarfism and mental retardation) and radiological features (irregular lace-like appearance of the iliac crests) are reported.

Forearm IVRA, using 0.5% lidocaine in a dose of 1.5 mg/kg with ketorolac 0.15 mg/kg for hand and wrist surgeries

AIM

Local anesthetic toxicity remains one of the most dreaded complications of the intravenous regional anesthesia (IVRA) technique. It results from the sudden release of a large amount of local anesthetic (LA) into the systemic circulation. This release can occur when the tourniquet deflates accidentally during the procedure or when it is deflated intentionally at the end of the procedure to terminate the anesthesia. The forearm tourniquet IVRA technique may offer distinct advantages over the conventional upper arm tourniquet IVRA technique. Use of a forearm tourniquet allows the dosage of local anesthetic to be decreased to almost half of what is required with an upper arm tourniquet, and the incidence of tourniquet pain has been reported to be less with forearm tourniquet. In this study, authors assessed the clinical efficacy of administering IVRA with lidocaine plus ketorolac using either a forearm or upper arm tourniquet.

METHODS

Upper arm IVRA was established using 0.5% lidocaine at a dose of 3 mg/kg with ketorolac at 0.3 mg/kg. Forearm IVRA was established using 0.5 % lidocaine at a dose of 1.5 mg/kg with ketorolac at 0.15 mg/kg. Quality of surgical anesthesia, onset, duration of sensory block and postoperative surgical pain and analgesic use were recorded and assessed. The incidence of local anesthetic toxicity and local complications due to the tourniquet were also recorded.

RESULTS

Surgical anesthesia was assessed as excellent or good (grade 0/1) in all 20/20 patients who received IVRA using an upper arm tourniquet and in 19/20 patients who received IVRA using a forearm tourniquet (P=1.00). Onset as well as regression of sensory block was similar in both the groups. Post operative VAS scores at 30 min and 60 min were statistically comparable between the two groups, as was the analgesic use in the first 24 h.

CONCLUSIONS

In conclusion, forearm IVRA provides effective perioperative anesthesia and analgesia. The technique results in a similar clinical profile as upper arm IVRA while using half the dose of both lidocaine and ketorolac.

[Food habits and caries experience in young adults from Rosario, Argentina]

Odontological assistance in Rosary City is offered in private and public services. The public ones lack programs to avoid dental loss in adults. Our aim was to describe the caries experience and dietetic habits in three sub-populations of young adults. Applying a standardized anamnesis, 517 patients, both sexes, 15-45 years old, attending to a private service (19%) and two public ones (81%), were investigated. Studied variables: oral health, lacteal and sweet food consumed, and instruction level. Student t-test, ANOVA and chi-square tests were applied. Average decayed teeth were 1.7+/-2.0 in the private service, and 4.1+/-2.8 in the public ones (p<0.0001); missing teeth were 5.4+/-5.2 and 6.8+/-5.4 (p=0.04); and filled teeth were 4.4+/-4.2 and 1.3+/-2.2, respectively (p<0.0001). Dairy foods daily consumption was higher in the private service (p<0.001). Patients in the public services expressed to replace milk by mate, and to relate its consumption with pregnancy and lactation, or to leave it for children. Sweets delicacies consumed in the private sector -considered of risk- were sweet breads, cakes, cookies and sweets, and in the public ones were soft candies, "alfajores" and sweet made with milk. Minor risk sweets consumption in private patients were ice creams, sodas and chocolates, and in the public ones, hard candies and chewing gums, with and without sugar. Although a high number of patients consume delicacies and sweet foods at any hour, private patients were a minority; and they were a majority when considering its ingestion only after a food.

Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees

Total knee arthroplasty was performed in 282 knees with image-free navigation (group A) and in 185 with optimized conventional technique (group B). Mean postoperative mechanical axis of the limb was 179.7 degrees in group A and 179.1 degrees in group B (P < .002). There was a higher percentage of knees in group A that had restoration of mechanical axis to +/-1 degrees, +/-2 degrees, and +/-3 degrees of neutral (P < .0001). There were 9.2% outliers (+/-3 degrees) in group A and 21.6% outliers in group B (P < .0001). For knees exceeding 20 degrees varus, there was no significant difference between the mean mechanical axes in the 2 groups. Both components were aligned within 3 degrees of neutral in 90.8% of the knees in group A and 76.2% of the knees in group B (P < .0001).

Prevalence of dental caries and treatment needs in the school-going children of rural areas in Udaipur district

Dental caries is among the most common dental problems affecting humans. This condition is a major health problem with high prevalence, globally involving the people of all regions and society. This study was conducted on 1587 government school children of Udaipur district in the age group of 5-14 years for recording the prevalence of dental caries and treatment needs. Dental caries was found in 46.75% children, and 76.87% children required some kind of dental treatment.

Prevalence of gingival diseases, malocclusion and fluorosis in school-going children of rural areas in Udaipur district

High prevalence of dental diseases has been recorded in Rajasthan, however, not much work has been done to ascertain the prevalence of dental diseases in Udaipur district. This study was conducted among 1,587 government school children of Udaipur district in the age group of 5-14 years for recording the prevalence of gingival diseases, fluorosis and malocclusion. Gingivitis was found in 84.37% of children, malocclusion in 36.42% and fluorosis in 36.36%.